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A clinical update on massive ovarian oedema – a pseudotumour?
RS Praveen 1, VR Pallavi 1, K Rajashekar 1, A Usha 2, K Umadevi 1 and UD Bafna 1
1 Department of Gynaecologic Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
2 Department of Pathology, Kidwai Memorial Institute of Oncology, Bangalore, India
Correspondence to: RS Praveen. Email: firstname.lastname@example.org
Objective: Benign massive ovarian oedema is a rare clinical entity arising from the ovaries, and it poses a significant clinical challenge as it can be easily mistaken for neoplasm. Due to the lack of pathognomonic clinical features or characteristic hallmarks on non-invasive diagnostic modalities and the dependence on the final histopathology, the efforts of the surgeon have been deviated from performing fertility-sparing surgery on young women. The lack of standardised guidelines due to the rarity of this condition calls for a review of the literature to enable the clinician to formulate treatment guidelines.
Methods and Material: A Medline search on the PubMed database for literature published in English from 1969 to 2011 was done using the keywords ‘massive ovarian oedema, massive ovarian oedema case report or case series, and pseudotumour of ovary’. A total of 177 women who had undergone a variety of treatments were retrieved. We also report the management options we used for four women presenting to us between August 2000 and October 2011, as well as a review of the literature.
Result: A total of 177 cases of massive ovarian oedema were identified. Out of these cases 151 (85.3%) were primary massive ovarian oedema; secondary massive ovarian oedema was identified in 26 (14.7%) cases. A salpingo-oophorectomy was done in 145 (81.9%) cases, 12 (6.8%) cases had an abdominal hysterectomy with bilateral salpingo-oophorectomy. A total of 76 (42.9%) cases intraoperatively were found to have ovarian torsions, and one patient with primary massive ovarian oedema had ascites. Conservative treatment was carried out in 20 (11.3%) patients; 14 of these had a wedge biopsy with frozen section and with or without ovarian suspension, one patient had diagnostic laparotomy, and five cases had only ultrasonographic or magnetic resonance imaging monitoring and symptomatic treatment. The four cases treated at the regional cancer institute from 2000 to 2011 revealed that the first three cases had salpingo-oophorectomy and the fourth case received a successful conservative treatment.
Conclusion: The majority of massive ovarian oedemas will respond to judicious use of intraoperative wedge resection and frozen section for the confirmation of diagnosis. The detorsion and transfixation of the ovary or partial debulking and drainage of fluid accumulated in the cyst may be more appropriate to preserve hormonal function and fertility in these young women.
Keywords: Massive ovarian Oedema, pseudotumour of ovary, fertility-sparing surgery, ovarian drilling, ovarian reconstruction.
Massive ovarian oedema is a rare solid tumour-like condition seen in young women. The term ‘massive ovarian oedema’ was first described by Kalstone in 1969  and the World Health Organization defined it as an accumulation of oedema fluid within the ovarian stroma separating normal follicular structures . The most commonly affected are young women in their reproductive stage, but a singular cases of a six-month-old infant and a postmenopausal woman have also been reported [3, 4]. Massive ovarian oedemas can involve one or both the ovaries [5, 6], and it has also been observed during pregnancy . The most common presenting symptoms are pain, distension or mass in the abdomen, infertility, and in some cases irregular vaginal bleeding [2–7]. The masculinisation features are frequently seen in many adult cases, and rarely a small number of cases are known to present with precocious puberty [3, 8–10].There are at least two types of massive ovarian oedema: primary, without concomitant pathology, and secondary, superimposed on already altered ovaries . The most favoured hypothesis for the aetiology is the development of massive oedema as a result of the disturbed venous and lymphatic circulation following complete or partial torsion of the mesovary, but not the arterial blood flow [2–6, 8–10]. As a result, there is stromal cell luteinisation in the oedematous ovary, occurring as a response to torsion and subsequent ischaemia. The stromal cells have positive oestrogen progesterone receptors and may undergo stimulatory changes responsible for the hormonally related symptoms often found associated with massive ovarian oedema [3, 4, 8–10]. Derangement of a local paracrine factor, such as insulin-like growth factor, epidermal growth factor, or cytokines, was an alternate explanation proposed by Eden et al . Massive ovarian oedema is commonly associated with normal levels of lactate dehydrogenase levels and tumour markers [3–11]. Secondary massive ovarian oedema rarely occurs in diseased ovaries with associated benign cysts and tumours [5, 12–17], the drugs used for ovulation induction  and malignancies [19–21]. Few reported cases of raised Ca-125 levels with or without raised lactate dehydrogenase levels in massive ovarian oedema with Meig’s syndrome, fibrothecomas, and so on are available in the literature [16, 17].
A definitive preoperative diagnosis of massive ovarian oedema is often difficult and the ultrasonographic findings are variable and not diagnostically accurate. The ultrasound findings in the majority of the cases have been reported as a heterogeneous complex ovarian mass, which is non-specific and can mimic neoplasia [4, 6]. However, Umesaki et al  described the ultrasonographic features that a solid ovarian tumour with multiple peripheral ovarian follicles with or without endometrial hypertrophy may indicate the possibility of massive ovarian oedema. Furthermore, Umesaki et al  described in another case report, a successful preoperative diagnosis of massive ovarian oedema aided by comparative imaging study using magnetic resonance imaging (MRI) and ultrasonography; as normal ovarian follicles are pressed towards the peripheral cortical area of the ovary by oedema fluid accumulated within the ovarian stroma. Similarly, Hall et al also report that by using MRI, they have demonstrated that multiple ovarian follicles situated around the periphery of the cortex of the enlarged ovary are the most characteristic of massive ovarian oedema . This appearance corresponds to the World Health Organization’s definition of massive ovarian oedema, namely, as ‘an accumulation of oedema fluid within the ovarian stroma separating normal follicular structures’ . The finding of multiple ovarian follicles located at the peripheral cortex of an enlarged ovary is thus a very important diagnostic indicator of massive ovarian oedema.
The morphological recognition of the lesion is fairly simple. The external surface is usually white and opaque. The sectioned surface typically exudes watery fluid after cutting with a knife due to the pressure of the oedema  (Figures 1 and 2).
Figure 1: The external surface of the massive ovarian oedema is usually white and opaque.
Figure 2: The sectioned surface typically exudes watery fluid after cutting with a knife due to the pressure of the edema.
Histologically, an oedematous and hypocellular ovarian stroma is present, and the ovarian architecture is preserved. The outer cortex is thickened and fibrotic. A cluster of luteinised stromal cells is present in the oedematous stroma in the minority of cases, especially those that have endocrine symptoms  (Figures 3 and 4). Necrosis and haemorrhage are unusual [2, 25]. Focal stromal luteinisation has been noted in some of the studied cases and is thought to be a mechanical process induced by stretching of the stromal cells . Immunohistochemical studies have shown phenotypic modulation of fibroblasts in massive ovarian oedema .
Figure 3: An ovarian stroma with marked oedema, at. H&Ex400.
Figure 4: Ovarian stroma with edema. A follicle is also seen. H&EX100.
Primary massive ovarian oedema is a rare benign tumour-like condition of the ovary and can be easily mistaken for malignancy, in which case the appropriate treatment will be removal of the whole ovary. However, as this condition is a benign enlargement of the ovary, it warrants a conservative treatment. We emphasise the need for a high degree of clinical suspicion preoperatively in this rare disorder, and the knowledge gained from the literature helped us to focus on fertility-sparing surgery in these young women, whose ovaries need to be conserved for further reproductive and hormonal functions.
A Medline search on Pub Med database since 1969 using the keywords ‘‘massive ovarian edema, massive ovarian edema case report or case series and a pseudotumor of ovary’’ found around 177 cases reported: 85 articles reporting a single case, 11 articles reporting two cases, four articles reporting three cases, and single articles each reporting four, five, six, eighteen and twenty five cases respectively were identified. The relevant articles in English with a specific interest in ovarian oedema were reviewed. The references of these articles generated also enabled a widening of the reference pool.
One hundred and fifty-one of 177 (85.3%) were primary massive ovarian oedema, of which 5 (2.8%) were associated with pregnancy. Secondary massive ovarian oedema was identified in 26 of the 177 (14.7%) women who were associated with a variety of clinical conditions such as pelvic fibromatosis, Meig’s syndrome, mucinous cyst adenoma of ovary, polycystic ovarian disease, clomiphene citrate administration, and contralateral ovarian mature teratoma, lymphoma, carcinoma stomach, uterine cervical cancer, and lung cancer in 8, 5, 3, 3, 2 and 1 cases in each category, respectively. The age group ranged from a neonate at six months of age to postmenopausal women up to 60-years-old. There were no pathognomonic clinical features, as all the children and women presented with abdominal pain and abdomino-pelvic mass detected either by clinical examination or by non-invasive radiological methods such as ultrasound, computed tomography (CT) scan or MRI. Variable clinical features such as ascites, hydrothorax, abnormal vaginal discharge, anorexia, fever and haemoptysis were more predominant in the secondary massive ovarian oedema except for one woman with ascites in the primary group. Virilisation was seen in 37 of 177 (20.9%) of women. Ovarian torsion was encountered in 76 of 177 (42.9%) intraoperatively.
Table 1: Different modalities of treatment reported in the literature
Regional cancer institute experience
We present the study of four cases of massive ovarian oedema managed at our regional cancer institute, from August 2000 to October 2011. The youngest patient was an eight-year-old premenarcheal girl, the oldest was a 26-year-old multipara and two were menarcheal girls aged 11 and 17 years. All four of them presented with abdominal pain, bimanually palpable adnexal masses, and case 2 had signs of virilisation. Ultrasonography revealed the presence of unilateral adnexal multicystic lesion in case 1 (R) and 3 (L) with characteristic peripheral orientation of multiple cysts, bilateral lesions with solid and cystic areas in cases 2 and 4 as described in Table 2. Figure 5 (case 1) shows the MRI characterisation of the right adnexal lesion measuring 8.2 cm × 3.2 cm × 5.2 cm that was isodense to hyperintense on both T1- and T2-weighted sections and contained well-defined hypointense capsule and did not show any fat component within. All the four patients had normal values of serum beta-human chorionic gonadotrophin (S-βhcg), alpha feto-protein (AFP), cancer antigen-125 (CA-125) and lactate dehydrogenase (LDH) levels.
