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PubMed2006

Column experiments to assess the effects of electron donors on the efficiency of in situ precipitation of Zn, Cd, Co and Ni in contaminated groundwater applying the biological sulfate removal technology.

BACKGROUND, AIMS AND SCOPE: In a previous study, we explored the use of acetate, lactate, molasses, Hydrogen Release Compound (HRC, which is based on a biodegradable poly-lactate ester), methanol and ethanol as carbon source and electron donor to promote bacterial sulfate reduction in batch experiments, this with regards to applying an in situ metal precipitation (ISMP) process as a remediation tool to treat heavy metal contaminated groundwater at the site of a nonferrous metal work company. Based on the results of these batch tests, column experiments were conducted with lactate, molasses and HRCI as the next step in our preliminary study for a go-no go decision for dimensioning an on site application of the ISMP process that applies the activity of the endogenous population of sulfate-reducing bacteria (SRB). Special attention was given to the sustainability of the metal precipitation process under circumstances of changing chemical oxygen demand (COD) to [SO4(2-)] ratios or disrupted substrate supply. METHODS: To optimize the ISMP process, an insight is needed in the composition and activity of the indigenous SRB community, as well as information on the way its composition and activity are affected by process conditions such as the added type of C-source/ electron donor, or the presence of other prokaryotes (e.g. fermenting bacteria, methane producing Archaea, acetogens). Therefore, the biological sulfate reduction process in the column experiments was evaluated by combining classical analytical methods [measuring heavy metal concentration, SO4(2-)-concentration, pH, dissolved organic carbon (DOC)] with molecular methods [denaturing gradient gel electrophoresis (DGGE) fingerprinting and phylogenetic sequence analysis] based on either the 16S rRNA-gene or the dsr (dissimilatory sulfite reductase) gene, the latter being a specific biomarker for SRB. RESULTS AND DISCUSSION: All carbon sources tested promoted SRB activity, which resulted within 8 weeks in a drastic reduction of the sulfate and heavy metal contents in the column effluents. However, unexpected temporal decreases in the efficiency of the ISMP process, accompanied by the release of precipitated metals, were observed for most conditions tested. The most dramatic observation of the failing ISMP process was observed within 12 weeks for the molasses amended column. Subsequent lowering the COD/ SO4(2-) ratio from 1.9 to 0.4 did not alter the outcome of sulfate reduction and metal precipitation efficiency in this set-up. Remarkably, after 6 months of inactivity, bacterial sulfate reduction was recovered in the molasses set up when the original COD/ SO4(2-) ratio of 1.9 was applied again. Intentional disruption of the lactate and HRC supplies resulted in an immediate stagnation of the ISMP processes and in a rapid release of precipitated metals into the column effluents. However, the ISMP process could be restored after substrate amendment. 16S rDNA-based DGGE analysis revealed that the SRB population, in accordance with the results of the previously performed batch experiments, consisted exclusively of members of the genus Desulfosporosinus. The community of Archaea was characterized by sequencing amplicons of archaeal and methanogen-specific PCR reactions. This approach only revealed the presence of non-thermophilic Crenarchaeota, a novel group of organisms which is only distantly related to methane producing Euryarchaeota. DGGE on the dsrB genes was successfully used to link the results of the ISMP process to the community composition of the sulfate reducing bacteria. CONCLUSIONS: In the case of an intentional disruption of substrate supply, the ISMP process failed most likely because the growth and activity of the indigenous SRB community stopped due to a lack of a carbon and electron donor. On the other hand, the cause of the sudden temporal shortcomings of the ISMP process in the presence of different substrates was not immediately clear. It was first thought to be the result of competition between methanogenic prokaryotes (MP) and sulfate reducers, since the formation of small amounts of CH4 (0.01-0.03 ppm ml(-1) was detected. However, the results of molecular analyzes indicate that methanogens do not constitute a major fraction of the microbial communities that were enriched in the column experiments. Therefore, we postulate that the SRB population becomes inhibited by the formed metal sulfides. RECOMMENDATION AND PERSPECTIVE: Our results indicate that the ISMP process is highly dependent on SRB-stimulation by substrate amendments and suggest that this remedial approach might not be viable for long-term application unless substrate amendments are continued and environmental conditions are strictly controlled. This will include the removal of affected aquifer material from the metal precipitation zone at the end of the remediation process, or removal of metal precipitates when the microbial activity decreases. Additional tests are necessary to investigate what will happen when clear groundwater passes through the reactive zone while no more C-sources are amended and all indigenous carbon is consumed. Also, the effects of dramatic increases in sulfate- or HM-concentrations on the SRB-community and the concomitant ISMP process need to be studied in more detail.

