Spatiotemporal changes in largemouth bass mercury concentrations from Connecticut waterbodies, 1995-2021.

We evaluated spatiotemporal changes in the mean and variation in largemouth bass (Micropterus salmoides) mercury concentrations over three discrete time periods (1995, 2005-2006, and 2019-2021) across 56 Connecticut waterbodies. We detected largemouth bass raw mercury concentrations that exceeded the US Environmental Protection Agency (USEPA) Fish Tissue Residue Criterion (≥ 0.30 µg g-1 ww) in 75.1%, 63.3%, and 47.7% of all fish sampled during 1995, 2005-2006, and 2019-2021, respectively. Total length (TL)-adjusted largemouth bass mercury concentrations declined across all ecoregions in Connecticut between subsequent sampling periods but increased between 2005-2006 and 2019-2021 in the Northwest Hills/Uplands ecoregion. The coefficient of variation (CV) of largemouth bass TL-adjusted mercury concentrations increased through time, increasing from 25.78% during 1995 to 36.47% during 2019-2021. The probability of a largemouth bass having a raw mercury concentration > 0.30 µg g-1 ww increased with total length (TL), but the TL with a 50% probability varied across ecoregions and periods. The variation in largemouth bass mercury concentrations highlights the roles that changes to individual behaviors, food web structure, lake properties, and legacy mercury may play in shaping broad patterns and trends in mercury consumption risks.

Variation in management of humeral and clavicular shaft fractures amongst fellowship trained orthopedic traumatologists.

BACKGROUND: There exists a wide variety of opinions on the appropriate management of diaphyseal humeral and clavicular fractures amongst orthopedic surgeons. The purpose of this study is to determine if there is a preference amongst orthopedic traumatologists on treatment of diaphyseal humerus and clavicle fractures with respect to various patient populations. METHODS: A 6-question survey was created using Surveymonkey.com and distributed via the Orthopedic Trauma Association (OTA) website to fellowship trained orthopedic surgery traumatologists to survey the preferred management of a simple oblique middle 1/3rd diaphyseal humerus fracture and a middle 1/3rd displaced diaphyseal clavicle fracture in the following 3 clinical settings: a healthy laborer, an older patient with co-morbidities, and if the surgeon themselves sustained the injury. The ratio of operative to non-operative management was calculated for all 6 questions. A chi-square value was performed to determine if the results are clinically significant based on the clinical scenario. RESULTS: There was 56 responses to the survey that were included in the analysis. Overall, there was a statistically significant trend towards surgical management of the surgeon's own diaphyseal humerus fractures (55%) compared to that of healthy patients (41%) and those with medical comorbidities (21%) (p = 0.02) A similar trend was noted for operative management for diaphyseal clavicle fractures by the surgeon on their own fractures (43%) compared to that of healthy patients (38%) and those with medical comorbidities (18%) (p = 0.02). CONCLUSION: While there are an increasing number of relative indications for treatment of diaphyseal humerus shaft and clavicle fractures, the results of this survey indicate that fellow-ship-trained orthopedic trauma surgeons prefer surgical management of simple humerus and clavicular fractures in young, healthy patients as well as in themselves.

A whale of a tale: A One Environmental Health approach to study metal pollution in the Sea of Cortez.

Marine metal pollution is an emerging concern for human, animal, and ecosystem health. We considered metal pollution in the Sea of Cortez, which is a relatively isolated sea rich in biodiversity. Here there are potentially significant anthropogenic inputs of pollution from agriculture and metal mining. We considered the levels of 23 heavy metals and selenium in seven distinct cetacean species found in the area. Our efforts considered two different periods of time: 1999 and 2016/17. We considered the metal levels in relation to (1) all species together across years, (2) differences between suborders Odontoceti and Mysticeti, (3) each species individually across years, and (4) gender differences for each of these comparisons. We further compared metal levels found in sperm whale skin samples collected during these voyages to a previous voyage in 1999, to assess changes in metal levels over a longer timescale. The metals Mg, Fe, Al, and Zn were found at the highest concentrations across all species and all years. For sperm whales, we observed decreased metal levels from 1999 to 2016/2017, except for iron (Fe), nickel (Ni), and chromium (Cr), which either increased or did not change during this time period. These results indicate a recent change in the metal input to the Sea of Cortez, which may indicate a decreased concern for human, animal, and ecosystem health for some metals, but raises concern for the genotoxic metals Cr and Ni. This work was supported by NIEHS grant ES016893 (J.P.W.) and numerous donors to the Wise Laboratory.

