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In the context of trade, national official assurance systems are the mechanism through which countries provide official assurance to other countries that their products are safe to trade. Regardless of the form in which it is conveyed, an official assurance, for the most part, is a statement from one competent authority to another about the conformity of a consignment with agreed requirements. Effectively, one government is providing a level of guarantee to the other government about matters such as the disease or pest status that exists nationally or regionally and/ or about the risk management activities that have been undertaken as relevant to the traded consignment. Accordingly, the degree of confidence that the importing competent authority has in the ethics, competence and capability of the exporting country's competent authority is central to how much trust the importing country places in the official assurances from the exporting country. The World Organisation for Animal Health Terrestrial Animal Health Code and Aquatic Animal Health Code (Section 5 of both) set out veterinary certificate requirements relating to animal health and zoonoses for both importing and exporting countries engaging in the trade of animals and animal products. These requirements are supplemented by the guidance developed by the Codex Committee on Food Inspection and Certification Systems, which covers the inspection and certification system requirements related to food safety and other non-health-related technical matters (e.g. composition, grade or organic status), as relevant to the international trade in food. This review discusses the need for countries to further align the form and content of their official assurance requirements with the relevant international standards and recommendations. It also notes, however, that there is currently a paucity of recommended standardised attestations. It highlights the increasing movement towards electronic certification and the potential this brings for further amalgamation of different certificate types and the coordination of border clearance processes. The basic components and principles that apply to national official assurance systems are identified and explained. Lastly, future trends and challenges for national official assurance systems, such as the impact of electronic commerce and regional distribution hubs, and the increasing recognition of containment zones and/or risk mitigations, such as treatments, are discussed.

SummaryAs a result of fierce aerial attacks on the fleet supporting the landing force on Friday, 21 May 1982, SS CANBERRA was ordered to sail from San Carlos Water. Elements of her medical organisation were hurriedly put ashore into a deserted refrigeration plant at Ajax Bay. Three weeks later they had treated over 650 battle casualties, performed 210 operations under general anaesthetic, and been bombed by Argentinian aircraft. Despite appalling circumstances, their results were a triumphant success. As Officer Commanding Medical Squadron, Commando Logistics Regiment RM, the author was in charge at Ajax Bay throughout the land phase of hostilities.

Summary Background To compare the impact of a 25% Hill-Sachs lesion (defect condition, D) and perfect and imperfect anatomic repairs (PAR and IAR) of such lesions on glenohumeral bony contact and capsular forces in response to compressive and anterior loads. Material and methods A robotic/universal force-moment sensor testing system applied joint compression (22N) and an anterior load (44N) to cadaveric shoulders ( n =9) at three glenohumeral joint positions (abduction/external rotation): 0°/0°, 30°/30°, and 60°/60°. The 25% bony defect state, PAR state, and IAR state were created and the loading protocol was performed. Bony contact/capsular forces were measured in each position for each shoulder state. Results PAR had the least biomechanical impact on the bony surfaces and capsule of the glenohumeral joint. D had less impact on the bones and capsule compared to the IAR. The bony surfaces and capsule of the glenohumeral joint sustained the greatest forces in the IAR condition. Conclusions The PAR state had the least force applied to the bony surfaces and capsule of the glenohumeral joint. The defect shoulder had significantly less force applied to the bones and capsule of the glenohumeral joint compared to the IAR (greatest force applied). Performing an osteoallograft repair that does not fully restore normal anatomy may result in abnormal bony contact/capsular forces, resulting in joint wear, arthritis, and injury to the surrounding capsule. Clinical relevance The importance of performing an osteoallograft repair of a Hill-Sachs defect that closely matches the pre-injury state and restores normal humeral head anatomy.

Background: Administration of alteplase is the standard of care for eligible patients presenting with symptoms of acute ischemic stroke (AIS). Telemedicine is increasingly being used to deliver acute stroke care to patients without in-person access to stroke expertise. This study reviews the alteplase experience and outcomes of the largest known teleneurology network spanning 34 states and distributed across a heterogeneous multihospital population. Methods: Data was abstracted from internal medical records systems and relevant medical records obtained from partner hospitals. A retrospective analysis on the prospectively maintained database of patients who have received alteplase was performed. Data was collected from December 1, 2015 to June 30, 2018. Outcome analysis was restricted to those patients with available complete discharge data. Collected data included demographics, stroke severity, symptomatic intracranial hemorrhages (sICH), discharge disposition and mortality. Results: The analysis revealed 6199 patients as having received alteplase during the study period. Of these, 56.7% had discharge information available. The mean patient age was 69.7 years, with a mean age of 71.8 years for females and 67.4 for males. The median initial NIHSS was 7, with 30.3% of patients presenting with NIHSS ≤4 and 8.5% initially presenting with initial NIHSS ≥21. Only 19.7% of patients were transferred to another facility. Clinical outcomes data were available for 3327 patients (53.7%). There were 1536 home discharges (46.2%), 626 acute rehabilitation discharges (18.8%), and 283 skilled nursing facility discharges (8.5%). The sICH rate in this population was 0.9% (29) and there were 136 patient deaths (4.1%). Conclusion: Large-scale teleneurology for the treatment of patients presenting with symptoms of AIS is feasible, with clinical outcome data similar to other published studies. Further refinement of this data, to include subgroup analyses, transfer patterns, and more comprehensive clinical outcomes is warranted.

Background: Thrombolysis with alteplase is the standard of care for treatment of eligible patients presenting with acute ischemic stroke (AIS). Telestroke physicians must use available information to make timely treatment decisions remotely. Through this practice, an unusual subset of patients presenting multiple times with symptoms of AIS has emerged. This study describes the largest known sample of this multiple-encounter population within a single teleneurology practice spanning 34 states. Methods: A retrospective observational study of the experience of a single teleneurology practice serving over 400 hospitals from July 1, 2015 to August 1, 2018 was performed. The alteplase patient database was queried to identify patients with multiple telestroke encounters (n=56). Demographic and clinical data were abstracted. Results: Within the queried period, 56 patients were identified to have had multiple encounters with the teleneurology practice, 37 males and 19 females. Of these, 29 were seen twice, 10 were seen three times, 8 were seen four times, and 9 had five or more encounters. Four patients received care in multiple states. Alteplase was administered on more than one encounter in 45 patients, with a maximum alteplase administration of 4 times in a single patient. The overall alteplase rate was 54.6% (106 of 194 encounters). The median NIHSS score for patients seen in multiple encounters was 5. Of the 56 patients, 98.2% had stroke risk factors, 42.9% had noncerebrovascular neurological comorbidities, and 42.9% had psychiatric disease history. All patients presented with at least one motor symptom, while 64.3% presented with a sensory symptom, 26.8% presented with aphasia, and 55.4% presented with other neurological symptoms. Conclusions: The observance of multiple teleneurology encounters for patients presenting with AIS symptoms and receiving alteplase at high rates is anecdotal and not yet largely described. History of cerebrovascular disease is a risk factor for recurrent stroke, but the true composition of this patient population is undefined. Given the associated risks and resource utilization involved with alteplase, future study of the characteristics and disease mechanism of this population is warranted.

