Dynamics of gas-phase trichloramine (NCl3) in chlorinated, indoor swimming pool facilities.

UNLABELLED: Trichloramine (NCl(3)) is recognized as an irritant of the human respiratory system and other tissues. Processes that lead to volatilization from the liquid phase allow for human exposure to gas-phase NCl(3) in swimming pool settings. The dynamics of these processes are not well defined. A N,N-diethyl-p-phenylenediamine/potassium iodide (DPD/KI)-based wet-chemistry method for measuring gas-phase NCl(3) concentration was verified and applied in chlorinated, indoor swimming pool facilities. Other gas-phase oxidants in the air of indoor pools provided interference of 15% or less. The DPD/KI method was applied for the measurement of gas-phase NCl(3) in four chlorinated, indoor swimming pool facilities. All results showed a correlation between bather loading and gas-phase NCl(3) concentration. The nature of swimmer activities also influenced air quality, presumably because of the effects of these activities on mixing near the gas-liquid interface. PRACTICAL IMPLICATIONS: The activities of swimmers promote transfer of volatile compounds from water to the surrounding air. For chlorinated, indoor pool facilities, this can lead to exposure to gas-phase chemicals that can cause irritation of the respiratory system and other tissues. The focus of this study was on NCl(3), a common disinfection by-product (DBP) in chlorinated pools. However, the conditions that promote NCl(3) transfer are likely to promote transfer of other volatile chemicals from water to air. As such, it is possible that other DBPs formed in pools may also contribute to diminished air quality.

Maternal preconception diet and the sex ratio.

Temporal variations in the sex ratio, or the ratio of boys to girls at birth, have been widely studied and variously attributed to social changes, conditions of war, and environmental changes. Recently, Mathews et al. ["You are what your mother eats: Evidence for maternal preconception diet influencing fetal sex in humans," Proc. R. Soc. bond. B 275:1661-1668 (2008)] studied the direct evidence of individual pregnancies and established an association between the sex at birth and the mother's preconception diet. We examined the hypothesis using new evidence from the wartime famine in Holland in 1944-1945 and failed to show an association between maternal diet in pregnancy and the sex ratio. This makes a causal link highly improbable.

Introducing evidence based medicine to the journal club, using a structured pre and post test: a cohort study.

BACKGROUND: Journal Club at a University-based residency program was restructured to introduce, reinforce and evaluate residents understanding of the concepts of Evidence Based Medicine. METHODS: Over the course of a year structured pre and post-tests were developed for use during each Journal Club. Questions were derived from the articles being reviewed. Performance with the key concepts of Evidence Based Medicine was assessed. Study subjects were 35 PGY2 and PGY3 residents in a University based Family Practice Program. RESULTS: Performance on the pre-test demonstrated a significant improvement from a median of 54.5 % to 78.9 % over the course of the year (F 89.17, p <.001). The post-test results also exhibited a significant increase from 63.6 % to 81.6% (F 85.84, p <.001). CONCLUSIONS: Following organizational revision, the introduction of a pre-test/post-test instrument supported achievement of the learning objectives with a better understanding and utilization of the concepts of Evidence Based Medicine.

Implementing a comprehensive relative-value-based incentive plan in an academic family medicine department.

The authors describe the implementation and first three years (1997-1999) of a department-wide incentive plan of the Department of Family Medicine at the State University of New York at Buffalo School of Medicine and Biomedical Sciences. By using a consensus approach, a representative elected committee designed a clinical relative value unit (explained in detail) that could be translated to equally value and reward faculty efforts in patient care, education, and research and which allowed the department to avoid the imposition of a model that could have undervalued scholarship and teaching. By 1999, the plan's goal of eight patient-care-equivalent points per four-hour session had been exceeded for pure clinical care. Clearly, only a small financial incentive was necessary (in 1999, an incentive pool of 4% of providers' gross salary) to motivate the faculty to be more productive and to self-report their efforts. Long-term productivity for pure clinical care rose from 9.8 points per session in 1997 to 10.4 in 1999. Of the mean total of 3,980 points for the year 1999, the contribution from teaching was 1,146, or 29%, compared with 25% in 1997. For scholarship, the number of points was 775, or 20%, in 1999, compared with 11% in 1997. The authors describe modifications to the original plan (e.g., integration of quality measures) that the department's experience has fostered. Problems encountered included the lack of accurate and timely billing information from the associated teaching hospitals, the inherent problems of self-reported information, difficulties of gaining buy-in from the faculty, and inherent risks of a pay-for-performance approach. But the authors conclude that the plan is fulfilling its goal of effectively and fairly quantifying all areas of faculty effort, and is also helping the department to more effectively demonstrate clinical productivity in negotiations with teaching hospitals.

Dating and context of three middle stone age sites with bone points in the Upper Semliki Valley, Zaire.

The extent to which the earliest anatomically modern humans in Africa exhibited behavioral and cognitive traits typical of Homo sapiens sapiens is controversial. In eastern Zaire, archaeological sites with bone points have yielded dates older than 89(-15)+22 thousand years ago by several techniques. These include electron spin resonance, thermoluminescence, optically stimulated luminescence, uranium series, and amino acid racemization. Faunal and stratigraphic data are consistent with this age.

Information systems in strategic planning in healthcare.

CEOs are faced with a wide variety of complex issues that threaten the very survival of the provider. In the early 1980s, the management at Harrisburg Hospital recognized that a solution was needed to deal with evolving trends and issues. That effort resulted in expanding the hospital to become a diversified but integrated healthcare delivery system--the Capital Health System.