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This article is informed by the planned behaviour and hierarchy of effect theories to examine the influence of five traditional promotion strategies on the performance of commercial banks in Tanzania, taking evidence from one of the leading commercial banks in the country - CRDB Plc. This quantitative based study used a self-administered questionnaire to collect data from randomly selected 208 sampled employees. With the support of the Statistical Package for Social Sciences (SPSS) software, a hypothesised model that included promotion strategies as predictors of commercial banks' performance was evaluated using a multiple linear regression model. The results supported the hypothesised model, indicating that all the promotion strategies had positive; and only four (excluding publicity) had important influence on the performance of commercial banks. From the findings, the study recommends that commercial banks need to innovatively prioritise adoption of the complementary use of the four significant promotion strategies of sales promotion, advertising, personal selling, and direct marketing to manage the performance of commercial banks. Nevertheless, publicity should not be entirely ignored as it also has some positive effect. [ABSTRACT FROM AUTHOR]

Background: A biphasic-plateau pattern in the maximal expiratory flow-volume (MEFV) curve has been described after single-lung transplantation (SLT) in patients with chronic airways obstruction (CAO). It has been theorized that this pattern is either related to stenosis at the anastomotic or subanastomotic site, or the sum of the airflow contribution from the native lung with airways obstruction and transplanted lung.Subjects and Methods: We analyzed data in 16 patients with CAO who had undergone transplantations (5 men, 11 women; mean age [+/- SD], 53.8 +/- 4.9 years), and 9 patients with pulmonary vascular disease (PVD) without airways obstruction who had undergone transplantations (2 men, 7 women; mean age, 35.4 +/- 11.4 years).Results: In the patients with PVD, there were no significant changes in static or dynamic lung volumes or in the MEFV curve after SLT. In the patients with CAO, indexes of airways obstruction improved significantly after SLT, and the typical biphasic-plateau pattern developed in the MEFV curve. In one patient with CAO who required pneumonectomy of the native lung after SLT, the biphasic pattern was absent.Conclusions: These results support the view that this MEFV pattern is a result of airflow from the native and transplanted lungs in patients with CAO. In addition, the results show that in patients with no prior airways obstruction, SLT does not alter static or dynamic lung volumes or maximal expiratory flow rate. [ABSTRACT FROM AUTHOR]

The concentration of an environmental estrogen (4-nonylphenol) was determined in suspended solids and large volume water samples (501) collected from a major sewage treatment plant (STP) and two sites located on the lower Fraser River in British Columbia, Canada. The collection of suspended solids and large volume water samples was conducted concurrently using an in situ continuous flow centrifuge and solid phase extraction. The phase partitioning profile and log Kocof 4-nonylphenol were determined in the STP effluent and the Fraser River receiving environment. The data indicate the following: i) in situ continuous flow centrifugation and solid phase extraction techniques are appropriate methods for the determination of trace levels of 4-nonylphenol in suspended solids and water ii) the highest concentrations of 4-nonylphenol were measured in the STP final effluent iii) 4-nonylphenol showed preferential partitioning to the suspended solid phase in the STP effluent sample and iv) elevated levels of 4-nonylphenol were detected in the Fraser River receiving environment downstream of the STP. [ABSTRACT FROM AUTHOR]

Donor body mass index (BMI) has been increasing over time in heart transplantation, mirroring the trends in the general population. Our purpose was to assess the survival and right heart hemodynamics in heart transplant recipients from donors with BMI ≥ 30 kg/m2. We retrospectively divided our heart transplant population from 2007 through July 2019 into two groups: donor BMI < 30 kg/m2 (non-obese donor) and donor BMI ≥ 30 kg/m2 (obese donor). We recorded baseline donor and recipient characteristics. Outcomes were one and three-year survival and hemodynamics from right heart catheterization at one year. A total of 257 heart transplant recipients were included with 100 patients in obese donor group and 157 patients in non-obese donor group. Twenty-eight of the 100 obese donor patients had a donor BMI > 40 kg/m2. Clinical characteristics and results are shown in the table (* p < 0.05 obese donor versus non-obese donor). Obese donors were more likely to be female and were significantly older than non-obese donors. Both 1-year and 3-year survival in the obese donor group were excellent and compared favorably to the non-obese donor group. In those patients who survived to 1 year and in whom right heart catheterization data was available at 1 year (97 patients in obese donor group and 141 in non-obese donor group), right atrial and pulmonary artery (PA) pressures were significantly higher in the obese donor group compared to non-obese. Pulmonary capillary wedge pressure (PCWP) was not different between the 2 groups. Allograft hearts from obese donors can be used in heart transplantation with excellent 1-year and 3-year survival. In our patient population, we demonstrated significantly higher right atrial and PA pressures in recipients of obese donors at 1-year post-transplant, although the absolute increase compared to the non-obese group was small. [ABSTRACT FROM AUTHOR]