Context Diisocyanates have been associated with respiratory and dermal sensitization. Limited number of case reports, and a few case studies, media, and other references suggest potential neurotoxic effects from exposures to toluene diisocyanate (TDI), 1,6 hexamethylene diisocyanate (HDI), and methylene diisocyanate (MDI). However, a systematic review of the literature evaluating the causal association on humans does not exist to support this alleged association. Objective To perform systematic review examining the body of epidemiologic evidence and provide assessment of causal association based on principles of the Sir Austin Bradford Hill criteria or considerations for causal analysis. Methods A comprehensive search of public databases for published abstracts, case reports, cross-sectional surveys, and cohort studies using key search terms was conducted. Additional searches included regulatory reviews, EU IUCLID and EU Risk Assessment databases, and unpublished reports in the International Isocyanate Institute database. An expert panel consisting of physicians, toxicologists, and an epidemiologist critically reviewed accepted papers, providing examination of epidemiologic evidence of each report. Finally, the Hill criteria for causation were applied to the summative analysis of identified reports to estimate probability of causal association. Results Twelve papers reporting exposed populations with a variety of neurological symptoms or findings suitable for analysis were identified, including eleven case or case series reports, and one cross-sectional study. Three papers reported on the same population. Each of the papers was limited by paucity of diisocyanate exposure estimates, the presence of confounding exposures to known or suspected neurotoxicants, a lack of objective biological measures of exposure or neurotoxic effects, and lack of relative strength of association measures. Additionally, reported health symptoms and syndromes lacked consistency or specificity. No plausible mechanism of toxicity was found. Application of a predictive mathematical model for determining probability of causal association for neurotoxicity was calculated to be 21%. Conclusion There is insufficient evidence for a causal association of neurotoxic effects and diisocyanate exposure based on lack of evidence in all categories of the Hill criteria for causality except for temporal association of reported symptoms and alleged exposure. Future reports should attempt to address more rigorous exposure assessment and control for confounding exposures.

Polyurethanes (PU) are polymers made from diisocyanates and polyols for a variety of consumer products. It has been suggested that PU foam may contain trace amounts of residual toluene diisocyanate (TDI) monomers and present a health risk. To address this concern, the exposure scenario and health risks posed by sleeping on a PU foam mattress were evaluated. Toxicity benchmarks for key non-cancer endpoints (i.e., irritation, sensitization, respiratory tract effects) were determined by dividing points of departure by uncertainty factors. The cancer benchmark was derived using the USEPA Benchmark Dose Software. Results of previous migration and emission data of TDI from PU foam were combined with conservative exposure factors to calculate upper-bound dermal and inhalation exposures to TDI as well as a lifetime average daily dose to TDI from dermal exposure. For each non-cancer endpoint, the toxicity benchmark was divided by the calculated exposure to determine the margin of safety (MOS), which ranged from 200 (respiratory tract) to 3 × 106 (irritation). Although available data indicate TDI is not carcinogenic, a theoretical excess cancer risk (1 × 10−7) was calculated. We conclude from this assessment that sleeping on a PU foam mattress does not pose TDI-related health risks to consumers.

Determining the magnitude of homing behaviour within migratory fish species is essential for their conservation and management. We tested for population genetic structuring in the anadromous alosines, Alosa alosa and A. fallax fallax, to establish fidelity of stocks to spawning grounds in the United Kingdom and Ireland. Considerable genetic differences were present among populations of both species, suggesting strong fidelity to breeding grounds and compatible with homing to natal origins. Moreover, the genetic structure of A. fallax fallax showed a clear pattern of isolation-by-distance, consistent with breeding populations exchanging migrants primarily with neighbouring populations. Spatial genetic differences were on average much greater than temporal differences, indicating relatively stable genetic structure. Comparing anadromous A. fallax fallax populations to the landlocked Killarney shad subspecies, A. fallax killarnensis (Ireland), demonstrated a long history of separation. These results demonstrating regional stock structure within the British Isles will inform practical management of stocks and their spawning habitats.

Bimodal extrusive volcanic rocks in the northeast Greater Antilles Arc consist of two interlayered suites, including (1) a predominantly basaltic suite, dominated by island arc basalts with small proportions of andesite, and (2) a silicic suite, similar in composition to small volume intrusive veins of oceanic plagiogranite commonly recognized in oceanic crustal sequences. The basaltic suite is geochemically characterized by variable enrichment in the more incompatible elements and negative chondrite-normalized HFSE anomalies. Trace element melting and mixing models indicate the magnitude of the subducted sediment component in Antilles arc basalts is highly variable and decreases dramatically from east to west along the arc. In the Virgin Islands, the sediment component ranges between 4% during the Cenomanian-Campanian interval. The silicic suite, consisting predominantly of rhyolites, is characterized by depleted Al2O3 (average

Constraints on the polarity of Cretaceous subduction in the Greater Antilles are provided through geochemical comparison between the erupted island arc lavas in central Puerto Rico and potential pelagic sediment reservoirs in the fl anking ocean basins. Early Jurassic to mid-Cretaceous (185- to 65-Ma) sediment from the open Pacifi c on the southwest is dominated by pelagic chert, which is highly refractory and depleted with respect to incompatible elements. In comparison, mid- to Late Cretaceous (ca. 112- to 65-Ma) sediment from the younger Atlantic basin on the northeast was dominated by mixtures of two end members. These include (1) biogenic clay and carbonates with elevated light rareearth element (LREE) abundances, negative MORB-normalized, high fi eld-strength element (HFSE) anomalies, and low Zr/Sm; and (2) turbiditic detritus of upper continental crust composition with high LREE, comparatively shallow HFSE anomalies, and high Zr/Sm. Compositions of Puerto Rican arc basalts are inconsistent with incorporation of Pacifi c pelagic chert. Instead, patterns characteristic of high-Fe island arc tholeiites are reproduced by incorporation of up to 4% of a low-Zr/Sm biogenic sediment component of Atlantic origin, whereas patterns of low-Fe lavas require, in addition to biogenic sediment, introduction of up to 2% of a high-Zr/ Sm crustal turbidite component. The Atlantic origin of all the subducted sediments indicates the polarity of subduction throughout the Cretaceous in the northeast Antilles was persistently southwest dipping. This conclusion is supported by the presence of a lowZr/Sm suprasubduction zone component of Atlantic origin in Caribbean plateau basalts (91‐88 Ma) from southwest Puerto Rico, which were erupted within the broad backarc region of the Greater Antilles during intermediate stages of arc development.

