Chemical Considerations for an Updated National Assessment of Brackish Groundwater Resources.

Brackish groundwater (BGW) is increasingly used for water supplies where fresh water is scarce, but the distribution and availability of such resources have not been characterized at the national scale in the United States since the 1960s. Apart from its distribution and accessibility, BGW usability is a function of the chemical requirements of the intended use, chemical characteristics of the resource, and treatment options to make the resource compatible with the use. Here, we discuss relations between these three chemical factors using national-scale examples and local case studies. In a preliminary compilation of BGW data in the United States, five water types accounted for the major-ion composition of 70% of samples. PHREEQC calculations indicate that 57-77% of samples were oversaturated with respect to barite, calcite, or chalcedony. In the study, 5-14% of samples had concentrations of arsenic, fluoride, nitrate, or uranium that exceeded drinking-water standards. In case studies of the potential use of BGW for drinking water, irrigation, and hydraulic fracturing, PHREEQC simulations of a hypothetical treatment process resembling reverse osmosis (RO) showed that BGW had the potential to form various assemblages of mineral deposits (scale) during treatment that could adversely affect RO membranes. Speciation calculations showed that most boron in the irrigation example occurred as boric acid, which has relatively low removal efficiency by RO. Results of this preliminary study indicate that effective national or regional assessments of BGW resources should include geochemical characterizations that are guided in part by specific use and treatment requirements.

Fractures of the tubular bones of the hand.

Age related differences in demographics, morphology, treatment and outcome were investigated in 701 fractures of the metacarpals or phalanges, including fracture-dislocations, in 655 patients. Fractures mainly due to sport occurred in 184 children, usually after 10 years of age. The base of the proximal phalanx was especially vulnerable. Thirty-seven percent of 256 young adults fractured their fifth metacarpal. The thumb was rarely involved. Half of these two groups fractured the fifth ray. Older adults had more fractures of the distal phalanx and displaced extraarticular fractures requiring stabilisation. Women predominated in the patients over 65. Forty percent of this group sustained their fracture on the road and more fractures involved the thumb, were oblique, intraarticular or multiple than in other groups. Detailed analysis of 423 X-rays demonstrated that only 10% of 70 intraarticular fractures and 19% of 363 extraarticular fractures were completely undisplaced. Patient response to postal questionnaire based outcome assessment using SF-12, MHQ was very poor.

Effect of normal synovial fluid on the metabolism of articular chondrocytes in vitro.

It is thought that articular cartilage gains most of its nutrition in vivo, via diffusion, from synovial fluid. There have been few studies investigating the effect of synovial fluid on chondrocyte metabolism in vitro. In the current study, bovine articular chondrocytes were isolated and cultured in agarose using normal allogenic synovial fluid as culture medium. Dulbecco's minimal essential medium + 20% fetal calf serum and Earle's balanced salt solution were used as control media. Cell viability at the end of the experiment showed that neither synovial fluid nor Earle's balanced salt solution had a significant effect on viability when compared with Dulbecco's minimal essential medium + 20% fetal calf serum during the period assessed. Results indicate that levels of glycosaminoglycan synthesis can be maintained when Dulbecco's minimal essential medium + 20% fetal calf serum is diluted with Earle's balanced salt solution to levels of 80% Earle's balanced salt solution. When Dulbecco's minimal essential medium + 20% fetal calf serum was diluted with synovial fluid, glycosaminoglycan synthesis was stimulated in a dose dependent manner to 80% synovial fluid. Even at 100% synovial fluid, synthesis levels were significantly higher than for Dulbecco's minimal essential medium + 20% fetal calf serum. Tritiated thymidine uptake decreased with increasing concentrations of either Earle's balanced salt solution or synovial fluid. The results suggest that culture in synovial fluid induces a state similar to that seen in vivo, with high levels of glycosaminoglycan synthesis and low levels of cell division.

Ketorolac versus DHE and metoclopramide in the treatment of migraine headaches.

Ketorolac IM was compared to DHE and metoclopramide IV in migraine patients whose regular abortive medication had failed and who presented to a headache clinic for acute treatment. Pain scale ratings and ratings of ability to function were recorded before and after injection. Ketorolac provided moderate relief in headache in six of nine patients compared to eight of nine given DHE and metoclopramide. The average improvement in patients receiving DHE and metoclopramide was greater in pain (p = .031) and disability scores (p = .057), than in those patients given ketorolac.