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Overview of data and conceptual approaches for derivation of quantitative structure-activity relationships for ecotoxicological effects of organic chemicals.

The use of quantitative structure-activity relationships (QSARs) in assessing potential toxic effects of organic chemicals on aquatic organisms continues to evolve as computational efficiency and toxicological understanding advance. With the ever-increasing production of new chemicals, and the need to optimize resources to assess thousands of existing chemicals in commerce, regulatory agencies have turned to QSARs as essential tools to help prioritize tiered risk assessments when empirical data are not available to evaluate toxicological effects. Progress in designing scientifically credible QSARs is intimately associated with the development of empirically derived databases of well-defined and quantified toxicity endpoints, which are based on a strategic evaluation of diverse sets of chemical structures, modes of toxic action, and species. This review provides a brief overview of four databases created for the purpose of developing QSARs for estimating toxicity of chemicals to aquatic organisms. The evolution of QSARs based initially on general chemical classification schemes, to models founded on modes of toxic action that range from nonspecific partitioning into hydrophobic cellular membranes to receptor-mediated mechanisms is summarized. Finally, an overview of expert systems that integrate chemical-specific mode of action classification and associated QSAR selection for estimating potential toxicological effects of organic chemicals is presented.

Animals↗

Using reinforcement-based methods to enhance membership recruitment in a volunteer organization.

The present study employed reinforcement-based methods to induce existing members to recruit new members to join a chamber of commerce. Three interventions took place during June and July of 3 successive years. The investigators trained chamber leaders to use reinforcement methods (e.g., contingent tokens) to reinforce recruitment and dues collections. All three interventions produced substantial increases in their targets.

Adult↗

Regulatory issues for evaluation of therapies to prevent or arrest disease progression.

The Federal Food Drug and Cosmetic Act gives authority to the US Food and Drug Administration (FDA) to regulate foods, human and veterinary drugs, biological products, and cosmetics which are to be introduced into interstate commerce. The approval of pharmaceutical products for the treatment and/or prevention of periodontal diseases requires presentation of evidence that supports the safety and efficacy of the particular drug therapy in question. Sponsors need to carefully consider each step in the overall development plan beginning with an Investigational New Drug Application and concluding with submission of a New Drug Application for pre-market approval. This paper focuses specifically on the design, conduct, and analysis of clinical trials of drugs for the prevention or treatment of periodontal diseases. It is based upon a guidance document under development at the time of this presentation by FDA's Center for Drug Evaluation and Research that will include separate chemistry, toxicology, and biopharmaceutics sections. Unlike more formal FDA guidelines, a guidance document can be more easily and regularly updated to reflect changes in the state of the art of periodontal diagnosis and treatment.

Clinical Trials as Topic↗

Propagation of the tick Amblyomma variegatum in the Caribbean.

The tropical bont tick, Amblyomma variegatum, is an African tick species which infests livestock and wildlife. It was probably introduced in the central eastern islands of the Caribbean during the 18th or 19th century, with cattle shipped from Senegal. In Africa and the Caribbean, this tick is a vector of heartwater (a rickettsial disease of ruminants) and is associated with acute dermatophilosis (a bacterial skin disease of animals). Until 1948, only Guadeloupe and the neighbouring islands of Marie Galante and Antigua were infested with this tick species. Following increased agricultural commerce between Guadeloupe and Martinique, the latter became infested in 1948. Between 1967 (when the tick was identified in St Croix) and 1988 (when a male tick was reported in St Vincent), fourteen new islands were reached by this tick. Most of the dissemination of the tick to new islands cannot be explained by legal or illegal movements of livestock. Recently-determined circumstantial evidence strongly links the increase in populations of the cattle egret (Bubulcus ibis), a migrating bird established in the Caribbean circa 1960, with increased colonisation of new islands by A. variegatum. Considering the wide range of areas currently occupied by this bird species in the Greater Antilles and on the American mainland, there is a high probability that the tick will also expand its range and invade new areas. Eradication of A. variegatum from the Caribbean and thus from the western hemisphere, and the strengthening of measures to prevent inter-island movements of livestock, would be the only effective means of preventing this threat.