Background: Isolated native tricuspid valve infective endocarditis remains a challenging disease to treat given the large number of patients with substance use disorder. There is limited data on the optimal treatment strategy and the impact of a multidisciplinary endocarditis program on outcomes for this population., Objectives: To assess the clinical outcomes associated with management of native tricuspid valve infective endocarditis by a multidisciplinary team., Design: Single-center, retrospective cohort study., Methods: Patient cases were identified from the registry of the institutional multidisciplinary endocarditis team. Patients with left-sided endocarditis, multivalvular endocarditis, prosthetic tricuspid valves and cardiac implantable electronic devices were excluded., Results: Between September 7th, 2021 and February 1st, 2024 72 consecutive patients with isolated native tricuspid valve infective endocarditis were identified. Sixty-six (91.7%) patients were managed medically. Five patients underwent percutaneous mechanical aspiration of tricuspid valve vegetations and one patient underwent tricuspid valve replacement during the index hospitalization. In-hospital mortality was 1.4% and 90-day mortality was 2.8%. Nineteen (26.4%) patients discharged before medically advised and 25% were re-admitted within 30 days. Ten (13.9%) patients underwent elective tricuspid valve replacements after outpatient follow-up., Conclusion: Among 72 patients with isolated native tricuspid valve infective endocarditis managed by a multidisciplinary endocarditis program over a 2.5-year period, in-hospital, 90-day mortality and 1-year mortality were very low despite low rates of percutaneous mechanical aspiration and tricuspid valve surgery. Multidisciplinary follow-up can lead to elective tricuspid valve surgery in a delayed fashion., (© The Author(s), 2024.)

Background: The opioid pandemic, and particularly injection drug use, has led to an increase in cases of tricuspid valve infective endocarditis. Indications for valve surgery in right-sided infective endocarditis are not well-defined. Percutaneous mechanical aspiration is considered an alternative in patients at high risk for re-infection of a prosthetic valve but lacks robust outcomes data. This retrospective analysis compares the primary outcome of death within 1 year for patients with isolated tricuspid valve infective endocarditis treated with medical therapy alone vs percutaneous mechanical aspiration or valve surgery., Methods: The authors performed a retrospective cohort study of patients with isolated tricuspid valve infective endocarditis over a 10-year period. Medical record review was performed to collect demographic-and outcomes-related data. The association between treatment group and outcomes was assessed using Cox proportional hazard regression with inverse probability of treatment weighting., Results: Between January 1, 2009, and December 31, 2018, 215 patients with isolated tricuspid valve infective endocarditis and surgical indications were identified. One hundred patients (46.5%) were managed medically, 49 (22.8%) were managed surgically, and 66 (30.7%) underwent percutaneous mechanical aspiration. There was no significant difference in 1-year mortality between the 3 treatment groups (P = .15). Vegetation size > 2.0 cm was associated with increased 1-year mortality (hazard ratio 3.01; P = .03). Addiction medicine consultation was associated with decreased 1-year mortality (hazard ratio 0.117; P = .0008)., Conclusion: The study highlights that surgery or percutaneous mechanical aspiration in addition to medical therapy does not improve 1-year mortality in patients with isolated tricuspid valve infective endocarditis. Addiction medicine consultation was associated with decreased 1-year mortality in patients with injection drug use-associated isolated tricuspid valve infective endocarditis., (Copyright © 2024 Elsevier Inc. All rights reserved.)

As a result of the ongoing opioid epidemic, physicians have encountered increasing rates of drug-use-related native tricuspid valve infective endocarditis (DU-TVIE), a complex multi-faceted disease that is best managed by interdisciplinary teams. Despite the large number of patients with DU-TVIE, there is little data to support the optimal treatment strategy with respect to medical and surgical therapy. The recent introduction of percutaneous mechanical aspiration of tricuspid valve vegetations has added another treatment modality that is also of uncertain benefit. Here we review the literature on the management of DU-TVIE and highlight the multi-step treatment approach developed by the multidisciplinary endocarditis team at the University of Kentucky., (© The Author(s), 2024.)

