Examining the ultraviolet optical screening tool as a viable means for delineating a contaminated organic sediment.

Rapid and accurate delineation of contaminated sediments in marine environments is critical for the effective assessment of site risks and the development of appropriate remedial action plans. In this study, a new application of the ultraviolet optical screening tool (UVOST) equipped with electrical conductivity measurement (UVOST-EC) is proposed to delineate a water-covered sediment contaminated with dioxins and furans in a decommissioned pulp and paper wastewater stabilization basin. Bench scale experiments are presented that were used to develop a UVOST-EC interpretation method for delineating between two different sediment types present in the basin: an anthropogenically derived organic rich contaminated sediment ("black sediment") and a naturally occurring grey organic silt sediment with marine provenance ("grey sediment"). The method involves comparative analysis of fluorescence and electrical conductivity signatures between the two sediments. Results indicate that each sediment type presents unique "signatures" related to fluorescence and electrical signals which corresponds to variability in their physio-chemical structure. Almost 100 UVOST-EC tests performed at the study site were paired with ex situ physical gravity core measurements of the black sediment to test the accuracy of the UVOST-EC-based method. A statistical analysis at seven sample "cluster" sites (i.e. multiple sub-samples within a defined area) indicated that the mean of sediment thickness obtained by the UVOST-EC measurement technique at a given site were not significantly different (p = 0.05) from measurements derived from sediment gravity core measurements. The UVOST-EC-based sediment thickness delineation method reliably determined the thickness of the dioxin and furan contaminated sediments as compared to gravity core determination for the sediment in this study. Application of this approach to other studies should be assessed in a similar manner. The UVOST-EC method offers health and safety, cost, logistics, and data interpretation benefits.

Pharmacy costs associated with nonformulary drug requests.

Pharmacy costs associated with handling nonformulary drug requests were studied. Data for all nonformulary drug orders received at a university hospital between August 1 and October 31, 1999, were evaluated to determine their outcome and the cost differential between the nonformulary drug and formulary alternative. Two sets of data were used to analyze medication costs: data from nonformulary medication request forms, which allowed the cost of nonformulary drugs and their formulary alternatives to be calculated, and data from the pharmacy computer system, which enabled actual nonformulary drug use to be captured. Labor costs associated with processing these requests were determined through time analysis, which included the potential for orders to be received at different times of the day and with different levels of technician and pharmacist support. Economic analysis revealed that the greatest cost saving occurred when converting nonformulary injectable products to formulary alternatives. Interventions were least costly during normal business hours, when all the satellite pharmacies were open and fully staffed. Pharmacists' interventions in oral product orders resulted in a net increase in expenditures. Incremental pharmacy costs associated with processing nonformulary medication requests in an inpatient setting are greater than the drug acquisition cost saving for most agents, particularly oral medications.

Midwifery in Indonesia: a professional snapshot.

In 1988, Indonesia had the highest maternal mortality rate in South East Asia, but the Government's commitment to reducing this has already demonstrated a measure of success. Initiatives include: use of voluntary healthcare workers (kaders) in the local community family planning initiatives raising awareness of the status of women in society by the appointment of a Minister for Women's Affairs. The commitment of both the government and midwives to promoting safe motherhood in Indonesia should make a significant contribution to achieving the WHO aim of halving the maternal mortality rate by the year 2000.

Use and sterility of multidose ophthalmic medications.

Liquid ophthalmic products in opened multidose containers were studied to determine whether the date of opening was marked on the container and whether the drugs were contaminated. Pharmacy personnel collected opened containers for four months from a hospital's eye center clinic and outpatient surgery area. Half of the containers were randomly selected and the contents tested for bacterial and fungal contamination. The ophthalmic products were dripped from the containers' dropper tips into nutrient broth. Broth samples that became turbid after incubation were to be tested in the microbiology laboratory. Of 166 opened containers collected, 118 were marked with dates. The dates indicated that 97 had been opened within 30 days before collection; nursing policy dictated that containers be discarded 30 days after being opened. Acquisition cost for the undated, opened containers, which should have been discarded by nurses, was $182. In incubated samples from 81 opened containers, 61 of them dated and 52 dated within the past 30 days, no turbidity was seen. Although no bacterial or fungal contamination was detected in these ophthalmic products from opened containers, the absence of dates on some containers indicated deviation from institutional policy and probable avoidable waste of undated products.

Behavioural assessment of the effectiveness of a communication programme for medical students.