Figure 5 and 6: MRI of T1 & T2 weighted image isodense to hypointense capsule. The image did not show any fat component within and multiple normal ovarian follicles(arrows) noted in the periphery of the mass.
Table 2: Clinical characteristics.
All the four cases had laparotomies as malignancy was suspected. A frozen section was performed in all four cases that revealed massive ovarian oedema and was confirmed as primary massive ovarian oedema in all the four specimens by final histopathological examination (Figures 3 and 4). A search for intra-abdominal metastatic deposits did not contribute significantly, see Table 3.
Table 3: The surgical details, histopathology and follow-up.
Figure 7: Intra-operative picture showing bilateral pearly white ovarian enlargement with multiple cysts and smooth shiny intact capsule.
Figure 8: Wedge resection with bilateral ovarian drilling and drainage of the multiple cysts.
Figure 9: Ovarian reconstruction following wedge resection with ovarian drilling and drainage of the multiple cysts.
Massive ovarian oedema can occur as a primary or secondary oedema. Primary massive ovarian oedema is most commonly diagnosed, which is seen in more than 85% of reported cases. Primary oedema occurs in a normal ovary with torsion or twisting of the ovarian pedicle to the extent that it interferes with the venous blood supply without affecting the arterial flow leading to oedema. Incomplete or intermittent torsion can occur. Secondary massive ovarian oedema occurs in a diseased ovary, such as when there is an ovarian mass or cyst-like ovarian capillary haemagioma , mucinous and serous cyst adenomas [13, 14], mature cystic teratoma , Meig’s syndrome , ovarian fibrothecoma , and polycystic ovary . And malignancies, causing to lymphatic permeation by metastatic carcinoma from the uterine cervix , gastric carcinoma , and lymphangitis carcinomatosa . Secondary to the drugs used for ovulation induction . Young et al explained that fibromatosis and massive oedema of the ovary are possibly related entities, as discussed in a report of 14 cases of fibromatosis and 11 cases of massive oedema . The similar age range and clinical manifestations of these two processes and the overlap in their histological features suggest that they are closely related and may reflect differing morphologic expressions of the same underlying disorder. Some of the cases of massive oedema, however, may result from the development of stromal oedema in ovaries involved by hyperthecosis .
Primary massive ovarian oedema is a rare clinical condition, occurring in young women, with an absence of any pathognomonic clinical features, as it resembles an ovarian cyst with or without torsion, pain in the abdomen being the commonest presentation. Radiological imaging in most of the situations can be ambiguous, with addition of tumour markers such as S-βhcg, LDH, CA-125, AFP; the differential diagnosis can be scaled down, differentiating the condition from dysgerminomatous and mixed germ cell tumours. However, an intraoperative frozen section can assist in performing a fertility-sparing surgery, which will have a bearing on her future reproduction.
An extensive search of the literature regarding the management of massive ovarian oedema reveals that, the majority of the women had been over treated with salpingo-oophorectomy on the mistaken pretext of an association with malignancy [2–10], similar to our institutional experience of the first three patients who also underwent a unilateral salpingo-oophorectomy. Data supporting conservative treatment in massive ovarian oedema advocate a strong degree of clinical suspicion when women in the reproductive age group present with painful abdomen, radiological evidence of multiple peripheral ovarian follicles in a solid ovarian tumour-like mass and normal biochemical tumour markers. Definitive surgical treatment should be undertaken only after confirmed pathological diagnosis [8, 28]. The role of frozen section needs to be emphasised in preventing unnecessary catastrophic reproductive outcomes. However, the chance of recurrence is a matter of concern although the chance is remote as discussed by Elkins et al . The role of wedge resection, when massive ovarian oedema is suspected, involves removal of 30% or more of the ovarian volume to exclude secondary causes of the condition, and the possibility of adhesions needs to be weighed as against the complete removal of the ovary as a cause of fertility issues as discussed by Daboubi et al . The successful treatment of massive ovarian oedema by laparoscopy is reported by various authors [30–33]. Laparoscopy with its double advantage of both diagnostic and therapeutic value is a possible option. If the ovary is enlarged and appears grey due to twisted pedicle and intact capsule, it would be prudent to detort the pedicle allowing the ovary to regain its vitality and then perform an ovarian biopsy followed by fixation of the ovary the posterior aspect of the uterus, which has been recommended in the presence of torsion, hence conserving the ovarian tissue and preventing a further episode of torsion. Following the conservative procedure, Hubbell et al  recommend the use of oral contraceptive therapy for a few months during the follow-up period, which may be beneficial in cases of massive ovarian oedema without the evidence of torsion.
Medical management would not be a practical option as the diagnosis of massive ovarian oedema is usually retrospective and there are no known medical methods available to manage this condition. A minimum of wedge resection with frozen section for confirmation of the diagnosis would be mandatory. Although wedge resection might negatively affect fertility at least in some cases due to the development of adhesions, this would be better than complete extirpation of the ovary. Hence, we were more conservative in our approach for the fourth woman in our study .We performed a frozen section and once the diagnosis of massive ovarian oedema was made, an ovarian decompression by ovarian drilling followed by wedge resection and reconstruction of the distorted ovary with redundant capsule close to normal was performed with great success.
Massive ovarian oedema is a rare gynecologic condition in women in the reproductive age group. Due to the absence of pathognomonic clinical, radiological or biochemical characters, the role of intraoperative frozen section needs to be emphasised, which can guide a clinician to perform fertility-sparing procedures such as ovarian detorsion, ovarian drilling and decompression of the fluid, wedge resection, ovarian reconstruction with or without ovarian fixation procedures, hence preserve hormonal functions and fertility in these young women.
Conflict of interest
The authors declare that they have no conflict of interest.
Dr. Praveen was involved in manuscript preparation, article design, analysis, patient care, reference hunting and final editing. Dr. Pallavi was involved with patient care and editing the manuscript. Dr Rajashekar was involved with patient care and editing the manuscript. Dr Usha was involved in histopathological diagnosis and reporting. Dr Uma Devi was involved with patient care and editing the manuscript. Dr Bafna played a key role in manuscript preparation, article design, the final corrections and editing the manuscript.
We thank Dr Sapna, Dr Shakuntala, Dr Ravi, Dr Shobha, Dr Abhilasha, Dr Anbukanni for their input in patient care and Dr Geetashree for histopathological microphotographs. We thank our senior nursing staff Mrs Padma and her team whose dedication helped our patients to recover uneventfully during the postoperative period.
2. Roth LM, Tsubara A, Dietel M and Senzaki H (2003) Miscellaneous tumors and tumor-like conditions of the ovary In: Tavassoli FA and Devilee P, eds. Pathology and Genetics of Tumors of the Breast and Female Genital Organs, World Health Organization Classification of Tumors, vol. 5 (IARC Press: Lyon) pp 182–90
3. Natarajan A, Wales JK, Marven SS and Wright NP (2004) Precocious puberty secondary to massive ovarian edema in a 6-month-old girl Eur J Endocrinol 150(2) 119–23 DOI: 10.1530/eje.0.1500119 PMID: 14763908
5. Guvenal T, Cetin A and Tasyurt A (2001) Unilateral massive ovarian edema in a woman with polycystic ovaries Eur J Obstet Gynecol Reprod Biol 99(1) 129–30 DOI: 10.1016/S0301-2115(01)00362-1 PMID: 11604203
7. Coakley FV, Anwar M, Poder L, Wang ZJ, Yeh BM and Joe BN (2010) Magnetic resonance imaging of massive ovarian edema in pregnancy J Comput Assist Tomogr 34(6) 865–7 DOI: 10.1097/RCT.0b013e3181efdfaa PMID: 21084901
8. Geist RR, Rabinowitz R, Zuckerman B, Shen O, Reinus C, Beller U et al (2005) Massive edema of the ovary: a case report and review of the pertinent literature J Pediatr Adolesc Gynecol 18(4) 281–4 DOI: 10.1016/j.jpag.2005.05.008 PMID: 16171733
10. Siller BS, Gelder MS, Alvarez RD and Partridge EE (1995) Massive edema of the ovary associated with androgenic manifestations South Med J 88(11) 1153–5 DOI: 10.1097/00007611-199511000-00015 PMID: 7481990
12. Gehrig PA, Fowler WC Jr and Lininger RA (2000) Ovarian capillary hemangioma presenting as an adnexal mass with massive ascites and elevated CA-125 Gynecol Oncol 76(1) 130–2 DOI: 10.1006/gyno.1999.5648 PMID: 10620457
13. Hameed A, Ying AJ, Keyhani-Rofagha S, Xie D and Copeland LJ (1997) Ovarian mucinous cystadenoma associated with mural leiomyomatous nodule and massive ovarian edema Gynecol Oncol 67(2) 226–9 DOI: 10.1006/gyno.1997.4867 PMID: 9367713
14. Khalbuss WE and Dipasquale B (2006) Massive ovarian edema associated with ovarian serous cystadenoma: a case report and review of the literature Int J Gynecol Cancer 16(Suppl 1) 326–30 DOI: 10.1111/j.1525-1438.2006.00368.x
15. Lakhey M, Upreti D, Kulshrestha R and Rani S (2003) Massive ovarian edema with contralateral mature cystic teratoma–a case report of an uncommon combination Indian J Pathol Microbiol 46(2) 219–21 PMID: 15022916
19. Krasevic M, Haller H, Rupcic S and Behrem S (2004) Massive edema of the ovary. A report of two cases due to lymphatic permeation by metastatic carcinoma from the uterine cervix Gynecol Oncol 93(2) 564–7 DOI: 10.1016/j.ygyno.2004.02.015 PMID: 15099983
23. Umesaki N, Tanaka T, Miyama M, Nishimura S, Kawamura N and Ogita S (2000) Successful preoperative diagnosis of massive ovarian edema aided by comparative imaging study using magnetic resonance and ultrasound Eur J Obstet Gynecol Reprod Biol 89(1) 97–9 DOI: 10.1016/S0301-2115(99)00185-2 PMID: 10733033
25. Yamashiro T, Inamine M, Kamiya H, Kinjo A, Murayama S and Aoki Y (2008) Massive ovarian edema with torsion: unusual hemorrhage and the recovery of contrast enhancement Emerg Radiol 15(2) 115–8 (Epub 2007 Jun 26) DOI: 10.1007/s10140-007-0648-3
26. Lifschitz-Mercer B, Gabbiani G, Gal R, Siegal A and Czernobilsky B (1996) Phenotypic modulation of fibroblasts in massiveovarianedema: an immunohistochemical study of three cases J Submicrosc Cytol Pathol 28(4) 435–40 PMID: 8933730
27. Young RH and Scully RE (1984) Fibromatosis and massive edema of the ovary, possibly related entities: a report of 14 cases of fibromatosis and 11 cases of massive edema Int J Gynecol Pathol 3(2) 153–78 DOI: 10.1097/00004347-198402000-00005 PMID: 6490313
32. Cheng MH, Tseng JY, Suen JH and Yang CC (2006) Laparoscopic plication of partially twisted ovary with massive ovarian edema J Chin Med Assoc 69(5) 236–9 DOI: 10.1016/S1726-4901(09)70226-6 PMID: 16835988

domain: literature


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Please show your support for the Alisa Ann Ruch Burn Foundation by attending their annual North Bay Firefighters Burn Relay on Friday, May 14th. The relay will run from Healdsburg to Marin City. Proceeds will go towards fire safety education programs and youth summer camps.