While the role of the upper torso and pelvis in driving performance is anecdotally appreciated by golf instructors, their actual biomechanical role is unclear. The aims of this study were to describe upper torso and pelvis rotation and velocity during the golf swing and determine their role in ball velocity. One hundred recreational golfers underwent a biomechanical golf swing analysis using their own driver. Upper torso and pelvic rotation and velocity, and torso-pelvic separation and velocity, were measured for each swing. Ball velocity was assessed with a golf launch monitor. Group differences (groups based on ball velocity) and moderate relationships (r � 0.50; P5 0.001) were observed between an increase in ball velocity and the following variables: increased torso – pelvic separation at the top of the swing, maximum torso – pelvic separation, maximum upper torso rotation velocity, upper torso rotational velocity at lead arm parallel and last 40 ms before impact, maximum torso – pelvic separation velocity and torso – pelvic separation velocity at both lead arm parallel and at the last 40 ms before impact. Torso – pelvic separation contributes to greater upper torso rotation velocity and torso – pelvic separation velocity during the downswing, ultimately contributing to greater ball velocity. Golf instructors can consider increasing ball velocity by maximizing separation between the upper torso and pelvis at the top of and initiation of the downswing.

Two-pyroxene-bearing high-Mg andesite, hornblende basalt and andesite, and high-Fe augite basalt were erupted simultaneously in southwest Puerto Rico between 85 and 65 Ma. An analogy with geologic settings in Cenozoic arcs indicates that hornblende-bearing lavas and high-Mg andesites, restricted to the southwestern-most corner of Puerto Rico, represent the forearc assemblage, whereas high-Fe basalts, concentrated in an adjacent volcanic belt toward the northeast, represent the arc-axis suite. This arrangement implies northeast-dipping subduction of refractory Jurassic chert from the Caribbean Basin, and is, therefore, consistent with relatively low Sr-isotope ratios in all three lava suites compared with correlative strata in Eastern Puerto Rico. Moreover, Pb- and Nd-isotope ratios and trace element melting models for both high-Mg andesites and hornblende-bearing lavas are consistent with the presence of a slab melt component generated by high-pressure fusion of incompatible element-enriched plateau basalts. The most likely source for such a basaltic component is the Caribbean basalt plateau, which is represented in southwest Puerto Rico by the Upper Cajul Formation. The models indicate that up to 5% slab melt was added to the source of hornblende-bearing lavas, but higher proportions, as much as 10%, are required to generate high-Mg andesites. The elevated buoyancy of the more enriched and siliceous high-Mg andesite source apparently destabilized the mantle wedge and induced combined mantle-mass assimilation and fractional crystallization of orthopyroxene (AFC ≈ 1), which ultimately produced elevated MgO and low Al2O3 concentrations characteristic of the high-Mg andesites. The tectonic setting in southwest Puerto Rico was unlike Cenozoic analogues, because the pre-arc basement was already old (Early Jurassic, 185–155 Ma) at the time of initial island arc volcanism (∼ 85 Ma). However, geothermal gradients in the region were increased again immediately preceding arc volcanism by emplacement of the Caribbean mantle plume (92–88 Ma), during which the original N-MORB-type upper mantle in the region was replaced by incompatible element-enriched material. The elevated heat flow produced by plume emplacement, supplemented by ascent of plume basalts from depth and associated gabbroic underplating, is inferred to have promoted slab melting. The presence of a low Zr/Sm component in both plateau basalts and arc lavas in southwest Puerto Rico is consistent with the incorporation of a small biogenic supra-subduction zone component of Atlantic origin, introduced into the back-arc region of an older (from 115 Ma) southwest-dipping subduction zone in eastern Puerto Rico.

Background A massive rotator cuff tear leads to poor shoulder function as evidenced by diminished glenohumeral abduction and superior translation of the humeral head compared to its normal position. The inclination angle of the glenoid has been associated with rotator cuff tears. The objective of this study was to quantify the effect of a decreased glenoid inclination angle on glenohumeral kinematics during active abduction in shoulders with a simulated, massive rotator cuff tear. Methods Eight fresh-frozen full upper extremities were tested using a dynamic shoulder testing apparatus. After recording the kinematics of the intact shoulder, a massive rotator cuff tear was surgically simulated. An osteotomy of the glenoid was then performed and the inclination angle was decreased by 30°. The translation of the humeral head during abduction and the maximum abduction angle were recorded. Findings With an intact rotator cuff minimal humeral head translation on the glenoid occurred and the maximum abduction angle was mean 85.5° (SD 7.4°). A massive rotator cuff tear resulted in superior translation of the humeral head with impingement on the acromion. The maximum abduction angle was mean 15.5° (SD 9.4°). Decreasing the inclination angle of the glenoid resulted in a significant reduction of superior humeral head translation during abduction and there was no impingement on the acromion. The maximum abduction achieved was mean 28.5° (SD 17.0°). Interpretation From a clinical perspective the reduced superior translation may decrease shoulder pain since the humeral head no longer impinges on the acromion. Further investigations are necessary to assess if the improvement in abduction is clinically significant.

Our aim was to determine the most repeatable three-dimensional measurement of glenoid orientation and to compare it between shoulders with intact and torn rotator cuffs. Our null hypothesis was that glenoid orientation in the scapulae of shoulders with a full-thickness tear of the rotator cuff was the same as that in shoulders with an intact rotator cuff. We studied 24 shoulders in cadavers, 12 with an intact rotator cuff and 12 with a full-thickness tear. Two different observers used a three-dimensional digitising system to measure glenoid orientation in the scapular plane (ie glenoid inclination) using six different techniques. Glenoid version was also measured. The overall precision of the measurements revealed an error of less than 0.6°. Intraobserver reliability (correlation coefficients of 0.990 and 0.984 for each observer) and interobserver reliability (correlation coefficient of 0.985) were highest for measurement of glenoid inclination based on the angle obtained from a line connecting the superior and inferior points of the glenoid and that connecting the most superior point of the glenoid and the most superior point on the body of the scapula. There were no differences in glenoid inclination (p = 0.34) or glenoid version (p = 0.12) in scapulae from shoulders with an intact rotator cuff and those with a full-thickness tear. Abnormal glenoid orientation was not present in shoulders with a torn rotator cuff.

