Evaluation of a Stable Isotope-Based Direct Quantification Method for Dicamba Analysis from Air and Water Using Single-Quadrupole LC-MS.

Dicamba is a moderately volatile herbicide used for post-emergent control of broadleaf weeds in corn, soybean, and a number of other crops. With increased use of dicamba due to the release of dicamba-resistant cotton and soybean varieties, growing controversy over the effects of spray drift and volatilization on non-target crops has increased the need for quantifying dicamba collected from water and air sampling. Therefore, this study was designed to evaluate stable isotope-based direct quantification of dicamba from air and water samples using single-quadrupole liquid chromatography-mass spectrometry (LC-MS). The sample preparation protocols developed in this study utilize a simple solid-phase extraction (SPE) protocol for water samples and a single-step concentration protocol for air samples. The LC-MS detection method achieves sensitive detection of dicamba based on selected ion monitoring (SIM) of precursor and fragment ions and relies on the use of an isotopically labeled internal standard (IS) (D3-dicamba), which allows for calculating recoveries and quantification using a relative response factor (RRF). Analyte recoveries of 106-128% from water and 88-124% from air were attained, with limits of detection (LODs) of 0.1 ng mL-1 and 1 ng mL-1, respectively. The LC-MS detection method does not require sample pretreatment such as ion-pairing or derivatization to achieve sensitivity. Moreover, this study reveals matrix effects associated with sorbent resin used in air sample collection and demonstrates how the use of an isotopically labeled IS with RRF-based analysis can account for ion suppression. The LC-MS method is easily transferrable and offers a robust alternative to methods relying on more expensive tandem LC-MS/MS-based options.

Difficult Patients in the Emergency Department: Personality Disorders and Beyond.

Physician-patient encounters in clinical settings, especially in the emergency department, can be of varying degrees of difficulty. Medically complicated, challenging cases can be paradoxically rewarding, whereas psychologically driven difficulty is frustrating and counterproductive for patient care. This article presents 3 different complementary perspectives on difficult patients: clinical presentations, manifestations of personality traits and disorders in clinical settings, and how physician feelings may affect care. Management strategies are discussed.

Low-Intensity Repetitive Exercise Induced Rhabdomyolysis.

Rhabdomyolysis is a rare condition caused by the proteins of damaged muscle cells entering the bloodstream and damaging the kidneys. Common symptoms of rhabdomyolysis are muscle pain and fatigue in conjunction with dark urine; kidney damage is a common symptom among these patients. We present a case of a 23-year-old woman who displayed myalgia in the upper extremities caused by low-intensity and high-repetition exercise. She was successfully diagnosed and treated for exertional rhabdomyolysis. This patient had no significant medical history that would induce this condition. We urge the emergency medical community to observe and monitor patients that complain of myalgia to ensure they are not suffering from rhabdomyolysis even in atypical cases.

Evaluation of a market in wetland credits: entrepreneurial wetland banking in Chicago.

With the rise of market-led approaches to environmental policy, compensation for permitted discharge of dredge or fill material into wetlands under Section 404 of the U.S. Clean Water Act has been purchased increasingly from entrepreneurial third-party providers. The growth of this practice (i.e., entrepreneurial wetland banking) has resolved many challenges associated with wetland compensation. But it has also produced (1) quantifiable temporal loss of wetland ecological functions, (2) spatial redistribution of wetland area, and (3) a degree of regulatory instability that may pose a threat to entrepreneurial compensation as a sustainable component of wetland-compensation policy. We used achieved compensation ratios, lapse between bank credit sale and the attainment of performance standards, distance between impact and bank site, and changes in bank market area to examine these 3 factors. We analyzed data from a census of all such transactions in the Chicago District of the U.S. Army Corps of Engineers, compiled from site visits, Corps databases, and contacts with consultants and Section 404 permittees. Entrepreneurial banking provided compensation at a lower overall ratio than nonbank forms of compensation. Approximately 60% of bank credits were sold after site-protection standards were met but before ecological performance standards were met at the bank site. The average distance between bank and impact site was approximately 26 km. The area of markets within which established banks can sell wetland credits has fluctuated considerably over the study period. Comparing these data with similar data for other compensation mechanisms will assist in evaluating banking as an element of conservation policy. Data characterizing the performance of entrepreneurial wetland banks in actual regulatory environments are scarce, even though it is the most established of similar markets that have become instrumental to federal policy in administering several major environmental protection laws.