Penticton Regional Hospital

Perfluorinated acids (PFAs) are an emerging class of environmental contaminants present in various environmental and biological matrices. Two major PFA subclasses are the perfluorinated sulfonic acids (PFSAs) and carboxylic acids (PFCAs). The physicochemical properties and partitioning behavior for the linear PFA members are poorly understood and widely debated. Even less is known about the numerous branched congeners with varying perfluoroalkyl chain lengths, leading to confounding issues around attempts to constrain the properties of PFAs. Current computational methods are not adequate for reliable multimedia modeling efforts and risk assessments. These compounds are widely present in surface, ground, marine, and drinking waters at concentrations that vary from pg L(-1) to microg L(-1). Concentration gradients of up to several orders of magnitude are observed in all types of aquatic systems and reflect proximity to known industrial sources concentrated near populated regions. Some wastewaters contain PFAs at mg L(-1) to low g L(-1) levels, or up to 10 orders of magnitude higher than present in more pristine receiving waters. With the exception of trifluoroacetic acid, which is thought to have both significant natural and anthropogenic sources, all PFSAs and PFCAs are believed to arise from human activities. Filtration and sorption technologies offer the most promising existing removal methods for PFAs in aqueous waste streams, although sonochemical approaches hold promise. Additional studies need to be conducted to better define opportunities from evaporative, extractive, thermal, advanced oxidative, direct and catalyzed photochemical, reductive, and biodegradation methods. Most PFA treatment methods exhibit slow kinetic profiles, hindering their direct application in conventional low hydraulic residence time systems.

Published reports of functional abnormalities in schizophrenia remain divergent due to lack of staging point-of-view and whole-brain analysis. To identify key functional-connectivity differences of first-episode (FE) and chronic patients from controls using resting-state functional MRI, and determine changes that are specifically associated with disease onset, a clinical staging model is adopted. We analyze functional-connectivity differences in prodromal, FE (mostly drug naïve), and chronic patients from their matched controls from 6 independent datasets involving a total of 789 participants (343 patients). Brain-wide functional-connectivity analysis was performed in different datasets and the results from the datasets of the same stage were then integrated by meta-analysis, with Bonferroni correction for multiple comparisons. Prodromal patients differed from controls in their pattern of functional-connectivity involving the inferior frontal gyri (Broca's area). In FE patients, 90% of the functional-connectivity changes involved the frontal lobes, mostly the inferior frontal gyrus including Broca's area, and these changes were correlated with delusions/blunted affect. For chronic patients, functional-connectivity differences extended to wider areas of the brain, including reduced thalamo-frontal connectivity, and increased thalamo-temporal and thalamo-sensorimoter connectivity that were correlated with the positive, negative, and general symptoms, respectively. Thalamic changes became prominent at the chronic stage. These results provide evidence for distinct patterns of functional-dysconnectivity across FE and chronic stages of schizophrenia. Importantly, abnormalities in the frontal language networks appear early, at the time of disease onset. The identification of stage-specific pathological processes may help to understand the disease course of schizophrenia and identify neurobiological markers crucial for early diagnosis.

This double-blind, placebo-controlled study examined the efficacy and tolerability of quetiapine in combination with selective serotonin reuptake inhibitors (SSRIs)/venlafaxine in 58 patients with major depressive disorder, comorbid anxiety symptoms (HAM-A-14 score > or =14), and residual depressive symptoms (HAM-D-17 score > or =18, CGI-S score > or =4). Patients had received an SSRI/venlafaxine (at a predefined therapeutic dose) for > or =6 weeks. Overall, 62% (18/29) of quetiapine- and 55% (16/29) of placebo-treated patients completed the study. The mean change in HAM-D and HAM-A total scores from baseline to Week 8 (primary endpoint) was significantly greater with quetiapine (mean dose 182 mg/day) than placebo: -11.2 vs. -5.5 (P=.008) and -12.5 vs. -5.9 (P=.002), respectively. The onset of quetiapine efficacy (HAM-D/HAM-A/CGI-I) was rapid (by Week 1) and continued through to Week 8. Significant differences (P<.05) from baseline to Week 8 were observed between groups in 7/17 HAM-D (including feelings of guilt, suicide) and 6/14 HAM-A items (including tension, cardiovascular symptoms). Response (> or =50% decrease in total score) was higher for quetiapine than placebo: HAM-D, 48% vs. 28% (not significant, NS); HAM-A, 62% vs. 28% (P=.02). Remission (total score < or =7) was higher for quetiapine than placebo: HAM-D, 31% vs. 17% (NS); HAM-A, 41% vs. 17% (NS). CGI-S, CGI-I, and the Global Assessment Scale showed that quetiapine was significantly more effective than placebo. For quetiapine, adverse events (AEs) were similar to those previously observed; sedation/somnolence/lethargy was the most commonly reported. Here quetiapine was shown to be effective as augmentation of SSRI/venlafaxine therapy in patients with major depression, comorbid anxiety, and residual depressive symptoms, with no unexpected tolerability issues. Further studies are warranted.