Context:In vivo scapular kinematics during humeral movements are commonly assessed with electromagnetic tracking devices despite few published data related to reliability and precision of these measurements.Objective:To determine the intrasession reliability and precision of assessing scapular kinematics using an electromagnetic tracking device.Design:Scapular position and orientation were measured with an electromagnetic tracking device during humeral elevation/depression in several planes. Intrasession reliability and precision were established by comparing 2 trials performed in succession.Setting:A human-movement research laboratory.Participants:15 healthy individuals.Main Outcome Measures:Intrasession intraclass correlation coefficients and standard error of measurement of all scapular variables were established.Results:The mean intrasession reliability for all variables was ICC = .97 ± .03. The mean intrasession precision was .99° ± .36°.Conclusions:In vivo scapular kinematics can be measured with high reliability and precision during intrasession research designs.

Normal function of the glenohumeral joint depends on coordinated muscle forces that stabilize the joint while moving the shoulder. These forces can either provide compressive forces to press the humeral head into the glenoid or translational forces that may destabilize the glenohumeral joint. The objective of this study was to quantify the effect of pectoralis major and latissimus dorsi muscle activity on glenohumeral kinematics and joint reaction forces during simulated active abduction. Nine fresh-frozen whole upper extremities were tested using a dynamic shoulder testing apparatus. Seven muscle force combinations were examined: a standard combination and 10%, 20%, or 30% of the deltoid force applied to the latissimus dorsi or pectoralis major tendon, respectively. Pectoralis major and latissimus dorsi muscle activity decreased the maximum angle of glenohumeral abduction and external rotation, and increased the maximum horizontal adduction angle compared to the standard muscle combination. Thoracohumeral muscle activity also created a more anteriorly directed joint reaction force that resulted in anterior translation compared to the standard muscle combination. Therefore, the ratio between anteriorly directed translational forces and compressive forces increased during abduction due to this muscle activity, suggesting that thoracohumeral muscle activity may decrease glenohumeral stability based on the joint position and applied loads. A better understanding of the contribution of muscle forces to stability may improve rehabilitation protocols for the shoulder aimed at maximizing compression and minimizing translation at the glenohumeral joint.

To evaluate the ability of the EmulSiv™ filter (EF) to remove extrinsic microbial contaminants from propofol. Aliquots of Staphylococcus aureus (S. aureus), Candida albicans (C. albicans), Klebsiella pneumoniae (K. pneumoniae), Moraxella osloensis (M. osloensis), Enterobacter agglomerans (E. agglomerans), Escherichia coli (E. coli), Serratia marcescens (S. marcescens), Moraxella catarrhalis (M. catarrhalis), Haemophilus influenzae (H. influenzae) and Campylobacter jejuni (C. jejuni) were inoculated into vials containing 20 mL of sterile propofol. The unfiltered inoculated propofol solutions served as controls. Ten millilitres and 20 mL samples of the inoculated propofol were filtered through the EF. All solutions were then subplated onto three culture plates using a precision 1 μL calibrated platinum loop and incubated. The number of colony forming units (CFU) were counted. Data were analyzed using a one-sample t test, and a P value of less than 0.05 was selected as the level of statistical significance. The EF was able to completely remove CFU of S. aureus, C. albicans, K. pneumoniae, M. osloensis, E. agglomerans, E. coli, S. marcescens, and M. catarrhalis (P < 0.05). A small number of H. influenzae CFU were able to evade filtration in both the 10 mL and 20 mL samples. C. jejuni CFU were able to evade filtration in only the 10 mL sample. The EF removes the majority of microbial contaminates from propofol with the exception of H. influenzae and C. jejuni. Although the EF is capable of removing most of the microbial contamination produced by H. influenzae and C. jejuni, a few CFU are capable of evading filtration. Consequently, even the use of a filter capable of removing microbial contaminants is not a substitute for meticulous aseptic technique and prompt administration when propofol is used.

The initial volcanic phase of Cretaceous island arc strata in central Puerto Rico, at the eastern end of the extinct Greater Antilles Arc, comprises a 6-km thick pile of lava and volcanic breccia (Rio Majada Group). Preserved within the sequence is a conspicuous shift in absolute abundances of the more incompatible elements, including Th, Nb, and the light rare earth elements (LREE: La, Ce, Pr and Nd). The compositional shift is marked by a decrease in La/Sm from averages of 2.11 in the lowest third of the pile (Formation A) to 1.48 at the top (Formation C), and by a distinctive flattening of LREE segments of chondrite-normalized REE patterns. i87Sr/86Sr and ɛNd average about 0.7035 and 8.2, respectively, in early Formation A basalts. These ranges normally overlap samples from later Formations B and C. Isotope compositions of the latter group are more variable, however, and several samples are considerably more radiogenic than Formation A basalts, such that i87Sr/86Sr averages almost 0.7042 while ɛNd-values decrease to 7.5 in Formation B and C basalts. Theoretical models of non-modal melting processes in both amphibole peridotite and spinel lherzolite sources provide insight into the origin of depleted Th, Nb, and LREE abundances in Puerto Rican basalts. Low Nb concentrations less than normal mid-oceanic ridge basalts in Formation A basalts indicate the wedge was slightly depleted by low-volume decompression fusion due to induced convection in the back-arc region prior to entry of the source into the arc melting zone. However, depleted patterns in Formation C basalts cannot be generated by relatively greater degrees of decompression fusion in the back-arc, because addition of the La-enriched slab-derived component to more depleted source material invariably produces elevated rather than decreased La/Sm. Refluxing of Formation A harzburgitic residua is similarly precluded. In contrast, the observed patterns are readily reproduced by multistage melting models involving hybridized sources containing normal Formation A lherzolite source material blended with recycled, unrefluxed harzburgite residua. Successful models require hybrid sources containing large volumes of recycled harzburgite (up to 50%) during generation of Formation C basalts. Slightly elevated radiometric Sr and Nd isotopes in a few flows from Formation C are attributed to partial refluxing of the hybrid sources within the wedge.

