Botulinum toxin in the treatment of residual limb hyperhidrosis: A systematic review

The aim of the study was to analyze the current evidence regarding the effect of intradermal injections of botulinum toxin on residual limb hyperhidrosis. A comprehensive search of the MEDLINE and Scopus databases from inception until December 2021 was performed according to the PRISMA guidelines. The search terms used were "botulinum toxins", "botulinum toxins, Type A", "rimabotulinumtoxinB", "amputees", "amputation stumps", "amputation" and "residual limbs". The specific controlled vocabulary of each database was also used (e.g., MeSH). One hundred and thirty-one different studies met this search criteria and were reviewed. Two independent reviewers assessed the quality of the manuscripts. Eight studies met the inclusion criteria for this review. The results demonstrated an improvement in residual limb hyperhidrosis in all studies. Botulinum toxin A or B can be regarded as safe and effective for the treatment of residual limb hyperhidrosis, as well as improving prosthesis use and quality of life.

A multimetric approach to evaluate offshore mussel aquaculture effects on the taxonomical and functional diversity of macrobenthic communities

A multimetric approach was used to detect structural, compositional, and functional shifts in the underlying macrobenthic communities of an offshore mussel (Mytilus galloprovincialis) farm in a Portuguese Aquaculture Production Area. Sampling stations distributed inside and outside this area were used to evaluate sediment descriptors and macrobenthic samples collected before (April and September 2010) and after (June and September 2014) the initiation of mussel farming. Sediment fine fraction, organic matter content, and trace element concentrations were found to increase with depth, independently from the mussel farm. Moreover, the structure and composition of the macrobenthic communities were likewise structured by depth. Turnover was the dominant temporal and spatial pattern of beta diversity for all communities. Furthermore, the functional diversity of these communities was unaffected by the mussel farm. These results suggested that an offshore profile allowed hydrodynamic conditions to weaken the impact of mussel farming and highlighted the importance of conducting an integrative multimetric analysis when studying aquaculture impacts on benthic communities.

The last frontier: Coupling technological developments with scientific challenges to improve hazard assessment of deep-sea mining

The growing economic interest in the exploitation of mineral resources on deep-ocean beds, including those in the vicinity of sensitive-rich habitats such as hydrothermal vents, raise a mounting concern about the damage that such actions might originate to these poorly-know ecosystems, which represent millions of years of evolution and adaptations to extreme environmental conditions. It has been suggested that mining may cause a major impact on vent ecosystems and other deep-sea areas. Yet, the scale and the nature of such impacts are unknown at present. Hence, building upon currently available scientific information it is crucial to develop new cost-effective technologies embedded into rigorous operating frameworks. The forward-thinking provided here will assist in the development of new technologies and tools to address the major challenges associated with deep sea-mining; technologies for in situ and ex situ observation and data acquisition, biogeochemical processes, hazard assessment of deep-sea mining to marine organisms and development of modeling tools in support of risk assessment scenarios. These technological developments are vital to validate a responsible and sustainable exploitation of the deep-sea mineral resources, based on the precautionary principle.

Energy relations in cattle can be quantified using open-circuit gas-quantification systems

