Oxygenated VOCs, aqueous chemistry, and potential impacts on residential indoor air composition.

Dampness affects a substantial percentage of homes and is associated with increased risk of respiratory ailments; yet, the effects of dampness on indoor chemistry are largely unknown. We hypothesize that the presence of water-soluble gases and their aqueous processing alters the chemical composition of indoor air and thereby affects inhalation and dermal exposures in damp homes. Herein, we use the existing literature and new measurements to examine the plausibility of this hypothesis, summarize existing evidence, and identify key knowledge gaps. While measurements of indoor volatile organic compounds (VOCs) are abundant, measurements of water-soluble organic gases (WSOGs) are not. We found that concentrations of total WSOGs were, on average, 15 times higher inside homes than immediately outside (N = 13). We provide insights into WSOG compounds likely to be present indoors using peer-reviewed literature and insights from atmospheric chemistry. Finally, we discuss types of aqueous chemistry that may occur on indoor surfaces and speculate how this chemistry could affect indoor exposures. Liquid water quantities, identities of water-soluble compounds, the dominant chemistry, and fate of aqueous products are poorly understood. These limitations hamper our ability to determine the effects of aqueous indoor chemistry on dermal and inhalation exposures in damp homes.

Topical lidocaine and the effect on enoxaparin absorption in children: a pilot study.

UNLABELLED: Enoxaparin, a low molecular weight heparin (LMWH), is frequently used for the prevention and treatment of thromboembolic complications in infants and children (Sutor et al., 2004 [1]). Injection pain and the fear and anxiety associated with needle phobia in the pediatric population are well documented. Best practice pediatric pain management standards of care recommend mitigating the child's pain experience whenever possible. The use of topical anesthetics such as liposomal-lidocaine 4% results in a rapid onset of anesthesia, minimal blanching, without vasoconstriction (Koh et al., 2004 [2]) or risk of methemoglobinemia. Topical lidocaine has been used to reduce the injection pain of enoxaparin, but there is no data available examining whether it will interfere with the absorption of LMWH. OBJECTIVE: To determine if the topical lidocaine, Maxilene, interferes with enoxaparin absorption as measured by peak anti-Xa levels. METHODS: Infants and children clinically prescribed enoxaparin were eligible for this study. Children in group 1 were pre-treated with Maxilene prior to enoxaparin injection on day 1 with no Maxilene pre-treatment on day 2. For group 2, the order was reversed. Peak anti-Xa levels were measured following each enoxaparin dose and were compared between the groups. RESULTS: 26 children of ages 14d-16 y (median 6.7 months) were enrolled. Anti-Xa levels following topical lidocaine administration were 0.070 U/mL (95%CI 0.025; 0.114) lower than without prior topical lidocaine administration. Anti-Xa levels on the second day were on average 0.013 U/mL (95%CI -0.066; 0.040) higher compared to day one regardless of the order of topical lidocaine administration. There were no reported incidences of local reactions such as redness, hives or blanching. CONCLUSIONS: Topical lidocaine (Maxilene) administration before enoxaparin injection results in a small, clinically non-significant, reduction in anti-Xa levels.

Nurses' experience of violence in Alberta and British Columbia hospitals.

This study examined responses to a survey on violence in the workplace from a sample of 8,780 registered nurses practising in 210 hospitals in the Canadian provinces of Alberta and British Columbia. Findings relate to the frequency of violence against nurses, reported as the number of times they experienced a violent incident in the workplace. Nearly half (46%) of those surveyed had experienced 1 or more types of violence in the last 5 shifts worked. Frequency varied by type: emotional abuse 38%, threat of assault 19%, physical assault 18%, verbal sexual harassment 7.6%, sexual assault 0.6%. Further, 70% of those who had experienced violence indicated they had not reported it. Patients constituted the main source of all types of violence. The most prevalent type, emotional abuse, was further explored for its possible determinants. This was also the type of violence most evenly distributed among sources (patients, families, co-workers, physicians). Multiple regression modelling using the individual nurse as the unit of analysis showed the significant predictors of emotional abuse to be age, casual job status, quality of care, degree of hospital restructuring, type of unit, relationships among hospital staff, nurse-to-patient ratios, and violence-prevention measures; using the hospital as the unit of analysis the predictors were found to be quality of care, age, relationships with hospital staff, presence of violence-prevention measures, and province. These findings illustrate important differences in models that use the individual and the institution as the unit of analysis. Implications include targeting prevention strategies not only at the nurse but, perhaps more importantly, at the hospital. Overall, the findings suggest that health-care institutions are not always healthy workplaces and may increasingly be stressful and hazardous ones.

