Field-scale monitoring of pharmaceutical compounds applied to active golf courses by recycled water.

The scarcity of potable water in arid and semiarid environments has led to the wider use of recycled water for irrigating agricultural fields, parks, golf courses, and other areas. One concern using recycled water as a source of irrigation has been the presence, fate, and transport of pharmaceutical compounds in water that percolates below the root zone of plants; however, very few multiyear field studies have been reported in the peer-reviewed literature. Here, we assessed compound mass flux of 13 pharmaceuticals in the fairways of four golf courses in the southwestern United States during a 2-yr field study. The sites varied by climate and soil type but were similar regarding turfgrass management. The results showed the presence of at least one pharmaceutical compound in nearly all samples collected, although concentrations were substantially lower after transport through the soil. Percent reduction in compound mass fluxes in drainage water was effectively 100% in 22 of 52 cases, 98 to 100% in 27 of 52 cases, and 73 to 94% in 3 of 52 cases (a case is defined as a specific compound measured at a specific site). Mass fluxes migrating below the root zone were calculated as <250 × 10 g ha for all compounds and >100 × 10 g ha in only two cases. For cases where the majority of the analyses were reportable, all fluxes were <8.80 × 10 g ha. Carbamazepine, meprobamate, and sulfamethoxazole were most commonly found in drainage water, representing nearly 80% of all reportable detections. This research demonstrates the potential of turfgrass/soil systems to reduce contaminant loading below the root zone and potentially toward groundwater.

Improving depression care in a psychiatry resident psychopharmacology clinic: measurement, monitoring, feedback and education.

OBJECTIVE: Better outcomes for major depressive disorder (MDD) are associated with proactive treatment, including timely follow-up, systematic assessment and treatment changes for inadequate improvement. The effectiveness of an intervention to facilitate proactive treatment for MDD in a resident psychopharmacology clinic was studied. METHODS: A quality improvement program with administrative process changes to improve flow and a 40-week pre/post study to evaluate the effect of education and feedback was conducted. A systematic assessment and reengineered scheduling system were implemented. During the first 20 weeks, baseline data were collected; during the second 20 weeks, feedback to residents and attending psychiatrists about adherence to evidence-based treatment recommendations was added. RESULTS: Reengineering our system to improve flow was successful. By linking outcomes collection to completion of billing sheets, outcomes at 90% of visits for MDD throughout the 40-week study was assessed. By centralising our scheduling system, the percentage of active-phase patients with MDD seen for follow-up within 6 weeks was improved from 19% to 59%. In response to feedback, residents did not make significant changes to their overall practice patterns. Patient outcomes did not improve as a result of feedback to residents. Residents did improve their practice patterns for a subset of patients including those without comorbid psychiatric disorders and those whose depressive episodes had lasted <1 year. CONCLUSIONS: Improving administrative processes for the treatment of patients with MDD resulted in rapid changes that were associated with improvements in the delivery of evidence-based care. Feedback to residents was more difficult and less successful.

Changes in axial length following trabeculectomy and glaucoma drainage device surgery.

AIM: This study examines the changes in axial length (AL) after trabeculectomy and glaucoma drainage device (GDD) surgery and enabled an equation to be derived allowing prediction of AL change after filtering surgery. METHODS: This was a prospective, interventional case series from the Glaucoma Service of the Doheny Eye Institute. PATIENT POPULATION: One eye of 39 patients undergoing trabeculectomy and 22 undergoing Baerveldt tube shunt implantation for uncontrolled glaucoma. INTERVENTION: These patients had AL measurements by non-contact, partial coherence interferometry preoperatively, at 1 week, 1 month, and >3 months after surgery. MAIN OUTCOME MEASURES: Axial length and intraocular pressure were compared at preoperative and postoperative visits. Postoperative intraocular pressure (IOP) was categorised as hypotonous (0-4 mm Hg), low (5-9), normal (10-17), and high (18 or more). RESULTS: There was a statistically significant reduction in IOP after 3 months of -12.8 (SD 1.5) mm Hg following trabeculectomy (p<0.001), and -10.7 (1.9) mm Hg after GDD (p<0.001). There was a statistically significant reduction in AL, which was similar after trabeculectomy and GDD at all time points (p<0.001), of -0.15 (0.03) and -0.21 (0.04) mm (1 week), -0.18 (0.02) and -0.10 (0.02) mm (1 month), and -0.16 (0.03) and -0.15 (0.03) mm (3 months). At 3 months or later the AL reduction was related to postoperative IOP and to the amount of IOP reduction (p<0.05, stepwise multiple regression). 10.2% (4/39) of trabeculectomy patients had hypotony after 3 months, with a mean AL reduction (-0.39 (0.11)) that was statistically significantly lower (p<0.01) than the other trabeculectomy eyes (-0.14 (0.15)). CONCLUSIONS: There is a small but statistically significant decrease in AL after both trabeculectomy and GDD surgery, greater in eyes that are hypotonous after surgery. The authors suggest that AL reduction can be predicted after 3 months by the formula: AL reduction (mm) = -199+0.006 x IOP reduction+0.008 x final IOP.