Introduction: For Jehovah's Witness (JW) patients requiring cardiac surgery, various strategies such as preoperative use of erythropoietin stimulating agents (ESAs), intravenous iron (IVI), and non-pharmacologic interventions have emerged to prevent complications from blood loss given transfusion is not acceptable in this population., Methods: Retrospective case-control of cardiac surgeries performed by the same surgeon between 1/1/2011 and 8/30/2021. JW patients were matched to non-JW who received blood products and non-JW who did not receive blood products on a 1:2:2 basis. Patients were matched on procedure, age, gender, and Society of Thoracic Surgeons morbidity score. Eligible patients were aged > 18 years and had a sternotomy procedure. The primary efficacy and safety outcomes included mean hematocrit values perioperatively and thrombotic events., Results: A total of 27 JW, 52 non-JW transfused, and 53 non-JW not transfused patients were included in the analysis. JW patients had significantly higher mean hematocrits at every time point when compared to non-JW transfused patients and at all time points except clinic and the last recorded operating room value when compared to non-JW not transfused patients. No significant differences in thrombotic rates were found between groups, however there was a numerically higher incidence in the JW population (JW: 7.4%; non-JW transfused: 0%; non-JW not transfused: 1.9%; p = .106)., Conclusion: A blood conservation protocol in a JW population was associated with higher perioperative hematocrit values when compared to matched controls. Further prospective study is warranted before applying similar protocols to other populations given the possibility for an increased rate of venous thromboembolism., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Over 21 months, 12 patients with invasive Candida infections detected during the course of treatment of bacterial endocarditis, including 11 with candidemia, were identified. Invasive Candida infections can occur as a complication of bacterial endocarditis and may occur more frequently in patients with injection drug use and broad-spectrum antibiotic exposure., Competing Interests: Potential conflicts of interest. The authors: No reported conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Although literature has demonstrated the noninferiority of oral antibiotics in the treatment of infectious endocarditis, widespread adoption of this practice has yet to occur in the United States. We report on 32 patients with infectious endocarditis treated by a multidisciplinary endocarditis team and a standardized approach to partial oral antibiotic therapy with a high rate of clinical success., Competing Interests: Potential conflicts of interest. The authors: No reported conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Although multidisciplinary teams have been shown to decrease in-hospital mortality for patient with infectious endocarditis, most studies have focused on the inpatient role of these teams, and are primarily based at European tertiary care centers. There is limited literature available on the optimal longitudinal care of this patient population. Here we outline our experience developing an interdisciplinary endocarditis program at the University of Kentucky, which cares for patients from their index hospitalization into the outpatient setting, while also coordinating transfers from regional hospitals and offering education to regional providers., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to disclose., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: The outcomes following COVID-19 positive donor (CPD) utilization for heart transplant are unknown., Methods: UNOS database was analyzed for heart transplants performed from the declaration of COVID-19 pandemic until September 30, 2022., Result: Since the onset of pandemic, there were 9876 heart transplants reported. COVID-19 antigen or NAT results were available in 7698 adult donors within 14 days of donation, of which 177 (2.3%) were positive. There was no difference in recipient demographics, including age (COVID positive donor vs. negative: 55 vs. 56 years, p = .2) and BMI. Listing status 1 and 2 were similar in both groups (7% vs. 10% and 48% vs. 49% respectively, p = .4). Durable and temporary mechanical support were similar in both groups pre-transplant (both groups 33%, p = .9). There was no difference in days on the waitlist (median 31 days, p = .9). Simultaneous renal transplant rates were similar (11% vs. 10%, p = .9). CPD utilization has increased since the onset of the pandemic, and the adoption is present across most UNOS regions. Post-transplant, there was no difference in length of stay (median 16 vs. 17 days, p = .9) and acute rejection episodes prior to discharge (3% vs. 8%, p = .1). In survival analysis of 90-day follow up, number of deaths reported were comparable (5% in both groups, p = .9) Follow-up LVEF was comparable (62% vs. 60%, p = .4)., Conclusion: Active COVID-19 infection in donors did not affect survival or rejection rates in the short-term post-heart transplant., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Intravenous drug use (IVDU) is a growing public health crisis worldwide. A known complication of IVDU is right-sided infective endocarditis (RSIE) involving the tricuspid valve. As the tricuspid valve is burdened with infectious vegetations, it becomes a potential source of pulmonary and, very rarely, paradoxical systemic emboli. We report two patients with RSIE involving the tricuspid valve presenting with acute change in mental status. Subsequent imaging demonstrated embolisation to the brain in the setting of elevated right atrial pressures and the presence of a patent foramen ovale (PFO) with right-to-left shunting. We employed a strategy of percutaneous closure of PFO, to prevent further embolisation, as a successful bridge to definitive surgical management of RSIE. We emphasise that clinicians should evaluate for intracardiac shunting and pursue transesophageal echocardiography when encountering systemic emboli of unknown origin, particularly in patients with RSIE., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