Animals↗

District, state or regional veterinary diagnostic laboratories.

The district, regional or state laboratory is the local laboratory to which veterinarian practitioners usually submit samples, and consequently these laboratories are usually the first to observe a suspected disease problem. In most countries, these laboratories are under the jurisdiction of the State or region in which they are located. In the United States of America (USA), most veterinary diagnostic laboratories are State-associated and operate under the aegis of either the State Department of Agriculture or a university. The national laboratory provides reference assistance to the State laboratories. In the USA, the national Laboratory (the National Veterinary Services Laboratories) acts as a consultant to confirm difficult diagnoses and administer performance tests for State-associated laboratories. District, state or regional laboratories need to share information regarding technological advances in diagnostic procedures. This need was met in the USA by the formation of the American Association of Veterinary Laboratory Diagnosticians (AAVLD) in the late 1950s. Another requirement of district, state or regional diagnostic laboratories is a method to confirm quality assurance, which was fulfilled in the USA by an accreditation programme established through the AAVLD. The Accreditation Committee evaluates laboratories (on request) in terms of organisation, personnel, physical facilities and equipment, records, finance and budget. Those laboratories which meet the standards as established in the 'Essential Requirements for Accreditation' are given accreditation status, which indicates that they have the expertise and facilities to perform tests on food-producing animals for shipment in national or international commerce and on companion, laboratory or zoo animals. While confidentiality of test records is most important, it is becoming necessary to release certain types of animal disease test information if a country is to participate in the exportation of animals and animal products. As district, state and regional laboratories operate under many different administrative entities (i.e., universities, State governments and the Federal government), various checks at different administrative levels provide safeguards and reduce the possibility of faulty disease reporting.

Accreditation↗

Emerging or re-emerging bacterial zoonotic diseases: bartonellosis, leptospirosis, Lyme borreliosis, plague.

There are a whole series of emerging and re-emerging zoonotic diseases present in the Northern Hemisphere and the author describes four of them, namely, bartonellosis, leptospirosis, Lyme borreliosis and plague. Reasons for the emergence or re-emergence of such diseases are not clear, but factors such as human demographics, economic development and land use, international travel and commerce, and microbial adaptation, are thought to be involved. Control of emerging and re-emerging diseases has become a major challenge for the international community and it is important to disseminate information about diagnosis and control capabilities, particularly to people working in public health.

Animals↗

West Nile virus and North America: an unfolding story.

Before the introduction of the West Nile virus (WNV) into the United States of America (USA) in 1999, conditions in North America were ideal for an arboviral epidemic. Such factors as the large, susceptible and non-immune animal and human populations, the presence of competent vectors, increasing international travel and commerce, existing methods for rapid dissemination and an ill-prepared animal and public health infrastructure all combined to create the essential elements for a severe animal and public health crisis--the 'perfect microbial storm'. The introduction of WNV into New York City was the final factor, serving as the catalyst to initiate one of the most significant epidemics in the USA. The spread of WNV across the country resulted in very large populations of wildlife, equines and people being exposed and infected. The epidemic is still not fully understood and its character continues to change and adapt. The recent recognition of a number of non-vector modes of transmission has revealed the disease as a greater threat and more difficult to control than first thought. West Nile virus gives every indication that it will become a permanent part of the 'medical landscape' of the USA, continuing to threaten wildlife, domestic animals and humans as a now endemic disease. This paper discusses the features of this extraordinary epidemic, and emphasises the need for an integrated surveillance system, greater diagnostic capacity and improved control strategies.

Animals↗

Professional drivers: protection needed for a high-risk occupation.