For more information: Jessica Derrick email@example.com, 1-800-755-BURN
The Alisa Ann Ruch Burn Foundation (AARBF) is a California-based nonprofit organization dedicated to preventing burns and fires and providing services to those who have been affected by a burn injury. For more information about the Foundation and how you can help, please visit www.aarbf.org

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AN Israeli athlete who was castrated and killed by terrorists at the 1972 Munich Olympics can at last enter a “complete rest”, his widow has told The AJN after winning a 45-year fight for a memorial.
Ilana Romano, the widow of weightlifter Yossef Romano, spoke soon after returning home to Tel Aviv from Munich for the opening of a commemoration centre in the place where 11 Israelis were taken hostage by the Black September Palestinian terror group.
“It was emotional, truly emotional – we waited 45 years for this,” said Romano, recalling how for decades the request by bereaved families for a memorial was met with antagonism from German officials.
“At first they said, ‘what do you want of Germany,’ and they spoke of the terrorists as freedom fighters not terrorists.”
The Germans redeemed themselves with the opening of the new memorial, in the eyes of Romano and other relatives of athletes.
“It is high time and we owe it firstly to you, the relatives,” said German President Frank-Walter Steinmeier.
“The Olympic village became a place of Palestinian terrorists, a stage for their boundless hatred for Israel. It should never have happened.”
The struggle for proper commemoration has often been an uphill one – and one which Australian Jews have rushed to support. In 2012 large numbers of AJN readers signed letters to the International Olympic Committee calling for a minute’s silence dedicated to Munich victims during the opening ceremony of the London games.
To the disappointment of families, the IOC did not agree.
However, it did help with the cost of the new Munich memorial, and committee president Thomas Bach gave a speech at the ceremony.
“I know that no ceremony and no memorial can fill the void left by those whose lives were taken so violently,” he said.
“It is my sincere hope, however, that the memorial we opened this morning will be a symbol of our shared grief; will be a tool of education for us and for future generations; will be a demonstration of our determination to defend our Olympic values of peace and tolerance.”
The opening of the new memorial felt like a real watershed moment, Romano said.
“The deceased were given a respect they were never given before,” she commented, adding that she “never returned home before as I returned home now – with all the hurt in my heart but also a real joy.”
At the ceremony, Israel’s President Reuven Rivlin said that the memorial is important – but the commemoration fight isn’t over.
“For 45 years, almost half a century, the victims’ families and the State of Israel looked expectantly for this moment: the inauguration of a centre of remembrance and a memorial in the Olympic Village,” said Rivlin.
“Some of the delegation who survived the massacre are sadly no longer alive – indeed just a month ago, weightlifter Tuvia Sokolsky passed away – and still we are waiting for injustice to be rectified, that there will be a minute’s silence at the opening ceremony of the Olympic Games.”


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Make a difference in the challenge to confront global warming and prevent nuclear war and the development and use of nuclear weapons.
The Papal Encyclical calls all of us to protect life and the planet! Write a Letter to the Editor and stand in solidarity with the Pope's call for climate action.
Chicago Tribune Investigation Reveals Deceptive Chemical Industry Tactics Promoting Toxic Flame Retardant Chemicals
May 7, 2012
"Scientific evidence is exhaustive, yet the flame retardant industry continues to deceive the public and policymakers," says Martha Dina Arguello of Physicians for Social Responsibility-LA. Source: Californians For Toxic Free Fire Safety
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without Internet Explorer,
in 1280 x 960 resolution
|1.||City of Stone||01:46||Show lyrics|
|3.||Dear Shit Book||01:11||Show lyrics|
|4.||Short Term Goals, Long Term Disappointments||02:14||instrumental|
|6.||Make Your Grave||01:30||instrumental|
Co-Released by Capital Kill.
Enhanced multimedia section includes 2 additional audio tracks:
7. 132 and the Evil Jesus (9:27)
8. Armageddon Waltz (2:00)
Drums and bass recorded on November 12th, 2004 at June Music Studio.
Everything else recorded in November and December, 2004 at the House of Fuck.
Mixed and mastered in early 2005 at CB Audio.
Enhanced tracks created and recorded sometime in 1997.

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For the 2020 model year, our favorite subcompact executive coupe was completely remodeled. Retaining its four-door coupe fastback style, the second-generation 2020 Mercedes-Benz CLA makes an excellent option for any luxury shopper looking for something small here in the Hilton Head area. Inside and out, the 2020 CLA is an incredible vehicle packed full of premium features and sophisticated design cues.
This year, the Mercedes-Benz CLA is available in four different models. They include the CLA 250 Coupe, CLA 250 4MATIC Coupe, AMG CLA 35 Coupe and the AMG CLA 45 Coupe.
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PULLMAN, Wash. — Scott E. Carson, who is responsible for the financial
management of the world’s largest producer of commercial airplanes, will
deliver a lecture, “Leading from the Top,” at 3 p.m. Tuesday, Nov. 16, in Todd
Hall, Room 276 on the Washington State University Pullman campus. Carson is
executive vice president and chief financial officer of Boeing Commercial
Carson is this fall’s DeYoung Executive-in-Residence at the WSU College of
Business and Economics. He graduated from the college in 1972 with a
bachelor’s degree in business administration.
He will also visit several classes in the college on Tuesday and Wednesday,
and will lunch with students in the MBA program.
Carson joined Boeing in 1973 as a financial analyst on the B-1 bomber avionics
program, and held several management positions over the years. Today, he
oversees the finance organization for the company as well as the functions of
program management, information systems and facilities.
Before his current position, he served as executive vice president of business
resources for Boeing Information, Space and Defense Systems, where he was
responsible for finance, business planning, business ethics and conduct,
communications, customer relations, contracts, information systems, people
processes and skills, and program management.
The DeYoung Executive-in-Residence program was established in 1973 and is
sponsored by the Dennis DeYoung family of Kirkland. The program brings
prominent national and regional business leaders to campus in fall and spring
to discuss corporate life from their perspective, and to interact with the

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News from The Business Journals
May 17, 2013, 3:29 pm EDT
Regions Financial Corp. (NYSE: RF) held on to its spot in April as the top employer with the most job openings in the Birmingham-Hoover metro area.
May 17, 2013, 10:35 am EDT
The unemployment rate for the state of Alabama fell to 6.9 percent for April from 7.2 percent in March, according to the latest report from the Alabama…
Apr 22, 2013, 4:55 pm EDT
Regions Financial Corp., Brookwood Medical Center and The University of Alabama had the most job openings posted in the Birmingham-Hoover metro area for…
Apr 19, 2013, 10:54 am EDT
Alabama’s unemployment rate held steady at 7.2 percent for March, unchanged from the previous month and the same period the prior year, according to…
Apr 8, 2013, 12:50 pm EDT
Alabama is losing nine weeks of federal Emergency Unemployment Compensation benefits due to its lower unemployment rate, the Alabama Department of Labor…
Apr 4, 2013, 11:03 am EDT
The approximately 16,500 Alabamians who are receiving emergency unemployment compensation can expect to see a 12.8 percent reduction in their weekly benefits…
Apr 1, 2013, 5:31 pm EDT
The Alabama Department of Labor released data showing which companies increased the number of job openings in the metro area, as I previously reported.
Apr 1, 2013, 3:29 pm EDT
Several employers in the Birmingham-Hoover metro area have increased the number of job openings at their companies, according to new data released by the…
Mar 29, 2013, 10:58 am EDT
Alabama’s unemployment rate was 7.2 percent for February, up from January’s rate of 6.9 percent and equal to February 2012’s adjusted rate, according…
Mar 18, 2013, 10:46 am EDT
Alabama’s unemployment rate was 6.9 percent for January, the second month it has fallen below 7 percent, according to the Alabama Department of Labor.
Mar 7, 2013, 2:01 pm EST
Planning to look for a job in the next decade? You should probably be looking in the health care and technology sectors.
Those fields dominate our new…
Jan 18, 2013, 1:03 pm EST
Alabama’s unemployment rate fell to 7.1 percent in December, according to the Alabama Department of Labor.
It was below November’s rate of 7.5 percent…
Dec 21, 2012, 11:08 am EST
The unemployment rate in Alabama fell to 7.5 percent in November as employment in the state grew by about 11,000, according to data from the Alabama Department…
Nov 16, 2012, 11:20 am EST
Alabama’s unemployment rate dipped to 8.1 percent in October from the previous month’s revised rate of 8.2 percent and the prior year’s rate of 8.5…
Oct 19, 2012, 10:30 am EDT
The unemployment rate in Alabama fell to 8.3 percent in September, according to the Alabama Department of Labor.
That's down from 8.5 percent in August.

domain: finance


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PG&E Power Lines Sparked Deadliest Wildfire in California History, Investigation Confirms
Power lines owned by Pacific Gas and Electric were the immediate cause of the deadliest and most destructive wildfire in California state history, a California Department of Forestry and Fire Protection (Cal Fire) investigation concluded Wednesday, The New York Times reported.