This study was conducted to evaluate the relationships between metabolisable energy (ME) intake and outputs of methane (CH4), rumen-derived carbon dioxide (rCO2), lung-derived carbon dioxide (lCO2), and total carbon dioxide output (tCO2) measured using an open-circuit gas-quantification system (GQS). Three trials were conducted to produce a wide range of energy intake and gas emissions to allow relationships between gas outputs and ME intake to be quantified. Gas emissions and ME intake were measured in eight Angus steers (455 ± 24.6 kg initial bodyweight; Trials 1 and 2), and in eight pregnant Angus heifers (503 ± 22.0 kg initial bodyweight; 5 months pregnant; Trial 3). Animals were fed twice daily to allow ad libitum intake in Trial 1, whereas in Trials 2 and 3, feed intake was restricted and energy density was varied to provide a wide range of ME intakes. Animals were allocated to individual pens during a 20-, 19- and 15-day experimental periods, and total faecal output was measured for the last 8, 4 and 4 days in Trials 1, 2 and 3 respectively. Gas emissions were measured for 16, 8 and 8 days after the adaptation period (4, 11 and 7 days) and each animal was allowed to visit the GQS every 2 h. Total CO2 in breath (tCO2) was separated into CO2 arising from rumen fermentation (rCO2) and CO2 in expired air from the lungs (lCO2) by manually identifying the eructations from normal breaths using the GQS gas-output trace. All CO2 outputs (lCO2, rCO2 and tCO2) were highly correlated with each other (r = 0.74–0.99; P < 0.01). Measurement of CO2 output was more repeatable with fewer days of measurement than was CH4 output. Metabolisable-energy intake was closely related to all three measures of CO2 output (rCO2, r = 0.69, P < 0.001; lCO2, r = 0.70, P < 0.001; and tCO2, r = 0.73, P < 0.001). Heat production was estimated from lCO2 output by assuming a value of 0.85 for the respiratory quotient of metabolised products. The heat production estimated at the extrapolated zero ME intake (0.52 MJ/kg0.75) was 60% higher than previous estimates of fasting heat production in cattle. However, our estimate was made under non-fasting, non-sedentary, non-thermoneutral conditions, so it may be a realistic estimate of maintenance energy requirement excluding heat increment of feeding. In conclusion, the open-circuit GQS can be used to provide estimates of the ME intake and heat production of cattle, and, as such, provides a valuable opportunity to describe the energy relations and efficiency of beef cattle in the field, with minimal interference to normal grazing patterns and behaviour.

Abnormal mortality of octopus after a storm water event: Accumulated lead and lead isotopes as fingerprints

Octopus vulgaris is a sedentary organism that inhabits coastal waters being exposed to anthropogenic compounds. Lead concentration in coastal environments reflects many processes and activities namely weathering, industrial and domestic discharges, and atmospheric deposition. Since lead isotopic composition is little affected by kinetic processes occurring between source and sink, its signature has been used to identify different Pb sources. After a short-term heavy rainfall, hundreds of octopus appeared dead in two Portuguese coastal areas. Histopathology and Pb levels and its stable isotopes were determined in tissues, such as digestive gland, of stranded octopus and compared to alive specimens, sediments and runoff material from the same areas. Histology results showed severe damage in stranded octopus tissues suggesting that death was probably associated to multiple organ failure linked to hypertrophy and exudates input. In addition, Pb in stranded specimens reach concentrations up to one order of magnitude above the levels reported for alive octopus. Pb isotopic signatures in stranded organisms were closer to runoff material pointing to a similar origin of Pb. In summary, the results in this study showed that a short-term runoff event might change abruptly the salinity leading to the disruption of the osmoregulation function of octopus and consequently leading to its death. The analyses of stable isotopic Pb signature in octopus tissues corroborate these results and points to a change in the Pb source due to runoff after the storm water event. Pb stable isotopes in octopus proved to be an adequate tool to confirm the cause of death and linking it to the environment conditions.

Position Paper from the Portuguese Association of Hospital Pharmacists for biosimilar therapeutic antibodies

WHAT IS KNOWN AND OBJECTIVE

Biopharmaceuticals are an important class of drugs for the treatment of autoimmune/inflammatory and oncologic diseases. With patent expiries, biotechnological manufacturers can now develop biosimilar drugs. Due to timeliness of introducing new and more complex biosimilars, the Portuguese Association of Hospital Pharmacists gathered to develop a common positioning on the use of biosimilar monoclonal antibodies.