Combined effects of salinity, temperature, hypoxia, and Deepwater Horizon oil on Fundulus grandis larvae.

Oil spills have polluted the marine environment for decades and continue to be a major source of polycyclic aromatic hydrocarbons (PAHs) to marine ecosystems around the globe, for example during the 2010 Deepwater Horizon spill. Although the toxicity of PAHs to fish has been well studied, their effects combined with abiotic stressors are poorly understood. The goal of this study was to describe the combined impacts of crude oil and environmental stressors on fish larvae, a sensitive life stage. Gulf killifish (Fundulus grandis) larvae (<24 h post-hatch) were exposed for 48 h to high energy water accommodated fractions (HEWAF; total PAHs 0-125 ppb) of Macondo oil from the Deepwater Horizon spill under different combinations of environmental conditions (dissolved oxygen 2, 6 ppm; temperature 20, 25, 30 °C; salinity 3, 10, 30 ppt). Even under optimal environmental conditions (25 °C, 10 ppt, 6 ppm) larval survival and development were negatively affected by PAHs, starting with the lowest concentration tested (∼15 ppb). Hypoxia and high temperature each increased the adverse effects of HEWAF on development and mortality. In contrast, salinity had little effect on any of the endpoints measured. Importantly, expression of the detoxifying gene cyp1a was highly induced in PAH-exposed larvae under normoxic conditions, but not under hypoxic conditions, potentially explaining the enhanced toxicity observed under hypoxia. This work highlights the importance of considering how suboptimal environmental conditions can exacerbate the effects of pollution on fish early life stages.

Betaine in the Brain: Characterization of Betaine Uptake, its Influence on Other Osmolytes and its Potential Role in Neuroprotection from Osmotic Stress.

Betaine (N-trimethylglycine), a common osmolyte, has received attention because of the number of clinical reports associating betaine supplementation with improved cognition, neuroprotection and exercise physiology. However, tissue analyses report little accumulation of betaine in brain tissue despite the presence of betaine/GABA transporters (BGT1) at the blood brain barrier and in nervous tissue, calling into question whether betaine influences neuronal function directly or indirectly. Therefore, the focus of this study was to determine what capacity nervous tissue has to accumulate betaine, specifically in the hippocampus, a region of the brain associated with learning and memory and one that is particularly susceptible to damage (e.g., seizure activity). Here we report that hippocampal slices actively accumulate betaine in a time, dose and osmolality dependent manner, resulting in peak intracellular concentrations four times extracellular concentrations within 8 h. Our data also indicate that betaine uptake differentially influences the accumulation of other osmolytes. Under isosmotic conditions, betaine uptake minimally impacted some osmolytes (e.g., glycerylphosphorylcholine and glutamate) while significantly reducing others (taurine, creatine, and myo-inositol). Under osmotic stress (hyperosmotic) conditions, we observed dramatic changes in osmolytes like glycine and glutamine-key players in inhibitory neurotransmission-and little change in osmolytes such as taurine, creatine and myo-inositol when betaine was available. These data suggest that betaine may influence pathways of inhibitory neurotransmitter production/recycling in addition to serving as an osmolyte and metabolic intermediate. In sum, our data provide detailed characterization of betaine uptake in the hippocampus that implicates betaine in the modulation of hippocampal neurophysiology and neuroprotection.

Efficacy and safety of once-weekly GLP-1 receptor agonist albiglutide (HARMONY 2): 52 week primary endpoint results from a randomised, placebo-controlled trial in patients with type 2 diabetes mellitus inadequately controlled with diet and exercise.

