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[Effects of earthworm activity on phosphorus fraction and available phosphorus content in red soil].

By the methods of incubation test and Hedley's phosphorus fractionation, this paper studied the effects of inoculating earthworm (Pheretinma pingi) on the phosphorus fractions and available phosphorus contents in red soil. The results showed that during a 100-day incubation, earthworm inoculation combined with organic materials (rice straw RS, peanut residue PR, and rape residue RR) amendment increased significantly the content of soil available phosphorus. Statistics analysis showed that there was a significant difference in soil available phosphorus content between treatments PR or RR with and without earthworm inoculation. Compared with the contents of anion-exchange resin P(trace), NaCO3-soluble P(14.5 mg x kg(-1)) and microbial P(1.0 mg x kg(-1)) in CK, those in treatments of earthworm inoculation plus organic materials amendment increased to 10.5 - 17.8 mg kg(-1), 23.5-35.6 mg x kg(-1), and 6.8 - 9.7 mg x kg(-1), respectively, organic phosphorus content enhanced from 37.9 mg x kg(-1) to 50.7-59.3 mg x kg(-1), whereas residual P was reduced. Earthworm performed an activated effect on the availability of phosphorus in red soil.

Animals↗

Availability and use of hepatitis B vaccine in laboratory and nursing schools in the United States.

Hepatitis B is a well-documented occupational hazard for health care workers, including both laboratory and nursing personnel. Since the development of effective hepatitis B vaccines, the Immunization Practices Advisory Committee (ACIP) has recommended that health care workers receive the vaccine. In this study, 78 laboratory training programs and 83 nursing training programs were surveyed regarding availability and usage of hepatitis B vaccine. The hepatitis B vaccine was made available to students in 81 percent of the laboratory programs and 23 percent of the nursing programs. In those programs making the vaccine available, only 59 percent of the laboratory programs and 5 percent of the nursing programs reported a high (greater than 75 percent) use by students. Concern about cost and payment for the vaccine was the most common reason (80 percent) noted by laboratory schools that did not have hepatitis B vaccination programs for students. Of the nursing schools that did not have vaccine programs, 58 percent had not yet considered a program. At laboratory schools with vaccination programs, who paid for the vaccine (hospital or school versus student) was among the most important determinants for vaccine usage by students. These findings point out that some laboratory schools and many nursing schools have not applied the ACIP recommendations to their own programs. Educational efforts and creative payment plans for the vaccine are needed to increase the availability and use of hepatitis B vaccine among laboratory and nursing students.

Hepatitis B↗

Availability of phosphorus in bone meal.

Two commercially available bone meal products (grades 0-12-0 and 6-12-0) were examined. Samples were prepared according to AOAC method 2.007, and total and available phosphorus contents were determined. Portions of these preparations were reground to pass through successively smaller sieves, and subsequent analyses indicated the availability of phosphorus to be directly proportional to fineness of grind. A quantity of the citrate-insoluble fraction of the bone meal was obtained by following AOAC extraction procedures. Agronomic studies were conducted that compared this insoluble fraction with the original bone meal material and with reagent grade Ca(H2PO4)2.H2O. The data indicated poor correlation between the analytically defined and agronomically determined availability of phosphorus.

Biological Products↗

Syrup of ipecac availability: before and after a poisoning.

A retrospective review was conducted of 1,230 human poison exposures in which syrup of ipecac was administered to determine the availability of this emetic. Ipecac was available in 41.1% of the homes, while 42.5% obtained it from the pharmacy. Eight and two tenths percent were referred to a health care facility, 2.9% obtained ipecac from a neighbor, 2.3% went to an emergency room prior to calling the poison center, and 3% obtained ipecac from other sources. A randomly selected sample of 150 of these 1,230 cases were contacted 6 months after their initial call to the poison center to determine any changes in the availability of syrup of ipecac in the home. Although almost 30% more homes had syrup of ipecac than previously, 22.2% of homes still did not have ipecac available, despite the previous poisoning experience. Greater effort should be made during follow-up to educate the public regarding ipecac and its use.

Drug Utilization↗

Trends in physician availability in 10 urban areas from 1963 to 1980.