The University of Kentucky College of Medicine and Albert B. Chandler Hospital opened over 50 years ago to serve Kentucky. After initial growth and expansion, both were struggling clinically, academically, and financially in the early 2000s. Difficulties were apparent in cardiovascular (CV) services, which captured only 11% of the regional patients hospitalized for cardiac disease. Over the next 15 years, CV services dynamically transformed to become the leading provider with a large network of regional partners, garnering 42% of market share. This article describes strategic plans and initiatives leading to clinical and academic growth. Future value-based initiatives are also described.

Triclosan is widely used in personal care products (skin creams, toothpastes, soaps, deodorants, body spray) and cleaning products (dishwashing detergent and all-purpose cleaners) (Halden in Environ Sci Technol 48:3603-3611, 2014). In 2001, it was selected for screening-level risk assessment under the Canadian Environmental Protection Act (HC and EC in Preliminary assessment. Triclosan. Chemical abstracts Service Number 3380-34-5, 2012. http://www.ec.gc.ca/ese-ees/default.asp?lang=En&n=6EF68BEC-1 ), and its physicochemical and toxicological characteristics indicate that there may be a risk to aquatic environments due to releases of the chemical in Canada. A surveillance initiative across Canada has included sampling at 44 sites from July 2012 to March 2018. Triclosan was detected in 226 of 918 samples; concentrations ranged from less than 6 to 874 ng L -1 , and the detections averaged 54.23 ng L -1 (standard deviation; 97.6 ng L -1 ). However, using the entire dataset (including censored data estimated with the Kaplan-Meier model), the mean triclosan concentration was 17.95 ng L -1 , and the standard deviation was 52.84 ng L -1 . Three samples at Wascana Creek (downstream), Saskatchewan, had concentrations above the Federal Environmental Quality Guidelines of 470 ng L -1 , indicating a potential risk to the aquatic ecosystem. In this study, triclosan in samples collected downstream from municipal wastewater treatment plant discharges usually demonstrated higher concentrations than upstream samples. Based on the results of this study, it is hypothesized that triclosan concentration have fluctuated between years of this study but not in an overall or significant increase or decreasing trend. Triclosan concentrations and detections also are more prevalent in urban than in rural or mixed development rivers. Performance evaluation of triclosan concentrations in the Canadian environment is scheduled to be reassessed by 2024. Therefore, a 3-year sampling program should be in place across Canada by 2021.

Prior to its closure, the base-metal smelter in Flin Flon, Manitoba, Canada was one of the North America's largest mercury (Hg) emission sources. Our project objective was to understand the exchange of Hg between the soil and the air before and after the smelter closure. Field and laboratory Hg flux measurements were conducted to identify the controlling variables and used for spatial and temporal scaling. Study results showed that deposition from the smelter resulted in the surrounding soil being enriched in Hg (up to 99 μg g(-1)) as well as other metals. During the period of smelter operation, air concentrations were elevated (30 ± 19 ng m(-3)), and the soil was a net Hg sink (daily flux: -3.8 ng m(-2) h(-1)). Following the smelter closure, air Hg(0) concentrations were reduced, and the soils had large emissions (daily flux: 108 ng m(-2) h(-1)). The annual scaling of soil Hg emissions following the smelter closure indicated that the landscape impacted by smelter deposition emitted or re-emitted almost 100 kg per year. Elevated soil Hg concentrations and emissions are predicted to continue for hundreds of years before background concentrations are re-established. Overall, the results indicate that legacy Hg deposition will continue to cycle in the environment long after point-source reductions.