AIMS/HYPOTHESIS: Additional safe and effective therapies for type 2 diabetes are needed, especially ones that do not cause weight gain and have a low risk of hypoglycaemia. The present study evaluated albiglutide as monotherapy. METHODS: In this placebo-controlled study, 309 patients (aged ≥ 18 years) with type 2 diabetes inadequately controlled by diet and exercise and who were not using a glucose-lowering agent (HbA1c 7.0-10.0% [53.00-85.79 mmol/mol], body mass index 20-45 kg/m(2), and fasting C-peptide ≥ 0.26 nmol/l) were randomised (1:1:1 on a fixed randomisation schedule using an interactive voice response system) to receive once-weekly albiglutide 30 mg (n = 102) or 50 mg (n = 102) or matching placebo (n = 105). The study treatments were blinded to both patients and study personnel. All study data were collected at individual patient clinic visits. The primary efficacy endpoint was change in HbA1c from baseline to week 52. The primary analysis was applied to the intent-to-treat population. Additional efficacy and safety endpoints were assessed. RESULTS: At week 52, both albiglutide 30 mg and 50 mg were superior to placebo in reducing HbA1c. The least-squares means treatment difference from placebo was -0.84% (95% CI -1.11%, -0.58%; p < 0.0001) with albiglutide 30 mg and -1.04% (-1.31%, -0.77%; p < 0.0001) with albiglutide 50 mg. Injection-site reactions were reported more frequently with albiglutide (30 mg: 17.8%; 50 mg: 22.2%) than with placebo (9.9%). Other commonly reported adverse events included nausea, diarrhoea, vomiting and hypoglycaemia; the incidences of these were generally similar across treatment groups. CONCLUSIONS/INTERPRETATION: Albiglutide is safe and effective as monotherapy and significantly lowered HbA1c levels over 52 weeks, did not cause weight gain, and had good gastrointestinal tolerability and a low rate of hypoglycaemia compared with placebo. Trial registration ClinicalTrials.gov NCT00849017 Funding This study was sponsored by GlaxoSmithKline.

Development of a comprehensive analytical method for furanocoumarins in grapefruit and their metabolites in plasma and urine using UPLC-MS/MS: a preliminary study.

To develop a comprehensive analytical method for photoactive furanocoumarins, grapefruit (whole, flesh, peel and juice) was extracted using QuEChERS (Quick, Easy, Cheap, Effective, Rugged and Safe) method. Seven furanocoumarins: bergaptol, psoralen, 8-methoxypsoralen, bergapten, 6',7'-dihydroxybergamottin (6',7'-DHB), epoxybergamottin and bergamottin were determined in grapefruit using UPLC-MS/MS. The concentrations of furanocoumarins in the plasma and urine of six healthy young adults before and after ingestion of grapefruit or grapefruit juice were also determined. Recovery rates of furanocoumarins by QuEChERS method from matrix spike sample and laboratory calibrate sample were 125.7 ± 25.4% and 105.7 ± 6.3%, respectively. Bergamottin and 6',7'-DHB were predominant compounds in grapefruit flesh, juice and plasma, while bergaptol and 6',7'-DHB were major compounds detected in the urine. The results demonstrated that bergamottin and 6',7'-DHB were metabolized to bergaptol. Overall, the analytical methods developed in the present study can be applied to the analysis of various furanocoumarins in plant sources and biological samples.

Rapid quick, easy, cheap, effective, rugged, and safe extraction with novel phospholipid cleanup: A streamlined ultra high performance liquid chromatography with ultraviolet detection approach for screening polycyclic aromatic hydrocarbons in avian blood cells and plasma.

A streamlined method has been developed for the isolation and analysis of polycyclic aromatic hydrocarbons in avian blood cells and plasma utilizing quick, easy, cheap, effective, rugged, and safe extraction in combination with novel phospholipid cleanup technology. A variety of traditional extraction and cleanup techniques have been employed in the preparation and analysis of polycyclic aromatic hydrocarbonsin a variety of matrices; liquid-liquid partitioning, solid-phase extractions, gel permeation chromatography, and column chromatography are all effective techniques, however they are laborious and time consuming processes that require large amounts of solvent. Using quick, easy, cheap, effective, rugged, and safe extraction coupled with phospholipid cleanup, samples can be quickly screened while maintaining high throughput and sensitivity. With a liquid chromatography approach, analysis times may be kept short at 16 min while maintaining high analyte recovery. Recoveries in quality control samples ranged from 70 to 109%, with average surrogate recoveries of 80.6 ± 1.10%. The result of using a quick, easy, cheap, effective, rugged, and safe extraction approach in conjunction with phospholipid cleanup is a methodology that significantly reduces sample preparation time and solvent use while maintaining high sensitivity and reproducibility.

Migrating Tundra Peregrine Falcons accumulate polycyclic aromatic hydrocarbons along Gulf of Mexico following Deepwater Horizon oil spill.