The overall growth in the physician supply has so dominated the public policy agenda that issues of physician distribution within urban areas have received little attention. In this study, we examined the changes in physician availability in the poverty and nonpoverty areas of 10 U.S. cities between 1963 and 1980. We found that the overall availability of patient care physicians increased in both poverty and nonpoverty areas, with greater growth in the nonpoverty areas. For office-based primary care physicians, however, there was a 45% decline in availability in the poverty areas and a 27% decline in the nonpoverty areas. We conclude that the overall increase in the physician supply may not adequately correct geographic and specialty maldistribution in urban areas. We suggest that special educational, service delivery, and financing strategies within urban areas continue to be needed to address problems of inequitable physician availability.

Adult↗

Discrepancies in the availability of open access services: comparison between the Northern and Oxford regions.

General practitioners have long been aware of variations in the range of open access services available to them.This study compares the availability of 22 open access services in the Northern and Oxford regions and examines possible reasons for variations. From data collected from general practitioners and community managers two striking patterns emerge. First, there is a difference between the regions with wider availability in the Oxford region. Secondly, there are differences in the range of services available between health authorities, sometimes neighbouring, within the same region, although this is less marked in Oxford.These discrepancies probably reflect the situation nationally and it would appear questionable whether there is any policy coordination at regional or national level to ensure an equitable distribution of open access services.

England↗

Recent trends in the availability, distribution, utilisation and cost of general practitioner services.

GMS data for the 1983-4 and 1986-7 years were analysed to determine the availability, distribution and utilisation of general practitioners in New Zealand. In 1986-7 there were 1724 full time equivalents (FTE) general practitioners, one per 1923 population, an annual increase in availability of 2.8% over the three years studied. The rate of availability appears to be increasing rapidly and, from Medical Council data, was around 6% for the 1986-7 year. Wide variation exists in availability, the highest being in central Auckland with one general practitioner per 1351 population, the lowest being in Invercargill with one per 2500. Utilisation increased by just over 1% annually to 3.9 services per person. The median workload in 1986-7 was 7184 services per general practitioner equivalent to a GMS income of $31,454. Each general practitioner was associated with government expenditure of about $359,000 but received only about $33,670 of this, less than one seventh of that paid by government for pharmaceuticals. Radical changes are proposed to redress inefficiencies, inequities and the perverse incentives which continue to increase in this almost totally unmanaged but fundamentally important area of health care.

Costs and Cost Analysis↗

The effect of vasopressin on oxygen availability.

Vasopressin has been used with increasing frequency to control gastrointestinal bleeding, the beneficial effect being attributed to marked splanchnic vasoconstriction. Because vasopressin may result in impaired cardiac function and because other potent vasoconstrictive substances have been shown to increase the pulmonary shunt and decrease arterial oxygenation, this study was undertaken to determind the effect of vasopressin on oxygen availability. Ten healthy anesthetized mechanically ventilated dogs received a five hour intravenous vasopressin infusion, 0.005 U/kg/min. The heart rate decreased moderately and briefly. The mean systemic arterial pressure increased and then decreased, both minimally. The pulmonary shunt and the arterial oxygen content decreased slightly. The total systemic resistance increased and the stroke volume decreased, both substantially. The pulmonary artery wedge pressure gradually increased. The oxygen availability decreased markedly. This study demonstrated that a vasopressin infusion causes a marked decrease in oxygen availability due primarily to a decreased stroke volume and, to a lesser extent during the first hour, to a decreased heart rate. The pulmonary shunt did not increase. Increased systemic resistance followed by a gradual increase in the pulmonary wedge pressure suggests that the decreased stroke volume resulted, at least in part, from an increased afterload and left ventricular failure. It is suggested that until the effect of vasopressin on the cardiopulmonary systems and hence oxygen availability is fully studied in critically ill patients, that it be used with caution and with appropriate hemodynamic monitoring.

Animals↗

Medical resources after nuclear war. Availability v need.