"On the job" motor vehicle deaths number more than 4,000 annually in the U.S. and comprise nearly one-third of all work-related deaths. Yet the Department of Labor has set no standards relating to on-the-road safety of the millions of workers whose jobs entail large amounts of driving, and Department of Transportation standards affecting occupational safety cover only drivers in interstate commerce. Drivers of some commercial vehicles, such as heavy trucks, are at special risk of injury because trucks have usually been exempted for many years from federal motor vehicle safety standards--such as standards for brakes and seatbelts--designed to prevent crashes or protect occupants in crashes. Observations based on a series of 150 fatal crashes involving tractor trailers illustrate the need for better protection of this large population of high-risk workers. Clarification of responsibility within the various federal agencies and application of available knowledge and technology are essential.

Accidents, Traffic↗

The emerging relevance of antitrust laws to the delivery of health care.

Until relatively recently, antitrust enforcement in the delivery of health care was virtually non-existent. Not even 15 years ago, many legal observers might have concluded that the professional services of medical care providers were exempted from the federal antitrust laws altogether; or that many providers were engaged in local activities beyond the reach of federal interstate commerce jurisdiction. Even 10 years ago, many providers were arguing that collective agreements among potential competitors were not only sound public policy, but also that such concerted activities were actively encouraged by various federal laws. Today, however, the enforcement of the federal antitrust is an integral part of the complicated legal environment of American health care delivery.

Delivery of Health Care↗

Beneficial reuse and sustainability: the fate of organic compounds in land-applied waste.

Land application systems, also referred to as beneficial reuse systems, are engineered systems that have defined and permitted application areas based on site and waste characteristics to determine the land area size requirement. These terrestrial systems have orders of magnitude greater microbial capability and residence time to achieve decomposition and assimilation compared with aquatic systems. In this paper we focus on current information and information needs related to terrestrial fate pathways in land treatment systems. Attention is given to conventional organic chemicals as well as new estrogenic and pharmaceutical chemicals of commerce. Specific terrestrial fate pathways addressed include: decomposition, bound residue formation, leaching, runoff, and crop uptake. Molecular decomposition and formation of bound residues provide the basis for the design and regulation of land treatment systems. These mechanisms allow for assimilation of wastes and nondegradation of the environment and accomplish the goal of sustainable land use. Bound residues that are biologically produced are relatively immobile, degrade at rates similar to natural soil materials, and should present a significantly reduced risk to the environment as opposed to parent contaminants. With regard to leaching and runoff pathways, no comprehensive summary or mathematical model of organic chemical migration from land treatment systems has been developed. For the crop uptake pathway, a critical need exists to develop information for nonagricultural chemicals and to address full-scale performance and monitoring at more land application sites. The limited technology choices for treatment of biosolids, liquids, and other wastes implies that acceptance of some risks and occurrence of some benefits will continue to characterize land application practices that contribute directly to the goal of beneficial reuse and sustainability.

Agriculture↗

Waterlogging effects on growth and yield components in late-planted soybean.

A major agronomic problem in the southeastern USA is low yield of late-planted soybean [Glycine max (L.) Merr.]. This problem is aggravated by the adverse effect of waterlogging on crop growth. Our objectives were to identify soybean growth stages sensitive to waterlogging; identify yield components and physiological parameters explaining yield losses induced by waterlogging; and determine the extent of yield losses induced by waterlogging under natural field conditions. Greenhouse and field studies were conducted during 1993 and 1994 near Baton Rouge, LA, (30 degrees N Lat) on a Commerce silt loam. Waterlogging tolerance was assessed in cultivar Centennial (Maturity Group VI) at three vegetative and five reproductive growth stages by maintaining the water level at the soil surface in a greenhouse study. Using the same cultivar, we evaluated the effect of drainage in the field for late-planted soybean. Rain episodes determined the timing of waterlogging; redox potential and oxygen concentration of the soil were used to quantify the intensity of waterlogging stress. Results of the greenhouse study indicated that the early vegetative period (V2) and the early reproductive stages (R1, R3, and R5) were most sensitive to waterlogging. Three to 5 cm of rain per day falling on poorly drained soil was sufficient to reduce crop growth rate, resulting in a yield decline from 2453 to 1550 kg ha-1. Yield loss in both field and greenhouse studies was induced primarily by decreased pod production resulting from fewer pods per reproductive node. In conclusion, waterlogging was determined to be an important stress for late-planted soybean in high rainfall areas such as the Gulf Coast Region.