Monitoring internal crude oil exposure can assist the understanding of associated risks and impacts, as well as the effectiveness of restoration efforts. Under the auspices of a long-term monitoring program of Tundra Peregrine Falcons (Falco peregrinus tundrius) at Assateague (Maryland) and South Padre Islands (Texas), we measured the 16 parent (unsubstituted) polycyclic aromatic hydrocarbons (PAHs), priority pollutants identified by the United States Environmental Protection Agency and components of crude oil, in peripheral blood cells of migrating Peregrine Falcons from 2009 to 2011. The study was designed to assess the spatial and temporal trends of crude oil exposure associated with the 2010 Deepwater Horizon (DWH) oil spill which started 20 April 2010 and was capped on 15 July of that year. Basal PAH blood distributions were determined from pre-DWH oil spill (2009) and unaffected reference area sampling. This sentinel species, a predator of shorebirds and seabirds during migration, was potentially exposed to residual oil from the spill in the northern Gulf of Mexico. Results demonstrate an increased incidence (frequency of PAH detection and blood concentrations) of PAH contamination in 2010 fall migrants sampled along the Texas Gulf Coast, declining to near basal levels in 2011. Kaplan-Meier peak mean ∑PAH blood concentration estimates varied with age (Juveniles-16.28 ± 1.25, Adults-5.41 ± 1.10 ng/g, wet weight) and PAHs detected, likely attributed to the discussed Tundra Peregrine natural history traits. Increased incidence of fluorene, pyrene and anthracene, with the presence of alkylated PAHs in peregrine blood suggests an additional crude oil source after DWH oil spill. The analyses of PAHs in Peregrine Falcon blood provide a convenient repeatable method, in conjunction with ongoing banding efforts, to monitoring crude oil contamination in this avian predator.

Are low-energy open ankle fractures in the elderly the new geriatric hip fracture?

As the geriatric population in the United States continues to increase, ankle fractures in the elderly are predicted to exponentially increase in the future. As such, these injuries will become a common injury seen by physicians in various fields. Currently, no studies discussing low-energy open ankle fractures in the elderly and/or the mortality rate associated with these devastating injuries have been published. The purpose of the present study was to retrospectively review the morality rate associated with low-energy open ankle fractures in the elderly. We retrospectively identified 11 patients >60 years old who had sustained low-energy open ankle fractures and been treated at our institution. The patient demographics, mechanism of injury, wound size, medical comorbidities, treatment, follow-up data, and outcomes were recorded. Low-energy falls were defined as ground level falls from sitting or standing. The mean age of the patients was 70.72 years, with a mean body mass index of 35.93 ± 10.24. Of the 11 patients, 9 (81.81%) had ≥3 comorbidities (i.e., hypertension, diabetes, coronary artery disease, congestive heart failure, and/or chronic obstructive pulmonary disease). The mean size of the medially based ankle wound was 14.18 ± 4.12 cm; 10 (90.90%) were Gustilo and Anderson grade IIIA open ankle fractures. In our study, low-energy open ankle fractures in the elderly, very similar to hip fractures, were associated with a high mortality incidence (27.27%) at a mean of 2.67 ± 2.02 months, and 81.81% of our patients had ≥3 medical comorbidities.

Concentrations of the genotoxic metals, chromium and nickel, in whales, tar balls, oil slicks, and released oil from the gulf of Mexico in the immediate aftermath of the deepwater horizon oil crisis: is genotoxic metal exposure part of the deepwater horizon legacy?

Concern regarding the Deepwater Horizon oil crisis has largely focused on oil and dispersants while the threat of genotoxic metals in the oil has gone largely overlooked. Genotoxic metals, such as chromium and nickel, damage DNA and bioaccumulate in organisms, resulting in persistent exposures. We found chromium and nickel concentrations ranged from 0.24 to 8.46 ppm in crude oil from the riser, oil from slicks on surface waters and tar balls from Gulf of Mexico beaches. We found nickel concentrations ranged from 1.7 to 94.6 ppm wet weight with a mean of 15.9 ± 3.5 ppm and chromium concentrations ranged from 2.0 to 73.6 ppm wet weight with a mean of 12.8 ± 2.6 ppm in tissue collected from Gulf of Mexico whales in the wake of the crisis. Mean tissue concentrations were significantly higher than those found in whales collected around the world prior to the spill. Given the capacity of these metals to damage DNA, their presence in the oil, and their elevated concentrations in whales, we suggest that metal exposure is an important understudied concern for the Deepwater Horizon oil disaster.

