Does rectal examination have any value in the clinical diagnosis of cauda equina syndrome?

PURPOSE: This study aims to quantify the value of digital rectal examination (DRE) in the clinical diagnosis of cauda equina syndrome. METHODS: A retrospective case note review was performed on all patients referred to a University Teaching Hospital over a one-year period with documented suspicion of cauda equina syndrome. All Patients underwent MRI scanning to either confirm or rule out the diagnosis. RESULTS: Fifty-seven such patients were identified, 13 (23%) of whom had confirmation of cauda equina syndrome on MRI scanning. The DRE did not significantly discriminate for the outcome of MRI (p = 0.897, test accuracy 51%, diagnostic odds ratio 1.42). There was no correlation between the cumulative number of positive clinical findings in an individual patient and the likelihood of MRI diagnosis and no significant link between any individual clinical feature and the MRI result. CONCLUSIONS: Digital rectal examination has no significant value in the acute diagnosis of cauda equina syndrome. This study further confirms that there is no discreet clinical protocol applicable with which to confidently confirm or rule out this diagnosis. DRE is traditionally enshrined as an essential facet of clinical assessment in suspected cauda equina syndrome but it cannot be used as a discriminator to ration urgent MRI scanning.

Nonpoint source arsenic contamination of soil and groundwater from legacy pesticides.

Arsenic (As) contamination in wells is common throughout the northeastern United States. It is well documented that lead-arsenate (PbHAsO4 ) pesticides were widely used on fruit tree orchards from the 1890s to 1950s. This study evaluates the potential for As contamination of groundwater from former orchards in Connecticut, where there were over 47,000 orchards in 1935. A proximity analysis involving 189 orchards and 114 domestic wells was conducted to assess the spatial relationship between historic orchards and As in wells. Field studies were then conducted to characterize As and lead (Pb) distributions in soils and wells near historic orchards. The proximity analysis found that the wells with no detected As were further away from historic orchards and had fewer historic orchards within their vicinity when compared with wells that contained As. The field investigations found that elevated levels of As and Pb were widespread in soils from orchards established by 1951, with some As concentrations exceeding 200 ppm. In some soils, As and Pb were leachable at concentrations exceeding USEPA drinking water standards in synthetic precipitation laboratory tests. It was also found that the wells nearest to the impacted soils tended to contain the highest As concentrations, while the wells located in areas that were forested prior to 1970 contained no As. Overall, this study found that As and Pb from legacy pesticide residues are still abundant in former orchard soils and that a strong spatial relationship exists between As-contaminated wells and historic orchards. Greater consideration should be given to historic orchard soils as a potential contributing nonpoint source of As to the groundwater in Connecticut, where domestic well contamination rates are high.

Use of bacteria community analysis to distinguish groundwater recharge sources to shallow wells.

In this study, bacteria community analysis was performed to supplement a preexisting evaluation of nitrate contamination in drinking water wells at a coastal site in Old Lyme, CT. Given well usage and coastal hydrogeologic conditions, the source(s) of nitrate contamination in domestic wells could not be discerned between local septic systems or a nearby farm where organic fertilizers were used. Groundwater bacteria communities are known to be sensitive to a variety of environmental conditions. As such, they are potentially useful in distinguishing groundwater recharge sources. Groundwater samples collected from wells were analyzed using polymerase chain reactions (PCR) and 16S rRNA sequencing to determine the bacteria distributions in each well. The biostatistical analysis of the data using Bray-Curtis nonmetric multidimensional scaling and permutational multivariate analysis of variance revealed three distinct bacteria community distributions that coincided with three different areas on the site. Additionally, principal component analysis (PCA) of the water quality data revealed that wells with similar bacteria shared similar water quality, all of which was indicative of local recharge. These findings suggested that the domestic well nitrate contamination was derived from local septic systems rather than the farm. Septic indicator analysis using ultra-performance liquid chromatography-tandem mass spectrometry determined the presence of caffeine in domestic wells, which was consistent with the conclusions from the bacteria analysis, PCA, and the known hydrogeologic conditions. The low cost, ease of sample collection, and growing availability of bioinformatics laboratory services and software are conducive to the application of microbial community analysis as a supplemental tool for groundwater investigations.

Regional-scale drivers of forest structure and function in northwestern Amazonia.

Field studies in Amazonia have found a relationship at continental scales between soil fertility and broad trends in forest structure and function. Little is known at regional scales, however, about how discrete patterns in forest structure or functional attributes map onto underlying edaphic or geological patterns. We collected airborne LiDAR (Light Detection and Ranging) data and VSWIR (Visible to Shortwave Infrared) imaging spectroscopy measurements over 600 km2 of northwestern Amazonian lowland forests. We also established 83 inventories of plant species composition and soil properties, distributed between two widespread geological formations. Using these data, we mapped forest structure and canopy reflectance, and compared them to patterns in plant species composition, soils, and underlying geology. We found that variations in soils and species composition explained up to 70% of variation in canopy height, and corresponded to profound changes in forest vertical profiles. We further found that soils and plant species composition explained more than 90% of the variation in canopy reflectance as measured by imaging spectroscopy, indicating edaphic and compositional control of canopy chemical properties. We last found that soils explained between 30% and 70% of the variation in gap frequency in these forests, depending on the height threshold used to define gaps. Our findings indicate that a relatively small number of edaphic and compositional variables, corresponding to underlying geology, may be responsible for variations in canopy structure and chemistry over large expanses of Amazonian forest.

Geological control of floristic composition in Amazonian forests.

AIM: Conservation and land-use planning require accurate maps of patterns in species composition and an understanding of the factors that control them. Substantial doubt exists, however, about the existence and determinants of large-area floristic divisions in Amazonia. Here we ask whether Amazonian forests are partitioned into broad-scale floristic units on the basis of geological formations and their edaphic properties. LOCATION: Western and central Amazonia. METHODS: We used Landsat imagery and Shuttle Radar Topography Mission (SRTM) digital elevation data to identify a possible floristic and geological discontinuity of over 300 km in northern Peru. We then used plant inventories and soil sampling to document changes in species composition and soil properties across this boundary. Data were obtained from 138 sites distributed along more than 450 km of road and river. On the basis of our findings, we used broad-scale Landsat and SRTM mosaics to identify similar patterns across western and central Amazonia. RESULTS: The discontinuity identified in Landsat and SRTM data corresponded to a 15-fold change in soil cation concentrations and an almost total change in plant species composition. This discontinuity appears to be caused by the widespread removal of cation-poor surface sediments by river incision to expose cation-rich sediments beneath. Examination of broad-scale Landsat and SRTM mosaics indicated that equivalent processes have generated a north-south discontinuity of over 1500 km in western Brazil. Due to similarities with our study area, we suggest that this discontinuity represents a chemical and ecological limit between western and central Amazonia. MAIN CONCLUSIONS: Our findings suggest that Amazonian forests are partitioned into large-area units on the basis of geological formations and their edaphic properties. The evolution of these units through geological time may provide a general mechanism for biotic diversification in Amazonia. These compositional units, moreover, may correspond to broad-scale functional units. The existence of large-area compositional and functional units would suggest that protected-area, carbon sequestration, and other land-use strategies in Amazonia be implemented on a region-by-region basis. The methods described here can be used to map these patterns, and thus enable effective conservation and management of Amazonian forests.