Agriculture↗

Republicans accused of witch-hunt against climate-change scientists.

Some of America's leading scientists have accused Republican politicians of intimidating climate-change experts by placing them under unprecedented scrutiny. A far-reaching inquiry into the careers of three of the U.S.'s most senior climate specialists has been launched by Joe Barton, chairman of the House of Representatives committee on energy and commerce. He has demanded details of all their sources of funding, methods, and everything they have ever published. The inquiry has sent shockwaves through the U.S. scientific establishment, already under pressure from the Bush administration, which links funding to policy objectives.

Climate↗

Have risks associated with the presence of synthetic organic contaminants in land-applied sewage sludges been adequately assessed?

Land application has become the dominant means for sewage sludge disposal in the United States. In 1993, the EPA concluded that synthetic organics therein posed an insignificant risk, based on the results of the 1988 National Sewage Sludge Survey, the view that most persistent organics are no longer in commerce and that industrial pretreatment further reduces their release to municipal treatment plants. However, we detected high concentrations of several problematic compounds in biosolids that were overlooked in the risk assessment, including persistent, bioaccumulative polybrominated diphenyl ethers and estrogenic nonylphenols. These results and other findings call into question the assessment's certainty.

Journal Article↗

Is globalization undermining the welfare state? The evolution of the welfare state in developed capitalist countries during the 1990s.

The authors analyze the evolution of macro-indicators of social and economic well-being during the 1990s in the majority of developed capitalist countries, grouped according to their dominant political traditions since the end of World War II. Their analysis shows that, despite the economic globalization of commerce and finance, "politics still matters" in explaining the evolution of the welfare states and labor markets in these countries; the impact of the globalization of financial capital in forcing reductions in the financial resources available for welfare state purposes has been exaggerated.

Developed Countries↗

The problem of current toxic chemicals management.

In this article, we explore the limitations of current chemicals management policies worldwide and the evolution of new European, International and U.S. policies to address the problem of toxic chemicals control. It is becoming increasingly apparent that current chemicals management policies in Europe and the United States are inadequate. There is a general lack of toxicity and exposure information on chemicals in commerce and the vast majority of chemicals were considered safe until proven guilty in legislation. Governments must then prove each chemical is dangerous through a slow and resource-intensive risk assessment process. For more than a decade, Nordic countries, such as Denmark and Sweden, have actively promoted integrated chemicals policies to address contamination of critical waterways. They have successfully used a variety of voluntary and mandatory policy tools, such as education, procurement, lists of chemicals of concern, eco-labeling, research and development on safer substitutes, and chemical phase-out requirements, to encourage companies using chemicals to reduce their reliance on harmful substances and to develop safer substitutes. While previously isolated to particular countries, innovative and exciting European-wide policies to promote sustainable chemicals management are now moving forward, including the recently published draft Registration, Evaluation and Authorization of CHemicals (REACH) policy of the European Union. A sweeping change in chemicals management policies in Europe is inevitable and it will ultimately affect manufacturers in the U.S. and globally. The European movement provides an opportunity to initiate a discussion on integrated chemicals policy in the U.S. where some innovative initiatives already are underway.

Journal Article↗

The role of a community coalition in the development of health services for the poor and uninsured.

Access to primary health care for indigent citizens presents a dilemma for many communities in the United States. In response, communities have developed a variety of strategies to effectively deal with the problem. This article describes the evolution of a small free clinic into a comprehensive primary care clinic developed through the actions of a community-based coalition. The clinic originated within an umbrella organization for indigent residents as free medical service provided at a night shelter by a local physician once a week. Through a coalition of business, religious, medical, hospital, foundation, lay volunteer, county health department, and chamber of commerce representatives, the service was enlarged into a formal clinic operation with a small staff and volunteers providing services for about 3,500 patient visits each year. As the demand for services increased beyond resources, an expanded coalition created HealthServe Medical Center, a comprehensive primary care clinic operating 40 hours per week. The HealthServe Board is currently active in supporting service delivery at the clinic, with plans to serve 24,000 medical and dental visits annually by mid-1995. The evolution process was based upon the characteristics of effective community coalitions and the commitment of individuals from diverse community sectors.