"After a very meticulous and thorough investigation, CAL FIRE has determined that the Camp Fire was caused by electrical transmission lines owned and operated by Pacific Gas and Electricity (PG&E) located in the Pulga area," Cal Fire concluded.
The investigation uncovered two ignitions related to PG&E lines: the first near the community of Pulga in Butte county and the second at the intersection of Concow and Rim Roads. The latter was caused by an interaction between vegetation and electrical distribution lines. Cal Fire is passing the results of the investigation along to Butte County District Attorney Mike Ramsey.
PG&E said it accepted the results of the investigation in a statement reported by CNBC. The company had already acknowledged in a February regulatory filing that its lines were the "probable" cause of the blaze. The company filed for bankruptcy protection in January after a number of lawsuits stemming from wildfires in Northern California in 2017 and 2018. It could face criminal charges, including murder or involuntary manslaughter.
"Our hearts go out to those who have lost so much, and we remain focused on supporting them through the recovery and rebuilding process," the company said in a statement reported by The Washington Post. "We also want to thank the brave first responders who worked tirelessly to save lives, contain the Camp Fire and protect citizens and communities."
The company had previously said it would increase tree-trimming, maintenance and inspections in response to the heightened threat of wildfires. But survivors of the fire and their lawyers have criticized the company for filing for bankruptcy, according to The New York Times.
"If I caused the fire, I wouldn't be able to file bankruptcy and I wouldn't be able to make other people pay for it," Randi Hall, who lost her Paradise home to the Camp fire and now lives in a recreational vehicle, told The New York Times in an interview last week. "Why does a company that has so many millions of dollars in insurance get to do it?"
Ramsey's office said the forwarding of the most recent investigation was "strictly symbolic," according to a statement reported by CNBC.
"The fact the Camp Fire was started by a malfunction of equipment on a Pacific Gas & Electric Company transmission line has been known for months by investigators and had been, essentially, admitted by Pacific Gas & Electric in an early December 2018 report to the California Public Utility Commission," the statement said. "The investigation into how and why the PG&E transmission line equipment failed is ongoing in an effort to determine if PG&E or any of its personnel have any criminal liability."
In its report, Cal Fire also acknowledged the role of climate conditions in spreading the blaze.
"The tinder dry vegetation and Red Flag conditions consisting of strong winds, low humidity and warm temperatures promoted this fire and caused extreme rates of spread," the investigation said.
There were more than 7,571 wildfires in California in 2018 that burned more than 1.8 million acres.
EcoWatch Daily Newsletter
A jury in Missouri awarded a farmer $265 million in a lawsuit that claimed Bayer and BASF's weedkiller destroyed his peach orchard, as Reuters reported.
A coalition of local and national groups on Friday launched a legal challenge to a Louisiana state agency's decision to approve air permits for a $9.4 billion petrochemical complex that Taiwan-based Formosa Plastics Group plans to build in the region nationally known as "Cancer Alley."
Well, he told us he would do it. And now he's actually doing it — or at least trying to. Late last week, President Trump, via the U.S. Department of the Interior's Bureau of Land Management, announced that he was formalizing his plan to develop lands that once belonged within the Bears Ears and Grand Staircase-Escalante National Monuments in southern Utah. The former is a stunningly beautiful, ecologically fragile landscape that has played a crucial role in Native American culture in the Southwest for thousands of years; the latter, just as beautiful, is one of the richest and most important paleontological sites in North America.


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17th Annual Anesthesiology Journal Symposium: A Precarious Breath: Diagnosis and Management of Difficult Airways and Obstructive Sleep Apnea
Tuesday, October 21, 2008, 8:00 am to 11:00 am, Orange County Convention Center, Chapin Theater, Orlando, Florida
The 17th Annual Journal Symposium will be a multifaceted session that explores the latest scientific investigations of the human airway, how to predict and determine which airway may be difficult to manage, the physiologic manifestations and consequences of obstructive sleep apnea (OSA), and concepts in the perioperative management of OSA. Although many anesthetic techniques and devices have been developed to overcome the obstacles presented by the difficult airway, few have investigated the nature of the difficult airway and identified those factors that transform the easy airway into one that is difficult. At this Symposium, key factors that make the difficult airway difficult will be discussed. OSA has been a disorder few in the pediatric realm have considered serious until a striking relation between chronic intermittent nocturnal hypoxia and sleep-disordered breathing was recognized. The notion that sleep-disordered breathing may modulate opioid sensitivity in children has opened a whole host of concerns that will be addressed in this session. The pathophysiology and management of OSA in adults will be addressed, challenging current dogma and presenting new concepts. Each of the three lecturers will highlight the best science available to support their recommendations for optimally managing these challenging issues.
Presentations at the Symposium by our three invited lecturers, and interactive discussion with the authors of the selected scientific posters will address many of these questions regarding the factors that make a difficult airway difficult and OSA. The Symposium will be facilitated by Journal Editors Jerrold Lerman, M.D., from Women and Children's Hospital of Buffalo, State University of New York at Buffalo, Buffalo, New York, and University of Rochester, Rochester, New York; and Evan D. Kharasch, M.D., Ph.D., from Washington University, St. Louis, Missouri. The three invited speakers for this symposium are
Shiroh Isono, M.D., Associate Professor of Anesthesiology, Graduate School of Medicine, Chiba University, Chiba, Japan: “Why Is This Difficult Airway Difficult?”
Karen Brown, M.D., F.R.C.P.C., Professor of Anesthesia, Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada: “Hypoxia and Opioid Sensitivity in Children”
B. Tucker Woodson, M.D., F.A.C.S., Professor and Chief, Division of Sleep Medicine, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Director of the Froedtert Memorial Lutheran Hospital/Medical College of Wisconsin Sleep Disorders Program, Milwaukee, Wisconsin: “Diagnosis and Perioperative Implications of Obstructive Sleep Apnea”
These lectures will be followed by a walk-around poster discussion of eight posters selected for their relevance to the Symposium topics of the difficult airway and OSA. The text for each abstract can be found at the American Society of Anesthesiologists (ASA) abstract Web site or in the CD-ROM that is included in this issue of the Journal.
“Importance of the ASA Task Force Airway Management Risk Factors in Predicting Difficult Intubation” by Ling Qun Hu, R. Michael Boyer, R-Jay Marcus, Philip Robles, Robert J. McCarthy, Northwestern University Feinberg School of Medicine, Chicago, Illinois. The authors investigated the contribution of each of the 11 variables identified by the ASA Airway Task Force as predictors of a difficult airway. Based on the limited sample size, they determined that limited neck motion was a substantive risk factor. [A1242]
“Incidence, Predictors, and Management of Impossible Mask Ventilation (IMV): A Review of 40,000 Anesthetics” by Sachin Kheterpal, Lizabeth Martin, Amy Shanks, Kevin K. Tremper, University of Michigan, Ann Arbor, Michigan. The authors conducted a 4-yr prospective study to address the incidence, predictors, and management of IMV. They determined 70 cases (0.15% incidence) of IMV with four variables as predictors of IMV: male, Mallampati 3 or 4, history of sleep apnea, and neck radiation. Airway management was difficult, although only two required a surgical airway. [A1243]
“Incidence of a Difficult Airway in 19,500 Children Aged 0–17 Yr” by Juergen Schmidt, Thea Koch, University Clinics Dresden, Dresden, Germany. The incidence and severity of the difficult airway in children is poorly understood. A retrospective review of an 8-yr experience in 19,500 children demonstrated the greatest incidence of difficult airway in the neonate/infant (0.57%) with greater incidence in toddlers than in older children and adults. Most airways were managed successfully with a mask and/or laryngeal mask airway. [A1244]
“High Resolution Pulse Oximetry (HRPO) Detects Airway Obstruction: Screening Implications for OSAS” by Frank J. Overdyk, Haley E. Moore, Philip Rust, Andrew Chickoree, Qanta Ahmed, Medical University of South Carolina, Charleston, South Carolina. HRPO is a new variant on the pulse oximeter that provides a greater resolution, improved sampling rates and possibly identification of desaturation patterns in patients with obstructive sleep apnea syndrome (OSAS) who have not had a sleep study. This device seems to detect airway obstruction as evidenced by polysomnography and may provide a portable, at-home screen/monitor for OSAS. [A1245]
“Postoperative Events in Patients at Risk for Obstructive Sleep Apnea Undergoing Elective Surgery” by Bhargavi Gali, Francis X. Whalen, Darrell R. Schroeder, Mayo Clinic, Rochester, Minnesota. The authors sought to determine whether a screening test for OSA could predict postoperative and cardiorespiratory events that occurred after the postanesthesia care unit (PACU). They also determined whether respiratory events in the PACU could foretell post-PACU events. They concluded that this prospective cohort study demonstrated that both the preoperative screening and recurrent PACU respiratory events predicted a greater risk for desaturation and respiratory complications after PACU. [A1246]
“Derivation of a Simple Preoperative Sleep Apnea Prediction Score (P-SAP Score)” by Satya Krishna Ramachandran, Sachin Kheterpal, Amy Shanks, Tara Doherty, Kevin K. Tremper, University of Michigan, Ann Arbor, Michigan. The purpose of this study was to identify clinical predictors of OSA and to develop a model to predict OSA when sleep studies were not available. The results suggest that a model to predict OSA should include a history of snoring, diabetes mellitus, hypertension, male sex, age older than 43 yr, obesity, thick neck, Mallampati 3 or 4, and thyromental distance less than 6 cm. [A1247]
“Postoperative Complications in Patients with Obstructive Sleep Apnea, a Case–Control Study” by Frances Chung, Pu Liao, Balaji Yegneswaran, Santhira Vairavanthan, Toronto Western Hospital, Toronto, Ontario, Canada. In this retrospective case-controlled study, the authors sought to determine the incidence of perioperative respiratory complications in adults with OSA. They found that adults with OSA developed significantly greater incidence of respiratory complications that often required additional interventions. [A1248]
“Boussignac CPAP Immediately following Extubation Improves Lung Mechanics in Morbidly Obese Patients” by Patrick J. Neligan, Guarav Malhotra, Michael Fraser, Maurizio Cereda, Edward A. Ochroch, University of Pennsylvania, Philadelphia, Pennsylvania. The authors investigated the potential role for the Boussignac portable continuous positive airway pressure (CPAP) device immediately after extubation of morbidly obese patients after laparoscopic bypass surgery to attenuate the incidence of perioperative respiratory complications. They demonstrated that the Boussignac CPAP device improved spirometry during the first 24 postoperative hours. [A1249]
Best Abstracts of the Meeting: Anesthesiology Editors' Picks
Monday, October 20, 2008, 8:00 am to 10:00 am, Orange County Convention Center, Room W230A, Orlando, Florida
New this year is a session sponsored by Anesthesiology of abstracts selected by Drs. James C. Eisenach and Mark A. Warner as being of broad interest and scientific importance. These were selected from the top-rated abstracts as scored by each scientific subcommittee charged with choosing abstracts for presentation at the Annual Meeting. This session highlights 10 outstanding abstracts, which will be presented in traditional oral format followed by a brief discussion.