OBJECTIVE: To determine early outcomes and early improvements in a prospective inception cohort of children with juvenile idiopathic arthritis (JIA) treated with current standard therapies. METHODS: Patients selected were enrolled in an inception cohort of JIA, the Research in Arthritis in Canadian Children Emphasizing Outcomes Study. The juvenile rheumatoid arthritis core criteria set measures were completed at enrollment and 6 months later. Frequencies of normal values for each of the core set measures and the American College of Rheumatology (ACR) Pediatric 30, 50, and 70 (Pedi 70) criteria response rates achieved at 6 months after enrollment were calculated for each JIA-onset subtype group. RESULTS: Among 354 patients in the study, the median interval between diagnosis and enrollment was 0.7 months. At 6 months after enrollment, median values of active joint counts were highest in patients with rheumatoid factor (RF)-positive polyarthritis (4) and RF-negative polyarthritis (2), but were 0 or 1 for other subtypes. Fifty percent or more of patients with oligoarthritis, systemic arthritis, enthesitis-related arthritis, and undifferentiated arthritis had no active joints, and the ACR Pedi 70 criteria response rate was 48% or more in those with oligoarthritis, RF-negative polyarthritis, and systemic arthritis. CONCLUSION: With current management strategies in clinical practice, improvement in disease activity was noted in considerable proportions of patients in all of the JIA subtype groups, but low levels of disease activity persisted in many. We expect that these early outcomes will prove to be significant predictors of long-term outcomes.

Fulminant, potentially life-threatening infection is a major long-term risk after splenectomy or in persons who are functionally hyposplenic as a result of various systemic conditions. Most of these infections are caused by encapsulated organisms such as pneumococci, Haemophilus influenzae and meningococci. A splenectomized patient is also more susceptible to infections with intraerythrocytic organisms such as Babesia microti and those that seldom affect healthy people, such as Capnocytophaga canimorsus. Most patients who have lost their spleens because of trauma are aware of their asplenic condition, but some older patients do not know that they are asplenic. Other patients may have functional hyposplenism secondary to a variety of systemic diseases ranging from celiac disease to hemoglobinopathies. The identification of Howell-Jolly bodies on peripheral blood film is an important clue to the diagnosis of asplenia or hyposplenia. Management of patients with these conditions includes a combination of immunization, antibiotic prophylaxis and patient education. With the increasing prevalence of antibiotic-resistant pneumococci, appropriate use of the pneumococcal vaccine has become especially important.

Abstract A prototype broadband geodetic very long baseline interferometry system has been implemented, and measurements of the baseline length over approximately two years, between December 2014 and January 2017, have been made in the process of exercising the system, developing operational procedures, and assessing geodetic precision for the new broadband observing concept. In addition to developing a broadband signal chain and installing the instrumentation on both a new 12‐m antenna at the Goddard Geophysical and Astrophysical Observatory and the 18‐m Westford antenna at the Massachusetts Institute of Technology Haystack Observatory, it was necessary to develop new correlation and analysis procedures to process the four‐band, dual‐linear‐polarization data. A geodetic analysis of the data from 19 sessions that were observed during this period yielded a weighted root‐mean‐square deviation of the baseline length residuals about the weighted mean of 1.6 mm. These results validate several of the expectations set forth for the vision of the next‐generation geodetic very long baseline interferometry system.