Bacteria↗
PubMed2001

An EXAFS study of zinc coordination in microbial cells.

Five microbes were isolated from metal amended enrichment cultures derived from the sediments of a lake contaminated by a zinc smelter. Each of these organisms was grown in pure culture in the presence of zinc. Quick Extended X-ray Absorption Fine Structure (QEXAFS) spectroscopy was used to investigate the average coordination environment of the zinc associated with the microbial biomass. Fitting of the first coordination shell of zinc shows that significant differences exist for each microbial species examined. The coordination environment of zinc varies between sulfurs to six-fold nitrogen/oxygen. with two microbial strains showing mixed coordination shells. Further study is required in order to characterize these sites and their locations within the cell.

Bacteria↗
PubMedDate not supplied

Phosphorus transfer in runoff following application of fertilizer, manure, and sewage sludge.

Phosphorus (P) transfer in surface runoff from field plots receiving either no P, triplesuperphoshate (TSP), liquid cattle manure (LCS), liquid anaerobically digested sludge (LDS), or dewatered sludge cake (DSC) was compared over a 2-yr period. Dissolved inorganic P concentrations in runoff increased from 0.1 to 0.2 mg L(-1) on control and sludge-treated plots to 3.8 and 6.5 mg L(-1) following application of LCS and TSP, respectively, to a cereal crop in spring. When incorporated into the soil in autumn, runoff dissolved P concentrations were typically < 0.5 mg L(-1) across all plots, and particulate P remained the dominant P form. When surface-applied in autumn to a consolidated seedbed, direct loss of LCS and LDS increased both runoff volume and P transfers, but release of dissolved P occurred only from LCS. The largest P concentrations (>70 mg L(-1)) were recorded following TSP application without any increase in runoff volume, while application of bulky DSC significantly reduced total P transfers by 70% compared with the control due to a reduced runoff volume. Treatment effects in each monitoring period were most pronounced in the first runoff event. Differences in the release of P from the different P sources were related to the amounts of P extracted by either water or sodium bicarbonate in the order TSP > LCS > LDS > DSC. The results suggest there is a lower risk of P transfer in land runoff following application of sludge compared with other agricultural P amendments at similar P rates.

Agriculture↗
PubMed1983

Social Security benefits; disability insurance benefits; deductions, reductions, and nonpayments of benefits--SSA. Final rules with comment period.

These regulations amend the existing regulations under which Social Security benefits payable to a disabled worker and his or her family may be reduced because of the worker's concurrent entitlement to workers' compensation benefits. They provide that entitlement to certain other public disability benefits may reduce the disability benefits paid by Social Security; that the reduction applies to the first month of concurrent entitlement regardless of the month in which we are notified of entitlement to the public disability benefit; and that the reduction applies to all months of concurrent entitlement until the disabled worker attains age 65. These regulations also provide that where a public disability law or plan provides for reduction of the public disability benefit on the basis of entitlement to Social Security disability insurance benefits that provision will preclude reduction of the Social Security benefits but only if it was in effect on February 18, 1981. These regulations implement section 2208 of the Omnibus Budget Reconciliation Act of 1981 (Pub. L. 97-35).

Social Security↗
PubMed1995

Pharmacokinetics of amikacin in children with kwashiorkor.

The pharmacokinetics of intravenous amikacin, administered as a mean (SD) bolus dose of 5.5 (1.2) mg/kg to children between the ages of 1 and 4 years with kwashiorkor, was studied. Although there was a tendency for the average volume of distribution to increase to the upper limit of normal, plasma elimination half-life, first order elimination-phase rate constant and clearance remained close to the reference values for adults. Despite marginal elevation of the average t1/2 beta-value, reflecting a general trend, renal impairment in respect of amikacin clearance could not be demonstrated. It was concluded that the changes in pharmacokinetic parameters found in kwashiorkor are not large enough to amend the current therapeutic regimens for amikacin in this condition.