“Anesthetic Technique and the Cytokine Response to Primary Breast Cancer Surgery” by Catherine A. Deegan, Donal J. Buggy, Denis C. Moriarty, Daniel I. Sessler, Brian P. Kavanagh, Mater Misericordiae University Hospital, Dublin, Ireland. Breast cancer, a common malignancy, is often treated primarily with surgery. There is clinical evidence suggesting that choice of anesthetic technique may alter the immune response to surgery and the success of this primary treatment. These investigators examined the effect of surgery on circulating cytokines in 32 women undergoing breast cancer surgery who were randomly assigned to sevoflurane general anesthesia plus postoperative opioid analgesia, or to paravertebral nerve blockade supplemented with propofol anesthesia. They observed that paravertebral block favorably influenced this cytokine response, with greater increases in interleukin (IL) 10, thought to be antitumorigenic, and decreases in IL-1β and IL-8, thought to be tumorigenic, compared with general anesthesia. Ongoing studies by this and other groups may help to guide the choice of anesthetic technique for cancer surgery and improve long-term outcome and survival. [A841]
“Preoperative Executive Function and Depression Predict Postoperative Delirium” by Nathaniel H. Greene, Deborah K. Attix, Stephanie L. Macy, Terri G. Monk, Duke University School of Medicine, Durham, North Carolina. Postoperative delirium increases morbidity and mortality. The risk factors for this acute problem may be overlapping but unique compared with those of postoperative cognitive dysfunction. These investigators performed extensive preoperative testing of 52 patients scheduled to undergo major noncardiac surgery with general anesthesia, and 7 of these patients developed postoperative delirium. The presence of preoperative depression and lower performance on an executive task that measured sequencing and cognitive flexibility were independent predictors of postoperative delirium. Larger population studies built on these observations may lead to guidelines for preoperative screening and interventions to minimize the incidence of postoperative delirium. [A842]
“Mechanisms of Induction of Ischemic Tolerance with Erythropoietin” by Steven Roth, John C. Dreixler, Afzhal R. Shaikh, Daniel M. Rosenbaum, University of Chicago, Chicago, Illinois. Perioperative ischemic optic neuropathy remains a devastating problem. This research builds on original observations by this group that cytokine erythropoietin can protect against such ischemic injury. They showed that protection against ischemic injury to the retina by a preceding brief period of ischemia (ischemic preconditioning) can be prevented by scavenging erythropoietin in the eye. They also found that erythropoietin caused this protection by a pathway involving Akt2, but not by mitochondrial adenosine triphosphate–sensitive potassium channels. Further study on the mechanisms of erythropoietin against ischemic optic neuropathy may lead to preventive strategies for this crippling clinical problem. [A843]
“Antibody Blockade of Potassium Channels in the Thalamus Reverses Desflurane-induced Unconsciousness” by Michael T. Alkire, Amanda M. Franciscus, Emily L. Hahn, University of California at Irvine, Irvine, California. Loss of consciousness from general anesthetics most likely occurs by actions at many sites and mechanisms but may involve a few key circuits. This group of investigators, who have pioneered the role of the central medial thalamic nucleus as one of those key circuits, examined the effects of Kv1.2 potassium channels at this site in hypnosis induced by sevoflurane. They chose this target because of its importance in the regulation of the natural sleep state and selectively blocked the activity of these channels by microinfusing specific antibodies to them in the central medial thalamic nucleus of sevoflurane anesthetized rats. If the injection was placed within 1 mm of this nucleus, consciousness was temporarily restored for several minutes despite the continued presence of the anesthetic. These studies add further to our understanding of key regulators of consciousness in this circuit and their interaction with general anesthetics. [A844]
“Epidemiology of Anesthesia-related Deaths in the United States, 1999–2004” by Guohua Li, Margaret Warner, Barbara Lang, Lin Huang, Lena Sun, Columbia University, New York, New York. The rarity of anesthesia-related deaths renders study of risk factors difficult, particularly because most data are captured by case reports, closed claims, or data from individual hospitals. These authors screened the International Classifications of Diseases codes to identify those specifically attributed to anesthesia and applied them to a census of death certificates maintained by the National Center for Health Statistics over the 1999–2004 time period. There were more than 300 deaths per year related to anesthesia, with 11% of these listing anesthesia as the underlying cause of death and the remainder listing anesthesia as a contributing cause. Nearly half of the anesthesia-related deaths were attributed to an overdose of anesthetics, and the anesthesia-related mortality rate, twice as great for men as for women, increased markedly after age 65 yr. This study provides a standard methodology for prospectively examining anesthesia-related deaths and helps to define key components of the causes of such deaths. [A845]
“Causes of Mortality after Noncardiac Surgery: Interrelationship Between Beta Blockers and Anemia” by Nasser Al Kemyani, Keyvan Karkouti, Duminda Wijeysundera, Gregory Hare, W. Scott Beattie, Toronto General Hospital, Toronto, Ontario, Canada. Mortality after noncardiac surgery exceeds 2% in many studies, and the role of perioperative β blockade to reduce cardiac related mortality is uncertain. Using propensity analysis, these investigators examined the role of perioperative β blockade and its interaction with hemoglobin concentration in 90-day mortality after noncardiac surgery in 5,000 patients. They found that β blockade and anemia were independent risk factors for a composite outcome of death and myocardial infarction. Propensity analysis showed an increased risk of this outcome, particularly when patients who were given β-blockers had postoperative decreases in hemoglobin more than 30%. The authors speculated that β blockade prevented one or more of the compensatory responses to acute anemia. [A846]
“Estrogen Is Renoprotective in Cardiac Arrest” by Takaaki Nakano, Patricia Hurn, Michael Hutchens, Oregon Health and Science University, Portland, Oregon. Anesthesiologists have led research for several decades in resuscitation and improving outcome after resuscitation. These researchers have previously shown that acute kidney injury after cardiac arrest is less common and less severe in females than in males, and that estrogen is the mediating factor. In this study, they showed that acute kidney injury after potassium chloride–induced cardiac arrest and resuscitation was reduced by estrogen supplementation in ovariectomized mice, and that the degree of protection was greater if the supplementation reached physiologic concentrations of estrogen. These results are important in understanding the modulatory role of estrogen on injury to the kidney after cardiac arrest and could potentially lead to novel approaches for the prevention of such injury. [A847]
“Natriuretic Peptide Gene Variants Independently Predict Ventricular Dysfunction after CABG Surgery” by Amanda A. Fox, Charles D. Collard, Stanton K. Shernan, Kuang-Yu Liu, Simon C. Body, Brigham and Women's Hospital, Boston, Massachusetts. Severe ventricular dysfunction affects nearly 1 in 8 patients undergoing primary coronary artery bypass graft surgery and is associated with increased morbidity and mortality. These authors investigated polymorphism in the genes coding natriuretic peptides synthesized by myocytes in response to increased wall tension and noted previously as independent markers for postoperative ventricular dysfunction. Using single nucleotide polymorphism analysis of more than 600 patients undergoing primary coronary artery bypass grafting, they observed that genetic variation in the genes for natriuretic peptides independently predicted in-hospital severe ventricular dysfunction. This study carries important implications for preoperative testing and therapeutic intervention to assess risk and potentially decrease the incidence of severe ventricular dysfunction, respectively, after this surgery. [A848]
“Immediate Postoperative Noninvasive Ventilation Improves Lung Mechanics following Bariatric Surgery” by Patrick J. Neligan, Gaurav Malhotra, Michael Fraser, Maurizio Cereda, Edward A. Ochroch, University of Pennsylvania, Philadelphia, Pennsylvania. Laparoscopic bariatric surgery in morbidly obese patients is associated with an increased risk of perioperative pulmonary complications due to the morbid obesity in these patients. This study examined whether the timing of biphasic positive airway pressure (BiPAP) application affected pulmonary function after this surgery. Forty morbidly obese patients were randomly assigned to receive BiPAP beginning in the operating room immediately after endotracheal extubation, or beginning in the postanesthesia care unit 30 min later, a common clinical practice. They observed a postoperative reduction in pulmonary function as measured by spirometry in both groups, but a clinically relevant lesser reduction in patients who received BiPAP in the operating room immediately after endotracheal extubation. These data suggest the need for larger studies to determine whether even a short delay in ventilatory support after surgery in morbidly obese patients increases their risk of pulmonary complications. [A849]
“A Novel Pharmacologic Strategy to Potentiate Relaxation of Human Airway Smooth Muscle” by George Gallos, Yi Zhang, Sang-Woo Pak, Jay Yang, Charles W. Emala, College of Physicians and Surgeons of Columbia University, New York, New York. Reactive airway disease remains a problem in the perioperative period, and previous research by this group demonstrated the presence of ionotropic γ-aminobutyric acid type A (GABAA) channels on airway smooth muscle cells, which might be harnessed to produce airway relaxation. In this study, they used guinea pig tracheal rings and human airway smooth muscle to show that muscimol, a GABAAagonist, potentiated the relaxant effects of the β-adrenoceptor agonist isoproterenol. These data support the development of a novel treatment for severe bronchospasm using GABAAagonists. [A850]
Anesthesiology/FAER Session: Anesthesia and the Developing Brain: Implications for Obstetrics and Pediatrics
Tuesday, October 21, 2008, 1:00 pm to 3:00 pm, Orange County Convention Center, Room W230A, Orlando, Florida
Recent findings suggest that commonly used general anesthetics and hypnotics may cause detrimental effects to the immature mammalian brain manifested as developmental neuroapoptosis and long-lasting cognitive deficits. The focus of our discussion will be on clinical and laboratory studies of the effects of anesthetics administered during neonatal life and young childhood on brain development and cognitive function. The Session will be moderated by
