An evaluation of the Chesapeake Bay management strategy to improve water quality in small agricultural watersheds.

Chesapeake Bay water quality has been a concern since 1970. In rural areas, agriculture is the dominant N and P source, and the voluntary application of best management practices (BMPs) is the primary management tool. Here we test the hypothesis that the current management approach of primarily voluntary, untargeted BMP implementation is insufficient to create detectable, widespread reductions in N, P, and total suspended solid (TSS) concentrations in agricultural watersheds of the Choptank basin, a tributary of Chesapeake Bay. To test this hypothesis, we assessed BMP implementation and sampled water quality on participating farms, at intermediate streams within each watershed, and at watershed outlets of four watersheds from 2013 to 2014. We also present water quality data from 2003 to 2014 at the outlets of 12 additional agricultural and one forested watershed and survey-directed interviews of farmers. By the end of 2014, large numbers of BMPs, both structural and cultural, had been implemented. Of the 16 agricultural watersheds, 50% showed significant decreases in baseflow N, 37.5% showed no changes, and 12.5% showed increasing TN. Baseflow P significantly decreased at just one watershed, increased at one, and remained stable at 14. Stormflow N was similar to baseflow, but stormflow P was 5 times higher than baseflow. These data partially support our hypothesis. Surveys suggested farmers considered themselves responsible for the quality of water leaving their farms, but out-of-pocket cost was the major impediment to further BMP adoption. We suggest that greater outreach and more financial support for farmers to implement BMPs is required to increase the types and densities of BMPs needed to achieve regional water quality goals.

Characterization of a high-brightness, laser-cooled Li+ ion source.

Ion sources based on laser cooling have recently provided new pathways to high-resolution microscopy, ion milling, and ion implantation. Here, we present the design and detailed characterization of a 7Li magneto-optical trap ion source (MOTIS) with a peak brightness of (1.2 ± 0.2) × 105 A m-2 sr-1 eV-1 and a maximum continuous current over 1 nA. These values significantly surpass previous Li MOTIS performance benchmarks. Using simple models, we discuss how the performance of this system relates to fundamental operating limits. This source will support a range of projects using lithium ion beams for surface microscopy and nanostructure characterization, including Li+ implantation for studies of ionic transport in energy storage materials.

Magnetic resonance microscopy of morphological alterations in mouse trabecular bone structure under conditions of simulated microgravity.

This work describes the use of magnetic resonance (MR) microscopy to examine changes in tibial trabecular bone structure in mice following 28 days of hindlimb suspension, a model simulating the effects of microgravity in rodents. In this first MR study involving mice, analysis of 3D images showed that apparent bone volume fraction, trabecular number, and trabecular thickness were decreased, and apparent trabecular spacing increased, significantly (P < 0.05) in hindlimb-suspended mice compared to controls. These changes agreed well with light microscopy measurements from an independent study and also with actual spaceflight experiments with rats.

Eye irritation: updated reference chemicals data bank.

A list of 55 chemicals for which comprehensive rabbit eye irritation data were available was published by ECETOC in 1992. Similar data for a further 77 chemicals are now available. The total of chemicals included in the enlarged data bank is 132, assessed in 149 in vivo studies in rabbits. 28 of the chemicals were tested as solids, 24 as aqueous solutions. No new in vivo testing was carried out in order to qualify a chemical for inclusion in the data bank. The chemicals are available at known, high, consistent purity and are expected to be stable in storage. The in vivo data have been generated since 1981 in studies carried out according to OECD Test Guideline 405 and following the principles of Good Laboratory Practice. The data were obtained from tests normally using at least three animals evaluated at the same time, involving instillation of 0.1ml (or equivalent weight) into the conjunctival sac, and in which observations were made at least 1, 2 and 3 days after instillation. The chemicals are ranked for eye irritation potential on the basis of a 'modified maximum average score'. The reference chemicals data bank should be of use in validation tests of promising alternatives to the in vivo rabbit eye irritation test.

The stigma and enigma of chronic non-malignant back pain (CNMBP) treated with long-term opioids (LTO).

Certain diseases and drugs, like chronic non-malignant back pain (CNMBP) and opioids, are maligned by society, resulting in sufferers and users experiencing discrimination within the health care system which has the effects of increasing, rather than alleviating their pain and suffering. Many patients with severe CNMBP suffer not because their pain is untreatable but because their pain and personhood have not been validated by doctors and nurses who are opioiphobic. Such ignorances fears, beliefs and biases not only deny some CNMBP patients adequate pain relief but also puts their lives at risk as it has long been recognised that chronic pain can lead to immunosuppression, affecting morbidity and mortality. Beyond the effects on patients, CNMBP treated with long term opioids (LTO) has a profound impact on families, whose pain and suffering is rarely addressed in practice. There is an urgent need to change current practice if CNMBP patients treated with LTO are to maximise their health potential and become responsible consumers of health care.

Billing Medicare for investigational devices: what's OK, what's not.