A synthesis of C(16),C(18)-bis-epi-cytochalasin D via Reformatsky cyclization.

Triene 5 has been prepared by the E-selective olefination of aldehyde 12 with the ylide 11. Several alternative syntheses of 12 were evaluated, and the successful route involved conversion of 22 into the vinyl ether 23 by Petasis olefination, followed by Claisen rearrangement. Diels-Alder cycloaddition of 5 with 4 gave the adduct 6 in 77% yield, and Reformatsky cyclization under dilution conditions afforded 10 (67%). After conversion to enol silane 32, oxidation with dimethyldioxirane produced 34. Conversion to a key intermediate 38 using electrophilic selenenylation and selenoxide rearrangement, followed by enolate alkylation and deprotection, gave 43. The X-ray crystal structure of 43 was determined to prove the stereochemistry.

"Nurses as health evangelists"?: The evolution of public health nursing in Canada, 1918-1939.

Public health nurses provided leadership for the advancement of public health in Canada in the early decades of this century, although leadership by nurses is not celebrated in public health history. The historical period (1918-1939) selected for this inquiry is one in which public health nurses created a legacy of achievements in public health nursing education, practice, and the organization of community health services within the most challenging of social, economic, and political contexts. The practice of public health nursing in Canada during the interwar years included strategies that were then and still are integral to the discipline--those of forming connections with the community, providing leadership in the public health movement, and facilitating community organization. It is vital to understand the significance of these origins of public health nursing as forces in the present context of practice threaten to alter fundamentally the nature of public health nursing's connection with the community. The purpose of this article is to highlight aspects of this historical legacy so that its influence can be more fully understood and strengthened in current health system transitions.

Empowerment strategies in nursing education: a foundation for population-focused clinical studies.

Building on the already substantial body of literature on education for population-focused practice, this article incorporates the teaching of empowerment strategies into this literature. These strategies provide a framework for teaching nursing students to promote the health of populations by shifting their focus of care to one that is compatible with principles of primary health care and health promotion within a context of health care reform. Since 1989, education for these shifts in practice has taken place within a clinical studies course on population-focused practice and has continued to evolve within an innovative nursing curriculum developed by The University of Victoria and its collaborative partners in nursing education in British Columbia, Canada. Faculty have worked to develop innovative teaching strategies and practica that provide students with opportunities to practice empowerment strategies with populations. Examples of how students have learned and practiced these strategies in a baccalaureate nursing program at the University College of the Cariboo in Kamloops, British Columbia, Canada provide useful illustration of the shifts in nursing education that are needed to shape the next era of health care.

A randomized comparison of once-monthly or twice-monthly high-dose aerosolized pentamidine prophylaxis.