Amikacin↗
PubMedDate not supplied

Science: part of the problem, most of the answer.

The history of the drug approval process in the United States includes three phases. First, the Food and Drug Act of 1906 essentially required that the labeling of drugs be truthful. The 1938 Food, Drug, and Cosmetic Act added a requirement that drugs be proven safe, and the 1962 act added the requirement that drugs be efficacious. Each of these steps required more and more sophisticated science. Subsequent to the Kefauver-Harris Amendments of 1962, the number of innovative molecular entities each year has declined, the reasons for which have been subject to great debate. This decline has paralleled decreases in innovation across almost all American industry, leading to questions about the future of our country as an industrialized society. Both the Carter and Reagan administrations attempted to address this problem in a number of ways, including cutting back on those regulations that are perceived as unnecessary. Other innovative approaches have been used, such as the establishment of an Office of Small Manufacturers Assistance in the FDA Bureau of Medical Devices, mandated by the 1976 Medical Device Amendments. The latter came about in recognition of the fact that small businesses tend to be more creative and efficient than larger industries and more adversely affected by regulation. However, the problems raised in the regulation of technology transfer almost inevitably arise because of perceived scientific questions. Such questions, in turn, can only be answered by good science performed by the sponsor and understood by the regulator. Thus, it is essential that the FDA be staffed with knowledgeable scientists who can interact easily with their peers in academia and industry. Although science is often the cause of our troubles, it is also our only hope for minimizing the costs of new drugs and other technology. In turn, minimizing such costs will maximize the opportunities for innovation.

Costs and Cost Analysis↗
PubMedDate not supplied

Phosphorus runoff from two water sources on a calcareous soil.

Phosphorus (P) in irrigation runoff may enrich offsite water bodies and streams and be influenced by irrigation water quality and antecedent soil surface conditions. Runoff, soil loss, and P fractions in runoff using reverse osmosis (RO) water or mixed RO and well water (RO/ Tap) were studied in a laboratory sprinkler study to evaluate water source effects on P transport. A top- or subsoil Portneuf silt loam (coarse-silty, mixed, superactive, mesic Durinodic Xeric Haplocalcid), either amended or not amended with manure and/or with cheese whey, with Olsen P from 20 to 141 mg kg(-1) and lime from 108 to 243 g kg(-1), was placed in 1.5 x 1.2 x 0.2-m-deep containers with 2.4% slope and irrigated three times from a 3-m height for 15 min, applying 20 mm of water. The first irrigation was on a dry loose surface, the second on a wet surface, and the third on a dry crusted surface. Surface (ca. 2 cm) soil samples, prior to the first irrigation, were analyzed for Olsen P, water-soluble P (Pws), and iron-oxide impregnated paper-extractable P (FeO-P) analyses. Following each irrigation we determined runoff, sediment, dissolved reactive phosphorus (DRP) in a 0.45-microm filtered sample, and FeO-P and total P in unfiltered samples. Soil surface conditions had no effect on P runoff relationships. Water source had no significant effect on the relationship between DRP or FeO-P runoff and soil test P, except for DRP in RO runoff versus water-soluble soil P (r2 = 0.90). Total P in RO runoff versus soil P were not related; but weakly correlated for RO/Tap (r2 < 0.50). Water source and soil surface conditions had little or no effect on P runoff from this calcareous soil.

Agriculture↗
PubMed1983

Child support enforcement program; medical support enforcement--Office of Child Support Enforcement. Notice of Proposed rulemaking.

OCSE is proposing to amend the Child Support Enforcement program regulations governing medical support enforcement activities. Currently these activities are pursued through optional cooperative agreements between the State IV-D agency and the State Medicaid agency. This proposal would require all State IV-D agencies, as part of the IV-D State plan, to perform certain limited medical support activities. First, the IV-D agency would be required to attempt to obtain basic medical support information during the normal processing of child support cases and provide this information to the State Medicaid agency. Second, the IV-D agency would be required to petition to include medical support in new or modified support orders in situations in which coverage is available to the absent parent at reasonable cost and to inform the State Medicaid agency of any new or modified support orders which include a medical support obligation. These activities would result in increased use of available third party resources in the form of private medical insurance and in medical cost savings to State and Federal governments. Federal funding would be available to IV-D agencies for these required medical support activities.

