Chemical fingerprinting of naphthenic acids and oil sands process waters-A review of analytical methods for environmental samples.

This article provides a review of the routine methods currently utilized for total naphthenic acid analyses. There is a growing need to develop chemical methods that can selectively distinguish compounds found within industrially derived oil sands process affected waters (OSPW) from those derived from the natural weathering of oil sands deposits. Attention is thus given to the characterization of other OSPW components such as oil sands polar organic compounds, PAHs, and heavy metals along with characterization of chemical additives such as polyacrylamide polymers and trace levels of boron species. Environmental samples discussed cover the following matrices: OSPW containments, on-lease interceptor well systems, on- and off-lease groundwater, and river and lake surface waters. There are diverse ranges of methods available for analyses of total naphthenic acids. However, there is a need for inter-laboratory studies to compare their accuracy and precision for routine analyses. Recent advances in high- and medium-resolution mass spectrometry, concomitant with comprehensive mass spectrometry techniques following multi-dimensional chromatography or ion-mobility separations, have allowed for the speciation of monocarboxylic naphthenic acids along with a wide range of other species including humics. The distributions of oil sands polar organic compounds, particularly the sulphur containing species (i.e., OxS and OxS2) may allow for distinguishing sources of OSPW. The ratios of oxygen- (i.e., Ox) and nitrogen-containing species (i.e., NOx, and N2Ox) are useful for differentiating organic components derived from OSPW from natural components found within receiving waters. Synchronous fluorescence spectroscopy also provides a powerful screening technique capable of quickly detecting the presence of aromatic organic acids contained within oil sands naphthenic acid mixtures. Synchronous fluorescence spectroscopy provides diagnostic profiles for OSPW and potentially impacted groundwater that can be compared against reference groundwater and surface water samples. Novel applications of X-ray absorption near edge spectroscopy (XANES) are emerging for speciation of sulphur-containing species (both organic and inorganic components) as well as industrially derived boron-containing species. There is strong potential for an environmental forensics application of XANES for chemical fingerprinting of weathered sulphur-containing species and industrial additives in OSPW.

[Increasing frequency of bariatric surgery interventions since replacement of gastroplasty by laparoscopic gastric banding in the treatment of morbid obesity]. / Steigende Frequenz bariatrisch-chirurgischer Eingriffe seit Ersatz der Gastroplastik durch das laparoskopische Magenband zur Behandlung der morbiden Adipositas.

Between 1984 and 1996 we performed a Mason gastroplasty for the treatment of morbid obesity: 14 patients (average age 40 (26-48) years, body mass index (BMI) 48 (37-71) kg/m2, excessive body weight 67 (41-116) kg). Since the end of 1996 we now apply adjustable laparoscopic gastric banding (lab band): 73 patients (average age 39 (22-64) years, BMI 45 (32-69) kg/m2, excessive body weight 66 (41-116) kg). We compared the early and late results of both methods. Early results: no relevant morbidity or mortality for neither method. Late/intermediate results: reoperation rate for both methods 15%. After an average of 3.7 years the excessive body weight loss (EWL) for gastroplasty was 54 (22-96)%. The EWL after lab band for 24 patients after 12 months was 47 (11-127)% and for 8 patients after 18 months 51 (28-139)%. Since the introduction of the lap band the number of bariatric operations has greatly increased. Nevertheless, the perioperative complication rate has remained low, and the long-term outcome is similar for both methods.

Double-blind placebo-controlled study of velnacrine in Alzheimer's disease.

The present study assessed the safety and efficacy of the cholinesterase inhibitor, velnacrine, for treating the cognitive symptoms of Alzheimer's disease. Patients (N = 236) meeting NINCDS-ADRDA criteria for Alzheimer's disease entered a double-blind, placebo-controlled dose-ranging protocol (30, 75, 150, 225 mg/day each for one week) to identify velnacrine responders (> or = four point improvement on the cognitive subscale of the Alzheimer's Disease Assessment Scale [ADAScog]). After a two week drug washout, velnacrine responders were randomly assigned to their best velnacrine dose or placebo in a six week dose-replication protocol employing the ADAScog and the Clinical Global Improvement scale as primary outcome measures. During dose-replication, intent-to-treat analysis revealed that velnacrine patients scored significantly better than placebo patients on the ADAScog after two (p < 0.004), four (p < 0.025) and six (p < 0.001) weeks of treatment. No significant treatment effect on Clinical Global Improvement scores was observed. The primary adverse event was an asymptomatic elevation of liver transaminases found among 28% of the 236 treated patients. Cholinergic side effects including diarrhea (14%), nausea (11%) and vomiting (5%) were observed and 8% of patients experienced skin rash. The present study identified a subgroup of Alzheimer's patients who demonstrated a significant, but modest, improvement during velnacrine treatment on structured cognitive testing.