In 1993-1994, the Office of Inspector General (OIG) conducted an investigation of allegations that numerous hospitals had fraudulently billed the Medicare program for investigational cardiac devices. OIG found evidence of fraud related to these devices as well as to certain investigational procedures. Partly as a result of this probe, Senate hearings were held in 1996 to ascertain whether fraud and abuse in Medicare billing was a widespread problem. Investigational devices and procedures received particular attention during these proceedings. Hospitals involved in the 1993-1994 OIG investigation maintained that the Federal government previously sanctioned billing for the use of some investigational or experimental devices, that the devices and procedures in question had already been proven to be safe and effective, and that the devices or procedures resulted in better patient care or shorter lengths of stay. For these and other reasons, the hospitals contended, billing Medicare for these devices was appropriate. Although HCFA has allowed the Medicare program to pay for the use of some investigational devices and procedures since November 1995, Federal fraud and abuse investigators continue to scrutinize the billing practices of hospitals engaged in clinical trials. Financial managers in healthcare organizations that use investigational devices--even those not engaged in clinical trials--need to carefully review their organizations' compliance with Medicare billing requirements.

The evolution of change: from nurse auditor to clinical reimbursement specialist.

The nurse auditor's role remains essentially to improve documentation and billing, with the commitment to quality improvement.

Skin irritation: Reference chemicals data bank.

A list of 176 chemicals, all of high or consistent purity and stable on storage, has been developed using available comprehensive in vivo rabbit skin irritation data. No new in vivo testing was conducted to qualify a chemical for inclusion in the list. The chemicals were tested undiluted in in vivo studies, apart from those chemicals where high concentrations could be expected to cause severe effects. The in vivo data were generated in studies carried out since 1981 according to OECD Test Guideline 404 and following the principles of Good Laboratory Practice. The data were obtained from tests normally using at least three rabbits evaluated at the same time, involving application of 0.5 g or 0.5ml to the flank under semi-occlusive patches for 4 hr, and in which observations were made at least 24, 48 and 72 hr after removal of the patch. The chemicals represent a range of chemical classes [acids, acrylates/methacrylates, alcohols, aldehydes, alkalis, amines, brominated derivatives, chlorinated solvents, esters, ethers, fatty acids and mixtures, fragrance oils, halogenated aromatics, hydrocarbons (unsaturated), inorganics, ketones, nitrites, phenolic derivatives, S-containing compounds, soaps/surfactants, triglycerides] and different degrees of irritancy. They are ranked for skin irritation potential on the basis of a 'primary irritation index'. These chemicals could be used in validation tests of promising alternatives to the in vivo rabbit skin irritation/corrosion test. This is an essential step in the progression to regulatory acceptance of alternative procedures.

Positioning for capitation by redesigning internal processes.

Now that healthcare reform is no longer at the forefront of President Clinton's agenda, competition among providers, practitioners, and health systems will become more common as they ready themselves for capitation. In addition, mergers, consolidations, acquisitions, alliances, and partnerships will continue to reshape the healthcare industry. In order for the parties to be successful in a capitated environment, providers, practitioners, and healthcare systems must manage and adapt to consolidation, capitation, communication, control, cost, customer, capital, and culture.

Eye irritation: Reference chemicals data bank.

A list of 55 chemicals has been developed for which comprehensive in vivo rabbit eye irritation data are available. No new in vivo testing has been carried out to qualify a chemical for inclusion in the list. The 55 chemicals selected are available at high and consistent purity and are expected to be stable on storage. They have been tested undiluted in in vivo studies, except those chemicals where high concentrations of the substance could be expected to cause severe effects. The in vivo data have been generated since 1981 in studies carried out according to OECD Test Guideline 405 and following the principles of Good Laboratory Practice. The data were obtained from tests normally using at least three rabbits evaluated at the same time, involving instillation of 0.1 ml (or equivalent weight) into the conjunctival sac, and in which observations were made at least at 24, 48 and 72 hr after instillation. The chemicals represent a range of chemical classes (acetates, acids, alcohols, alkalis, aromatics, hydrocarbons, inorganics and surfactants) and different degrees of irritancy. They are ranked for eye irritation potential on the basis of a 'modified maximum average score'. The reference data bank should be of use in validation tests for promising alternatives to the in vivo rabbit eye irritation test. This is an essential step in the progression to regulatory acceptance of alternative procedures.

Institutional alternatives to psychotherapy. A study of growth center users.

Are growth centers used as alternative institutions to traditional mental health facilities? Survey methods compared growth centers (N=426) and National Training Laboratories (N=108) participants with clinic patients (N=89). Symptoms, life stress, motivations for participation, process expectations, and various attitudes toward authority, time, and help were assessed prior to participation. Comparisons on degree of psychological distress and avowed motivation indicated that most who attend such activities do so for "psychotherapeutic purposes." Growth centers were found not to be an alternative to traditional psychotherapy, but rather an addition. Eighty percent of the growth center sample had previous or current psychotherapeutic experience. Of the people studied, most go to both rather than to one or the other, and from the perspective of the participants, the institutions do not differ greatly in what they offer, how long the process will take, or what goals will be met.