Child Welfare↗
PubMed2005

Behaviour of the pathogen surrogates Listeria innocua and Clostridium sporogenes during production of parsley in fields fertilized with contaminated amendments.

The survival and transfer of Listeria innocua and Clostridium sporogenes, used as surrogates of the food borne pathogens Listeria monocytogenes and Clostridium botulinum, were quantitatively assessed under field conditions. In the soil, spores of C. sporogenes declined by less than 0.7 log cycles within 16 months and were detected on parsley leaves throughout the experiment. In contrast, L. innocua in the soil declined by 7 log cycles in 90 days and was detected on leaves in low numbers (>0.04 MPN g(-1)) during the first 30 days. Rates of decline in soil were similar in the laboratory at 20 degrees C for two strains of L. innocua and L. monocytogenes ; and in the field for L. innocua over two different years. L. innocua survived better in winter, indicating an important influence of temperature. The major cause of transfer of L. innocua from soil to parsley leaves was splashing due to rain and irrigation. As few as 1 CFU g(-1) Listeria in soil led to contamination of parsley leaves. Internalisation of Listeria through parsley roots was not observed. Under the conditions of soil and climate studied, a delay of 90 days between application of potentially contaminated fertilizer and harvest should be sufficient to eliminate L. monocytogenes.

Clostridium↗
PubMed2006

Bioavailability of selenium to forage crops in a sandy loam soil amended with Se-rich plant materials.

Greenhouse experiments were conducted to study the bioavailability of selenium (Se) to sorghum (Sorghum bicolor L.), maize (Zea mays L.) and berseem (Trifolium alexandrinum L.) fodders in a sandy loam soil amended with different levels of Se-rich wheat (Triticum aestivum L.) and raya (Brassica juncea L. Czern) straw containing 53.3 and 136.7microg Seg(-1), respectively. Each of the fodder crops was grown after incorporation of Se-rich materials either individually or in a sequence - sorghum-maize-berseem by incorporating Se-rich straws only to the first crop. Application of Se-rich straws to each crop, even at the greatest rate of 1%, did not have any detrimental effect on dry matter yield of different crops. With increase in the level of wheat straw from 0% to 1%, Se content in sorghum and maize plants increased to greatest level of 1.3 and 1.5microg g(-1), respectively, at 0.3% of applied straw and thereafter it decreased consistently. In case of raya straw, the greatest Se content in sorghum (2.3microg g(-1)) and maize (3.0microg g(-1)) was recorded at 0.3% and 0.4% of the applied straw, respectively. Unlike sorghum and maize fodders, Se content in all the four cuts of berseem continued to increase with increase in the level of applied straws and for different cuts of berseem it varied from 1.6 to 2.3 and 3.4 to 4.3microg g(-1) in case of wheat and raya straw, respectively. Similar variations in Se content of different fodder crops were recorded when these were grown in the sequence - sorghum-maize-berseem; but Se content was 2-4 times lower than when each crop was grown with fresh application of Se-rich straw. None of the fodders absorbed Se in levels toxic for animal consumption (>5microg g(-1)) even at the greatest level of applied straw. Of the total Se added through Se-rich straws, utilization of Se was not more than 2% in case of sorghum and maize crops and up to 5% in case of berseem. At the time of sowing of sorghum, hot water soluble Se (HWS-Se) in soils treated with different levels of Se-rich wheat and raya straw, respectively, varied from 18 to 36 and 18 to 79microg kg(-1). Whereas in case of berseem, it varied from 33 to 101 and 33 to 154microg kg(-1), respectively. HWS-Se present at the sowing time of berseem was significantly correlated with Se content of all the four cuts in the soil treated with Se-rich straws; the coefficients of correlation 'r' varied between 0.79 (p0.05) and 0.99 (p0.001). Selenium-rich materials supplied significant amounts of S, P and micronutrients to the growing fodder crops. These investigations suggest that Se-rich raya and wheat straw may be disposed off safely in soils used for growing fodders.

Biological Availability↗
PubMed2003

Using satisfaction to measure the quality of palliative care: a review of the literature.