Partitioning and persistence of trichlorfon and chlorpyrifos in a creeping bentgrass putting green.

Golf course putting greens typically receive high pesticide applications to meet high quality demands. Research on pesticide fate in turf ecosystems is important to better understand the potential impact of pesticide use on the environment and human health. This research was conducted to evaluate the environmental fate of two commonly used insecticides--trichlorfon (dimethyl 2,2,2-trichloro-1-hydroxyethylphosphonate) and chlorpyrifos (O,O-diethyl O-3,5,6-trichloro-2-pyridylphosphorothioate)--in a creeping bentgrass (Agrostis palustris Huds.) putting green under customary field management practices at the University of California-Riverside Turf Research Facility during 1996 and 1997. The two insecticides were chosen because of their difference in water solubility, persistence, adsorption, and vapor pressure. Volatilization, clipping removal, and soil residues of the insecticides were quantified and leaching was monitored using lysimeters installed in putting green plots. Results showed trichlorfon volatilization, clipping removal, and leaching loss was insignificant (in the range of 0.0001-0.06% of applied mass) both in 1996 and 1997. No significant difference in clipping removal of trichlorfon and chlorpyrifos was observed in both years (0.06 and 0.05% of applied mass for trichlorfon and 0.15 and 0.19% of applied mass for chlorpyrifos, respectively, in 1996 and 1997), but significantly lower cumulative leaching and lower soil concentration was observed in 1997 than in 1996. Volatilization loss of chlorpyrifos was not significantly different between 1996 (2.05%) and 1997 (2.71%). Volatilization loss of trichlorfon in 1996 (0.01%) was significantly higher than in 1997 (0.008%). This study demonstrated the fraction of applied insecticides leaving the turf putting greens was minimal.

Environmental fate of metalaxyl and chlorothalonil applied to a bentgrass putting green under southern California climatic conditions.

Putting greens usually receive high inputs of fertilizers and pesticides to meet the high demand for visual quality and to overcome the stress from close mowing and traffic. In this study, two commonly used fungicides, metalaxyl (methyl N-(methoxyacetyl)-N-(2,6-xylyl)-DL-alaninate) and chlorothalonil (2,4,5,6-tetrachloro-1,3-benzenedicarbonitrile), were evaluated for their partitioning and persistence in a bentgrass (Agrostis palustris Huds) putting green under southern California climatic conditions. The putting green site was constructed according to the US Golf Association (USGA) specifications. Lysimeter assemblies installed at the center of each plot were used to monitor the leachate, flux chambers were used to measure volatilization, clippings were collected to determine the residues on grass, and soil cores were sampled to determine residues in the soil profile. Results showed that cumulative volatilization loss accounted for 0.10 and 0.02%, clipping removal 0.11 and 0.13%, and cumulative leaching 0.71 and 0.002% of the applied metalaxyl and chlorothalonil, respectively. The two fungicides were mainly found in the top 10 cm of the soil profile due to the high organic carbon content in the thatch and mat layers. The dissipation half-life was 1.4 days for metalaxyl and 4.9 days for chlorothalonil on grass, shorter than those found in agricultural fields. This study showed that, under normal turf management practices, the offsite transport of the parent fungicides was minimal. Future research should focus on investigating the fate and mobility of the metabolites of the fungicides.

Metastatic adenocarcinoma with rupture through the Bruch membrane simulating a choroidal melanoma.

PURPOSE: To report a case of adenocarcinoma metastatic to the choroid with rupture through the Bruch membrane, thus, simulating a choroidal melanoma. METHODS: Interventional case report. Evaluation in a university-based clinic, including a complete eye examination, fluorescein angiography, and ultrasonography; oncological evaluation; and eventual enucleation with histopathological study, including immunohistochemical stains. RESULTS: A 62-year-old Hispanic female presented with visual loss, right eye, of short duration because of a choroidal mass with retinal detachment. Ultrasonography showed a dome-shaped lesion with an eccentric collar-button projection and medium internal reflectivity, which suggested a choroidal melanoma. Initial systemic evaluation was negative. Severe pain necessitated enucleation, RE, and histopathology of the choroidal mass demonstrated an adenocarcinoma. Further examination revealed a left, upper lobe, nonsmall cell lung carcinoma. CONCLUSION: Metastatic choroidal tumors may present, although rarely, with collar-button configurations.

Specific frontal lobe subregions correlated with unawareness of illness in schizophrenia: a preliminary study.