Consecutive extraction of latex and natural rubber from the roots of rubber-bearing plants such as Taraxacum kok-saghyz (TKS), Scorzonera tau-saghyz (STS), and Scorzonera Uzbekistanica (SU) were carried out. Latex extraction was carried via two methods: Blender method and Flow method. The results of latex extraction were compared. Cultivated rubber-bearing plants contained slightly higher latex contents compared to those from wild fields. Several creaming agents for latex extraction were compared. About 50% of total natural rubber was extracted as latex. The results of the comparative studies indicated that optimum latex extraction can be achieved with Flow method. The purity of latex extracted by Blender method ( approximately 75%) was significantly lower than that extracted by Flow method (99.5%). When the latex particles were stabilized with casein, the latex was concentrated significantly. Through concentrating latex by flotation, the latex concentration of 35% was obtained. Bagasse contained mostly solid natural rubber. The remaining natural rubber in the bagasse (left after the latex extraction) was extracted using sequential solvent extraction first with acetone and then with several nonpolar solvents. Solid natural rubber was analyzed for gel content and characterized by size exclusion chromatography (SEC) for molecular weight determinations. SEC of solid natural rubber has shown that the molecular weight is about 1.8E6 and they contain less gel compared to TSR20 (Grade 20 Technically Specified Rubber), a commercial natural rubber from Hevea brasiliensis.

OBJECTIVES: To audit a cohort of ambulatory outpatients with eosinophilia detected on automated blood cell counting. Specific objectives included the determination of whether the eosinophilia had been anticipated, the etiology of the eosinophilia, the clinical follow-up and investigations performed on patients with eosinophilia, and the effect of the detection of eosinophilia on patient management and ultimate clinical outcome. DESIGN: A year-long retrospective review of all patients with an absolute eosinophil count of greater than 0.7 x 10(9)/L. SETTING: A large outpatient laboratory system. The patient population was managed by family physicians and specialists. INTERVENTION: Data collection included the results of the hematology profile, the absolute eosinophil count, the clinical situation responsible for the hematologic profile determination, and the probable cause of eosinophilia. Individual physicians were surveyed to determine if discovery of the eosinophilia had changed patient management plan or clinical outcome. PRINCIPAL RESULTS: Out of 195,300 patients who had a hematology profile performed, 225 were found to have an absolute eosinophilia count higher than 0.7 x 10(9)/L. The overall incidence of eosinophilia in the study population was 0.1%. The eosinophilia was not anticipated in 85% of patients. No obvious cause was detected for the eosinophilia in 36% of patients. Various allergic diseases were responsible for the eosinophilia in the majority of the remaining patients. Fewer than 9% of individuals manifested a serious systemic illness or parasitemia. Further clinical follow-up had been performed in 69% of patients. Additional laboratory tests had been ordered in 59% of patients. The laboratory tests most frequently ordered were a repeat hematology profile or stool examinations for ova and parasites. In only two instances did the discovery of the eosinophilia appear to result in a significant change in patient management or ultimate clinical income. CONCLUSION: The vast majority of eosinophilias detected in ambulatory outpatients are associated with allergic processes. An extensive investigation of eosinophilia in ambulatory North American outpatients does not appear to be warranted unless specifically indicated by the results of the history and physical examination.

BACKGROUND: Persistent formal thought disorder (FTD) is one of the most characteristic features of schizophrenia. Several neuroimaging studies report spatially distinct neuroanatomical changes in association with FTD. Given that most studies so far have employed a univariate localisation approach that obscures the study of covarying interregional relationships, the present study focussed on the multivariate systemic pattern of anatomical changes that contribute to FTD. METHODS: Speech samples from nineteen medicated clinically stable schizophrenia patients and 20 healthy controls were evaluated for subtle formal thought disorder. Ultra high-field (7T) anatomical Magnetic Resonance Imaging scans were obtained from all subjects. Multivariate morphometric patterns were identified using an independent component approach (source based morphometry). Using multiple regression analysis, the morphometric patterns predicting positive and negative FTD scores were identified. RESULTS: Morphometric variations in grey matter predicted a substantial portion of inter-individual variance in negative but not positive FTD. A pattern of concomitant striato-insular/precuneus reduction along with frontocingular grey matter increase had a significant association with negative FTD. CONCLUSIONS: These results suggest that concomitant increase and decrease in grey matter occur in association with persistent negative thought disorder in clinically stable individuals with schizophrenia.