RESULTS: Ten of the 146 (7 percent) evaluable subjects developed PCP during the year study period, and there was no difference in the efficacy of the two regimens. Among patients receiving secondary prophylaxis, the attack rate of PCP at 1 year was 11 percent. This compares favorably with a 1-year attack rate of 19 percent in similar patients receiving standard dose (300 mg) prophylaxis and suggests, but does not prove, a dose-response effect. Concentrations of pentamidine in BAL fluid were not significantly different among the three lobes of the lung. Intrapulmonary pentamidine did not accumulate during the year of study. Aerosolized pentamidine was associated with a marginal but statistically significant increase in the residual volume, decreased flow rates, and increased airway reactivity. OBJECTIVE: The optimal regimen of aerosolized pentamidine in unknown. Published data suggest that there is a dose-response effect and that the occurrence of Pneumocystis carinii pneumonia (PCP) has been associated with prolongation of the interval between doses. The purpose of this study was to compare the efficacy, pharmacokinetics, and physiologic effects of two high-dose regimens of aerosolized pentamidine prophylaxis. DESIGN: Prospective, randomized study of 300 mg twice monthly vs 600 mg once monthly during a 1-year observation period. Pentamidine concentrations in plasma and bronchoalveolar lavage (BAL) fluid were measured and serial pulmonary function was measured. SETTING: A large teaching hospital in San Francisco. PATIENTS: One hundred fifty-one adult (age > 18 years) men with human immunodeficiency virus infection. Of 146 evaluable patients, prophylaxis was primary (no prior PCP) in 108 (75 percent) and secondary (one prior episode of PCP) in 38 (25 percent). MEASUREMENTS: Date and diagnosis of PCP, occurrence of drug toxicity, pulmonary function testing, and concentrations of pentamidine in BAL and plasma. CONCLUSIONS: The data suggest, but do not prove, that a dose-response effect has been demonstrated, and that high-dose aerosolized pentamidine may further reduce the attack rate of PCP. These preliminary observations should be confirmed in a double-blind trial comparing 300 mg with 600 mg administered once monthly. The clinical relevance of the adverse pulmonary effects is unclear and requires further investigation.

Ethical challenge in community health nursing.

Community health nurses frequently face situations involving ethical conflicts, but little research has been carried out in this area. This paper, based on a study of dilemmas defined by 30 practising community health nurses in urban and rural British Columbia, Canada, presents an analysis of the situations that contain the most serious ethical conflicts for nurses working in the community. Although issues related to client's rights, nurses' interactions with colleagues and the system, and nurses' rights were explored, nurses in the study reported that situations involving high-risk parenting provided the most serious ethical challenges. Strategies to help nurses caring for such vulnerable clients are described. As well, this paper offers some discussion on implications for community health nursing practice and education in light of current changes and challenges.

The effects of atenolol (tenormin) and methyldopa on simple tests of central nervous function.

Two identical studies, one comparing the effect of single doses of a new beta-adrenoceptor blocker, atenolol (Tenormin) (50 mg and 100 mg) and placebo, and the other comparing the effect of single doses of methyldopa (250 mg and 500 mg) and placebo, in healthy volunteers, were carried out. 2 In both studies the effect of the drugs upon reaction time, critical flicker frequency, subjective drowsiness, pulse rate and blood pressure was measured. 3 Atenolol produced no effect upon reaction time, critical flicker frequency or subjective feelings, while methyldopa produced a statistically significant prolongation of reaction time and a statistically significant increase in the subjective sensation of drowsiness. 4 Atenolol produced statistically significant reductions in systolic and diastolic blood pressure and in pulse rate while methyldopa was without effect. 5 It is concluded that atenolol is unlikely to produce the side effects of sedation or drowsiness.

The clinical pharmacology of viloxazine hydrochloride-a new anti-depressant of novel chemical structure.

1 The clinical pharmacological properties of viloxazine hydrochloride (ICI 58,834, Vivalan), a new antidepressant of novel chemical structure, have been investigated in a series of double-blind randomized studies comparing it with placebo and imipramine. Throughout the studies, viloxazine hydrochloride was given in single doses of 100 mg (expressed as base), and imipramine hydrochloride was given in single doses of 50 mg (expressed as salt). 2 The effect of viloxazine upon the following parameters was measured: pulse rate, blood pressure, forced expiratory volume, reaction time, critical flicker frequency, salivary flow, pupil size and palpebral fissure size. In addition, the possible interaction between viloxazine and alcohol was investigated using measurements of reaction time. 3 Both viloxazine and imipramine produced a transient tachycardia, but no consistent effect on blood pressure was seen. Neither drug had any effect upon forced expiratory volume. 4 The differences that emerged between viloxazine and imipramine were that viloxazine depressed critical flicker frequency whereas imipramine did not, and imipramine prolonged reaction time whilst viloxazine did not. Imipramine reduced salivary flow and increased the size of the pupil and palpebral fissure. Viloxazine did neither. 5 Imipramine was shown to potentiate alcohol whereas, at the doses used, viloxazine did not. 6 It is concluded that viloxazine appears to have less anticholinergic and possibly less sympathomimetic properties than imipramine. It is also concluded that viloxazine, unlike imipramine, does not potentiate alcohol.