The authors examined the relationship between unawareness of illness and eight frontal lobe subregions in 15 patients with schizophrenia. Significant inverse correlations were seen between unawareness and bilateral middle frontal gyrus volume and between symptom misattribution and superior frontal gyrus volume.

Exudative retinal detachment in relapsing polychondritis : case report and literature review.

OBJECTIVE: To report the atypical ocular symptoms (arterialized conjunctival vessels, exudative retinal detachment) that can be the presenting manifestations of relapsing polychondritis. DESIGN: Observational case report and literature review. METHODS: A complete ocular and systemic evaluation was performed on a patient with relapsing polychondritis and exudative retinal detachment. MAIN OUTCOME MEASURES: Retinal, choroidal, and scleral findings. RESULTS: A 73-year-old man with relapsing polychondritis presented with a unilateral large bullous exudative retinal detachment and marked choroidal and scleral thickening bilaterally. CONCLUSIONS: Ophthalmologists should consider relapsing polychondritis in the differential diagnosis of exudative retinal detachment. A combination of echographic and laboratory findings can assist in the accurate diagnosis of this rare condition.

Volatility of radiopharmacy-prepared sodium iodide-131 capsules.

OBJECTIVE: The aims of this study were to quantify the extent of volatilization from 131I-NaI therapeutic capsules prepared in a centralized radiopharmacy and to quantify the amount of volatile 131I released from a dispensing vial containing a compounded 131I-NaI therapy capsule. METHODS: Therapy capsules were prepared by injecting 131I oral solution into capsules containing anhydrous dibasic sodium phosphate. Volatilized activity was obtained by filtering air drawn across samples that were placed open on the bottom of a sample holder cup. Volatile 131I was captured by filtering it through 3 triethylenediamine-impregnated carbon cartridge filters, arranged in series. To quantify the amount of volatile 131I released from a dispensing vial during a simulated patient administration, a vial containing a compounded 131I therapy capsule was opened inside a collapsible plastic bag and all the air was drawn across TEDA-impregnated carbon cartridge filters. RESULTS: The 370-MBq (10-mCi) 131I capsules from the first part of the experiment released an average of 0.035% (SD 0.031%) of the capsule activity on the first day, 0.012% (SD 0.002%) on the second day, and 0.012% (SD < 0.001%) for days 3 through 5. The 37-MBq (1-mCi) 131I capsules released an average of 0.058% (SD 0.025%) on the first day, 0.029% (SD 0.009%) on the second day, and 0.020% (SD 0.004%) on the third day. The activity released from the vial during a simulated patient administration was 0.00093% of the 131I capsule activity. CONCLUSION: The amount of 131I, which volatilized daily from the exposed therapy capsules, was a small percentage of the capsule activity. The volatile 131I that would be released during a patient administration was much less than the activity that volatilized from the exposed therapy capsules.

The caudal infrasylvian surface in dyslexia: novel magnetic resonance imaging-based findings.

OBJECTIVE: To detect anatomic abnormalities of auditory association cortex in dyslexia by measuring the area of the perisylvian region known as the caudal infrasylvian surface(s) (cIS) in dyslexic and control subjects. BACKGROUND: Several quantitative morphometric investigations of cortical areas in dyslexia have focused on the cIS, which encompasses the supratemporal plane and the inferior bank of the posterior ascending ramus of the sylvian fissure. Inconsistencies in the results of these studies may be attributable in part to the use of measurement methods that do not account fully for surface undulations of the cIS. METHODS: The authors used an MRI-based surface reconstruction technique that models the curvature of the cerebral cortex in three dimensions to obtain whole-hemisphere and regional surface area estimates. Measurements were obtained in both hemispheres of eight right-handed male dyslexic subjects and eight right-handed male control subjects. RESULTS: The cIS area of dyslexic subjects was significantly larger than that of control subjects, and this result was not attributable to a difference in whole-hemisphere surface area. Neither the dyslexic nor control subjects showed a left or right asymmetry in this region, although there was a trend toward less variance of the asymmetry scores in dyslexic subjects. CONCLUSIONS: The gross anatomic organization of this region is different in dyslexic subjects, and elucidation of the precise nature of these differences may be aided by surface modeling techniques.

Search for the trematode Prouterina wescotti in black bears in Oregon.

Forty-six heads of free-ranging black bears (Ursus americanus) collected in May and June of 1995 and 1996 from Oregon (USA) were examined for the trematode Prouterina wescotti and other parasites. Only Sarcocystis sp. was detected in two adult male bears. Prouterina wescotti has been found only once previously in one black bear from Idaho (USA); its normal definitive host remains unknown.

Suprachoroidal hemorrhage.