The failures of engineered dams that retain freshwater or mining waste (tailings) have led to socioeconomic and environmental consequences. However, the global magnitude-frequency statistics of these occurrences remain poorly quantified, out-of-date and/or limited in scope. Addressing this gap would give insight into how the hazard-risk of water-retention (reservoir) dams and mine tailings impoundments has evolved over time, and would provide quantitative benchmarks for estimating likelihoods of facility failures and their societal impacts to support risk assessments. In this study, we analyze new datasets and estimates of the construction and failures of large reservoir facilities (LRFs) and tailings storage facilities (TSFs) worldwide in the period 1965–2020. We address long-standing data gaps on LRF failures in China, and subsequently worldwide, and on constructed TSFs worldwide by adopting multiple estimation/extrapolation approaches to illustrate the range of uncertainty in our results. The total number of LRF failures is estimated to have been between 394 and 608. The annual numbers of newly constructed and failed LRFs declined near-proportionally, thus the cumulative failure rate of LRFs stayed fairly constant, falling in the range of 1.2% to 1.8% as of end-of-2020. The rate drops to at least 0.7% when excluding China. The cumulative fatality rate of LRFs reduced over time to 1.2 deaths per constructed facility, and falls in the range of 64 to 98 deaths per failure, as of end-of-2020. Failures of LRFs with very high storage capacities (>200 million m3) have continued to occur since 2016. The annual number of TSF failures stayed relatively constant, whereas the annual construction rate of TSFs is estimated to have increased by ~3×, thus the cumulative failure rate of TSFs declined over time. When assuming our lower-estimate of the number of constructed TSFs (6810), the cumulative failure rate is ~4.4% as of end-of-2020. When adopting our upper-estimate (20,230 TSFs), we obtain a rate of ~1.5%, which falls in the same order as the corresponding rate of LRFs. Our review of published estimates of existing TSFs worldwide indicates that the "true" rate is much lower than 4.4% and closer to 1.5%. The cumulative fatality rates of TSF failures reduced over time to 0.1–0.3 death per constructed facility and 6 deaths per failure as of end-of-2020, which are lower than those of LRFs. However, the size and the environmental impact of TSF failures have increased on average worldwide, especially since 2014. The rising global rate of failed tailings volumes has been approximately proportional to the rising global rate of tailings production since the 1990s. Heavy rainfall events and intensifying precipitation patterns are statistically important causative variables for the failures of both LRFs and TSFs. This has implications for the design and management of storage capacity, freeboard, facility drainage and spillways under climate change conditions. Our results are applicable broadly on a global scale and are conditioned by uncertainties in the data and the methods used to address data gaps. To improve the robustness of future statistical analyses, a more comprehensive public disclosure effort is necessary, particularly with respect to reservoir facility failures in China and constructed TSFs worldwide.