This study evaluated the effectiveness of a communication programme taught to medical students at the University of Melbourne in their preclinical years. The effectiveness of the programme was assessed by comparing videotaped history-taking interviews completed by a cohort of first-year clinical students in 1986, who had not undertaken the communication programme, with a similar cohort of first-year clinical students in 1992 who had undertaken the programme. The students from the 1986 cohort who had not undertaken communication training in their preclinical course completed their videotaped interviews as part of the experimental evaluation of a consulting skills training programme carried out in 1986-87. A comparison of ratings given by two experimentally naive, independent observers revealed that the 1992 student cohort demonstrated some significantly better skills at questioning and facilitating communication with patients. By contrast, the 1986 student cohort showed significantly greater skills at maintaining relevance in their interviews and greater capacity to explore patients' psychosocial concerns. These data suggest that students acquire the most effective interview skills when interacting with patients during their clinical training.

Lectures and skills workshops as teaching formats in a history-taking skills course for medical students.

The consulting skills acquired by medical students during their training are an important determinant of their ability to conduct adequate and efficient clinical interviews. These skills comprise: the acquisition of medical knowledge and the ability to apply this; and communication skills required to obtain full, accurate clinical histories from patients and to be able to give to patients the information they need to comply with prescribed regimens. Until recently, consulting skills training has certainly not had a high profile in medical curricula, despite evidence that students do not gain sufficient expertise during their medical training. A history-taking skills course within the Austin Hospital Clinical School, utilizing mass lecture and small-group skills workshops is described. Independent evaluation of students' videotaped interviews with patients, completed before training, after mass lectures and following small-group workshops, showed that students trained in consulting skills demonstrated significant improvements in interview skills and techniques, compared with a similar group of students for whom training followed the more traditional model. Whilst there were some improvements after mass lectures, most significant gains in history-taking skills were obtained following skills workshops. Ongoing evaluation of these students will determine if these short-term improvements in consultation skills persist over their clinical training and internship.

A communication skills programme for increasing patients' satisfaction with general practice consultations.

The research literature on patient perceptions of general practice consultations shows that, while patients are generally satisfied with the treatment they receive from doctors, they report less satisfaction with the amount and clarity of information they receive and doctors' expression of caring and respect. In the surgery, inadequate information transmission during the interaction also has the effect of increasing the level of anxiety reported by patients after their consultations. A communication skills programme was developed, incorporating variables from both the emotional and cognitive domains of the consultation. A group of GPs undertook training in this programme. It was hypothesized that patients of the trained doctors would report greater satisfaction and less anxiety, compared with patients of untrained general practitioners. Subsequent randomized interviews with patients of the trained doctors showed that these patients were significantly more satisfied with their consultations. Patients of the trained doctors also reported less state anxiety immediately following their consultations, as measured using the State-Trait Anxiety Inventory. Attempts by doctors to communicate more effectively in consultations therefore increased patients' positive feelings and reduced anxiety.

Purification and characterization of pregastric esterase from calf.

Calf pregastric esterase (PGE) was purified from calf gullet tissues. The tissue was excised and lyophilized, and lipid materials were extracted with acetone and n-butanol at -20 degrees C. Proteins were extracted from the delipidated tissue with a buffer containing a chaotropic salt (NaSCN) to solubilize hydrophobically bound protein aggregates. Calf PGE precipitated from the crude extract at pH 5.0. The precipitated, solubilized proteins were subjected to anion-exchange chromatography on DEAE-Sephacel, and the enzymatic activity was eluted using a linear gradient from 0.10 to 0.50 M NaCl at pH 8.0. Fractions with high specific activities were then chromatographed twice using gel filtration on Sephadex G-100. The resultant enzyme was shown to be pure upon discontinuous electrophoresis in 12% polyacrylamide containing 0.1% sodium dodecyl sulfate (SDS-PAGE). From SDS-PAGE gel patterns, a molecular weight of 49,000 was determined. The amino acid composition of the enzyme allowed calculation of an "average hydrophobicity" (Bigelow index) of 1150 cal/residue. This indicates that calf PGE is relatively hydrophobic, being similar to proteins such as alpha-lactalbumin and bovine serum albumin in average hydrophobicity.

Antibody levels in reduced/alkylated intravenous immune globulin.

Antibody titers, found in representative lots of a reduced and alkylated intravenous immune globulin, against a variety of common microorganisms are presented. With the more frequently occurring pathogens the specific antibody level does not vary significantly between lots. Depending upon the type of assay used, antibody titers per se may or may not reflect the therapeutic activity of the preparation against a specific microorganism.