Assessment of mitochondrial DNA damage in little brown bats (Myotis lucifugus) collected near a mercury-contaminated river.

Historical discharges of Hg into the South River near the town of Waynesboro, VA, USA, have resulted in persistently elevated Hg concentrations in sediment, surface water, ground water, soil, and wildlife downstream of the discharge site. In the present study, we examined mercury (Hg) levels in in little brown bats (Myotis lucifugus) from this location and assessed the utility of a non-destructively collected tissue sample (wing punch) for determining mitochondrial DNA (mtDNA) damage in Hg exposed bats. Bats captured 1 and 3 km from the South River, exhibited significantly higher levels of total Hg (THg) in blood and fur than those from the reference location. We compared levels of mtDNA damage using real-time quantitative PCR (qPCR) analysis of two distinct regions of mtDNA. Genotoxicity is among the many known toxic effects of Hg, resulting from direct interactions with DNA or from oxidative damage. Because it lacks many of the protective protein structures and repair mechanisms associated with nuclear DNA, mtDNA is more sensitive to the effects of genotoxic chemicals and therefore may be a useful biomarker in chronically exposed organisms. Significantly higher levels of damage were observed in both regions of mtDNA in bats captured 3 km from the river than in controls. However, levels of mtDNA damage exhibited weak correlations with fur and blood THg levels, suggesting that other factors may play a role in the site-specific differences.

Mercury in bats from the northeastern United States.

This study examines mercury exposure in bats across the northeast U.S. from 2005 to 2009. We collected 1,481 fur and 681 blood samples from 8 states and analyzed them for total Hg. A subset (n = 20) are also analyzed for methylmercury (MeHg). Ten species of bats from the northeast U.S. are represented in this study of which two are protected by the Endangered Species Act (ESA 1973) and two other species are pending review. There are four objectives in this paper: (1) to examine correlates to differences in fur-Hg levels among all of the sampling sites, including age, sex, species, and presence of a Hg point source; (2) define the relationship between blood and fur-Hg levels and the factors that influence that relationship including age, sex, species, reproductive status, and energetic condition; (3) determine the relationships between total Hg and MeHg in five common eastern bat species; and (4) assess the distribution of Hg across bat populations in the northeast. We found total blood and fur mercury was eight times higher in bats captured near point sources compared to nonpoint sources. Blood-Hg and fur-Hg were well correlated with females on average accumulating two times more Hg in fur than males. On average fur MeHg accounted for 86 % (range 71-95 %) of the total Hg in bat fur. Considering that females had high Hg concentrations, beyond that of established levels of concern, suggests there could be negative implications for bat populations from high Hg exposure since Hg is readily transferred to pups via breast milk. Bats provide an integral part of the ecosystem and their protection is considered to be of high priority. More research is needed to determine if Hg is a stressor that is negatively impacting bat populations.

Nondestructive indices of mercury exposure in three species of turtles occupying different trophic niches downstream from a former chloralkali facility.

Turtles are useful for studying bioaccumulative pollutants such as mercury (Hg) because they have long life spans and feed at trophic levels that result in high exposure to anthropogenic chemicals. We compared total Hg concentrations in blood and toenails of three species of turtles (Chelydra serpentina, Sternotherus odoratus, and Graptemys geographica) with different feeding ecologies from locations up- and downstream of a superfund site in Virginia, USA. Mercury concentrations in turtle tissues were low at the reference site (average ± 1SE: blood = 48 ± 6 ng g(-1); nail = 2,464 ± 339 ng g(-1) FW) but rose near the contamination source to concentrations among the highest ever reported in turtles [up to 1,800 ng g(-1) (blood) and 42,250 ng g(-1) (nail) FW]. Tissue concentrations remained elevated ~130 km downstream from the source compared to reference concentrations. Tissue Hg concentrations were higher for C. serpentina and S. odoratus than G. geographica, consistent with the feeding ecology and our stable isotope (δ(13)C and δ(15)N) analyses of these species. In addition, we suggest that toenails were a better indication of Hg exposure than blood, probably because this keratinized tissue represents integrated exposure over time. Our results demonstrate that downstream transport of Hg from point sources can persist over vast expanses of river thereby posing potential exposure risks to turtles, but relative exposure varies with trophic level. In addition, our study identifies turtle toenails as a simple, cost-efficient, and minimally invasive tissue for conservation-minded sampling of these long-lived vertebrates.