MAIN ISSUES

The European pathway to biosimilar approval was developed to improve affordability and access to biological therapies, but it remains a work in progress because unresolved issues remain. Due to the present reality of biosimilar monoclonal antibodies, hospital pharmacists must play an important role in ensuring the safe, effective and cost-effective use of biosimilars in health systems; and educating healthcare administrators, providers, legislators, policymakers, payors and patients about these products.

WHAT IS NEW AND CONCLUSION

The conclusions presented in this work focused on the proposal for optimal biosimilar prescription criteria, the preparation of original biologics and biosimilars in the pharmacy, the management and selection of suppliers, extrapolation issues, the specific role of pharmacovigilance and risk management for the optimal use of biosimilar monoclonal antibodies.

Effect of flint corn processing method and roughage level on finishing performance of Nellore-based cattle

This study was conducted to evaluate the effects of flint corn processing method (CPM) and level of NDF from roughage (rNDF) on performance, carcass characteristics, and starch utilization by finishing Nellore-based cattle fed high-concentrate, flint corn-based diets. In this study, 112 Nellore type bulls (initial BW 384.07 ± 29.53 kg and 24-36 mo of age) were individually fed using Calan gates or individual pens. The animals were used in a randomized complete block design in a 2 × 4 factorial arrangement with 2 CPM, high-moisture flint corn (HMC) or finely ground dry flint corn (FGC), with 1 of 4 levels of rNDF, 3, 8, 13, and 18% (DM basis), using sugarcane silage (SS) as roughage. Bulls were adapted to the finishing diet over a 21-d period and fed for a total of 81 d. Fecal starch (FS) concentration was determined on d 46 and 74 of the feeding period. There was a quadratic effect of rNDF on final BW ( < 0.01) and ADG ( = 0.01). Optimal concentrations of rNDF were estimated using the first derivative of second order polynomials, indicating that final BW and ADG were maximized with 13.3 and 13.0% rNDF, respectively. An interaction was observed between CPM and rNDF ( = 0.05) for DMI, with peak DMI occurring at 11.3 and 13.7% rNDF with FGC and HMC, respectively. Cattle fed HMC had 13.9% greater G:F ( < 0.01) compared with those fed FGC (0.172 vs. 0.151, respectively). There were quadratic effects of rNDF on HCW ( = 0.04) and ME intake ( < 0.01); heaviest carcass weights were estimated, in both cases, to be achieved with 12.8% rNDF. A quadratic effect of rNDF for renal, pelvic, and inguinal fat weight ( = 0.04) was observed, with a peak estimated to occur at 12.6% rNDF. An interaction between CPM and rNDF also was observed for FS ( < 0.05). Bulls fed FGC with 3% rNDF had greater FS content, and FS linearly decreased as concentration of rNDF increased. For bulls fed HMC, FS was 3.0% of DM and was unaffected by rNDF in the diet. Lower FS from bulls fed HMC suggests that availability of starch from flint corn was greater than that of FGC. For Nellore-based cattle fed a flint corn-based diet containing SS and 8% whole lint cottonseed, performance was optimized with 12.8% rNDF. In the absence of cottonseed addition to diets, optimal performance would be expected with about 14.5% rNDF.

Efficacy of methane-reducing supplements in beef cattle rations

The objective of the present study was to evaluate the effect of including a pellet containing feed components targeted at methane-producing microbes and methane-producing biochemical pathways, into the ration of beef cattle in southern Australia. The so-called ‘methane-reducing supplement’ (MRS) components were chosen from readily available and inexpensive sources to ensure high adoption of the practice if successful. The effect of the pellet on animal performance, diet DM digestibility and gas emissions (measured using an open-circuit gas quantification system) of beef cattle in comparison with animals fed a control diet or high-quality supplement (HQS) was evaluated. In the first trial, there were no differences in DM and digestible energy (DE) intake, but the methane emission in g/day, g/MJ of DE intake (P < 0.01), and in g/kg of DM intake (P = 0.01) were lower for steers fed MRS. There was also a trend to lower carbon dioxide emission (g/MJ of DE intake) in steers fed MRS (P = 0.07). In the second trial, heifers fed the MRS produced 18.7% less carbon dioxide (P < 0.01) and 15.5% less methane (P = 0.01) than heifers on the HQS supplement, when expressed in g per unit supplement intake on a bodyweight basis. There was no difference in growth rate of heifers on the HQS and MRS supplements. Combining methane-inhibiting feedstuffs derived from agro-industrial by-products into supplements for cattle in southern Australia appears to be an effective means of reducing methane output and methane intensity from grazing beef cattle.