BACKGROUND: The advent of clinical governance in British health policy has placed increased demands on health care providers and practitioners to ascertain the quality of their services. Traditional indicators of quality of health care, such as death or recovery rates, are not appropriate in palliative care. Thus, it is important to establish alternative approaches to measuring the quality of palliative care services and interventions. AIMS: Satisfaction levels have been used widely in palliative care to assess quality. A literature review was conducted which aimed to explore the strengths and weaknesses of using satisfaction as an indicator of the quality of palliative care services. It also aimed to provide a solid basis upon which further work could be built. METHODS: Five electronic databases were searched using key words and phrases and key authors. Hand searches were conducted of four journals that contributed significantly to the concept of satisfaction, and reference lists of reviewed papers were scrutinized. Relevant papers were reviewed, data were extracted and these data were thematically analysed. FINDINGS: There are a number of important unresolved issues in the literature with regard to using satisfaction as an indicator of the quality of palliative care services. First, few alternatives to satisfaction are available. Secondly, satisfaction is under-theorized and no widely accepted definition exists. Thirdly, there are methodological inconsistencies across studies. It is important to take into account these findings when planning and implementing change following service evaluation using satisfaction as a measure. CONCLUSIONS: Relying on findings of satisfaction surveys to determine clinical and policy amendments in palliative care may not result in improvements in overall quality of care. Using satisfaction as a method of assessing the quality of health care services is particularly problematic and requires further investigation in both practical and conceptual terms.

Humans↗
PubMed2004

In situ expression of nifD in Geobacteraceae in subsurface sediments.

In order to determine whether the metabolic state of Geobacteraceae involved in bioremediation of subsurface sediments might be inferred from levels of mRNA for key genes, in situ expression of nifD, a highly conserved gene involved in nitrogen fixation, was investigated. When Geobacter sulfurreducens was grown without a source of fixed nitrogen in chemostats with acetate provided as the limiting electron donor and Fe(III) as the electron acceptor, levels of nifD transcripts were 4 to 5 orders of magnitude higher than in chemostat cultures provided with ammonium. In contrast, the number of transcripts of recA and the 16S rRNA gene were slightly lower in the absence of ammonium. The addition of acetate to organic- and nitrogen-poor subsurface sediments stimulated the growth of Geobacteraceae and Fe(III) reduction, as well as the expression of nifD in Geobacteraceae. Levels of nifD transcripts in Geobacteraceae decreased more than 100-fold within 2 days after the addition of 100 microM ammonium, while levels of recA and total bacterial 16S rRNA in Geobacteraceae remained relatively constant. Ammonium amendments had no effect on rates of Fe(III) reduction in acetate-amended sediments or toluene degradation in petroleum-contaminated sediments, suggesting that other factors, such as the rate that Geobacteraceae could access Fe(III) oxides, limited Fe(III) reduction. These results demonstrate that it is possible to monitor one aspect of the in situ metabolic state of Geobacteraceae species in subsurface sediments via analysis of mRNA levels, which is the first step toward a more global analysis of in situ gene expression related to nutrient status and stress response during bioremediation by Geobacteraceae.

Acetates↗
PubMedDate not supplied

From cottages to condos: the expansion of the home health care industry under Medicare.

The home health care industry has undergone a dramatic period of growth since the passage of Medicare (Title XVIII of the Social Security Act) in 1965. This growth has occurred in both the expansion of the total number of Medicare-certified agencies providing care, as well as the number of clients served and hours of care provided. It has been suggested that the single most important factor in this market expansion was the inclusion of a home care benefit in the original Medicare legislation, thus making it possible for nonprofit home care agencies to rely on a predictable source of government reimbursement. This paper explores the influence that amendments to the Medicare legislation since 1980 have had on market expansion, as well as other federal, state and private policy initiatives that have also influenced this growth. The authors suggest that overall growth does not equate with improved access or availability of needed services in the home for the frail and functionally-impaired elderly. Research findings from the first year of a three year study designed to document the impact of cost containment policies on community-based care for the elderly are reported in summary form to illustrate the authors position.

Aged↗
PubMed2005

Assessment of dietary intake of flavouring substances within the procedure for their safety evaluation: advantages and limitations of estimates obtained by means of a per capita method.

