Targeting for nonpoint source pollution reduction: A synthesis of lessons learned, remaining challenges, and emerging opportunities.

The ability to identify, target, and treat critical pollution source areas on a landscape is an ongoing challenge for water quality programs that seek to address nonpoint source (NPS) pollution. In this article, we develop a conceptual framework for targeting program design, and review recent experience with the implementation of targeting programs that corresponds with a wide range of program characteristics. Through this review, we emphasize that the complex and locally dependent nature of NPS generation and transport makes it impossible to define a narrow set of rules to guide targeting programs everywhere. Instead, we evaluate key features of NPS targeting in several different contexts, highlighting lessons learned from recent experience. This synthesis of targeting program design and implementation points toward several areas of opportunity for improved NPS policy, however more research is needed to systematically document changes in behavior and pollutant loads. The lack of monitoring data at refined scales presents a major obstacle to targeting program success. This paper synthesizes new opportunities and ongoing challenges for the implementation of targeting in NPS water quality programs.

An education programme for professionals who specialize in substance misuse in St Petersburg, Russia: part 1.

This paper provides an account of a joint project of education and training of doctors and nurses in St Petersburg, funded by the Know How Fund Health Sector Small Partnership Scheme (Russia). Contextual material on drug and alcohol misuse in Russia is introduced prior to a focus on the drug and alcohol misuse issues in St Petersburg. Reference is made to historical and contemporary material on alcohol and drug misuse, and attention is drawn to the reliability of statistical data. The main aims of the project and the work carried out are outlined. Firstly, to bring together medical and nursing colleagues, enabling a recognition of the overlap in training and educational needs of both professional groups, and the learning that can occur from understanding each others roles and responsibilities. Secondly, that the theory and practice of different approaches to care and treatment can be incorporated into already established curricula used to educate both nurses and doctors. Colleagues in St Petersburg have requested the support and guidance of UK practitioners and nurse educationalists to facilitate these changes in perspectives. The paper concludes with a brief discussion of the influence of the project in anticipation of a forthcoming paper that will detail evaluation processes that the provision has undergone and examine the findings in more detail.

A naturalistic study of home detoxification from opiates using lofexidine.

The study describes the outcome of home detoxification from opiates using lofexidine, a centrally-acting alpha2-adrenergic agonist, in a consecutive series of 28 unselected individuals. Eleven detoxifications (39%) were successful and 17 (61%) unsuccessful. No major medical or psychological problems were reported. Successful outcome was associated with not using heroin, good compliance with a methadone programme and prediction of success by the key worker. Home detoxification using lofexidine appears to be a useful treatment for some opiate-dependent individuals, and is most likely to be successful in those individuals whose drug use is already well-controlled.

Survey of amphetamine prescribing in England and Wales.

A survey was undertaken of senior medical specialists in drug dependence in England and Wales, enquiring about their attitudes and practices concerning the prescription of amphetamines to dependent users. Of the 149 who replied, 60% saw a role for amphetamine prescribing, with 46% currently doing so. Of those who did not prescribe, 32% would like to have done so. Respondents often did not know if general practitioners in their area were prescribing amphetamines. Many could not estimate the percentage of injecting amphetamine users in their area. There was a wide range in the dosage of amphetamine prescribed with a mean maximum of 66 mg. There was agreement about entry criteria for prescribing programmes and also on ways of monitoring those receiving amphetamine. Our results indicate that amphetamine prescribing is widespread in England and Wales although there is little scientific evidence for its efficacy. We have developed some guidelines for good practice, drawing on our own and others' experience.

Drug and alcohol user treatment/intervention services in Russia--a Western perspective.

This paper reviews the state of drug and alcohol treatment/intervention services in Russia. The background and the development of addiction services in Russia is described, and the current problems of alcohol and particularly drug misuse are discussed. Current methods of treatment are considered, in the context of a description of the addiction services in St. Petersburg. Some of the issues facing the authorities are discussed: poor training in addiction, the low status of the speciality, overmedicalization of treatment, and the absence of any community-based services. The lack of any harm reduction policies or practice is noted.

Alcohol treatment services in Russia: a worsening crisis.

This paper reviews the state of alcohol treatment services in Russia. There have been some recent improvements, for example the introduction of confidentiality in treatment, the closure of correctional centres, and the payment of state benefits to in-patients. However, there remains a considerable stigma attached to a diagnosis of alcoholism. Although new approaches to treatment have been promulgated, in practice Russian treatment methods remain idiosyncratic with little in the way of psychotherapy. Many techniques utilise placebos and persuasion, with the patient as a passive recipient. Services are generally of a poor quality, and underfunded and medical specialists are poorly trained. To improve matters it is suggested that there will need to be: (1) changes in knowledge and attitude among the general population and within the specialist services; and (2) a continuing exchange of ideas and specialists between Russia and the West.

Is the prescription of amphetamine justified as a harm reduction measure?

Although amphetamine is the most widely illicitly used drug in the United Kingdom after cannabis, relatively few problematic users present to treatment agencies. Injecting amphetamine users are a high risk group as far as HIV transmission is concerned. This paper reviews the first 3 years' operation of an oral amphetamine prescribing programme for injecting users. Over half the subjects ceased injecting, and there was a considerable reduction in injecting by the remainder. 85% had not used or shared injecting equipment during the programme. However, subjects reported still using street amphetamine and offending, although at a lower rate than previously. There was little change in sexual practices. There was an increase in primary amphetamine users presenting for treatment. There is a case to be made that closely controlled and monitored programmes such as this can be justified on harm reduction grounds. A number of issues concerned with amphetamine prescribing are discussed.

Results of new air caloric testing method among normal subjects. I. Biphasic testing.

A new air caloric testing method is described in which the temperature of a continuous aural irrigation is switched hot and cold values at times calculated to control the intensity of the resulting vestibular stimulation. Applications of low or high caloric stimulus intensities to normal subjects were well tolerated and reliably produced appropriate low or high intensity nystagmic responses. Nystagmus intensity values obtained from this study were compared with predicted intensity values from a computerized simulation of the actual test conditions, and also with values obtained when using biphasic water irrigations. As a result, further improvements in our methodology have been effected.

Results of new air caloric testing method among normal subjects. II. Monophasic testing.

A new caloric irrigation method is described. In the new method, the temperature of a continuous aural irrigation is switched between hot and cold values at precisely specified times. The durations of hot and cold pulses have been calculated to produce specific caloric stimulation intensities based on known heat transmission characteristics of the labyrinth area. A brief "washout" irrigation is used to eliminate promptly all caloric stimulation effects at the conclusion of each test. The present study concentrated upon the question of how long the "washout" pulse should be in order to obtain optimum results. Repetitive application of a uniform stimulus intensity to 6 normal subjects indicated that short inter-test intervals can be used without causing vestibular habituation. Prompt removal of the caloric stimulus can be accomplished by proper timing the "washout" phase of the new technique.