Effect of water treatment residuals on soil phosphorus, copper and aluminium availability and toxicity.

Water treatment residuals (WTRs) are produced by the treatment of potable water with coagulating agents. Beneficial recycling in agriculture is hampered by the fact that WTRs contain potentially toxic contaminants (e.g. copper and aluminium) and they bind phosphorus strongly. These issues were investigated using a plant bioassay (Lactuca sativa), chemical extractions and an isotopic dilution technique. Two WTRs were applied to an acidic and a neutral pH soil at six rates. Reductions in plant growth in amended soils were due to WTR-induced P deficiency, rather than Al or Cu toxicity. The release of potentially toxic Al from WTRs was found to be mitigated by their alkaline nature and pH buffering capacity. However, acidification of WTRs was shown to release more soluble Al than soil naturally high in Al. Copper availability was relatively low in all treatments. However, the lability of WTR-Cu increased when the WTR was applied to the soil.

Habitat inventory at a regional scale: a comparison of estimates of terrestrial Broad Habitat cover from stratified sample field survey and full census field survey for Wales, UK.

Estimates of terrestrial Broad Habitat cover for Wales from the Countryside Survey 2000 stratified sample field mapping programme in Britain are compared with the findings of a full census field mapping project, the Habitat Survey of Wales. The Countryside Survey sampling regime comprised a stratified random sample of 1 km squares [corrected] covering <0.5% of the land surface. Comparative assessment indicates that although few of the sample-derived estimates for individual Broad Habitats are within 30% of the full census survey results, relative extents accord with data from the complete census survey for all Broad Habitats apart from Arable & Horticultural. The accuracy of this estimate is improved when the national boundary of Wales is taken into account in the sample stratification scheme. It is suggested that cultural land-use differences between countries render cropland habitat extent less predictable from physical environmental parameters than semi-natural habitat extent. It is also shown that the precision of sample-derived cover estimates is influenced by habitat pattern: the error term associated with habitats of broadly equal extent is greater for those with the most clumped distributions.

Repeatability of Phase 1 habitat survey.

As the major part of a Habitat Survey of Wales, over 80% of the land surface was surveyed in the field between 1987 and 1997 using the Phase 1 method. A resurvey of 294 randomly selected points was carried out during the early stages to audit the quality of the data being collected, leading to the development of a set of recommendations for the surveyors to improve the consistency and accuracy of habitat mapping. Recent studies have indicated a high level of discrepancy between organisations in field habitat mapping using the Phase 1 method. The findings of the Phase 1 audit in Wales are presented here to show the level of repeatability that was achieved within an organisation. There was 76% correspondence in habitat mapping between 'surveyor' and 'assessor' at the level of individual Phase 1 habitat classes. The degree of repeatability varied according to habitat strata: it was highest for modified land cover types (88%), lowest for semi-improved types (56%) and intermediate for semi-natural types (75%). An overall estimate of the repeatability of Phase 1 survey in the study area of 83% was obtained by weighting the figures for the three strata by the proportion of land area occupied by each stratum. This figure increased to 85% when habitats were amalgamated into Broad Habitat groups. These results are considerably better than those reported by studies of consistency between organisations. Most of the discrepancies between surveyor and assessor were caused by differences in habitat identification. However, at almost two thirds of the points where such a difference occurred, the assessor noted that the vegetation was transitional or borderline with that mapped by the surveyor.

Results of a nationwide Veterans Affairs initiative to align graduate medical education and patient care.

CONTEXT: Planning for the US physician workforce is imprecise. Prevailing policy generally advocates more training in primary care specialties. OBJECTIVE: To describe a program to increase primary care graduate medical education (GME) in a large academic health system-the Veterans Health Administration of the Department of Veterans Affairs (VA). DESIGN: In 1995, a VA advisory panel recommended a 3-year plan to eliminate 1000 specialist training positions and add 750 primary care positions. After assessing the impact of the first year of these changes on patient care, the VA implemented modifications aimed at introducing primary care curricula for training of internal medicine subspecialists, neurologists, and psychiatrists. The change in strategy was in response to the call for better alignment of GME with local patient care and training needs to provide coordinated, continuous care for seriously and chronically ill patients. SETTING: The VA health system, including 172 hospitals, 773 ambulatory and community-based clinics, 206 counseling centers, and 132 nursing homes. PARTICIPANTS: A total of 8900 VA residency training positions affiliated with 107 medical schools. MAIN OUTCOME MEASURE: Proportion of residents in primary care training during the 3-year alignment. RESULTS: Over 3 years, primary care training in the VA increased from 38% to 48% of funded positions. Of this total, 39% of the increase was in internal medicine subspecialties, neurology, and psychiatry. CONCLUSION: In this case study of GME realignment, national policy was driven more by local patient care issues than by a perceived national need for primary care or specialty positions.