Community Health Services↗

Neoliberalism, "globalization," unemployment, inequalities, and the welfare state.

This analysis of "neoliberalism" and its economic and social consequences is presented in six sections. Section I begins by describing the impact of neoliberal public policies on economic growth and inflation, on business profits and business investments, on productivity, on business credit, on unemployment and social inequalities, on social expenditures, and on poverty and family debt. The author shows that, except in the area of business profits and control of inflation, neoliberal policies have not proved superior to those they replaced. Section II deals with unemployment and social polarization in the developed capitalist countries. The author criticizes some of the theories put forward to explain these social problems, such as the introduction of new technologies and globalization of the economy, and suggests that a primary reason for these problems is the implementation of neoliberal policies. Section III challenges the widely held neoliberal perception that the U.S. economy is highly efficient and the E.U. economies are "sclerotic" due to their "excessive" welfare states and "rigid" labor markets. The author shows that the U.S. economy is not so dynamic, nor the E.U. economies so sclerotic. Some developed countries with greater social protection and more regulated labor markets are shown to be more successful than the United States in producing jobs and lowering unemployment. The reasons for the growing polarization in developed capitalist countries, rooted in political rather than economic causes, are discussed in section IV--especially the enormous power of the financial markets and their influence on international agencies and national governments, and the weakness of the labor movements, both nationally and internationally. Section V questions the major theses of globalization. The author shows that rather than globalization of commerce and investments, we are witnessing a regionalization of economic relations stimulated by political considerations. He also analyzes the globalization of capital finance, criticizing the thesis that capital markets are determining public policies. The economic determinism that underlies the globalization position is questioned, uncovering the importance of political explanations for understanding major social problems such as unemployment. Finally, section VI shows that neoliberal public policies on the deregulation of labor markets are creating enormous instability in the labor force, worsening the living conditions of the majority of the populations.

Developed Countries↗

What is eHealth (3): a systematic review of published definitions.

CONTEXT: The term eHealth is widely used by many individuals, academic institutions, professional bodies, and funding organizations. It has become an accepted neologism despite the lack of an agreed-upon clear or precise definition. We believe that communication among the many individuals and organizations that use the term could be improved by comprehensive data about the range of meanings encompassed by the term. OBJECTIVE: To report the results of a systematic review of published, suggested, or proposed definitions of eHealth. DATA SOURCES: Using the search query string "eHealth" OR "e-Health" OR "electronic health", we searched the following databases: Medline and Premedline (1966-June 2004), EMBASE (1980-May 2004), International Pharmaceutical Abstracts (1970-May 2004), Web of Science (all years), Information Sciences Abstracts (1966-May 2004), Library Information Sciences Abstracts (1969-May 2004), and Wilson Business Abstracts (1982-March 2004). In addition, we searched dictionaries and an Internet search engine. STUDY SELECTION: We included any source published in either print format or on the Internet, available in English, and containing text that defines or attempts to define eHealth in explicit terms. Two of us independently reviewed titles and abstracts of citations identified in the bibliographic databases and Internet search, reaching consensus on relevance by discussion. DATA EXTRACTION: We retrieved relevant reports, articles, references, letters, and websites containing definitions of eHealth. Two of us qualitatively analyzed the definitions and coded them for content, emerging themes, patterns, and novel ideas. DATA SYNTHESIS: The 51 unique definitions that we retrieved showed a wide range of themes, but no clear consensus about the meaning of the term eHealth. We identified 2 universal themes (health and technology) and 6 less general (commerce, activities, stakeholders, outcomes, place, and perspectives). CONCLUSIONS: The widespread use of the term eHealth suggests that it is an important concept, and that there is a tacit understanding of its meaning. This compendium of proposed definitions may improve communication among the many individuals and organizations that use the term.

Delivery of Health Care↗