In Canada, perfluoroalkyl acids (PFAAs) have been the focus of several monitoring programs and research and surveillance studies. Here, we integrate recent data and perform a multi-media assessment to examine the current status and ongoing trends of PFAAs in Canada. Concentrations of perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), and other long-chain perfluorocarboxylates (PFCAs) in air, water, sediment, fish, and birds across Canada are generally related to urbanization, with elevated concentrations observed around cities, especially in southern Ontario. PFOS levels in water, fish tissue, and bird eggs were below their respective Draft Federal Environmental Quality Guidelines, suggesting there is low potential for adverse effects to the environment/organisms examined. However, PFOS in fish and bird eggs tended to exceed guidelines for the protection of mammalian and avian consumers, suggesting a potential risk to their wildlife predators, although wildlife population health assessments are needed to determine whether negative impacts are actually occurring. Long-term temporal trends of PFOS in suspended sediment, sediment cores, Lake Trout (Salvelinus namaycush), and Herring Gull (Larus argentatus) eggs collected from Lake Ontario increased consistently from the start of data collection until the 1990s. However, after this time, the trends varied by media, with concentrations stabilizing in Lake Trout and Herring Gull eggs, and decreasing and increasing in suspended sediment and the sediment cores, respectively. For PFCAs, concentrations in suspended sediment, sediment cores, and Herring Gulls generally increased from the start of data collection until present and concentrations in Lake Trout increased until the late 1990s and subsequently stabilized. A multimedia comparison of PFAA profiles provided evidence that unexpected patterns in biota of some of the lakes were due to unique source patterns rather than internal lake processes. High concentrations of PFAAs in the leachate and air of landfill sites, in the wastewater influent/effluent, biosolids, and air at wastewater treatment plants, and in indoor air and dust highlight the waste sector and current-use products (used primarily indoors) as ongoing sources of PFAAs to the Canadian environment. The results of this study demonstrate the utility of integrating data from different media. Simultaneous evaluation of spatial and temporal trends in multiple media allows inferences that would be impossible with data on only one medium. As such, more co-ordination among monitoring sites for different media is suggested for future sampling, especially at the northern sites. We emphasize the importance of continued monitoring of multiple-media for determining future responses of environmental PFAA concentrations to voluntary and regulatory actions., (Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.)

A nationwide study was conducted to examine concentrations of polybrominated diphenyl ethers (PBDEs) in top predatory fish, with a focus on lake trout (Salvelinus namaycush), across Canada, and to explore possible influences of food web processes. Concentrations of the three most abundant PBDE homolog groups (tetra-, penta-, and hexa-PBDEs) were, for the most part, higher in Great Lakes and Lake Champlain fish compared with fish from other systems. The Canadian Federal Environmental Quality Guideline for the penta-homolog was exceeded in 70% of the fish examined. However, virtually no guideline exceedances were found for other congeners. In general, PBDE-47 (a representative lower brominated congener) was significantly and positively correlated with fish length, weight, age, lipid content, and stable isotopes of nitrogen and carbon. Significant differences in the slopes of the PBDE-47/covariate relationships between sites prevented concentrations from being adjusted using an analysis of covariance (ANCOVA). However, plots showed that elevated concentrations of PBDE-47 in Great Lakes and Lake Champlain fish remained after accounting for the influence of covariates. In contrast, for PBDE-183 (a representative higher brominated congener), the relationships between fish concentrations and covariates were not consistent, which could be a result of biotransformation being more important in controlling its bioaccumulation. The data from the current study show an overall disconnect between fish PBDE concentrations and likely loadings, which may be caused by differences in food web processes between systems. Continued long-term fish contaminant monitoring is needed to evaluate potential risk to fish and their consumers. However, we also recommend sediment sampling and focused food web studies to provide information on PBDE inputs to the systems and mechanisms of biomagnification, respectively., (Copyright © 2011 SETAC.)

In Part I of this work we presented pesticide levels in the surface waters of the Lower Fraser Valley (LFV) region of British Columbia, Canada. In Part II pesticide levels in the groundwater of the LFV are presented. During the period 2003 to 2005 a study was conducted to determine the occurrence and spatial distribution of 78 pesticides in the groundwater of the LFV. Samples were collected and analyzed from one reference, nine agricultural, one urban, and three urban-agriculture mixed sites. Overall 24 different pesticides were detected in the sites monitored. The maximum single pesticide concentration observed was for simazine (90 ng L(-1)) at one of the agricultural sites. All concentrations of pesticides detected in groundwater samples were below Canadian surface water quality criteria and below available drinking water quality criteria set by World Health Organization (WHO), Health Canada, USEPA, and the European Union (EU). Pesticide levels in surface and groundwater were compared in the Abbotsford area. Generally, a pesticide with a high groundwater concentration tended to also have a high surface water concentration (Simazine 29 ng L(-1) in groundwater and 58 ng L(-1) in surface water, atrazine 5.5 ng L(-1) in groundwater and 14 ng L(-1) in surface water). For pesticides that were detected above 1 ng L(-1) concentration the only exception to this was desethylatrazine that showed greater concentration in groundwater (2.2 ng L(-1)) than surface water (1.5 ng L(-1)). Herbicides were the predominant pesticides detected in the agricultural sites and insecticides were predominant in the urban sites. Pesticide data presented in this study provide reference levels for future pesticide monitoring programs in the region.