This position statement reviews several aspects of spirometric testing in the workplace, where spirometry is employed in the primary, secondary, and tertiary prevention of occupational lung disease. Primary prevention includes pre-placement and fitness-for-duty examinations as well as research and monitoring of health status in groups of exposed workers; secondary prevention includes periodic medical screening of individual workers for early effects of exposure to known occupational hazards; and tertiary prevention includes clinical evaluation and impairment/disability assessment. For all of these purposes, valid spirometry measurements are critical, requiring: documented spirometer accuracy and precision, a rigorous and standardized testing technique, standardized measurement of pulmonary function values from the spirogram, adequate initial and refresher training of spirometry technicians, and, ideally, quality assessment of samples of spirograms. Interpretation of spirometric results usually includes comparison with predicted values and should also evaluate changes in lung function over time. Response to inhaled bronchodilators and changes in relation to workplace exposure may also be assessed. Each of these interpretations should begin with an assessment of test quality and, based on the most recent ATS recommendations, should rely on a few reproducible indices of pulmonary function (FEV1, FVC, and FEV1/FVC.) The use of FEF rates (e.g., the FEF25-75%) in interpreting results for individuals is strongly discouraged except when confirming borderline airways obstruction. Finally, the use of serial PEF measurements is emerging as a method for confirming associations between reduced or variable pulmonary function and workplace exposures in the diagnosis of occupational asthma. Throughout this position statement, ACOEM makes detailed recommendations to ensure that each of these areas of test performance and interpretation follow current recommendations/standards in the pulmonary and regulatory fields. Submitted by the Occupational and Environmental Lung Disorder Committee on November 16,1999. Approved by the ACOEM Board of Directors on January 4,2000.

OBJECTIVE: To describe occupant and crash characteristics in the first 27 publicly released investigations of air-bag-related fatalities. METHODS: A retrospective review of the first 27 released crash investigations of air-bag-induced fatalities was conducted. Data were obtained by the National Highway Traffic Safety Administration. RESULTS: Three separate groups of occupants are described: adult drivers, school-aged children riding in the right front passenger seat, and infants installed into rear-facing infant car seats placed into the right front passenger seat. Female drivers were significantly likely to be short-statured. Male drivers tended to be slumped over the wheel. Eleven children (100%) were improperly restrained and thrown forward by preimpact braking. Adults tended to have serious chest injuries, while children tended to have CNS or neck injuries. All three infants had fatal CNS injuries. The average deltaV (change in the vehicle's velocity at the moment of impact) was 12 mph and the average bumper crash was 8.8 inches. CONCLUSIONS: Air bags can cause fatal injury to car occupants in low- or moderate-speed crashes. Data suggest that proximity to the air bag at the time of deployment is the critical risk factor for fatal injury.

Although vascular ultrasonography has been established as an essential diagnostic tool in many clinical settings, its role in the emergency department patient population is uncertain. Preliminary reports of emergency physician--directed ultrasonography are promising. Further studies are needed to establish its reliability and suitability in the emergency department setting.

Objectives: To assess the feasibility of emergency physicians' (EPs') performing color-flow Doppler ultra-sonographic vascular studies in the ED to diagnose deep venous thrombosis (DVT), after a modest training program. Methods: A retrospective observational review was performed of the performance of color-flow Doppler ultrasonographic vascular studies by EPs. Prior to the study period, venous Doppler studies were not available at off-hours. Two attending EPs were trained by the hospital's vascular laboratory by observing studies and then performing 25–30 studies successfully. They were then available to examine all patients presenting to the ED at off-hours who were suspected of having DVT. Patients were admitted or released from the ED based on the examination results. All patients were to have formal vascular laboratory studies the next day. The study was performed at a university hospital ED and evaluated all patients who underwent off-hour examinations from January 1993 to February 1994. The examiners were aware of the clinical scenario. Results: Of 23 eligible patients, 15 completed the protocol with a follow-up next-day study. Based on the follow-up study, the ED examination was 100% sensitive (7 true positives) and 75% specific (6 true negatives). The 2 false-positive studies were for patients with old DVT. The 8 patients without follow-up studies were not included in the analysis, although 4 of these patients had negative studies and unremarkable clinical outcomes. Conclusions: These preliminary findings suggest that Doppler ultrasonographic studies of the lower extremity veins by EPs can be used to make admission decisions when formal studies are not available. Confirmatory studies should be performed. EPs may overread acute thrombosis in the setting of old venous disease. Issues of cost and logistics remain to be resolved.

SummaryIn 1982, a small percentage of Great Britain’s armed forces was involved in a short but bitter action to recover some territory in the South Atlantic region that had been invaded by another nation. As part of a UK Ministry of Defence-sponsored study, 30 Commanding Officers of British sea, land and air units involved in Operation CORPORATE participated between seven and nine years later in a research study investigating their individual variations in personality and the perceived effects of their experience of Command in War. Ten single-seat, fast jet pilots from a slightly younger age group were also investigated.

Caribbean granitoids occur among a series of widespread magmatic arcs that developed during a period of major oceanic plate convergence and subduction that began in Late Cretaceous time. Evaluation of Caribbean granitoids reveals that two main suites of granitoids are widespread. Low-K granitoids, including gabbro, diorite, quartz diorite, tonalite, and trondhjemite, comprise one of these suites. The second main type is distinctly more potassic and consists primarily of quartz monzodiorite and granodiorite, but also includes monzodiorite, quartz monzonite, and granite. Both groups contain rocks that are transitional to the other group. The granitoids are part of an extensive Caribbean calc-alkaline assemblage that includes low-K, medium-K, and high-K rocks. Island-arc tholeiitic and normal-K calc-alkalic compositions reflect geochemical continua within the orogenic granitoids. The granitoids (including low-K rocks) lie within the calc-alkaline field on FeOT/MgO and AFM diagrams. Alkali-lime indices genera...

To assess and compare the growth of four microorganisms in solutions of intravenous anesthetics, known quanta of Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Candida albicans were inoculated into propofol, thiopental, a 1:1 mixture of propofol and thiopental, and normal saline. All microorganisms were taken from standard stock cultures and incubated for 24 h (48 h for C. albicans). Growth of microorganism in each drug was compared by counting the number of colony forming units (CFUs) grown from a subculture of each inoculated anesthetic at 0, 3, 6, 12, and 24 h. The study shows that propofol strongly supports the growth of E. coli and C. albicans but is bacteriostatic toward S. aureus and weakly bactericidal toward P. aeruginosa. In contrast, both thiopental and the 1:1 mixture of propofol and thiopental behaved differently, exhibiting markedly bactericidal properties toward E. coli, S. aureus, and P. aeruginosa and a bacteriostatic effect on C. albicans. This finding supports recommendations that a strict aseptic technique should be used when handling propofol and that the contents of an ampoule should be used within 6 h of aspirating. The measured high pH of both thiopental and the 1:1 mixture of propofol and thiopental compared to propofol alone suggests pH to be a major factor in determining whether a given drug will support microbial growth.