A strategy for improvement in care at the end of life: the VA Faculty Leaders Project.

Given the commitment of the Veterans Health Administration (VA) to excellent, compassionate end-of-life and palliative care and the VA's extensive system of academic affiliations with the nation's medical schools, there may exist an opportunity to accelerate acceptance of state-of-the-art training for improved care for dying patients. Accordingly, the VA has initiated a project to develop strategies for implementation of benchmark curricula for end-of-life and palliative care. With the support of the Robert Wood Johnson Foundation, this initiative has been implemented in 30 internal medicine residency training programs affiliated with the VA nationally.

Safety and efficacy of a novel tartar control dentifrice containing 3.3% pyrophosphate: a controlled six-month clinical trial.

This study was undertaken to establish the tartar control efficacy and long-term safety of a new tartar control dentifrice that was formulated to enhance aesthetics and consumer acceptability. In a partially randomized, examiner-blind clinical trial, the experimental dentifrice, Crest MultiCare with 3.3% pyrophosphate, was compared to two currently marketed control dentifrices, Crest Regular Paste or Crest Tartar Protection Paste with 5.0% pyrophosphate. The eight-month trial model included a two-month pretest period to establish calculus formation after prophylaxis, followed by a six-month test period to evaluate efficacy and safety. Following the pretest period, 456 subjects were allocated to one of the three treatment groups and then monitored for calculus accumulation. After three and six months' test product use, the Crest MultiCare group experienced reductions in calculus accumulation of 28.9% and 32.3%, respectively compared to the regular control dentifrice. Over the six-month observation period, the experimental tartar control and the marketed tartar control dentifrices were comparable on adverse event frequency, type or severity, and no subject discontinued treatment due to an oral soft tissue adverse event. In this partially randomized and controlled six-month clinical trial, this new dentifrice exhibited tartar control efficacy, with a comparable overall safety profile to a marketed tartar control dentifrice.

VA aligns health professions education with healthcare priorities.

In 1997, the Veterans Health Administration constituted the Associated Health Professions Education Review Committee to provide recommendations for its associated health training programs. The Committee recommended that support for the 54,000 trainees in over 45 non-physician disciplines that train every year in VA facilities be allocated based on patient-focused criteria that emphasize the VA's healthcare priorities. Such priorities include accessible primary care, geriatrics, treatment of substance abuse, chronic care, and rehabilitation. The Committee also placed a high priority on disciplines that demonstrate inter-professional strategies for healthcare delivery and training. Educational institutions and disciplines that address these needs in innovative ways will find opportunities for clinical training in VA settings.

Breath effects of three marketed dentifrices: a comparative study evaluating single and cumulative use.

This randomized and controlled, examiner blind, parallel group study was undertaken to evaluate the efficacy of three commercial dentifrices on breath malodor. A total of 384 healthy adult subjects with oral malodor were randomized to one of four brushing groups, using either an antimicrobial dentifrice containing 0.45% stannous fluoride, an antitartar dentifrice containing 0.243% sodium fluoride and 5% pyrophosphate, an antimicrobial dentifrice containing 0.24% sodium fluoride and 0.30% triclosan/copolymer, or bottled distilled water which served as the negative experimental control. Breath quality was evaluated over a five-day period by second-person organoleptic grading and measurement of volatile sulfur levels. Following treatment, adjusted mean organoleptic scores and volatile sulfur levels were lowest for the stannous fluoride dentifrice group, with this group exhibiting superior breath quality compared to the negative control at three hours after a single brushing, and again at all cumulative use time points. While all test dentifrices showed some activity, only stannous fluoride had a second-person breath benefit. Breath effects for the other two dentifrices were limited to reductions in volatile sulfur levels at hours 99 and 104 for the antitartar sodium fluoride pyrophosphate dentifrice, and at hour 99 only for the antimicrobial sodium fluoride triclosan/copolymer dentifrice. This research establishes the comparative breath efficacy of three commercial dentifrices in a study model that may prove relevant for other dentifrice clinical trials.