Effects of sudden insight on long-term sentence priming in Alzheimer's disease.

The purpose of this study was to demonstrate spared, long-term sentence priming in individuals with Alzheimer's Disease (AD) using a sentence puzzle task. The sentence puzzle task required a decision--either yes or no--regarding the correctness of an answer supplied for a sentence puzzle. Twelve persons with AD, 12 older controls, and 12 younger controls took part. Speed of response (deciding if a puzzle answer was correct or incorrect) was recorded, with increased speed at retesting after 30-min and 1-week delays used as an index of priming. Individuals with AD demonstrated sentence priming over both a 30-min and 1-week delay, comparable in form to that of controls. In addition, persons with AD were affected by stimulus parameters (correct/incorrect puzzle answers; difficult/easy puzzles) in a similar manner as were controls.

The Cincinnati initiative.

Nationwide, purchaser coalitions are forming to use their buying clout to reform the delivery of health care. In Cincinnati, a collaborative effort between purchasers and providers is producing profound changes in the local health care market. After the first year in operation, data show a significant overall decrease in length of stay (LOS), a return to single-digit inflation, and intriguing changes in provider practice patterns. These results have been achieved through voluntary hospital and physician practice pattern changes without additional contractual allowances, price controls, or utilization management imposed by the initiative. This article explores the development of the Cincinnati initiative, results to date, lessons learned, and future implications.

Using measurement and feedback to reduce health care costs and modify physician practice patterns.

Rising health care costs coupled with an inability to determine what constitutes value in the delivery of health care services lead a group of Cincinnati health care purchasers to seek answers and solutions. The formation of a collaborative effort that includes both purchasers and providers is producing profound changes in the Cincinnati health care market. After one year in operation, data show a significant overall decrease in length of stay, a return to single-digit inflation, and intriguing changes in provider practice patterns.

Multi-infarct dementia.

Vascular dementia and its most common subtype, multi-infarct dementia, are pathologically proven clinical entities. Their prevalence is not as high as previously thought, but they do represent a significant percentage of the population of demented patients. The diagnosis is more difficult to make than is the diagnosis of Alzheimer's disease; however, there are excellent criteria to guide the physician in making the diagnosis. At present the only treatment available is to control the risk factors responsible for the basic disease process; in the majority of cases this requires controlling hypertension.

A search for quality and value in health care. Cincinnati initiative targets physician-specific data.

In response to double-digit health care inflation, Cincinnati employers joined forces to compare costs and outcomes at the city's hospitals. Here's how one hospital is using physician-specific data to improve quality and keep costs down.

Frontal lobe syndrome in a patient with bilateral globus pallidus lesions.

This article describes a patient who experienced the rapid onset of an irreversible behavioral change while vacationing in La Paz, Bolivia (altitude, 4070 m). The only lesions demonstrated on a magnetic resonance imaging scan were bilateral hemorrhages in the globus pallidus. The behavior change was characterized by apathy and lack of motivation, features commonly associated with bilateral frontal lobe disease. This case is a further demonstration of how subcortical lesions can produce behavioral syndromes that are clinically indistinguishable from classic cortical syndromes. It is cases such as this that show how a strict localizationist concept of behavioral function is too restrictive and how it is necessary to consider a wide network of neuronal interconnections when explaining the mechanism of a dissolution of complex higher functions.

Anomalous dominance in sibling stutterers: evidence from CT scan asymmetries, dichotic listening, neuropsychological testing, and handedness.

Two left-handed siblings with developmental stuttering are comprehensively described. The methods of study included speech and language evaluation, neurological and neuropsychological examinations, dichotic listening, auditory evoked responses, electroencephalogram, and CT scan asymmetry measurements. The data from each sibling showed evidence of anomalous cerebral dominance on many of the variables investigated. The CT scan measurements showed atypical asymmetries, especially in the occipital regions. These findings support the theory that stuttering may be related to anomalous cerebral dominance, both on functional as well as structural bases. Implications of anomalous dominance and the resultant effect of hemispheric rivalry on speech fluency are discussed.