The procedure for the safety evaluation of flavourings adopted by the European Commission in order to establish a positive list of these substances is a stepwise approach which was developed by the Joint FAO/WHO Expert Committee on Food Additives (JECFA) and amended by the Scientific Committee on Food. Within this procedure, a per capita amount based on industrial poundage data of flavourings, is calculated to estimate the dietary intake by means of the maximised survey-derived daily intake (MSDI) method. This paper reviews the MSDI method in order to check if it can provide conservative intake estimates as needed at the first steps of a stepwise procedure. Scientific papers and opinions dealing with the MSDI method were reviewed. Concentration levels reported by the industry were compared with estimates obtained with the MSDI method. It appeared that, in some cases, these estimates could be orders of magnitude (up to 5) lower than those calculated considering concentration levels provided by the industry and regular consumption of flavoured foods and beverages. A critical review of two studies which had been used to support the statement that MSDI is a conservative method for assessing exposure to flavourings among high consumers was performed. Special attention was given to the factors that affect exposure at high percentiles, such as brand loyalty and portion sizes. It is concluded that these studies may not be suitable to validate the MSDI method used to assess intakes of flavours by European consumers due to shortcomings in the assumptions made and in the data used. Exposure assessment is an essential component of risk assessment. The present paper suggests that the MSDI method is not sufficiently conservative. There is therefore a clear need for either using an alternative method to estimate exposure to flavourings in the procedure or for limiting intakes to the levels at which the safety was assessed.

Consumer Product Safety↗
PubMed2005

Dechlorination of tetrachloroethylene by palladized iron in the presence of humic acid.

The dechlorination of tetrachloroethylene (PCE) by palladized irons in the presence of humic acid was investigated to understand the feasibility of using Pd/Fe for the in situ remediation of contaminated groundwater. Untreated zerovalent iron (ZVI) was amended with Pd(II) ions to form palladized irons. X-ray photoelectron spectroscopy showed that Pd(II) was completely reduced to metallic Pd on the surface of ZVI. PCE was catalytically dechlorinated via beta-elimination to ethane and ethylene by palladized irons. The carbon mass balances were in the range of 78--98%. The dechlorination followed the pseudo first-order rate equation and the normalized surface reaction rate constant (k(sa)) for PCE dechlorination was 33.47+/-7.21 L/m(2)h in the absence of humic acid. Humic acid competed the reactive sites on the palladized irons with PCE, and thus lowered the dechlorination efficiency and rate of PCE. After 24h of equilibrium between humic acid and palladized irons prior to the injection of PCE, however, the efficiency and rate of PCE dechlorination could increase with increasing concentrations of humic acid. Addition of quinones having low redox potentials including AQDS, lawsone and hydroquinone also enhanced the dechlorination efficiency of PCE after 24h, depicting that humic acids serve as the electron shuttles to effectively transfer electrons and to accelerate the dechlorination efficiency and rate of PCE.

Humic Substances↗
PubMed2005

Patient perspectives: Tijuana cancer clinics in the post-NAFTA era.

This article contains observations and historical considerations on cancer and complementary and alternative medicine (CAM) in the Tijuana, Mexico, area. There are approximately 2 dozen such clinics in Tijuana, some of which have been treating international cancer patients since 1963. Among the first clinics to be established were the Bio-Medical Center (Hoxsey therapy), Oasis of Hope (a Laetrile-oriented clinic), and a series of clinics affiliated with the Gerson diet therapy. These original clinics were established mainly by American citizens in response to increased regulation of nonstandard therapies in the United States, particularly after passage of the Kefauver-Harris Amendments to the Food, Drug and Cosmetics Act in 1962. In the 1970s, the Tijuana clinics proliferated with the upsurge of interest in Laetrile (amygdalin). By 1978, 70,000 US cancer patients had taken Laetrile for cancer treatment, and many of those had gone to Tijuana to receive it. The popularity of the Tijuana clinics peaked in the mid-1980s. Although many new clinics opened after then, a dozen have folded in the past 10 years alone. The turning point for the clinics came with passage of the North American Free Trade Agreement (NAFTA), which facilitated greater cooperation among the antifraud authorities of Canada, the United States, and Mexico. In 1994, the tripartite members of NAFTA formed the Mexico-United States-Canada Health Fraud Work Group, or MUCH, whose brief is to strengthen the 3 countries' ability to prevent cross-border health fraud. Under the auspices of MUCH and its members, regulatory crackdowns began in earnest early in 2001. The clinics were also badly affected by the general downturn in travel after 9/11. If these trends continue, many Tijuana clinics are unlikely to survive. Some suggestions are made for how the Tijuana clinics could be reorganized and reformed to minimize the likelihood of governmental actions and to maximize public support. Such reforms center on 5 main areas: (1) research, (2) physical plant, (3) finances, (4) ethics, and (5) education.