Background:The effect of osteoallograft repair of a Hill-Sachs lesion and the effect of allograft fit on glenohumeral translations in response to applied force are poorly understood.Purpose:To compare the impact of a 25% Hill-Sachs lesion, a perfect osteoallograft repair (PAR) of a 25% Hill-Sachs lesion, and an “imperfect” osteoallograft repair (IAR) of a 25% Hill-Sachs lesion on glenohumeral translations in response to a compressive load and either an anterior or posterior load in 3 clinically relevant arm positions.Study Design:Controlled laboratory study.Methods:A robotic/universal force-moment sensor testing system was used to apply joint compression (22 N) and an anterior or posterior load (44 N) to cadaveric shoulders (n = 9) with the skin and deltoid removed (intact) at 3 glenohumeral joint positions (abduction/external rotation): 0°/0°, 30°/30°, and 60°/60°. The 25% bony defect state, PAR state, and IAR state were created and the loading protocol was performed. Translational motion was measured in each position for each shoulder state. A nonparametric repeated-measures Friedman test with a Wilcoxon signed-rank post hoc test was performed to compare the biomechanical parameters ( P < .05).Results:Compared with the defect shoulder, the PAR shoulder had significantly less anterior translation with an anterior load in the 0°/0° (15.3 ± 8.2 vs 16.6 ± 9.0 mm, P = .008) and 30°/30° (13.6 ± 7.1 vs 14.2 ± 7.0 mm, P = .021) positions. Compared with IAR, the PAR shoulder had significantly less anterior translation with an anterior load in the 0°/0° (15.3 ± 8.2 vs 16.6 ± 9.0 mm, P = .008) and 30°/30° (13.6 ± 7.1 vs 14.4 ± 7.1 mm, P = .011) positions, and the defect shoulder had significantly less anterior translation with an anterior load in the 30°/30° (14.2 ± 7.0 vs 14.4 ± 7.0 mm, P = .038) position.Conclusion:PAR resulted in the least translational motion at the glenohumeral joint. The defect shoulder had significantly less translational motion at the joint compared with the IAR. An IAR resulted in the most translational motion at the glenohumeral joint. This demonstrates the biomechanical importance of performing an osteoallograft repair in which the allograft closely matches the Hill-Sachs defect and fully restores the preinjury state of the humeral head.Clinical Relevance:This study demonstrates the importance of performing an osteoallograft repair of a Hill-Sachs defect that closely matches the preinjury state and restores normal humeral head anatomy.

I.V. rocuronium produces intense discomfort at the site of injection in conscious patients. Four strategies to reduce or prevent this discomfort were studied.Two hundred and fifty adult patients, ASA I-III, were randomized into five groups of 50 patients in a blinded, prospective study. The control group received rocuronium 10 mg alone. For the remaining four groups, rocuronium 10 mg was mixed with sodium bicarbonate 8.4% 2 ml, fentanyl 100 micro g, lidocaine 2% or normal saline. The pH and osmolality of all mixtures were measured. Patient data were analysed using ordinal logistic regression. Osmolality and pH data were analysed using the Kruskal-Wallis test with Dunn's multiple comparison test.When compared with rocuronium alone, only the addition of saline failed to significantly reduce the pain reported by patients. The addition of fentanyl reduced the complaint of pain by 1.9 times (P0.049) and the addition of lidocaine 2% reduced it by 3.6 times (P0.0001). Sodium bicarbonate 8.4% reduced the reporting of pain by 18.4 times (P0.0001).Sodium bicarbonate 8.4%, when added to rocuronium, markedly reduces the experience of pain during the i.v. administration of a small dose of rocuronium.

Island arc basalts (IAB) in the Greater Antilles, dating between Albian and mid-Eocene time (~112 to 45 Ma), consist of an early low-K, primitive island arc (PIA) basalt series and a later, predominantly intermediate calcalkaline (CA) series. The rocks resemble modern sediment-poor, low-light rare earth element (LREE)/heavy rare earth element (HREE) arc basalts from intra-oceanic tectonic settings and sediment-rich, high-LREE/HREE types from continental margin arcs, respectively. Isotope and incompatible trace element distribution along a 450 km segment of the arc in the northeast Antilles demonstrates that low-LREE/HREE basalts predominate in Albian to Santonian (~85 Ma) stratigraphic sequences in the Virgin Islands (VI) and northeast Puerto Rico (NEPR), while there is a gradual but spectacular increase in both LREE/HREE and absolute abundances of incompatible elements in central Puerto Rico (CPR). Northeastern Antilles basalts have consistently elevated La/Nb and relatively low Nb/Zr, both inconsistent with the presence of a significant ocean island basalt component. Hence, observed differences are interpreted to reflect variation in proportions of pelagic sediment subducted by the south-dipping Antilles arc system as it swept north-eastward across the Caribbean region and eventually approached the Bahama Banks along the south-eastern fringes of the North American Plate. Trace element mixing models indicate sediment proportions in VI and NEPR were limited, averaging considerably below 1.0%. In comparison sediment content in CPR increased from an average slightly above 1.0% in Albian (~112 Ma) basalts to as high as 8% in Cenomanian (100-94 Ma) types. Hypothetical pre-arc pelagic sedimentary facies in the subducted proto-Atlantic (or proto-Caribbean) basin, included 1) a young, centrally located longitudinal ridge-crest facies, with a thin sediment cover, eventually subducted by VI and NEPR, 2) a slightly older basin-margin facies of variable width and moderate sediment thickness, subducted by CPR during Albian time, and 3) a thick, pre-arc continental margin facies in the vicinity of Central America, subducted by CPR during Cenomanian time. Following collision of neighboring Hispaniola with the Bahamas sediment budgets in the northeast Antilles stabilized at moderate levels from 2 to 3%, reflecting widespread subduction of North Atlantic Cretaceous pelagic sediment (AKPS).