Detection of numerous phycotoxins in young bull sharks (Carcharhinus leucas) collected from an estuary of national significance.

Florida's Indian River Lagoon (IRL) has experienced large-scale, frequent blooms of toxic harmful algae in recent decades. Sentinel, or indicator, species can provide an integrated picture of contaminants in the environment and may be useful to understanding phycotoxin prevalence in the IRL. This study evaluated the presence of phycotoxins in the IRL ecosystem by using the bull shark (Carcharhinus leucas) as a sentinel species. Concentrations of phycotoxins were measured in samples collected from 50 immature bull sharks captured in the IRL between 2018 and 2020. Ultra-performance liquid chromatography/tandem mass spectrometry was used to measure toxins in shark gut contents, plasma, and liver. Analysis of samples (n = 123) demonstrated the presence of multiple phycotoxins (microcystin, nodularin, teleocidin, cylindrospermopsin, domoic acid, okadaic acid, and brevetoxin) in 82 % of sampled bull sharks. However, most detected toxins were in low prevalence (≤25 % of samples, per sample type). This study provides valuable baseline information on presence of multiple phycotoxins in a species occupying a high trophic position in this estuary of national significance.

Cost analysis of self-monitoring blood glucose in nonintensively managed type 2 diabetes.

OBJECTIVES: To compare health care resource utilization (HCRU) and costs between self-monitoring of blood glucose (SMBG) and continuous glucose monitoring (CGM) users in adults with nonintensively managed type 2 diabetes (T2D). STUDY DESIGN: Retrospective analysis of the MarketScan Databases. METHODS: Adults with T2D using SMBG or initiating CGM between January 2018 and March 2019 were eligible for inclusion. Inclusion criteria were (1) 2 consecutive claims for T2D or 1 claim for T2D and a claim for glucose-lowering therapy, (2) at least 1 pharmacy claim for SMBG strips or CGM sensors, and (3) continuous enrollment for 1 year before and after the index date. Individuals with evidence of CGM in the preindex period, pregnancy, use of rapid-acting insulin or glucagon, type 1 diabetes, gestational diabetes, or secondary diabetes at any time during the study period were excluded. SMBG and CGM patients were matched using propensity score, and all-cause HCRU and costs during a 1-year period were compared. RESULTS: A total of 3498 patients were included in each matched cohort. The per-patient per-year (PPPY) all-cause cost was $20,542 in CGM users vs $19,349 in SMBG users (P < .001). The PPPY cost of glucose-lowering medication was $6312 in CGM users vs $5606 in SMBG users (P < .001). No significant differences in the number of emergency department visits or hospitalizations were observed, but CGM users had more all-cause outpatient visits and office visits with an endocrinologist. CONCLUSIONS: In adults with nonintensively managed T2D, SMBG appears to be less costly than CGM and is associated with lower pharmacy costs.

A case of pseudohyperchloraemia caused by sodium nitrate ingestion.

Emergency department presentations of sodium nitrate poisoning are increasing in frequency. Point-of-care blood gas analysis is useful for identifying methaemoglobinaemia and other abnormalities in such patients. Topically applied nitrate is known to positively interfere with chloride measurement in both point-of-care instruments and automated analysers of the clinical chemistry laboratory. In this article, the authors describe a case of pseudohyperchloraemia caused by sodium nitrate, which was consumed orally for the purpose of suicide. Consistent with the established pattern of interference, the ABL800 (Radiometer Medical, Brønshøj Copenhagen) blood gas analyser produced spuriously high chloride results, whilst the Alinity (Abbott Diagnostics, Abbot Park, Illinois) automated analyser resulted in chloride measurements comparable to those of inductively coupled mass spectrometry (ICP-MS). Both instruments, measure chloride with ion-selective electrodes (ISEs). The ABL800 (Radiometer) uses a membrane electrode, which is vulnerable to permeation by lipophilic nitrate ions, whereas the Alinity (Abbott) employs a silver chloride redox electrode system that is resistant to precipitation of silver nitrate due to its relatively high solubility. These mechanistic differences likely explain why nitrate interferes with some point-of-care devices but does not appear to affect the results of automated analysers.

Urinary excretion of estrogenic chemicals following consumption of capsule coffee and French press coffee: A crossover study.