Cancer Care Facilities↗
PubMed2003

First detection of resistance to QoI fungicides in Mycosphaerella graminicola on winter wheat in Belgium.

A total of 740 Mycosphaerella graminicola strains were isolated between 2000 and 2002 from winter wheat F1 or F2 leaves showing Septoria leaf blotch lesions (SLB) collected mainly at the soft dough stage in fungicide trials, analysing at 12 locations in Belgium the possibilities and risks associated with the use of epoxiconazole and azoxystrobin at various doses, mixtures and application dates. Fungicide sensitivity tests were performed in microtitre plates on potato dextrose broth amended with various concentrations of azoxystrobin. A wide range of sensitivity to azoxystrobin was observed, with EC50 values ranging for 735 strains between 0.002 to 0.7 microg/ml, the highest frequency gradually shifting from EC50 classes 0.01 and 0.02 microg/ml azoxystrobin in 2000 to EC50 classes 0.02 and 0.04 microg/ml in 2002. No clear selection effect of particular fungicide use strategies was observed. Among the 382 strains isolated in 2002, five originating from 2 locations, showed azoxystrobin EC50 values >1 microg/ml. On medium amended with 100 microg/ml salicylhydroxamic acid (SHAM), 58% of the 2002 strains were strongly inhibited, which affected adequate azoxystrobin ED50 determination. This suggests widespread occurrence of M. graminicola strains relying in vitro on the alternative respiration pathway. In the presence of SHAM, strains 339 and 880 showed azoxystrobin EC50 values of 3 and >30 microg/ml, respectively. This high level of resistance to a QoI fungicide was confirmed by analysing mycelium growth inhibition on PDA. Cross-resistance to trifloxystrobin and kresoxim-methyl was demonstrated. Greenhouse assays on wheat plants revealed that control of QoI resistant strains by azoxystrobin is decreased, compared to control of sensitive ones. This highlights the risk of resistance to QoI fungicides also in M. graminicola populations, although up to now no decrease in field performance was noticed. It is recommended to delay build up of QoI resistance by an integrated approach, combining optimised fungicide use with the choice of SLB resistant cultivars and the application of farming practices promoting stubbles break down and so the reduction of the teleomorph stage.

Acrylates↗
PubMed2000

Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group.

The purpose of this randomized, double-masked, placebo-controlled study was to determine the efficacy and safety of risedronate in the prevention of vertebral fractures in postmenopausal women with established osteoporosis. The study was conducted at 80 study centers in Europe and Australia. Postmenopausal women (n = 1226) with two or more prevalent vertebral fractures received risedronate 2.5 or 5 mg/day or placebo; all subjects also received elemental calcium 1000 mg/day, and up to 500 IU/day vitamin D if baseline levels were low. The study duration was 3 years; however, the 2.5 mg group was discontinued by protocol amendment after 2 years. Lateral spinal radiographs were taken annually for assessment of vertebral fractures, and bone mineral density was measured by dual-energy X-ray absorptiometry at 6-month intervals. Risedronate 5 mg reduced the risk of new vertebral fractures by 49% over 3 years compared with control (p<0.001). A significant reduction of 61% was seen within the first year (p = 0.001). The fracture reduction with risedronate 2.5 mg was similar to that in the 5 mg group over 2 years. The risk of nonvertebral fractures was reduced by 33% compared with control over 3 years (p = 0.06). Risedronate significantly increased bone mineral density at the spine and hip within 6 months. The adverse-event profile of risedronate, including gastrointestinal adverse events, was similar to that of control. Risedronate 5 mg provides effective and well-tolerated therapy for severe postmenopausal osteoporosis, reducing the incidence of vertebral fractures and improving bone density in women with established disease.

Absorptiometry, Photon↗