Vesna Jevtovic-Todorovic, M.D., Ph.D., Harold Carron Professor of Anesthesiology and Neuroscience, University of Virginia Health System, Charlottesville, Virginia: “General Anesthetics-neurotoxins for the Developing Brain”
Lena S. Sun, M.D., Professor of Anesthesiology and Pediatrics, Vice Chairman, Columbia University, New York, New York: “Clinical Studies of Anesthetic Neurotoxicity: Past, Present, and Future”
Piyush M. Patel, M.D., Professor of Anesthesiology, University of California, San Diego, San Diego, California: “tPA Reduces Isoflurane Induced Neuronal Apoptosis and Dendritic Spines Loss in Rat Neonatal Neurons”
“Effects of Isoflurane on Hippocampal Neurogenesis in Neonatal Rats” by Greg Stratmann, Kavel Visrodia, Laura May, Jeffrey W. Sall, Yohan Shin, University of California at San Francisco, San Francisco, California. Exposure of neonatal rats to isoflurane at 7 days of age reduced the number of new neurons in the dentate gyrus of the hippocampus acutely and 4 h after exposure. However, there was no difference in neurogenesis 32 days after exposure. Whether this transient suppression of neurogenesis leads to the previously demonstrated cognitive dysfunction in isoflurane exposed neonatal pups remains to be clarified. [A1412]
“tPA Reduces Isoflurane Induced Neuronal Apoptosis and Dendritic Spines Loss in Rat Neonatal Neurons” by Piyush Patel, Brian Head, Hemal Patel, John Drummond, David Roth, University of California at San Diego, San Diego, California. In neurons isolated from neonatal rat pups, isoflurane increased neuronal death at 7 days of age. Simultaneously, the release of tissue plasminogen activator (tPA) from these neurons was reduced. Application of tPA significantly reduced this neuronal death. The data suggest that part of the neuronal death that occurs in neonatal rodents exposed to isoflurane is due to a reduction in tPA release and the subsequent signaling of proBDNF via the p75 neurotrophin receptor. [A1413]
“Preventing Anesthesia-induced Developmental Neuroapoptosis: Temperature Regulation Approach” by John W. Olney, Megan M. Straiko, Davide Cattano, Chainllie Young, Catherine Creeley, Washington University School of Medicine, St. Louis, Missouri. Exposure of neonatal rat pups to isoflurane, ketamine, or ethanol resulted in robust neuroapoptosis when the temperature of the pups was maintained in the normothermic range. However, hypothermia at approximately 25°C significantly reduced this anesthetic induced apoptosis. These results offer a potential therapeutic avenue through which anesthetic induced neuroapoptosis might be reduced. [A1414]
“Exposure to Anesthesia and the Risk of Developmental and Behavioral Disorders in Young Children” by Charles J. DiMaggio, Lena Sun, Athina Kakavouli, Guohua Li, Columbia University, New York, New York. Children who had inguinal hernia repair within 4 yr of age are at heightened risk of developmental and behavioral disorders in comparison with children from the same birth cohort. The excess risk of these disorders in children exposed to anesthesia and surgery cannot be completely explained by lower birth weight and other demographic factors, suggesting that anesthesia and surgery might contribute to the behavioral disorders. [A1415]
“Relationship between Exposure to Anesthesia and Subsequent Learning Disabilities in Children” by Robert T. Wilder, Randall P. Flick, Juraj Sprung, David O. Warner, Slavica K. Katusic, Mayo Clinic, Rochester, Minnesota. In a population-based cohort investigation, the risk of the development of learning disabilities in children who were subjected to a single anesthetic exposure was not different in comparison to a control group of children. With two or three anesthetic exposures, the risk of learning disabilities was significantly greater. Moreover, with multiple exposures, total duration of anesthesia in excess of 2 h was associated with increased learning disabilities. However, it is not clear whether the learning disabilities were related to anesthesia, surgery, or a combination of both. [A1416]
“Cognitive Development in Children and Age at the Time of First Anesthetic Exposure: A Pilot Study” by Cor J. Kalkman, Linda M. Peelen, Tom P. de Jong, Gerben Sinnema, Karel G. Moons, University Medical Center, Utrecht, The Netherlands. In this pilot study of children undergoing urologic surgery during general anesthesia, neurocognitive development was evaluated by a validated parental questionnaire. Deviation in the scores was greater in children who underwent anesthesia and surgery before 2 yr of age in comparison to those who underwent anesthesia and surgery after 2 yr of age. Based on these pilot data, a properly powered prospective cohort study would require the study of at least 1,200 children. [A1417]
6th Annual Celebration of Research
Monday, October 20, 2008, 12:30 pm to 2:00 pm, Orange County Convention Center, Room W415BC, Orlando, Florida. Lunch will be provided!
This year's Celebration of Research will take place on Monday during the Annual Meeting. James C. Eisenach, M.D., Editor-in-Chief of Anesthesiology, will serve as moderator. Featured speakers will be the 2008 recipient of the ASA Excellence in Research Award, Zeljko J. Bosnjak, Ph.D., Professor of Anesthesiology and Physiology, Vice Chairman of Research, Medical College of Wisconsin, Milwaukee, Wisconsin, and the recipient of the 2008 Presidential Scholar Award, John H. Eisenach, M.D., Assistant Professor of Anesthesiology, Mayo Clinic, Rochester, Minnesota. The recipients of the 2008 Residents' Research Annoucements will also be introduced during the Celebration event.
8th Annual Foundation for Anesthesia Education and Research Honorary Lecture: “Critical Thinking,” Steven L. Shafer, M.D., Professor of Anesthesiology, Columbia University, New York, New York
Monday, October 20, 2008, 2:00 pm to 3:00 pm, Orange County Convention Center, Room W415BC, Orlando, Florida
The Foundation for Anesthesia Education and Research (FAER) will present its 8th Annual FAER Honorary Research Lecture. FAER has created this annual lectureship as a means of recognizing outstanding scholarship by an anesthesiologist in an effort to encourage young anesthesiologists to consider careers in research and teaching, which are crucial if anesthesiology is to maintain its reputation as a medical specialty continuously striving for excellence in patient care.
Dr. Shafer's research interest is the clinical pharmacology of intravenous anesthetic drugs. He has published extensively on the pharmacokinetics and pharmacodynamics of most of the intravenous hypnotics and opioids used in anesthetic practice. However, his interest is less in the drugs themselves than in the mathematical models that characterize drug behavior. These include conventional pharmacokinetic and pharmacodynamic models, inverse models (used to drive target-controlled infusion systems), bayesian models (used to handle model uncertainty), models of drug interaction, and models that relate drug behavior to in silico pharmacogenetics. His work has resulted in more than 100 research publications, numerous editorials, several dozen book chapters, and seven patents.
Dr. Shafer's lecture, titled “Critical Thinking,” will explore a framework for evaluating evidence and illustrate the traps and consequences of noncritical thinking within that framework.
The 2008 FAER Panel: “Anesthesia and the Elderly Brain: What the Anesthesiologist Needs to Know”
Monday, October 20, 2008, 3:00 pm to 5:00 pm, Orange County Convention Center, Room W415BC, Orlando, Florida
Participants will discuss the importance of geriatric anesthesia with the trend for more elderly patients, normal aging of the brain, postoperative delirium, and cognitive dysfunction.
Arnold Berry, M.D., Professor of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
“The Graying of the Surgical Patient: Trends You Need to Understand,” Jeffrey H. Silverstein, M.D., Vice-Chair for Research, Department of Anesthesiology, Mount Sinai School of Medicine, New York, New York
“Why Can't I Remember Where I Put My Car Keys? What Happens to the Older Brain?” Christopher J. Jankowski, M.D., Assistant Professor of Anesthesiology, Mayo Clinic, Rochester, Minnesota
“Postoperative Delirium in the Elderly: Does Anesthesia Care Play a Role?” Frederick E. Sieber, M.D., Director, Department of Anesthesiology, Johns Hopkins Bayview Medical Center, Associate Professor, Johns Hopkins Medical Institutions, Baltimore, Maryland
“Postoperative Cognitive Dysfunction: Is It the Surgery or the Anesthesia?” Deborah Culley, M.D., Assistant Professor of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

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Research Article| February 01 2010
Collard Leaves for Misery
ardath weaver is research director at the North Carolina Arts Council, where she applies her art history degree from Brown University to documenting arts and culture. Her essay ““Creativity and Connectivity: Learning the Language of the Creative Economy”” recently appeared in the premiere issue of The Arts Politic. After nearly forty years in the South she still isn't fond of collards.
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Gastronomica (2010) 10 (1): 176.
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ardath weaver; Collard Leaves for Misery. Gastronomica 1 February 2010; 10 (1): 176. doi: https://doi.org/10.1525/gfc.2010.10.1.176
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The Indian Navy Will Launch a Tender Worth $6 Billion For 6 Submarines
Under Project 75-I, India’s government has announced a $6 Billion For 6 Submarines project. On June 4, the Military Acquisition Council, the Ministry of Defense’s procurement branch, provided its consent. It will enable the Indian Navy to release a tender for six submarines, with local shipbuilders as the target group. As per official reports, the decision was made to bridge the gap with China’s increasing naval supremacy.
Defence Minister Rajnath Singh presided over a session of the Defence Acquisition Council that made the decision. Authorities made way for the release of a Request for Proposals that “anticipates local production of six conventional submarines equipped with the state-of-the-art Air Independent Propulsion System,” as per a news release from the Ministry of Defense. The Indian Navy plans to develop six conventional diesel-electric submarines that will be about 50% bigger than the Scorpene-class submarines currently being built at Mazagon Dockyards Limited in Mumbai.
The submarines will be mounted with heavy-duty weapons, including at least 12 Land Attack Cruise Missiles and Anti-Ship Cruise Missiles, as per the maritime force’s requirements. According to the Navy, the submarines must also be capable of carrying and deploying 18 heavy warheads at sea. Submarines of the next generation will need considerably higher weaponry than the Scorpene.
