Pharmaceutical pollution sources and solutions: Survey of human and veterinary medication purchasing, use, and disposal.

Human and veterinary pharmaceuticals offer many benefits, but they also pose risks to both the environment and public health. Life-cycle stewardship of medications offers multiple strategies for minimizing the risks posed by pharmaceuticals, and further insight is required for developing best practices for pharmaceutical management. The goal of this study was to clarify points of intervention for minimizing environmental and public health risks associated with pharmaceuticals. Specifically, our objectives were to provide insight on purchasing, use, and disposal behaviors associated with human and veterinary medications. This study used a state-wide representative sample of Vermont adults (n = 421) to survey both human and veterinary pharmaceuticals as potential sources of the unintended consequences of prescribed and over-the-counter (OTC) medications. The majority (93%) of respondents had purchased some form of medication within the past twelve months, including OTC (85%), prescription (74%), and veterinary (41%) drugs. Leftover drugs of any kind were reported by 59% of respondents. While 56% of people were aware of drug take-back programs, the majority reported never being told what to do with leftover medications by their physician (78%), pharmacist (76%), or veterinarian (53%). Among all respondents, take-back programs were the most common disposal method (22%), followed by trash (19%), and flushing (9%), while 26% of respondents reported keeping unused drugs. Awareness of pharmaceutical pollution in the environment and having received information about proper disposal were both significantly associated with participation in take-back programs. These findings indicate that a large volume of drugs are going unused annually, and that only a portion of leftover medications are returned to take-back programs where they can be appropriately disposed. Our results warrant further investigation of clinical interventions that support lower dose prescribing and dispensing practices in order to reduce the unintended environmental and public health consequences of pharmaceuticals within the consumer sphere. In addition, our findings suggest that directed efforts to raise awareness of proper disposal may be more effective than broad awareness campaigns, and we recommend research on the efficacy of providing disposal instructions on drug packaging.

Effects of Sunlight on the Formation Potential of Dichloroacetonitrile and Bromochloroacetonitrile from Wastewater Effluents.

Sunlight plays an important role in transforming effluent organic matter as wastewater effluents travel downstream, but the corresponding effects on the formation of haloacetonitriles (HANs), a group of toxic disinfection byproducts, in wastewater-impacted surface water have not been thoroughly investigated. In this study, we observed that sunlight preferentially attenuated the formation potential of bromochloroacetonitrile (BCAN-FP) over that of dichloroacetonitrile (DCAN-FP) in chlorine- and UV-disinfected secondary effluents. For four effluent samples from different plants, 36 h of irradiation by simulated sunlight removed 28-33% of DCAN-FP and 41-48% of BCAN-FP. Across a larger set of effluent samples (n = 18), 8 h of irradiation (equivalent to 2-3 d of natural sunlight) decreased the calculated cytotoxicity contributed by dihaloacetonitrile-FP in most samples. Similar behavior was observed for a mixture of wastewater and surface water (volume ratio 1:1). For UV-disinfected effluents, the higher the UV dose, the more likely was there a reduction in DCAN-FP and BCAN-FP in the subsequent sunlight irradiation. Experiments with model compounds showed that fulvic acid and UV photoproducts of tryptophan yield excited triplet-state organic matters during sunlight irradiation and play an important role in promoting the attenuation of HAN precursors.

Copper-Catalyzed Asymmetric Propargylation of Cyclic Aldimines.

The copper-catalyzed asymmetric propargylation of cyclic aldimines is reported. The influence of the imine trimer to inhibit the reaction was identified, and equilibrium constants between the monomer and trimer were determined for general classes of imines. Asymmetric propargylation of a diverse series of N-alkyl and N-aryl aldimines was achieved with good to high asymmetric induction. The utility was demonstrated by a titanium catalyzed hydroamination and reduction to generate the chiral indolizidines (-)-crispine A and (-)-harmicine.

Public Health Nurses and Mothers Challenge and Shift the Meaning of Health Outcomes.

Maternal, child, and newborn health is a priority area in Canada and around the world. The work of public health nurses (PHNs) is often invisible and misunderstood. The purpose of this qualitative research project was to explore how universal and targeted home visiting programs for mothers and babies were organized, delivered, and experienced through the everyday practices of PHNs (n = 16) and mothers (n = 16) in Nova Scotia, Canada. Feminist poststructuralism and discourse analysis were used to analyze interviews. Concepts of relations of power enabled an understanding of how health outcomes had been socially and institutionally constructed through binary relations. PHNs and mothers spoke about the importance of "softer" health outcomes, including maternal self-confidence and empowerment that had been constructed as less important than health outcomes that were seen to be more tangible and physical. Findings from this research could be used to guide practice and planning of postpartum home visiting programs.

The power of relationships: exploring how Public Health Nurses support mothers and families during postpartum home visits.

Postpartum home visiting by Public Health Nurses (PHNs) has been used by many health departments across Canada as a way of supporting new mothers and their families. Although positive health outcomes are linked with support from PHNs, little is known about how this occurs during the home visit. The purpose of this research was to explore how home visiting programs for mothers and babies were organized, delivered, and experienced through the everyday practices of PHNs, mothers, and managers in Nova Scotia, Canada. Feminist poststructuralism was used to guide the research and semi-structured face-to-face interviews were conducted with 16 PHNs, 16 mothers, and 4 managers. Participants described how relationships were an essential part of supporting mothers and families. These findings also challenge dominant health discourses and stereotypes that are often associated with mothering and the practice of PHNs with families.

Comparing suppository mold variability which can lead to dosage errors for suppositories prepared with the same or different molds.

Suppository molds must be properly calibrated to ensure accurate dosing. There are often slight differences between molds and even in the cavities within a mold. A method is presented for the calibration of standard aluminum 6-, 12-, 50-, or 100-well suppository molds. Ten different molds were tested using water for volume calibration, and cocoa butter for standardization involving establishing the density factor. This method is shown to be straightforward and appropriate for calibrating suppository molds.