Memory assessment using the Strub-Black Mental Status Examination and the Wechsler Memory Scale.

A systematic mental status exam often can differentiate accurately patients with organic brain disease from normal persons and those with functional disorders. The present study attempts to validate the memory portion of the Strub-Black Mental Status Exam by comparing it to the Wechsler Memory Scale. Twenty-five brain-damaged and 25 routine medical patients were given Form I of the Wechsler Memory Scale and the memory portion of the Strub-Black Mental Status Exam at their hospital bedside. Results indicate significant differences in almost all scores between the brain-damaged and normal groups on both the Wechsler Memory Scale and Mental Status exam; the Mental Status Exam differentiated between groups at a higher level of significance of ANOVA and ANCOVA comparisons of total memory scores, as well as several subtests. In these samples, age, more than education, was an important factor that affected memory test performance. The Mental Status Examination appears valid for the differentiation of clinical samples and for the documentation of specific aspects of memory dysfunction in individual brain-damaged patients. This study represents a beginning step in providing normative data on components of the Strub-Black mental status examination.

Long-term effects of focal, cortical injuries upon articulation and discrimination performance.

Residual, long-term effects of cortical injuries upon speech production are rarely examined. In this study, we examined the articulation and discrimination abilities in twelve subjects who received focal, cortical injuries in Vietnam during 1968-1971. The subjects were divided into two groups based upon the hemisphere (right or left) of lesion. Data revealed the left-hemisphere injured group produced a greater number of articulation and discrimination errors than the right-hemisphere injured group. Articulation errors occurred more often than discrimination errors in both groups. However, a feature analysis revealed the left-hemisphere injured group made predominantly combination errors and the right-hemisphere injured group made predominantly place errors. Taken overall, the data suggest the left-hemisphere injured group may experience residual difficulties with the encoding of phonological units while the right-hemisphere injured group appears to have residual problems that may be related to the spatial correlates of speech.

The correlation between surgical and CT estimates of brain damage following missile wounds.

The occurrence of distant brain damage following an apparent focal missile injury to the brain has not been well documented until computerized tomography scanning demonstrated this phenomenon. Mechanisms of additional or distant damage within the brain may include a high deposit of kinetic energy from the penetrating missile, additional vascular damage, and possibly neuronal and axonal degeneration. Widespread and distant brain changes may explain some instances of late neuropsychological and psychiatric dysfunction or rehabilitation failure following a brain wound. Brain imaging should be used to properly evaluate the full extent of brain damage following wounding.

Neonatal hypermagnesemia: effect on parathyroid hormone and calcium homeostasis.

Twenty pre-eclamptic mothers treated with MgSO4 and their newborn infants were studied prospectively to determine the clinical and biochemical effects of hypermagnesemia. Maternal serum magnesium concentration rose to 4.4 mg/dl at delivery and was accompanied by a fall in maternal serum calcium concentration during labor. Neonatal serum Mg concentration remained elevated for the first 72 hours of life (mean at 72 hours = 3.0 mg/dl). Serum Mg concentration was higher in premature infants and in babies with birth asphyxia and/or hypotonia. Serum Ca concentration was higher and serum PTH was lower in hypermagnesemic study infants when compared to a retrospectively selected, matched froup of control infants. We speculate that elevated serum Mg values in these infants result in a shift of Ca from bone to plasma, and that elevated Mg and Ca concentrations further suppress neonatal parathyroid function.

The clinical utility of reproduction drawing tests with low IQ patients.

Bedside mental status testing in low IQ, poorly educated patients is often difficult. These patients, who comprise a significant proportion of the population served by major inner city public hospitals, have a limited ability to perform adequately on many higher cortical function tests. Because of this, it is often difficult to accurately differentiate between an organic brain syndrome and the effect of depressed intelligence in these patients. Copying line drawings and other constructional tasks are a very important element in a complete mental status examination, as they are frequently failed by patients with organic brain disease. The applicability of drawing tasks in the low IQ patient is an important issue; this study demonstrates that selected drawings can be effectively utilized to identify brain dysfunction in this low IQ population.