Suprachoroidal hemorrhage is a feared complication of all types of intraocular surgery. Although rare, it is typically associated with severe visual disability, and this has prompted efforts to better understand the pathogenesis of this condition, to identify the patients at risk for this event, and to improve treatment of patients who develop this condition either intraoperatively or postoperatively. Controversy still exists regarding the best course of treatment for these patients. Although the introduction of perfluorocarbon liquids as a surgical adjunct during vitrectomy surgery may assist in the removal of suprachoroidal hemorrhage, the visual outcomes still remain disappointing.

Uveal lymphoid infiltration. Report of four cases and clinicopathologic review.

PURPOSE: The purpose of the study was to report the clinicopathologic features of four patients with uveal lymphoid infiltration who were diagnosed by a conjunctival biopsy. DESIGN: A case series. PARTICIPANTS: Four patients at four institutions participated. MEASURES: The histopathologic findings of the conjunctival and episcleral biopsy specimens from four patients with the diagnosis of uveal lymphoid infiltration were recorded. The conjunctival specimens were placed in 10% neutral buffered formaldehyde solution or B5 solution and processed routinely for light microscopic examination and immunohistochemical analysis for B cells and T cells and kappa and lambda light chains. The clinical and histopathologic findings were compared with 47 previously reported cases of uveal lymphoid infiltration. RESULTS: Two men and two women (average age = 57 years) presented with diffuse punctate to coalescent yellow uveal infiltrates and epibulbar pink fleshy lesions. Ultrasonography of the lesions showed diffuse choroidal thickening and a lack of choroidal or scleral excavation. The conjunctival biopsy specimens showed diffuse infiltration of the substantia propria with B lymphocytes with variable kappa and lambda restriction. Scattered T lymphocytes also were present. Plasmacytoid cells and a prominent Grenz zone were present. CONCLUSIONS: Patients with solitary or multiple yellow uveal infiltrates should have careful conjunctival evaluation for the presence of pink conjunctival lesions. Biopsy specimens of the conjunctival lesion may establish the diagnosis of uveal lymphoid infiltration.

Brain size, head size, and intelligence quotient in monozygotic twins.

Many studies of monozygotic (MZ) twins have revealed evidence of genetic influences on intellectual functions and their derangement in certain neurologic and psychiatric diseases afflicting the forebrain. Relatively little is known about genetic influences on the size and shape of the human forebrain and its gross morphologic subdivisions. Using MRI and quantitative image analysis techniques, we examined neuroanatomic similarities in MZ twins and their relationship to head size and intelligence quotient (IQ). ANOVA were carried out using each measure as the dependent variable and genotype, birth order, and sex, separately, as between-subject factors. Pairwise correlations between measures were also computed. We found significant effects of genotype but not birth order for the following neuroanatomic measures: forebrain volume (raw, p < or = 0.0001; normalized by body weight, p = 0.0003); cortical surface area (raw, p = 0.002; normalized, p = 0.001); and callosal area (raw, p < or = 0.0001; normalized by forebrain volume, p = 0.02). We also found significant effects of genotype but not birth order for head circumference (raw, p = 0.0002; normalized, p < or = 0.0001) and full-scale IQ (p = 0.001). There were no significant sex effects except for raw head circumference (p = 0.03). Significant correlations were observed among forebrain volume, cortical surface area, and callosal area and between each brain measure and head circumference. There was no significant correlation between IQ and any brain measure or head circumference. These results indicate that: 1) forebrain volume, cortical surface area, and callosal area are similar in MZ twins; and 2) these brain measures are tightly correlated with one another and with head circumference but not with IQ in young, healthy adults.

Annular peripheral choroidal detachment simulating aqueous misdirection after glaucoma surgery.

PURPOSE: The purpose of the study was to define a newly recognized complication after glaucoma surgery and to recommend a therapeutic regimen. METHODS: Eighteen patients diagnosed initially as having aqueous misdirection after glaucoma surgery, but who subsequently were found by ultrasonography to have an annular peripheral choroidal detachment that resulted in secondary angle closure glaucoma, were studied. Ten of these patients were treated with topical cycloplegics and corticosteroids, and 8 were treated with drainage of suprachoroidal fluid. Outcomes of these two treatment methods were compared. RESULTS: Annular peripheral choroidal detachment reliably was diagnosed with ultrasonography. Of the variables studied, time elapsed before resolution of the annular peripheral choroidal detachment was noted to be statistically significant (P < 0.00005). Immediate resolution followed drainage of suprachoroidal fluid, whereas a mean of 19.6 days was required for resolution after medical therapy. CONCLUSIONS: Annular peripheral choroidal detachment should be considered in the differential diagnosis of a flat or shallow anterior chamber with normal or high intraocular pressure after glaucoma surgery. The diagnosis of annular peripheral choroidal detachment can be confirmed most reliably by ultrasonography. Medical therapy is as effective as is surgery, although a significantly longer time to resolution is required.