The use of biomarkers as integrative tools for transitional water bodies monitoring in the Water Framework Directive context - A holistic approach in Minho river transitional waters

The Water Framework Directive (WFD) provides an important legislative opportunity to promote and implement an integrated approach for the protection of inland surface waters, transitional waters, coastal waters and groundwaters. The transitional waters constitute a central piece as they are usually under high environmental pressure and by their inherent characteristics present monitoring challenges. Integrating water quality monitoring with biological monitoring can increase the cost-effectiveness of monitoring efforts. One way of doing this is with biomarkers, which effectively integrate physical-chemical status and biological quality elements, dealing holistically with adverse consequences on the health of water bodies. The new Marine Strategy Framework Directive (MSFD) already incorporates the biomarker approach. Given the recent activities of OSPAR and HELCOM to harmonize existing monitoring guidelines between MSFD and WFD the use of similar methodologies should be fostered. To illustrate the potential of the biomarker approach, juveniles of flounder (Platichthys flesus) were used to evaluate the quality of the Minho river-estuary water bodies. The use of juveniles instead of adults eliminates several confounding factors such changes on the biological responses associated with reproduction. Here, a panel of well-established biomarkers, EROD, AChE, SOD, CAT, GST, LPO, ENA and FACs (1-Hydroxyrene) were selected and measured along with a gradient of different physical conditions, and integrated with trace elements characterization on both biota and sediments. In general, a clear profile along the water bodies was found, with low seasonal and spatial variation, consistent with a low impacted area. Overall, the results support the use of both the battery of biomarkers and the use of juvenile flounders in the monitoring of the water quality status within the WFD.

Major factors influencing the elemental composition of surface estuarine sediments: the case of 15 estuaries in Portugal

Upper sediments (0-5 cm) were sampled in 94 sites of water bodies of the fifteen Portuguese estuaries characterized by distinct settings of climate, topography and lithology, and marked by diverse anthropogenic pressures. Confined areas recognized as highly anthropogenic impacted, as well as areas dominated by erosion or frequently dredged were not sampled. Grain size, organic carbon (Corg), Al and trace elements (As, Cd, Co, Cr, Cu, Hg, Ni, Pb and Zn) were determined. Normalisation of trace element concentrations to Al and Corg, correlations between elements and Principal Component Analysis (PCA) allowed identifying elemental associations and the relevance of grain-size, lithology and anthropogenic inputs on sediment chemical composition. Whereas grain-size is the dominant effect for the majority of the studied estuaries, the southern estuaries Mira, Arade and Guadiana are dominated by specific lithologies of their river basins, and anthropogenic effects are identified in Ave, Leça, Tagus and Sado. This study emphasizes how baseline values of trace elements in sediments may vary within and among estuarine systems.