PURPOSE: 2-Nitro-alpha-[(2,2,2-trifluoroethoxy)methyl]-imidazole-1-ethanol (TF-MISO) was investigated as a potential noninvasive marker of tissue oxygen levels in tumors using (19)F magnetic resonance spectroscopy (MRS) and (19)F chemical shift imaging. EXPERIMENTAL DESIGNS: In vitro data were obtained using high-performance liquid chromatography on tumor cells incubated under varying oxygen conditions to determine the oxygen-binding characteristics. In vivo data were obtained using a well-characterized hypoxic murine breast tumor (MCa), in addition to studies on a rat prostate tumor model (R3327-AT) implanted in nude mice. Detection of intratumor (19)F signal from TF-MISO was done using MRS for up to 10 h following a 75 mg/kg i.v. injection. Localized distribution of the compound in the implanted MCa tumor has been imaged using slice-selective two-dimensional chemical shift imaging 6 h after injection. RESULTS: The in vitro results showed that TF-MISO preferentially accumulates in cells incubated under anoxic conditions. The in vivo (19)F MR spectral features (line width and chemical shift) were recorded as a function of time after injection, and the results indicate that the fluorine atoms are indeed sensitive to changes in the local environment while still providing a detectable MR signal. Ex vivo spectra were collected and established the visibility of the (19)F signal under conditions of maximum hypoxia. Late time point (>6 h) tumor tissue concentrations, as obtained from (19)F MRS, suggest that TF-MISO is reduced and retained in hypoxic tumor. The feasibility of obtaining TF-MISO tumor distribution maps in a reasonable time frame was established. CONCLUSIONS: Based on the results presented herein, it is suggested that TF-MISO has the potential to be a valid magnetic resonance hypoxia imaging reporter for both preclinical hypoxia studies and hypoxia-directed clinical therapy.

The SPARC software program was validated for nitrogen-hydrogen acidity constant estimation of primary and secondary sulfonamides against a broad suite of substituted derivatives with experimental datasets in water and dimethylsulfoxide solvent systems and across a wide pK(a) range. Following validation, amidic proton pK(a) values were estimated for all C(1) through C(8) congeners of five major perfluoroalkyl sulfonamide classes: unsubstituted sulfonamides, N-methyl and N-ethyl sulfonamides, sulfonamidoethanols, and sulfonamidoacetates. Branching of the perfluoroalkyl chain is expected to have substantial impacts on amide moiety acidity in these contaminant groups, with intrahomologue variability of up to four pK(a) units and increasing pK(a) values with both increasing chain branching and greater proximity of the chain branching to the sulfonamide head group. Perfluoroalkyl chain length is not predicted to have a substantial influence on sulfonamide acidity. The predicted pK(a) values and variability are anticipated to have substantial impacts on the environmental partitioning and degradation of these compounds, as well as the modes and magnitudes of toxicological effects. Substantial pH dependent isomeric fractionation of perfluoroalkyl sulfonamides is expected both in situ and in vivo, necessitating the incorporation of amide group acidities in multimedia environmental models and pharmacokinetic studies.

INTRODUCTION: Stroke is one of the leading causes of death in Canada. While stroke care has improved dramatically over the last decade, outcomes following stroke among patients treated in rural hospitals have not yet been reported in Canada. OBJECTIVES: To describe variation in 30-day post-stroke in-hospital mortality rates between rural and urban academic hospitals in Canada. We also examined 24/7 in-hospital access to CT scanners and selected services in rural hospitals. MATERIALS AND METHODS: We included Canadian Institute for Health Information (CIHI) data on adjusted 30-day in-hospital mortality following stroke from 2007 to 2011 for all acute care hospitals in Canada excluding Quebec and the Territories. We categorized rural hospitals as those located in rural small towns providing 24/7 emergency physician coverage with inpatient beds. Urban hospitals were academic centres designated as Level 1 or 2 trauma centres. We computed descriptive data on local access to a CT scanner and other services and compared mean 30-day adjusted post-stroke mortality rates for rural and urban hospitals to the overall Canadian rate. RESULTS: A total of 286 rural hospitals (3.4 million emergency department (ED) visits/year) and 24 urban hospitals (1.5 million ED visits/year) met inclusion criteria. From 2007 to 2011, 30-day in-hospital mortality rates following stroke were significantly higher in rural than in urban hospitals and higher than the Canadian average for every year except 2008 (rural average range = 18.26 to 21.04 and urban average range = 14.11 to 16.78). Only 11% of rural hospitals had a CT-scanner, 1% had MRI, 21% had in-hospital ICU, 94% had laboratory and 92% had basic x-ray facilities. CONCLUSION: Rural hospitals in Canada had higher 30-day in-hospital mortality rates following stroke than urban academic hospitals and the Canadian average. Rural hospitals also have very limited local access to CT scanners and ICUs. These rural/urban discrepancies are cause for concern in the context of Canada's universal health care system.