The announcement explains, “This is a significant decision, as it is the first case completed under the strategic partnership system.” The Ministry of Defence made a strategic partner strategy in June 2017 that empowers businesses to work with foreign weapons manufacturers to develop important weapons and infrastructure, including submarines. The Indian Navy possesses more than 140 submarines and surface warships, whereas the Pakistani Navy has roughly 20. The Indian Navy, on the other hand, is establishing armaments to confront the Chinese Navy that operates in the Indian Ocean region occasionally.


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This 8 page paper provides an overview of some central points regarding the failure of national health reform in 1994 and the politics of healthcare reform. This paper provides an overview of the policy proposals and political strategies of the past and how these have informed the prospects for future reform efforts. Bibliography lists 6 sources.
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Sunday, March 26, 2017
Minis: K.Wirick, J.Zwirek, J.D.Woods
Jimmy Plays The Drums and A Natural Family, by John Dermot Woods. These are interesting, enigmatic comics that play a lot on the grid (the first is a product of Frank Santoro's correspondence course) and on very differing uses of color. Jimmy Plays The Drums is a story about expression and elusiveness, told in a time-fractured style over a long period of time. The entire story is done in bright CMYK in virtually every panel (with the black simply being the lines delineating the characters and the lettering), with the characters and backgrounds flipping colors in each panel. It's an interesting visual effect that forces the reader to reorient themselves on a constant basis as we figure out why the bespectacled Jimmy drummer is constantly trying to escape (from childhood) an older man. The people Jimmy hangs with and his peculiar abilities are only hinted at, but what is made clear is that his parents never allowed him to leave his penthouse home, and he only had the gardener as company--the man chasing him. It's a story about chosen family, a love of art that was not allowed or encouraged, and a slightly magical world that's given life but Woods' almost-exclusive use of colored pencil.
A Natural Family is more conventional in some respects. The use of color is purely functional and even bland. It presents with an unusual occurrence: a brother and sister (both adults) living alone in their family house, with the sister having fallen asleep for two straight days. It's told from the perspective of the brother, with a film crew, the police being brought in to observe the phenomenon and (presumably) have someone do something about it--to no avail. Woods then time-jumps back to the siblings, three days earlier, and reveals that a once-boisterous and happy familial relationship had been reduced to silence, and the suggestion by the brother that one of them leave the house to explore "missed opportunities" leads her to fall asleep in response--a move that prevents him from leaving. Much is left unsaid in this comic. What, precisely, was the nature of their relationship beyond being familial? There's a panel of the man in bed with a presumed sexual partner in the morning, seemingly ready to kick her out. The last page reveals that she went to bed naked, but it's clear that he put a dressing gown on her before he invited in the media. Is her escape into sleep a way of protesting her brother abandoning her, or is it something more? In both of his minis, Woods provides a lot of clues but ultimately leaves a lot of the answers up to the reader.
Stand-Up Comic, by Jeff Zwirek. Zwirek's one of my favorite comics formalists, especially in terms of the actual physical construction of his comics. This short mini about a stand-up comedian is made in such a way as to literally have a stand in the back, as though it were for display. It features a deeply schlubby comedian named Buster Guts, a pear-shaped fellow with a face that looks like it was arranged by Picasso. Zwirek starts off in a four-panel grid that falls away to an open page format as Buster Guts actually proves himself to be a top-notch, self-deprecating comedian whose gags go from tired to genuinely funny. This comic is a nice combination of gimmick and gags, with one grabbing the reader's attention and the latter standing on their own but aided by the mere sight of the comedian.
Nervenkrank #1, by Katherine K. Wirick. This is the first chapter of a much longer work about the life of German Dada artist John Heartfield, born as Helmut Herzfeld. There has been a proliferation of comics biographies as of late, mostly coming out of Europe, and they have a tendency to be pretty to look at but largely mundane. Wirick's work has a chance to be an exception, as Nervenkrank is clearly a passion project, not just a project researched for a contract. Heartfield's work is obviously important to her on a deep level, and it shows in the intensity of the rendering on each page and the emphasis on a slow narrative pace that establishes his emotional state as a soldier. The story opens in 1915, in the middle of World War I. Heartfield is a hospitalized soldier, clearly traumatized by what he's seen. Wirick emphasizes that by noting that his roommate literally won't come out from under the bed, another patient can't stop screaming about being bombed, etc. Returning to his boarding house, he is presented with compassion by the wife of the owner and contempt by the owner himself.
Wirick depicts the stuttering Heartfield as delicate and sensitive but not weak. He steals the German flag flying outside his room and burns it. Dada was born in large part as a reaction to the pointless stupidity and brutality of World War I as the people were sent to die for no good reason, and this issue emphasizes all of these issues. Wirick is a skilled naturalistic artist who masterfully uses greyscale to balance depth and density in each panel. It's clear that she thoughtfully and carefully resolves issues like negative space, character interaction in space and how to make her realistically-rendered characters still manage to appear alive on the page. Her page design is functional, relying more on her figure drawing than on an innovative approach, but it's clear that this story is meant to appear in a larger format. This mini came out nearly four years ago and I haven't seen another issue since, but I hope she continues to persevere on this project.

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It was a match-up of champions at the Field of Dream and the B-League winners came out on top.
In the opening night of the Cayman Islands Little League Association 2013 Fall Adult Coed Softball League, the defending A-League champions, KPMG A, took on the two-time defending B-League champions, the Coors Light Chuggers.
The Chuggers made the jump to the A-League this season and won’t have a chance to repeat as B-League champs. Coors Light showed they could compete in the higher league with a well-deserved 8-2 win at the Field of Dreams facility in George Town.
The two teams know each other well; it was KPMG A who knocked off the Chuggers in a close match in the 2012 Winter B-League title game. As Chuggers captain Alan Markoff points out, the teams have only played each other twice since then, splitting the two games.
“We go way back with KPMG A,” Markoff said. “We’ve had a lot of memorable game with them, most of them decided by one or two runs.”
On opening night, however, KPMG A just couldn’t get their bats going.
“I like to think it was my fabulous pitching,” Markoff said. “But in reality, they were a bit rusty and to our credit, we played solid defence. Usually we don’t get into that kind of form on defence until mid-way through the season.”
The Chuggers are on quite a defensive roll going back to last season’s play-offs, having given up a total of seven runs in the past four games they’ve played.
“Usually, if we only give up seven runs in a single game, that’s a good defensive effort,” said Markoff. “To do that over four games in co-ed slow pitch softball is really quite amazing.”
On offence, Coors Light was sparked by new team-member Neal Appleby, who hit a long home run in his first at-bat with his new team. Appleby also had a key hit in the Chuggers’ three-run third inning.
Although Coors Light didn’t have its best offensive game as a team, Markoff said they managed several rallies.
“KPMG A made some nice outfield plays on balls that would definitely have been hits in the B-League. It’s definitely harder to score in this league. The difference of the game though was that we were able to get the big hit when we needed it and KPMG A was leaving runners in scoring position all night long.”
Coors Light cocaptain Mark Wallace said he was glad the team listened to his sermon.
“I preach defence and timely hitting and that’s what we did,” Wallace said.
The 2013 Fall league saw a slew of other matches during opening week. UBS Aces beat Saxon G-Force, 5-4. Master Batters defeated Deloitte, 12-11. A.L. Thompson’s Hammers smashed Phoenix Hard Hats, 22-8. PwC B clobbered BritCay Premiums, 25-1. Rhino Rebar beat Rackham’s Crabbies, 11-8 and Dart took down Fluff and Fold Home Gas Misfits, 17-7.
Week two of the league kicks off on Monday, 5 August, with a double-header at 8pm. On field three, Crabbies face BritCay while the Al La Kebab Hitmen face Tower Marketing on field four.
On Tuesday, 6 August, G-Force battle Dart on field three with UBS challenging Misfits on field four. On Wednesday, 7 August, PwC face Phoenix on field three while Rhino Rebar tackle Chuggers on field four. On Thursday, 8 August, KPMG battle Deloitte on field three, while Hammers challenge Tower Marketing on field four. All of those games are at 8pm.
It should be noted that there is still time for players to join the league. Requests should go to Leon Conolly at [email protected]


Alright fellas. 96 1500. I drove my truck to another town last night and a funny sound started under the hood. The more I drove it the worse it got. Then on the way home on open road I could only get up to about 50 mph. Before I got to a buddies has a mile or so down the road I was down to about 15 mph. Its almost like its starving for air or something. The more you get on it, the more it lugs down. Ive been all over the motor and the only thing i found wrong was a loose sparkplug. Replaced all four. No smoke no nothing out of the ordinary except for no power. Could this be a plugged cat? If it is can i just gut the cat and solve my problem? Thanks everyone.


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Scientists have been elevating rising issues for many years over using poisonous “ceaselessly chemical compounds,” so referred to as as a result of their sturdy molecular bonds can take tons of of years to fully break down within the surroundings. Extensively utilized in client merchandise resembling cookware and clothes, these substances are turning up in all places from consuming water to our bloodstream. And now researchers are warning of one more—and to date underrecognized—supply of those troubling toxins: widespread pesticides. Practically 70 p.c of all pesticides launched into the worldwide market from 2015 to 2020 contained these chemicals or related compounds, in keeping with a evaluate paper not too long ago printed in Environmental Air pollution. And the surge of their use has come with out a full understanding of their potential impression on the surroundings and human well being.
Perpetually chemical compounds—scientifically often called perfluoroalkyl and polyfluoroalkyl substances, or PFASs—are a subset of so-called fluorinated chemical compounds, which possess sturdy carbon-fluorine bonds. Meaning such chemical compounds are each extremely secure and helpful in merchandise designed to repel grease and water. But it surely additionally means they don’t readily biodegrade. Although governments have been working to restrict using PFASs, these efforts are sophisticated by differing technical definitions of which fluorinated chemical compounds are technically PFASs—and as such pose a threat to folks and the surroundings. Many chemical compounds thought-about PFASs in a lot of the remainder of the world will not be categorised this fashion within the U.S. This case may go away communities uncovered to dangerous chemical compounds, together with pesticides that include fluorinated compounds and are sprayed on many alternative crops around the globe yearly.