Background: Hill-Sachs defects have been associated with failed repairs for anterior shoulder instability. However, the biomechanical consequences of these defects are not well understood because of the complicated interaction between the passive soft tissue and bony stabilizers. Hypothesis: The creation of a 25% Hill-Sachs defect would not significantly alter the glenohumeral translations but would increase the in situ forces in the glenohumeral capsule as well as the glenohumeral bony contact forces. Study Design: Controlled laboratory study. Methods: A robotic/universal force-moment sensor (UFS) testing system was used to apply joint compression (22 N) and an anterior or posterior load (44 N) to cadaveric shoulders (n = 9) with the skin and deltoid removed (intact) at 3 glenohumeral joint positions (abduction/external rotation): 0°/0°, 30°/30°, and 60°/60° (corresponds to 90°/90° of shoulder abduction/external rotation). A 25% bony defect on the posterolateral humeral head (defect) was then created in the most common position of anterior shoulder dislocation (90°/90°), and the loading protocol was repeated. A nonparametric repeated-measures Friedman test with a Wilcoxon signed-rank post hoc test was performed to compare translations, in situ forces in the capsule, and bony contact forces between each state ( P < .05). Results:At 0°/0°, anterior translation significantly increased from 15.3 ± 8.2 mm to 16.6 ± 9.0 mm ( P < .05) in response to an anterior load. At 30°/30°, anterior and posterior translations, respectively, significantly increased in response to both anterior (intact: 13.6 ± 7.1 mm vs defect: 14.2 ± 7 mm; P < .05) and posterior loads (intact: 15.7 ± 5.8 mm vs defect: 17.7 ± 5.1 mm; P < .05). In situ force in the capsule during anterior loading was increased in the defect state at both 60°/60° (intact: 38.9 ± 14.4 N vs defect: 43.2 ± 15.9 N; P < .05) and 30°/30° (intact: 39.6 ± 13.8 N vs defect: 45.6 ± 9.3 N; P < .05). The medial bony contact forces were also increased in the defect state at 30°/30° (intact: 25.0 ± 13.8 N vs defect: 28.9 ± 13.2 N; P < .05) during anterior loading. Conclusion: We believe that the stabilizing function of the intact capsule was the primary contributor to the finding of only small increases of anterior translation, capsule forces, and bony contact forces observed with a 25% Hill-Sachs defect in response to an anterior load. Clinical Relevance: These findings imply that a 25% Hill-Sachs defect in isolation may not be responsible for recurrent instability if the function of the capsule is restored to the intact state and that the presence of the Hill-Sachs defect may be a marker for significant concomitant injury to the anterior glenoid rim. However, the small changes in these parameters may have long-term implications for the development of osteoarthritis.

Native and white families in whom a diagnosis of tonsillopharyngitis had been documented during 1975 or 1976 were surveyed during 1978 whenever a family member presented to the Southwest Middlesex Health Centre. The relationship between smoking and allergic disorders within the family and the diagnosis of tonsillopharyngitis was determined. The presence of smoking family members and family members with allergic disorders was noted significantly more often in study than in control families. Similarly, families which had an average of two or more persons per bedroom were found significantly more frequently in study families with tonsillopharyngitis.Native patients were diagnosed as having tonsillopharyngitis significantly more frequently than white patients. In addition, native patients had a significantly greater number of positive bacterial throat cultures than did white patients.

The introduction of a phototherapy unit in a rural community hospital resulted in a significant increase in the detection of neonatal jaundice and hyperbilirubinemia in otherwise healthy term infants. Jaundiced newborns who were either missed or ignored in the past were now identified and monitored. Both the number of breast-fed infants and the number of primiparous women delivered increased significantly after the unit was obtained. However, these factors alone did not account for the marked increase in the detection rate of jaundice and hyperbilirubinemia. A sub-population of 94 infants was selected to evaluate the clinical assessment of jaundice in the term infant. The accuracy rate for clinical assessment was 70%; 13.8% of newborns with serum bilirubins above 10 mg/dl (170 umol/L) were not identified clinically.

Cardiotoxicity is a life-threatening complication of an intentional overdose of cyclic antidepressant and phenothiazine drugs. This case report illustrates the severe conduction abnormalities that can accompany a massive ingestion of maprotiline and perphenazine. The patient's condition was further complicated by the unexpected finding of hypothermia.

The 1500 m thick sequence of Huronian continental volcanics at Thessalon, Ontario is subdivided into 4 volcanic cycles, each of which includes abundant early mafic end-members, central intermediate flows, and late rhyolite units. Major and trace element concentrations are dominated by extensive gabbroic fractionation trends that ultimately produced two types of felsic flows: (1) rhyolites with high light rare earth element (LREE) and relatively low large-ion lithophile element (LILE) concentrations (high-LREE, low-LILE rhyolites), and (2) following late separation of REE-rich accessory phases, rhyolites depleted in LREE (low-LREE, high-LILE rhyolites). Mafic end-members of individual volcanic cycle are progressively less siliceous and less enriched in LILE and LREE with height in the stratigraphic section. Ti/Zr ratios gradually rise from 35 in early mafic flows to stabilize at about 85 in late units, while average SiO2 contents decrease from 56 to about 50% and Mg# rises from about 48 to 52. ɛ-Nd values are consistently negative, indicating variable degrees of pre-fractionation crustal contamination of the end-member magmas during their uprise through the crust. Mixing models are consistent with up to 50% contamination by crustal material of tonalitic hornblende-gneiss composition. A progressive increase in ɛ-Nd, from about-5.0 to-0.5 upward in the volcanic succession, reflects a decreasing degree of crustal contamination due to development of insulating layers along margins of the feeder system. Detailed stratigraphic variations suggest that successive magmas batches were intercepted by a progressively fractionating, periodically replenished magma source, giving rise to open-system magmatism. Despite the prevalence of crustal assimilation in the Huronian lavas, (La/Sr)N ratios are too low in least contaminated end-members to be explained by contamination of tholeiitic magmas. The late basalts resemble instead modern island are basalts, and it is suggested that the subcontinental mantle source was enriched by subduction-related processes during crustal formation. Within individual volcanic cycles gabbroic fractionation trends systematically deviate from calculated factors toward compositions characteristic of hornblende-gneiss. Such relations suggest that further crustal contamination of the magmas occurred simultaneous with crystal fractionation. probably within undulating sills at upper crustal levels. Quantitative analysis suggests assimilation/fractional crystallization (A/FC) ratios of about 0.45. As a result of extensive two-stage contamination, rhyolites from the initial volcanic cycle incorporate a total of over 60% of crust.

Using Pectinaria koreni as a biological model of larval dispersal, we coupled the analysis of differently evolving genetic markers (mitochondrial cytochrome oxidase I and four microsatellite loci) to hydrodynamic modeling of larval transport in the English Channel. To determine the influence of historical and contemporary processes on the genetic structure of our study populations, genetic relationships between English Channel, Irish Sea, and southern North Sea populations were assessed in relation to the long-term pattern of marine currents and to postglacial colonization pathways. Although significant, low level of overall nuclear genetic differentiation was best explained by the recent origin of populations within the study area and the retention of ancestral polymorphism. Both genetic data sets suggest that two ancestral gene pools contributed to the origin of our study populations, and secondary contacts occurred in the English Channel and southern North Sea as a result of two migration routes around the British Isles. Although Irish Sea and Belgium populations appeared more recently connected, populations of the eastern English Channel were more isolated. English Channel patterns of connectivity indicated high dispersal and gene flow along the French coast, from Normandy to the southern North Sea. Despite significant genetic differentiation between both coasts, migration model selection favored cross-channel gene flow and long-distance migration following the coastlines. Our results highlight the influence of postglacial colonization on genetic patterns in the English Channel, and indicate that contemporary mesoscale connectivity inferred by hydrodynamic modeling cannot, alone, explain the present genetic structure of populations in this area. Understanding connectivity over different spatial and temporal scales is fundamental for conserving and managing the diversity of biological systems. In the marine environment, most species of benthic marine invertebrates with external fertilization are composed of geographically disjunct populations linked together by a dispersive larval stage. For species with such a lifestyle, the structure, dynamics, and ultimately the stability and persistence of populations are strongly dependent upon the success of the

