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Construction activities may affect adjacent water systems by introducing increased levels of suspended solids into the water body and may subsequently affect the survival and growth of freshwater mussels. We tested three sediment types from sites in Missouri, including Spring River sediment (SRS), Osage River bank clay soil (ORC), and quarried limestone from Columbia (LMT). We prepared series of suspensions of each sediment with total suspended solids concentrations ranging from 0 to 5000 mg/L. Juveniles from three mussel species, Fatmucket (Lampsilis siliquoidea), Arkansas Brokenray (Lampsilis reeveiana), and Washboard (Megalonaias nervosa) were exposed to these suspensions in both acute (96-h) and chronic (28-d) tests. No clear impact on survival was observed from the acute or chronic exposures, but chronic test showed that juvenile mussels' growth was strongly affected. Interestingly, growth was enhanced at lower levels of SRS and ORC (≤500 mg/L, p < 0.05), and the juvenile mussels exposed to 500 mg/L SRS exhibited approximately 60 % more dry weight than those reared in the control. LMT did not enhance growth. Growth was slowed by high concentrations (>1000 mg/L) of all three sediments, implying that high suspended solids levels could reduce survival in the long term. Our findings may help to inform regulations and guidelines for construction activities to minimize adverse effects on juvenile mussels., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The US Geological Survey. Published by Elsevier B.V. All rights reserved.)

Background: Although iron deficiency frequently complicates anemia in patients with nondialysis-dependent CKD (ND-CKD), the comparative treatment value of IV iron infusion and oral iron supplementation has not been established., Methods: In a randomized, controlled multicenter trial, we compared the efficacy of iron sucrose, given as 1 g in divided IV doses over 14 days, with that of ferrous sulfate, given 325 mg orally thrice daily for 56 days in patients with ND-CKD stages 3 to 5, Hb < or =11 g/dL, TSAT < or =25%, and ferritin < or =300 ng/mL. Epoetin/darbepoetin therapy, if any, was not changed for eight weeks prior to or during the study., Results: The proportion of patients achieving the primary outcome (Hb increase > or =1 g/dL) was greater in the IV iron treatment group than in the oral iron treatment group (44.3% vs. 28.0%, P= 0.0344), as was the mean increase in Hb by day 42 (0.7 vs. 0.4 g/dL, P= 0.0298). Compared to those in the IV iron group, patients in the oral iron treatment group showed a greater decline in GFR during the study (-4.40 vs. -1.45 mL/min/1.73m2, P= 0.0100). No serious adverse drug events (ADE) were seen in patients administered IV iron sucrose as 200 mg IV over two to five minutes, but drug-related hypotension, including one event considered serious, occurred in two females weighing less than 65 kg after 500 mg doses were given over four hours., Conclusion: IV iron administration using 1000 mg iron sucrose in divided doses is superior to oral iron therapy in the management of ND-CKD patients with anemia and low iron indices.

The 28-gauge catheter supplied by Kendall Healthcare Products Company (Mansfield, MA) for continuous spinal anesthesia has two important characteristics. The ink used for the centimeter calibration marks and to identify the tip of the catheter "washes off" while it is inserted in the patient. In addition, the catheter has a tendency to stretch while it is in the patient or being removed. These two characteristics produced a situation in which it was impossible to determine whether a catheter fragment had been left in a patient. This predicament had a serious impact on the postoperative management of the patient. A computerized tomographic scan and spine films were negative, while other evidence suggested that a fragment was left behind. When the patient developed a postdural puncture headache, the authors felt that an epidural blood patch was contraindicated. The patient's headache did resolve with 48 hours of conservative therapy.