In the period 2003 to 2005, a study was conducted to determine the occurrence, and spatial and temporal distribution of 78 pesticides in surface waters of the Lower Fraser Valley (LFV) region of British Columbia, Canada. A high resolution gas chromatography/electron impact high resolution mass spectrometry (HRGC/[EI]HRMS) method capable of detecting analytes at the subnanograms per liter level was developed for this study. Samples were collected and analyzed from three reference, five agricultural and two urban sites. Endosulfan sulfate was detected in all samples collected during the study period including the samples from the reference sites. The maximum concentration of a pesticide detected at the reference sites was 0.261 ng L(-1) for beta-endosulfan. Over the study period, the numbers of pesticides detected at the agricultural sites ranged from 22 to 33 of which 20.8 to 40.9% had a 100% detection frequency. At the agricultural sites, the greatest concentration was detected for diazinon (12,500 ng L(-1)), followed by linuron (1050 ng L(-1)) and simazine (896 ng L(-1)). The greatest pesticide concentration observed for the urban sites was 90.4 ng L(-1) for simazine followed by diazinon (5.39 ng L(-1)). With few exceptions, greater concentrations of herbicides were observed for samples collected during spring than for samples collected during fall. Pesticide data presented in this study provide reference levels for future pesticide monitoring programs in the region.

In the period 2003-2005 a study was conducted to determine the occurrence, spatial and temporal distribution of five acidic herbicides in the Lower Fraser Valley (LFV) region of British Columbia, Canada. A high-resolution gas chromatography/high-resolution mass spectrometry (HRGC/HRMS) method capable of detecting analytes at the sub ng/L level was developed for this study. Samples were collected and analyzed from two references, five agricultural, two urban and five agricultural and urban mixed sites. Only (4-chloro-2-methylphenoxy)acetic acid and triclopyr were detected at the reference sites. The highest concentration of herbicide detected at the reference sites was 0.109ng/L for (4-chloro-2-methylphenoxy)acetic acid. Varying levels of all of the herbicides monitored were detected at the urban, agricultural and the mixed sites. For the urban sites the highest concentration of herbicide detected was 66.6ng/L for 2-(4-chloro-2-methylphenoxy)propanoic acid. For the agricultural sites the highest concentration of herbicide detected was 345ng/L for (2,4-dichlorophenoxy)acetic acid (2,4-D). For the mixed sites the highest concentration of herbicide detected was 1230ng/L for 2,4-D. Overall the mixed sites showed highest concentrations and detection frequencies followed by the agricultural and urban sites. With few exceptions higher concentrations of herbicides were observed for samples collected during spring than for samples collected during fall. The detected concentrations of herbicides were evaluated against established water quality criteria. Herbicide data presented in this study provide reference levels for future pesticide monitoring programs in the region.

In this work, an isotope dilution method for determination of selected acidic herbicides by high-resolution gas chromatography/high-resolution mass spectrometry (HRGC/HRMS) was developed for surface water samples. Average percent recoveries of native analytes were observed to be between 70.8 and 93.5% and average recoveries of labeled quantification standards [(13)C(6)]2,4-D and [(13)C(6)]2,4,5-T were 85.5 and 101%, respectively. Using this method, detection limits of 0.05 ng/L for dicamba, MCPA, MCPP, and triclopyr, and 0.5 ng/L for 2,4-D were routinely achieved. The method was applied to measuring the concentration of these analytes in surface water samples collected from five sampling locations in the Lower Fraser Valley region of British Columbia, Canada. All of the herbicides monitored were detected at varying levels in the surface water samples collected. The highest concentrations detected for each analyte were 345 ng/L for 2,4-D, 317 ng/L for MCPA, 271 ng/L for MCPP, 15.7 ng/L for dicamba, and 2.18 ng/L for triclopyr. Average detection frequencies of the herbicides were 95% for MCPA, 80% for MCPP, 70% for dicamba, 65% for 2,4-D, and 46% for triclopyr. Seasonal variations of herbicide levels are also discussed.