Tidally driven N, P, Fe and Mn exchanges in salt marsh sediments of Tagus estuary (SW Europe)

Short-sediment cores and flooding water were collected at 0, 5, 15, 25 and 50 min of tidal inundation in the two sites colonised by pure stands of Spartina maritima (low marsh) and Sarcocornia fruticosa (high marsh) from the Rosário salt marsh (Tagus estuary, SW Europe). Concentrations of NH(4)(+), NO(3)(-) + NO(2)(-) and HPO (4)(2-), Fe and Mn were measured in tidal flooding water and pore water. Flooding water is enriched in nutrients, particularly ammonium due to local discharge of untreated urban effluents. Nevertheless, NH(4)(+) and NO(3)(-) + NO(2)(-) concentrations in flooding waters at t = 5 min (NH(4)(+) = 246 ± 7 μM, NO(3)(-) + NO(2)(-) = 138 ± 1 μM for S. fruticosa and NH(4)(+) = 256 ± 8 μM, NO(3)(-) + NO(2)(-) = 138 ± 1 μM for S. maritima) rose sharply at both vegetated sites. An increase was also registered for HPO(4)(2-) and total dissolved Fe although the subsequent decrease was smoother. Advective transport induced by the two daily pulses of inundation is several orders of magnitude higher than the diffusive fluxes during submerged periods. In addition, solutes are exported from the sediment with the inundation and imported in submerged periods. The exported amount of inorganic nitrogen during tidal inundation (export of 3,200 μmol N m(-2) day(-1)to the water column), is not counterbalanced by the sink of -290 μmol N m(-2) day(-1) occurred during the submerged period.

Accumulation and biological cycling of heavy metal in four salt marsh species, from Tagus estuary (Portugal)

Pools of Zn, Cu, Cd and Co in leaf, stem and root tissues of Sarcocornia fruticosa, Sarcocornia perennis, Halimione portulacoides and Spartina maritima were analyzed on a bimonthly basis, in a Tagus estuary salt marsh. All the major concentrations were found in the root tissues, being the concentrations in the aboveground organs neglectable for sediment budget proposes, as seen by the low root-aboveground translocation. Metal annual accumulation, root turnovers and cycling coefficients were also assessed. S. maritima showed the higher root turnovers and cycling coefficients for most of the analyzed metals, making this a phytostabilizer specie. By contrast the low root turnover, cycling coefficient and low root necromass generation makes S. perennis the most suitable specie for phytoremediation processes. Although the high amounts of metal return to the sediments, due to root senescence, salt marshes can still be considered sinks of heavy metals, cycling heavy metals mostly between sediment and root.

A Survey of Canadian Practitioners Regarding Diagnosis and Evaluation of the Hypertensive Disorders of Pregnancy

BACKGROUND

How Canadian practitioners are diagnosing and managing the hypertensive disorders of pregnancy (HDP), particularly in relation to the 1997 recommendations published by the Canadian Hypertension Society (CHS), is not known.

METHODS

A survey, with French and English versions (and covering diagnosis, evaluation, and management of pregnancy hypertension), was mailed to all members of the Society of Obstetricians and Gynaecologists of Canada (SOGC) (N = 1757, including obstetricians, family doctors practicing obstetrics, and midwives). Additionally, internists [i.e., all nephrologists (N = 191) and a random sample of 25% of general internists (N = 450)] registered with the Royal College of Physicians and Surgeons of Canada were sampled. The survey was distributed in two mailings and one reminder card. Data were entered into Microsoft Access, and Graph Pad Prism used to summarize responses [N (%)]. Differences in practice between specialties were examined, with a Bonferonni correction used to calculate a significant p value based on the number of comparisons and alpha of 0.05.

RESULTS

Respondents numbered 1187 (49.5%), with 466 not informative for the purpose of the study (due to retirement, or practices that do not include pregnant women with hypertension). The final analysis included 721 completed surveys. Most (609, 84.5% of) respondents take blood pressure (BP) with women in the sitting position, and use a mercury sphygmomanometer (79%) and the 5th Korotkoff (61%) sound to designate diastolic BP (dBP). To monitor pregnancies complicated by preeclampsia, most clinicians use the proposed laboratory tests of maternal well-being (usually at least once/week), fetal well-being [nonstress test (NST, at least once/week), and ultrasonographic studies (once weekly to every two weeks)]. There is general agreement that women with preeclampsia should be delivered for uncontrolled hypertension, end-organ dysfunction, or fetal compromise (nonreassuring NST, severe oligohydramnios, biophysical profile < 4, estimated fetal weight < 5th centile, and reversed end-diastolic flow by umbilical artery Doppler velocimetry). Less consensus was seen for delivery for preeclampsia at > 34 weeks, mild asymptomatic HELLP syndrome, hyperreflexia, and absent end-diastolic flow by umbilical artery Doppler velocimetry.