Background: Coffee brewed from capsules contain estrogenic chemicals (ECs) that may harm the reproductive system. However, there are no studies investigating whether consuming capsule coffee causes these ECs to present in urine. Objective: Compare the effects of consuming capsule coffee vs. a plastic-free (French press) method on the appearance of ECs in urine. Methods: Participants (n = 30) were randomized to consume 540 mL of capsule or French press coffee once, then switched and consumed the other coffee after washout. Urine samples were collected prior to consumption, at 6 h and 24 h. Coffee and urine samples were analyzed for nine ECs using ultra-performance liquid chromatography with tandem mass spectrometry: bisphenol A (BPA), bisphenol F (BPF), bisphenol S, di(2-ethylhexyl) phthalate (DEHP), benzophenone, 4-nonylphenol (4-NP), dibutyl phthalate, caprolactam and dimethyl terephthalate. Results: In coffee samples, BPF (French press: 13.9 ng/mL, capsule: 16.1 ng/mL) and DEHP (capsule: 1.12 ng/mL) were present. In 6 h urine samples, the detection frequency for DEHP was 6.7% in capsule and 13.3% in French press coffee. BPF was detected in only one urine sample post-consumption. Conclusion: Consuming capsule coffee did not increase urinary EC exposure compared to consuming French press coffee.

Spatial gradients of methylmercury for breeding common loons in the Laurentian Great Lakes region.

Much of the Laurentian Great Lakes region is a mercury-sensitive landscape, in which atmospheric deposition and waterborne sources of mercury (Hg) have led to high concentrations of bioavailable methylmercury (MeHg) in predatory fish and piscivorous wildlife. Efforts since the early 1990s have established the common loon (Gavia immer) as the primary avian indicator for evaluating the exposure and effects of MeHg in North America. A regional Hg dataset was compiled from multiple loon tissue types and yellow perch (Perca flavescens), a preferred prey fish species for loons. Hg exposure in loons and perch was modeled to develop male and female loon units (MLU and FLU, respectively), standardized metrics that represent the estimated blood Hg exposure of a male or female loon for a given loon territory or water body. Using this common endpoint approach to assess loon Hg exposure, the authors demonstrate spatial trends in biotic Hg concentrations, examine MeHg availability in aquatic ecosystems of the Great Lakes region in relation to landscape-level characteristics, and identify areas with potentially significant adverse reproductive impacts to loons and other avian piscivores. Based on 8,101 MLUs, seven biological Hg hotspots were identified in the Great Lakes region. Policy-relevant applications are presented.

Effectiveness of Gravity and Manual Stress Radiographs and the Use of Lateral Talar Displacement in Determining Ankle Stability of Supination-External Rotation Type Ankle Fractures.

OBJECTIVES: (1) To evaluate adequacy and reproducibility of the gravity and manual stress imaging in the diagnosis of unstable ankle fractures and (2) to evaluate the diagnostic utility of lateral talar displacement ratio (LTDR) derived in relation to the talar body width on ankle stress imaging. DESIGN: Retrospective cohort study. SETTING: Level 1 Trauma Center. PATIENTS: One hundred seventy consecutive patients who presented with supination-external rotation 2 ankle fractures (OTA/AO 44-B2.1) requiring dynamic stress testing. INTERVENTION: Dynamic stress imaging to determine ankle stability. MAIN OUTCOME MEASURE: Ankle instability and subsequent need for surgical fixation as determined by dynamic stress imaging. RESULTS: No statistical significant difference was found between the adequacy of gravity stress radiographs and manual stress images in regards to surgical decision-making (P = 0.595). Using manual and gravity stress images, receiver operating characteristic curves were generated for medial clear space (MCS) (area under the curve = 0.793, 0.901) and LTDR (0.849, 0.850), corresponding to thresholds of 10.5% and 10.2% for manual and gravity, respectively. Seventy-three of 105 patients (69.5%) with MCS > 5 mm and 62 of 75 patients (82.7%) with LTDR > 10% were offered surgical intervention. Sixty-two of the 77 patients (80.5%) offered surgery had both MCS > 5 mm and LTDR > 10%. CONCLUSION: This study shows that manual stress radiographs are just as effective as gravity stress radiographs in making an assessment of ankle fracture stability as there was no difference in diagnostic value between gravity and manual stress imaging in regards to surgical decision-making. Use of additional radiographic measurements such as the LTDR can provide additional information in determining stability when MCS is within a clinical gray area. LEVEL OF EVIDENCE: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.