Pesticides produced from fluorinated chemical compounds, generally known as fluorinated pesticides, “may be unimaginable molecules that meet quite a lot of the challenges that exist in agriculture,” says research co-author Diogo Alexandrino, a researcher on the College of Porto in Portugal and a co-author of the Environmental Air pollution paper. “However they need to be correctly vetted, and we ought to be conscious that they will have a really big impression on the surroundings, on biodiversity and finally on our personal well being.”
Stability or Persistence?
Fluorinated chemical compounds, together with PFASs, have been broadly utilized in client merchandise for the reason that Nineteen Forties. However within the following many years scientists started realizing that these chemical compounds endured in consuming water and human our bodies, and within the Nineteen Nineties the Environmental Safety Company started investigating PFASs. Practically each U.S. resident now carries low ranges of PFASs of their blood. These chemical compounds have been linked to testicular and kidney cancers, reproductive problems, thyroid illness, high cholesterol levels, diminished immune response and even elevated susceptibility to COVID-19. Primarily based on these issues, the U.S. Congress is weighing a number of bipartisan payments to restrict their use in meals containers and cookware and to require the EPA to take comprehensive action to forestall PFAS air pollution—together with setting nationwide limits on ranges in consuming water. Below the Biden administration, the EPA has printed a PFAS Strategic Roadmap for addressing the crisis. Eight states have already adopted legal guidelines to ban PFASs in sure merchandise, particularly meals packaging—however not in pesticides.
Fluorinated pesticides first appeared in the marketplace within the Thirties, however it’s only previously decade that this use has expanded so dramatically. This rise is linked to enhancements in manufacturing processes and the expiration of patents which have allowed for wider competitors, Alexandrino says.
Fluorinated pesticides deliver “efficacy and stability” to pest administration, says Karen Reardon, spokesperson for the pesticide trade group Accountable Trade for a Sound Atmosphere (RISE). That stability makes pesticides stay efficient longer, she says—so crops may be sprayed much less usually than could be wanted with a nonfluorinated various.
However what Reardon calls stability, others name persistence. Information compiled by Alexandrino and his crew present half-lives (the quantities of time it takes chemical compounds to dissipate by half within the surroundings) starting from just a few days to 2.5 years for top-selling fluorinated pesticides. That’s lower than the half-lives of some older pesticides resembling DDT, however on the higher finish of the size, it’s nonetheless a comparatively very long time: the EPA defines a “persistent” pollutant as having a half-life of 60 days or extra. As Kyla Bennett, science director of the nonprofit environmental advocacy group Public Staff for Environmental Duty (PEER), bluntly places it, “Why on earth would you permit PFAS to be put in one thing that’s sprayed on thousands and thousands and thousands and thousands of acres each single 12 months? It’s referred to as a ceaselessly chemical for a motive.”
What Is—and Isn’t—a PFAS?
One of the widely used fluorinated pesticides is bifenthrin. It targets bugs’ nervous system and is the prime ingredient in additional than 600 pesticide formulations used on corn, soy, greens, berries and orchard crops. Additionally it is used to deal with seeds and to manage ants, termites and different pests in city settings. Its potential results on human well being will not be well-known, although there may be some proof that power publicity is linked to neurotoxicity, and the EPA has categorised it as a potential human carcinogen. Finally, the EPA concluded in a 2020 human health risk assessment that “dietary publicity and threat estimates will not be of concern for the prevailing makes use of of bifenthrin”—at the very least when ranges designated as secure for human consumption will not be exceeded. However quantities discovered lately on collard greens, eggplants, spinach, cherry tomatoes, candy potatoes and peaches have exceeded these EPA security ranges. Eradicating such residues from produce requires extra scrubbing as a result of bifenthrin is an oily substance.
Bifenthrin can be a persistent pollutant with a half-life of 97 to 345 days in soil, relying on soil sort. A 2016 U.S. Geological Survey study discovered that it binds to sediments contained in stormwater and may persist in floor waters, the place it harms useful bugs that present meals for fish, birds and wildlife. Its specific configuration of carbon and fluorine is “actually secure and will probably be actually persistent within the surroundings,” says College of Porto researcher Maria de Fátima Carvalho, a co-author of the brand new paper.
Though bifenthrin is one in all greater than 200 energetic pesticide components that might be acknowledged as a PFAS by the newest Group for Financial Co-operation and Growth (OECD) definition and is banned for many agricultural makes use of within the European Union, the EPA has a narrower definition of a PFAS. Differing definitions complicate efforts to grasp and regulate such chemical compounds’ use. The EPA definition solely contains compounds with comparatively longer carbon-fluorine molecule chains as a result of it says these are usually much less more likely to accumulate within the meals chain and are doubtlessly much less poisonous—although not all consultants agree on this. “It’s incorrect to argue that the whole lot is secure till you’ve got two, three or 4 [carbon-fluorine] bonds,” says Rolf Halden, director of the Biodesign Middle for Environmental Well being Engineering at Arizona State College. “We’ve created a chemistry with no recognized biodegradation mechanism. You’re signing up for a lifetime of publicity around the globe and for millennia.”
In an e-mail to Scientific American, EPA spokesperson Robert Daguillard wrote that the company’s PFAS definition, first developed in 2006, was meant to “establish the PFAS almost definitely to current threat to human well being and the surroundings.” The definition has since been adjusted, Daguillard added, and “we’re presently trying on the variations between the OECD and [EPA] definitions to find out whether or not the [EPA] definition ought to be modified to seize further substances.”
No less than three energetic pesticide components presently allowed by the EPA—broflanilide, pyrifluquinazon and noviflumuron—meet its definition for a PFAS. 4 others that the EPA qualifies as a PFAS have been banned within the U.S. however are nonetheless utilized in Japan, China and a few nations in Latin America. New pesticide components that the EPA would classify as PFASs proceed to return in the marketplace in China. Whereas the three allowed within the U.S. have half-lives of some months on the most, that measure doesn’t inform the entire story, says Nathan Donley, environmental well being science director on the Middle for Organic Variety, a nonprofit conservation group. “On paper, they seem like they break down inside an affordable time interval”—however the by-products of that breakdown additionally must be thought-about, Donley says. “You’ve received the dad or mum pesticide molecule that may break down into one thing that’s … nonetheless a fancy molecule, pretty fluorinated,” he provides. “And what these degradation merchandise are doing within the surroundings is actually not adopted up with in any respect.” Wendy Heiger-Bernays, a medical professor of environmental well being on the Boston College College of Public Well being, says the breakdown merchandise of fluorinated pesticides might work together with different environmental PFAS air pollution in unknown methods.
EPA spokesperson Cathy Milbourn says the company “has a strong course of for figuring out and assessing the environmental dangers of pesticide degradation merchandise or metabolites.” However Donley argues that whereas the EPA seems to be at preliminary breakdown merchandise, it doesn’t comply with the pesticide degradation course of to its completion—which he says can take many years or centuries and may produce dozens of various molecules alongside the way in which. Furthermore, what occurs within the surroundings doesn’t at all times monitor what occurs within the laboratory. “I don’t essentially anticipate the EPA to do all of the research essential to get definitive solutions for all of this stuff, however they should account for this uncertainty in some way,” Donley says. “The good thing about the doubt ought to be given to folks and the surroundings, to not the pesticide firms.”
When Scientific American requested what actions the EPA might take to limit pesticides that do meet its definition of a PFAS, Milbourn responded in an e-mail that “whatever the evolving definition of PFAS, pesticides endure a rigorous scientific evaluation course of previous to registration” and that “fluorinated pesticides in commerce have met acceptable risk-based requirements for registration.”
However PEER’s Bennett, who beforehand labored on the EPA’s New England regional workplace for greater than a decade, is amongst many who level out that the information the company use to judge pesticide security are nearly solely supplied by producers—which Bennet says leaves regulators open to “unimaginable trade seize” and “political strain” to get pesticides in the marketplace. She claims that EPA workers evaluating pesticide dangers should not have entry to sufficient data to do their job accurately. Current reporting by the Intercept and Investigate Midwest has additionally introduced these points to gentle. Responding to Bennett’s factors, RISE’s Reardon says that the “EPA’s pesticide determinations are made solely by the company because it fulfills its remit beneath the Federal Insecticide, Fungicide and Rodenticide Act.” The EPA declined to remark when requested about Bennett’s claims.
“The EPA and everyone seems to be telling us these [fluorinated pesticides] are so significantly better than the older [nonfluorinated] ones. And in some regards, that is likely to be true,” Donley says. “But it surely’s actually worrisome to me that though these don’t technically meet the EPA definition of PFAS, they meet the PFAS definition of a lot of the remainder of the world.”
Others, nevertheless, choose to give attention to the pesticides that the EPA has already labeled as PFASs. “We’ve seen fluoro teams in pesticides, however I might not name these PFAS,” says Graham Peaslee, a professor of physics on the College of Notre Dame. Heiger-Bernays additionally says she is “much less involved” concerning the potential for human hurt from some pesticides resembling bifenthrin. Emphasizing that she just isn’t a “pesticide advocate,” she says there may be authentic makes use of for these chemical compounds: “There are,” Heiger-Bernays notes, “occasions when we wish our homes to not be consumed by termites.” The problem, she says, is to determine what these restricted, authentic makes use of are—after which curtail the whole lot else.
Whether or not the EPA’s PFAS Strategic Roadmap will result in motion on fluorinated pesticides—notably those who meet its PFAS definition—stays to be seen. In an e-mail to Scientific American, Milbourn wrote that “as EPA continues to refine the testing course of, as regulatory work matures, and because the Company learns extra from its partnerships throughout the nation, the Company will regulate the definition of PFAS to replicate the data gathered by means of this course of. Because the company determines the scope of this concern, it can proceed to make use of all accessible regulatory and non-regulatory instruments to deal with PFAS.”
For some, these phrases will not be reassuring. “I believe quite a lot of us are holding our breath. We actually don’t know loads proper now,” Donley says. “I’m hoping for one of the best, however I believe it’ll take just a few years, or perhaps a few many years, to actually grasp what’s going to occur with all these new fluorinated pesticides.”
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domain: chemistry