Patients with a family history of thrombosis, early-onset or recurring thrombosis, thrombosis at unusual sites, or warfarin-induced skin necrosis should be investigated for a possible underlying inherited hypercoagulable disorder. These include AT-III deficiency, protein C and S deficiencies, and APC resistance. Many patients should also be evaluated for the antiphospholipid syndrome, an acquired disorder. Functional assays are more useful than immunologic assays for diagnosing AT-III deficiency, protein C and S deficiencies, and APC resistance. A molecular probe is now available for the abnormal factor V most often responsible for APC resistance. Testing for the antiphospholipid syndrome involves assays for the lupus anticoagulant and anticardiolipin antibodies. AT-III and protein C concentrates are now available for short-term therapy. Long-term prophylactic administration of warfarin may have to be considered for some symptomatic patients with proven abnormalities, especially after more than one thrombotic event. While the management of asymptomatic persons remains controversial, the use of prophylactic anticoagulation should be anticipated for trauma, surgery, pregnancy, or other high-risk situations.

The effectiveness of a parenting program was examined with an Australian sample regarding improved parent knowledge, parental sense of competence, and child behavior. One hundred and sixteen parents and their children were randomly assigned to three conditions: a two-session group based intervention, a two-session self-administered individual intervention, or to a waitlist control group. Across both treatment modalities results reveal a significant increase in parental satisfaction, efficacy, and a reduction in child problem behavior. Improvements were maintained at 3-months follow-up. Results indicate the individual self-administered format enhanced treatment gains relative to the group format.

OBJECTIVE: Fibromyalgia and major depressive disorder (MDD) frequently co-occur. Quetiapine fumarate extended-release (quetiapine XR) has demonstrated efficacy in the treatment of MDD and has been shown to have analgesic properties in patients with depression. The primary objectives of this study were to evaluate the effects of quetiapine XR on depressive and pain symptoms in patients with MDD and comorbid fibromyalgia, and to assess its safety and tolerability. METHODS: This was an 8-week, single-center, double-blind, randomized, controlled trial. A total of 120 nonpsychotic adult outpatients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnostic criteria for MDD and whose diagnosis of fibromyalgia was confirmed according to the American College of Rheumatology criteria were enrolled. The primary end point was the mean change from baseline to week 8 on the 17-item Hamilton Depression Rating (HAM-D) scale. Secondary end points included other depression-rating scores, pain scores, fibromyalgia scores, measures of quality of life and global functioning, and adverse events. RESULTS: The mean change in the HAM-D score from baseline to week 8 was significantly greater in the quetiapine XR group compared with the placebo group (-10.0 versus -5.8; P = 0.001). Improvements in most secondary outcomes were also significantly greater in the quetiapine XR group. Quetiapine XR was generally well tolerated. CONCLUSION: This study is the first to demonstrate that measures of depression, pain, and quality of life are significantly improved with quetiapine XR compared with placebo in patients with a dual diagnosis of MDD and fibromyalgia.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a common respiratory condition and the fourth leading cause of death in Canada. Optimal COPD management requires patients to participate in their care and physician knowledge of patients' perceptions of their disease. METHODS: A prospective study in which respiratory specialist physicians completed a practice assessment questionnaire and patient assessments for 15 to 20 consecutive patients with COPD. Patients also completed a questionnaire regarding their perceptions of COPD and its management. RESULTS: A total of 58 respiratory specialist physicians from across Canada completed practice assessments and 931 patient assessments. A total of 640 patients with COPD (96% with moderate, severe or very severe disease) completed questionnaires. Symptom burden was high and most patients had experienced a recent exacerbation. Potential COPD care gaps were identified with respect to appropriate medication prescription, lack of an action plan, and access to COPD educators and pulmonary rehabilitation. Perceived knowledge needs and gaps differed between physicians and patients. CONCLUSIONS: Despite the dissemination of Canadian and international COPD clinical practice guidelines for more than a decade, potential care gaps remain among patients seen by respiratory specialist physicians. Differing perceptions regarding many aspects of COPD among physicians and patients may contribute to these care gaps.