Cytolytic induction therapy of heart transplantation with OKT3 (immunoglobulin G2a isotype, anti CD3 idiotype) or T10B9.1A-31 (immunoglobulin MK isotype, anti-T-cell receptor alpha beta idiotype) was done in an open-label trial to determine the safety and efficacy of the latter monoclonal antibody. A total of nine patients undergoing orthotopic heart transplantation received a 10-day course of either T10B9.1A-31 (T10B9) (n = 4) 18 mg on bypass and 6 mg intravenously every 12 hours or OKT3 (n = 5) 10 mg on cardiopulmonary bypass and 5 mg intravenously daily. Endomyocardial biopsy surveillance revealed no rejection during induction therapy with T10B9, and one OKT3 induction failure was successfully treated with T10B9, all without significant side effects. T10B9 effectively prevented the onset of early acute rejection in heart transplantation with minimal side effects. T10B9 reversed rejection in one patient whose OKT3 induction failed. Results are encouraging and warrant further investigation.

Potential lung donors are frequently maintained in one position for prolonged periods of time prior to harvest. This study was designed to determine if the effects of gravity induced by maintaining an animal model in the supine position for 24 hr would have adverse effects on the harvested lung. Group 1 pigs were anesthetized, instrumented, mechanically ventilated, and the lungs harvested within 90 min. Group 2 pigs were anesthetized, instrumented, and mechanically ventilated in an identical manner then maintained in the same dorsal-spinal recumbency position for 24 hrs. Hemodynamic and respiratory parameters were stable and not statistically different between the two groups for the baseline and 1 hr time period measurements. There were no significant differences between the two groups for shunt fractions, wet/dry ratios, blood flow distribution, or flush solution distribution. We conclude that in anesthetized pigs there is no evidence that routine repositioning protocols improve blood flow distribution, shunting, or dependent edema.

Advances in myocardial preservation have made possible operative intervention early post-myocardial infarction or in the face of an evolving myocardial infarction. Results are dictated by preoperative factors primarily related to the ravages of low flow state. Resuscitation of the myocardium is possible under the vast majority of circumstances.

We report the case of a 32-year-old female patient with primary pulmonary hypertension who received a lung transplant from a donor who, unbeknownst to the medical staff, had pulmonary sarcoidosis diagnosed by lung biopsy 16 months earlier. After 16 months of follow-up, our patient did not show any histologic, radiologic, or clinical evidence of pulmonary sarcoidosis involving the transplanted lung. We reviewed the transplant experience involving donors or recipients with known sarcoidosis, and the available data suggest that normal organs transplanted into recipients with preexisting sarcoidosis are likely to develop sarcoid granulomas, whereas organs from donors with known sarcoidosis given to a "normal" recipient do not appear to develop significant or progressive disease. Although the available data in this regard are limited, we do believe that, on the basis of current information, sarcoidosis cannot be considered a priori to be an absolute contraindication to organ donation.

To facilitate timely application of new forms of cardiac support to patients at highest risk after cardiotomy despite conventional support with the intraaortic balloon pump, an accurate prediction of survival must be available at the time of weaning from cardiopulmonary bypass. We, therefore, acquired 240 demographic, disease, and perioperative characteristics of 322 patients (mortality rate, 48.4%) who required IABP support to separate from bypass. Four variables available before or within 10 minutes of the first attempt at weaning from bypass significantly predicted mortality by stepwise logistic regression: complete heart block as demonstrated by need for temporary pacing at weaning (p < 0.001), advanced age (p < 0.002), preoperative blood urea nitrogen concentration (p = 0.036), and female sex (p = 0.048). An equation generated by the logistic model predicted a 72.2% survival rate in the 25% of patients at least risk (actual survival rate, 71.6%); in the 25% at greatest risk, death was predicted in 73.0%, and the actual mortality rate was 74.1%. The equation was then prospectively applied to 330 intraaortic balloon pump-supported patients managed at another institution. The overall mortality rate there was 41.2%; in the 25% at least risk, predicted survival rate was 70.5% (actual survival rate, 77.1%), and in the 25% at greatest risk, predicted mortality rate was 75.7% (actual mortality rate, 62.7%). Thus, retrospectively at one institution and prospectively at another, the equation generated by this model based only on data available at the time of weaning from bypass was able to define one subgroup of patients 2.6 to 2.7 times as likely to die as another subgroup from within similar cohorts.(ABSTRACT TRUNCATED AT 250 WORDS)

A small and light direct-drive centrifugal pump has been developed for cardiopulmonary bypass. In the development process, blood compatibility studies including a hemolysis study, an in vitro fluid dynamic performance study, and in vivo durability and feasibility studies were performed. The centrifugal pump with a 50 mm diameter impeller resulted in almost the same index of hemolysis value as did a Bio-Medicus centrifugal pump. Heat dissipation from the motor was prevented by using a flexible drive cable. Forty-eight-hour sealing durability around the driving axis was accomplished by using a fluoro-rubber V-ring that connected to the hard chrome-plated stainless steel. In vitro and in vivo performances of the pump were satisfactory. Thrombus formation behind the impeller was prevented by using a holed impeller that generated blood flow from the back to the surface of the impeller. Elimination of air during priming procedures was also easier with this modification. This centrifugal pump has one-quarter of the priming volume, size, and weight of magnetically coupled centrifugal pump systems.