INTERPRETATION

This survey has clarified the current state of practice with respect to the diagnosis and evaluation of women with all types of HDP. In particular, we have identified areas of potential variability in BP measurement, and provided data on the feasibility of enrolling women with sub types of preeclampsia into intervention studies aimed at prolonging pregnancy.

Effects of infauna harvesting on tidal flats of a coastal lagoon (Ria Formosa, Portugal): implications on phosphorus dynamics

The systematic collection of benthic organisms in tidal flats of coastal lagoons should be taken into account for the management of these systems, once sediment disturbance affects biogeochemical processes by favouring pore water renewal during tidal inundation. The objective of the present work was to evaluate the effects of infauna harvesting on the phosphorus dynamics of muddy and sandy intertidal areas in the Ria Formosa. Sediment cores and overlying water were collected during August 2000 and February 2001 from reworked and undisturbed sediment before and after flooding. Results obtained showed that during the first minutes of flooding there was a marked decrease of phosphate in pore water of disturbed sediments. However, phosphate tidal fluxes from sandy sediment were clearly higher (17 nmol cm(-2) d(-1) in summer and 3 nmol cm(-2) d(-1) in winter) than in muddy sediment (0.4 nmol cm(-2) d(-1) in summer and -0.01 nmol cm(-2) d(-1) in winter). After muddy sediment disturbance concentrations of iron oxides increased quickly (from 5 to 16 micromol g(-1)) and phosphate was sorbed onto these iron oxides, resulting in a buffering of phosphate pore water concentrations at low values in the oxidized sediment zone. The estimated P-output from muddy sediment decreased one to two orders of magnitude after sediment disturbance in contrast to sandy sediments in which the impact of infauna harvesting was minimal. Consequently, the P-cycle is influenced by the disruption of muddy habitats in tide-driven systems. Such information could be useful for the management of the lagoon.

A survey of Canadian practitioners regarding the management of the hypertensive disorders of pregnancy

BACKGROUND

How Canadian practitioners are managing the hypertensive disorders of pregnancy (HDP) is not known, particularly in relation to the 1997 guidelines published by the Canadian Hypertension Society (CHS).

METHODS

A survey, with French and English versions (and covering diagnosis, evaluation, and management of pregnancy hypertension), was mailed to all members of the Society of Obstetricians and Gynaecologists of Canada (SOGC) (N = 1757, including obstetricians, family doctors practicing obstetrics, and midwives). Additionally, internists [i.e., all nephrologists (N = 191) and a random sample of 25% of general internists (N = 450)] registered with the Royal College of Physicians and Surgeons of Canada were sampled. The survey was distributed in two mailings and one reminder card. Data were entered into Microsoft Access, and Graph Pad Prism used to summarize responses [N (%)]. Differences in practice between specialties were examined, with a Bonferroni correction used to calculate a significant p value based on the number of comparisons and alpha of 0.05.