Abstract The cumulative impacts of human activities and natural disturbance are leading to loss and extinction of species, ecological communities and biocultural connections people have to those ecosystems. Exclusive and extractive western science methodologies often hinder the inclusion of Indigenous knowledge holders in cumulative effects assessments (CEAs), which can lead to regional conflict and ineffective assessment and management of cumulative effects. We offer our reflections on the development of a collaborative CEA process with the Kitasoo Xai'xais, Nuxalk and Wuikinuxv First Nations in what is now known as the Central Coast of British Columbia. We designed our CEA around the guiding principles of respecting Indigenous sovereignty and regional autonomy, designing for trauma‐informed approaches, and prioritizing inclusivity and reciprocity. We focused our efforts on identifying current and future pressures on species of the Nations' choice. We relied on expert elicitation and data‐driven approaches to identify and map current and future cumulative impacts to predict their consequences for species' health. We used combinations of visualizations, numerical, oral and written materials to convey, elicit and share complex information with experts. We found a diversity of elicitation processes fostered the involvement of a variety of experts (e.g. Indigenous knowledge holders and Nation staff, regional biologists, Crown managers, tenure holders). We mapped over 90+ impacts to species in the region and after conversation and facilitated elicitation processes with over 50 knowledge holders, emerged with predictions for the consequences of seven plausible scenarios of future cumulative impacts for eight species as well as broad themes for the management of cumulative impacts to the lands and waters of the Nations with whom we collaborated. Our shared lessons can support researchers, planners, proponents, and Indigenous and colonial government agencies to conduct inclusive, collaborative and accessible CEAs that inform regional land and marine use planning. Read the free Plain Language Summary for this article on the Journal blog.

The SPARC software program aqueous pK(a) prediction module was validated against corresponding experimental acidity constants for chlorinated and brominated phenols and the limited experimental aqueous pK(a) data sets for monohydroxylated polychlorinated biphenyls (OH-PCBs), polychlorinated diphenyl ethers (OH-PCDEs), and polybrominated diphenyl ethers (OH-PBDEs). pK(a) values were then estimated for all 837 monohydroxylated mono- through nona-halogenated congeners in each of the OH-PCB, OH-PCDE, and OH-PBDE classes, as well as for the monohydroxylated polybrominated biphenyls (OH-PBBs), giving a total of 3348 compounds. Large intrahomolog pK(a) variation by up to six units is expected within each contaminant class, with pK(a) values ranging from about 4 to 11 dependent on the degree and pattern of halogenation. Increasing halogenation generally decreased the average pK(a) within each homolog group. Significant intrahomolog differences in pK(a) values exist between OH-PCB, OH-PBB, OH-PCDE, and OH-PBDE congeners, including large acidity constant variation between isomers with equivalent halogenation patterns but varying location of the hydroxy moiety. Congener specific pH dependent investigations into the partitioning and degradation behaviors of these compounds are necessary, including greater consideration of analyte ionization effects during their extraction and analysis.

It is always important that physicians not overreact to apparently abnormal laboratory values by undertaking inappropriate further investigations or clinical treatments. When confronted with unexpected differing test results from repeat testing in the same individual, physicians should be aware of explanations other than laboratory error and change in the patient's clinical status. While test-related variables may be factors, intraindividual biologic variation is much more common and may be the explanation for discrepant results. For this reason, physicians need to know which laboratory tests are associated with significant intraindividual biologic variation as well as the magnitude of possible changes. Age-associated physiologic changes may significantly alter certain laboratory values in the elderly without constituting a pathologic process. Laboratory values that may appear abnormal in 10% or more of the healthy elderly without necessarily representing a pathologic process include serum alkaline phosphatase, fasting blood glucose, 2-hour postprandial glucose, erythrocyte sedimentation rate, hemoglobin, and a normal serum creatinine level in the face of a markedly decreased creatinine clearance. To ensure proper assessment of the geriatic patient, the clinician needs to be aware of these age-related changes and possible effects on laboratory values. More clinical research is needed to establish appropriate reference ranges, especially for those over the age of 75 years.