As the number of heart transplants and the number of transplant programs has increased, so has the waiting time for a suitable organ. To more accurately assess the magnitude of this increase and the influence of recipient size, we reviewed waiting times for large (body surface area greater than or equal to 1.95 m2) and small (body surface area less than 1.95 m2) patients with respect to era of transplantation. Patients who underwent transplantation early (1984 to December 31, 1986) waited 35 +/- 47 days (mean +/- standard deviation), whereas patients who underwent transplantation in the late era (1987 to September 30, 1989) waited 83 +/- 102 days (p = 0.001). Large patients waited longer (130 +/- 142 days) in the late era than did small patients (60 +/- 67 days; p = 0.008). During the heterotopic era (October 1, 1989 to June 30, 1990), waiting times for large patients who received a heterotopic transplant (67 +/- 46 days) were significantly shorter than those for patients who received an orthotopic transplant (166 +/- 157 days; p = 0.05). Waiting times for small patients remained unchanged. In addition, waiting time mortality decreased from 24% to 9% (p less than 0.05). Comparison of orthotopic and heterotopic procedures performed during the same era revealed no significant differences in recipient age, preoperative status, graft ischemic time, donor age, early and midterm survival, or early postoperative functional status. Heterotopic heart transplantation may effectively increase the size of the donor pool, decrease the waiting time, and decrease waiting time mortality without increasing the morbidity of the procedure.

The mechanism of death as a result of allograft ischemic heart disease is not well characterized. Ventricular tachycardia and fibrillation may not be the terminal events they often are in the general population. We report observations in a 41-year-old man with cardiac allograft arteriopathy who died suddenly while wearing an ambulatory monitor. The lethal rhythm was a progressive bradycardia terminating in asystole. Autopsy revealed epicardial and small vessel intramyocardial, coronary arteriopathy, and only mild allograft rejection. It is our belief that ischemia caused the bradycardic sudden death. We would like to hypothesize that prophylactic permanent pacemaker implantation may prevent bradycardic sudden death and improve survival in heart transplant patients with coronary disease.

Despite advances in preservation solutions, hypothermia remains a critical component of organ preservation for transplantation. Many surgeons involved in multi-organ procurement procedures have expressed concern about the possible detrimental effects of cardiopulmonary bypass and profound hypothermic circulatory arrest on non-thoracic transplant organ function. In order to assess the validity of these concerns, a review of 20 multi-organ harvest procedures performed utilizing cardiopulmonary bypass and profound hypothermic circulatory arrest was undertaken. In all instances this technique was combined with organ flushing utilizing cold preservation solution. Adequate data was available to assess post-transplant organ function of all organs recovered in 16 procedures. Indication for the use of this technique was procurement of a heart-lung bloc in 16 instances and donor instability (hypotension) refractory to volume loading and inotropic agents in 4 instances. Organs obtained, including all organs from unstable donors which would otherwise have been lost, functioned, acceptably. Additionally, blood drained into the pump was used for recipient transfusion in 8 instances. This report documents that cardiopulmonary bypass and profound hypothermic circulatory arrest may be easily combined with traditional procurement flushing techniques and it provides excellent organ preservation for subsequent transplantation. This approach can optimize organ recovery from hemodynamically unstable donors, increasing the number available for transplantation.

A completely implantable, one piece electromechanical total artificial heart (TAH) intended for permanent human use was developed. It consisted of left and right conically shaped pusher-plate blood pumps sandwiching a thin centerpiece with a compact, efficient electromechanical actuator. The actuator consisted of a direct current brushless motor; a planetary roller screw fit the space between the two conically shaped pusher-plates. The rotational motion of the motor was converted to the rectilinear motion of the rollerscrew to displace the left and right pusher-plates in the left master alternate mode. The diameter of the assembled TAH was 97 mm, with a central thickness of 82 mm. The overall weight was 620 g, with a displaced volume of 510 ml. The pump provided flows of 3-8 L/min with a preload of 1-15 mmHg against an afterload of 100 mmHg. The net efficiency ranged from 15% to 18%. This model showed good fit in the pericardial space of heart transplant recipients (body weight, 77 kg).