RESULTS

Respondents numbered 1187 (49.5%), with 466 not informative for the purpose of the study (due to retirement, or practices that do not include pregnant women with hypertension). The final analysis included 721 completed surveys. For all types of HDP, most internists, family doctors, and midwives initiate nonpharmacological therapy (most common advice to quit work) at dBP 80-89 mmHg (i.e., primary prevention). Only for preeclampsia do obstetricians most frequently use this threshold; otherwise, dBP 90-99 mmHg is usually chosen. For nonsevere hypertension, antihypertensive drug therapy (most commonly methyldopa or labetalol) is started by most practitioners at dBP 90-99 mmHg, although obstetricians are more likely to choose a higher threshold (p < 0.0001). There is little agreement about dBP treatment goal; most internists and family doctors normalize dBP, whereas obstetricians appear to be divided on dBP goals of 80-89 (46-51%) vs. 90-99 mmHg (41-44%) for all HDP (p = 0.66). Severe hypertension is commonly treated with parenteral hydralazine, labetalol, or magnesium sulphate. Short-acting or sustained release nifedipine is used rarely/never by most practitioners. Approximately one-third of obstetricians and family doctors use diazepam to treat eclampsia. The vast majority use MgSO4 prophylactically in women with preeclampsia.

INTERPRETATION

This survey has clarified current stated management of women with HDP, and identified the need for both research into the dBP treatment goal that optimizes pregnancy outcomes among women with HDP, and translation of definitive studies into clinical practice.

Geographical variation and partition of metals in tissues of Octopus vulgaris along the Portuguese coast

Zinc, Cu, Cd, Pb and Hg were determined in mantle, arm and digestive gland of 59 individuals of Octopus vulgaris captured at six sites along the Portuguese coast. Metal concentrations in tissues did not vary significantly (P<0.05) with size/weight, sex or sexual stage. The abundance of metals in each analysed tissue was: Zn>Cu>>Cd>Pb>Hg. Concentrations in the digestive gland reached one (Pb, Hg) and two (Zn, Cu, Cd) orders of magnitude higher than those found in arm and mantle, which indicates that the digestive gland contains the major storage sites for these elements, acting as a detoxification organ. However, concentrations in the digestive gland showed contrasting geographic patterns: Zn, Pb, Cu and Hg were higher in the Southern stations, while Cd levels increased drastically in Northern stations. This increase is in line with the contrasting Cd distribution in coastal waters. The lack of relations between metal concentration in tissues and biological parameters facilitates the recognition of those spatial patterns. The geographical contrast of Cd is extended to the accumulation in mantle and arm. A possible explanation for these enhanced values is that threshold level for Cd accumulation in digestive gland was attained and detoxification processes eventually modified.

What women want: women's preferences of caregiver behavior when prenatal sonography findings are abnormal

OBJECTIVE

To determine what women value when receiving news of a pregnancy abnormality detected by ultrasound.

METHODS

Women who had a pregnancy complication detected sonographically in the year 2000 were asked to complete a survey of 21 questions measuring the importance of various factors related to the receipt of bad news. Of the target sample of 117 women who agreed to participate, 76 (64.9%) returned completed surveys. Cases included serious anomalies (67%) and soft markers/obstetric complications (33%).

RESULTS

Responses to questions on 'information quality', 'prompt provision of information', 'information-provider behavior' and 'information provision environment' showed that women attached the most importance to information quality, much more so than to promptness. Speed was even less important than information-provider empathy. Answers concerning use of the terms 'fetus' or 'baby' revealed greater variation in preferences than any other. Privacy was the most important environmental variable, more important than some information quality variables, or any promptness variable. Intervening variables considered included demographic variables and the seriousness of the prognosis. Education was the most useful predictor of preferences, with highly educated women generally placing less value on environment and some information quality variables, and having different preferences concerning the terms 'fetus' and 'baby'.

CONCLUSIONS

Our findings shed some light on what is important to women who face bad news. Although more research is needed in this important area, we hope that our findings may assist institutions and caregivers in establishing guidelines for the effective and considerate communication of bad news.