Archean supracrustal volcanic successions in the Leonora-Laverton region of the Eastern Goldfields Province, Western Australia, are subdivided into two stratigraphic associations: (1) an early succession ten km thick containing homogeneous high-Ti tholeiite basalts displaying nearly flat chondrite-normalized incompatible lithophile element patterns with (La/Sm)N ratios ranging from 0.88 to 1.12, and (2) an unconformably overlying heterogeneous succession four km thick consisting of (a) early siliceous, low-Ti tholeiites and associated intermediate calc-alkaline volcanics, grading to (b) high-Ti tholeiite similar to those of association (1), and (c) late siliceous high-Mg, spinifex-textured basalts. Fractionation models and trace element distribution in high-Ti basalts suggest that all the flows were derived from similar but not identical parental magmas, and that subvolcanic gabbroic fractionation was characteristic. Basaltic end-members of the siliceous, low-Ti suite had identical fractionation patterns, but hornblende joined the assemblage in contaminated intermediate calc-alkaline members, producing low-HREE fractionates. The siliceous basalts exhibit variable enrichment in large-ion lithophile (LILE) and light rate earth (LREE) elements with a continuum of (La/Sm)N ratios up to 2.75. They also have marked negative anomalies for Nb, P, and Ti; several samples also exhibit a positive anomaly for Zr on normalized distribution diagrams. Low Sr concentrations are inconsistent with mantle enrichment processes, and compositions of siliceous volcanics are explained instead by up to 30% contamination of high-Ti tholeiite liquids by Archean crust composed of hornblende tonalite gneiss. Geochemistry of the volcancis is consistent with eruption in a continental back arc basin tectonic setting.

Core stability has received considerable attention with regards to functional training in sports. Core stability provides the foundation from which power is generated in cycling. No research has described the relationship between core stability and cycling mechanics of the lower extremity. The purpose of this study was to determine the relationship between cycling mechanics and core stability. Hip, knee, and ankle joint kinematic and pedal force data were collected on 15 competitive cyclists while cycling untethered on a high-speed treadmill. The exhaustive cycling protocol consisted of cycling at 25.8 km x h(-1) while the grade was increased 1% every 3 minutes. A core fatigue workout was performed before the second treadmill test. Total frontal plane knee motion (test 1: 15.1 +/- 6.0 degrees ; test 2: 23.3 +/- 12.5 degrees), sagittal plane knee motion (test 1: 69.9 +/- 4.9 degrees ; test 2: 79.3 +/- 10.1 degrees), and sagittal plane ankle motion (test 1: 29.0 +/- 8.5 degrees ; test 2: 43.0 +/- 22.9 degrees) increased after the core fatigue protocol. No significant differences were demonstrated for pedaling forces. Core fatigue resulted in altered cycling mechanics that might increase the risk of injury because the knee joint is potentially exposed to greater stress. Improved core stability and endurance could promote greater alignment of the lower extremity when riding for extended durations as the core is more resistant to fatigue.

Diisocyanates are used to produce a wide variety of polyurethane products; they are also recognized as an important cause of occupational asthma. Their chemical reactivity presents challenges to toxicologists and clinicians alike seeking to understand the mechanisms underlying diisocyanate asthma. In this article, we review the literature on immunoassay detection of IgE and IgG binding to diisocyanate-protein conjugates and assess the utility of such testing as a diagnostic tool and exposure indicator. Data from 29 studies of occupational exposure to diisocyanates revealed considerable variability in assay methodology and heterogeneity in the prevalence of positive antibody responses across laboratories. In studies that included both confirmed diisocyanate asthma subjects and exposed nonasthmatics, positive IgE responses identified cases with low sensitivity (18-27%), but high specificity (96-98%). Detection of IgG binding to diisocyanate conjugates is an indirect, qualitative indicator of disease status and past diisocyanate exposure. The utility of these assays is limited, however, due to a lack of (1) method standardization, (2) population norms to guide interpretation of results, and (3) demonstration that the assays improve either on disease prediction or on exposure confirmation beyond that of other indicators. Sources of assay heterogeneity are discussed and suggestions are offered for improving test performance and interpretability.

The historic processes which have led to the present-day patterns of genetic structure in the marine coastal fauna of the Northeast Atlantic are still poorly understood. While tectonic uplifts and changes in sea level may have caused large-scale vicariance, warmer conditions during glacial maxima may have allowed pockets of diversity to persist to a much wider extent than in the Northwestern Atlantic. The large-scale geographic distribution of deeply divergent lineages of the coastal polychaete tubeworms Pectinaria koreni (two clades) and Owenia fusiformis (three clades) were compared using a fragment of the mitochondrial cytochrome oxidase I gene (mtCOI). All lineages were present along the biogeographic transition zone on the north coast of Brittany (France) and we found evidence pointing towards congruence in the timing of cladogenic events between Pectinaria sp. (P. auricoma/P. belgica and P. koreni) and Owenia sp., suggesting a shared history of vicariant events. More conserved 16SrRNA sequences obtained from four species of Pectinariidae together with mtCOI sequences of P. koreni seem consistent with an initial establishment of pectinariids in the north, and a southward colonization of the Northeast Atlantic. Phylogeographic patterns in O. fusiformis were also consistent with a north/south pattern of lineage splitting and congruent levels of divergence were detected between lineages of both species. We observed signatures of both persistence in small northern glacial refugia, and of northwards range expansion from regions situated closer to the Mediterranean. However, whether the recolonization of the Northeast Atlantic by both species actually reflects separate interglacial periods is unclear with regards to the lack of molecular clock calibration in coastal polychaete species.

Toluene diisocyanate (TDI) is an important industrial intermediate used in manufacturing flexible polyurethane (PUR) foams, surface coatings, cast elastomers, sealants, and adhesives. In this review long-term trends in workplace exposures to TDI are assessed in both the producing and using industries, and respiratory health effects of TDI are evaluated in relation to workplace TDI concentrations. The key respiratory health effects associated with repeated or long-term TDI exposure are bronchial asthma and an accelerated rate of decline in lung function. In the early years of the industry, annual incidence rates of occupational asthma (OA) due to TDI ranged from 1% to as high as 5 to 6%, depending on the extent of engineering and work practice controls in the various workplaces. Since the mid-1970s, annual OA incidence rates have been