Short-term environmental impact of clam dredging in coastal waters (south of Portugal): chemical disturbance and subsequent recovery of seabed

The physical and chemical changes in sediment and near bottom water caused by clam dredging were examined during July and September 1999, at two locations Vilamoura (VL) and Armona (AR), south coast of Portugal. Sediment cores and near bottom water were collected simultaneously before dredging (control samples) and within short time intervals (min-h) after dredging. After dredging operations, microphytobenthos coming from the path were accumulated in the re-worked sediment (ridge). Chlorophyll a in superficial sediment increased from 1.2 microg x g(-1) before dredging to 1.7 microg x g(-1) after dredging and these higher values remained for a few hours. However, the expected increase of chlorophyll a in near bottom water due to re-suspension was not observed. After sediment disturbance an instantaneous sorption of phosphorus onto iron oxides occurred in the upper sediment layers (from 2 to 3 micromol x g(-1) before dredging to 4-5 micromol x g(-1) after dredging). A microcosm experiment showed that after sediment disturbance HPO(4)(2-) dissolved in pore water decreased from 40 to 10 microM being simultaneously sorbed onto iron oxides formed in the top layer of sediment. The ammonium, nitrates, organic nitrogen, phosphate and silicate dissolved in pore water decreased immediately after dredging activity and simultaneously an increase in near bottom water was sporadically observed. Generally, the re-establishment of seabed was reached within a short time (min-h), at both stations (VL and AR).

Mercury in contaminated sediments and pore waters enriched in sulphate (Tagus Estuary, Portugal)

Three sediment cores, collected nearby the effluent of a chlor-alkali industry, were sliced in 0.5-cm layers and centrifuged for pore water extraction. Mercury, Fe and Mn were determined in the solids as total concentration, hydroxylamine extractable fraction and HCl extractable fraction. Sulphur was determined in the HCl extraction. Total and reactive mercury, chlorinity, S(2-), SO(4)(2-), total Fe, and total Mn were measured in pore waters. The solids contained 3.0-60 nmol g(-1) of total Hg and pore waters 70-5800 pM of total Hg and 1.8-76 pM of reactive mercury. Pore waters presented 2.3-94 times more sulphate than the overlying estuarine waters due to the input from the industry. In layers where hydroxylamine extractable Fe exhibited a broad maximum (precipitation of Fe-oxides) sulphate was reduced to S(2-). The competition between the high content of SO(4)(2-) and Fe(III) as electron acceptors, in chemical reactions occurring in the upper sediments, may explain the co-existence of S(2-) and Fe-oxides in the same layers. Mercury was detected in the hydroxylamine extracts (20-29 nmolg(-1)) in the layers where Fe-oxides were formed, and reactive dissolved Hg showed minimum concentrations. The excess of sulphate in pore waters favoured the abundant Fe-oxides in the upper solid sediments, which appear to work as a barrier limiting the escape of mercury to the water column.

Illiteracy and brain damage. 2. Manifestations of unilateral neglect in testing "auditory comprehension" with iconographic materials

This report concerns the sentence-picture matching behavior of 100 neurologically healthy and 169 brain-damaged subjects, all of whom were unilingual adult right-handers. Within this population, 144 subjects were totally unschooled illiterates and the remaining 125 had received school education and thereafter had retained writing skills and reading habits. Brain-damaged subjects were tested less than 2 months after a first left- or right-hemisphere stroke. All subjects were administered an aphasia screening battery including, among other subtests, a set of six sentence-picture matching stimuli. For each of these six stimuli, subjects heard a sentence uttered by the examiner and were then requested to match this sentence with one of four drawings presented within a single display divided into four quadrants of equal surface. Three sentences were syntactically "simple" (noun subject + verb) and three were relatively more "complex" (noun subject + verb + one or two noun complements). Evidence of unilateral neglect was found in both left- and right-brain-damaged illiterates and literates. Moreover, the right neglect of left-brain-damaged subjects was manifest mostly when target sentences were relatively "complex" whereas the left neglect of right-brain-damaged subjects was manifest irrespective of the syntactic complexity of target sentences. Our data are interpreted as indicative of an interaction between two cognitive disorders resulting from dysfunctions of asymmetrically represented cognitive mechanisms. The implications of these findings with respect to clinical and research aphasia testing are discussed.