In defining capacity to "survive" a massive nuclear exchange, it is important to assess the medical resources that will be available in the post-nuclear war world. Approximately 80% of these resources--hospital beds and personnel, blood, drugs, and medical supplies--will have been destroyed, since they are located in or near the densely populated areas that constitute primary targets of attack. Casualty estimates published by federal agencies, together with data from the Hiroshima-Nagasaki experience, suggest the numbers and types of injuries that will afflict the US population. With a probable 48,000 surviving physicians to treat 32 million casualties, there will be one physician for every 663 patients. Of the trauma and burn victims, approximately 55% will require hospitalization; this will mean 64 patients for each available hospital bed. Data from recent wars have been utilized to determine the trauma-related blood requirements in the post-nuclear war world. Of the 64 million units of whole blood needed, only 14,000 will be available. Other medical resources will be in equally short supply. This disparity between need and availability indicates the difficulty of developing a meaningful medical response for the surviving injured.

Blood Transfusion↗

Comparative effects of phenylbutazone, naproxen and flunixin meglumine on equine platelet aggregation and platelet factor 3 availability in vitro.

Nonsteroidal anti-inflammatory drugs are commonly used in the treatment of inflammatory conditions, and have potential value in the treatment of thrombotic disease in the horse. This study compares the potency of three nonsteroidal anti-inflammatory drugs phenylbutazone, naproxen (equiproxen) and flunixin meglumine (banamine) with respect to their effects on equine platelets. Two functional responses of horse platelets were evaluated in vitro: their ability to aggregate and their ability to make available platelet factor 3 procoagulant activity. Flunixin at a concentration of 10(-6) M significantly depressed the maximum degree of adenosine diphosphate-induced (10(-6)M) aggregation while much higher concentrations of phenylbutazone and naproxen (5 X 10(5)M) were required to produce similar effects. None of the non-steriodal anti-inflammatory drugs significantly affected the duration of the lag phase or the initial velocity of adenosine diphosphate-induced aggregation within the range of drug concentrations used (10(-6)-10(-3)M). The lag phase and initial velocity of acid-soluble collagen-induced aggregation were significantly affected by 10(-6) M flunixin and 10(-4) M phenylbutazone or naproxen was required to produce equivalent effects. Concentrations of 5 X 10(-6) M flunixin and 5 X 10(-4) M phenylbutazone or naproxen were required to significantly depress the degree of collaen-induced aggregation of horse platelets. Although the effects of the nonsteroidal anti-inflammatory drugs were qualitatively similar, flunixin was a much more potent inhibitor of platelet aggregation than either of the other two drugs (which were equipotent). At very high drug concentrations (5 X 10(-4) M and greater), all three drugs produced the same degree of inhibition of equine platelet aggregation. Platelet factor 3 activity was made available by exposing horse platelets to 10(-5) M adenosine diphosphate or 1:800 acid-soluble collagen; but not by exposure to a suspension of kaolin particles. Only a small portion of the total platelet factor 3 activity was made available on stimulation with either adenosine diphosphate or collagen. Pretreatment of horse platelets with any of the nonsteroidal anti-inflammatory drugs (10(-4) M concentration) had no significant effect on adenosine diphosphate or collagen-induced platelet factor 3 availability.

Adenosine Diphosphate↗

Increasing the number of drugs available over the counter: arguments for and against.

Many drugs previously restricted to prescription only status are being reclassified as pharmacy only status and hence are becoming available over the counter to patients. A general practitioner should make enquiries about a patient's self-medication practices before deciding on treatment for the patient. Over-the-counter medicines are considered safe and their increased use indicates that patients are taking greater responsibility for their own health and possibly taking some of the financial burden of drug treatment from the National Health Service. The retention of their restriction to pharmacy only sale provides some additional protection for patients and promotes the role of pharmacists in the care of patients. However, having more drugs available for self-treatment may encourage patients to believe that there is a drug treatment for every ailment. Increasing the range of drugs available over the counter increases the risks of interactions and adverse reactions and of self-treatment being undertaken when medical aid should have been sought. For general practitioners to recommend positively use of over-the-counter preparations may involve some medicolegal risks, and the potential savings to the NHS may prove illusory. Education for patients and better communication between general practitioners and community pharmacists are required to allow easier availability of modern medicines to patients in order to bring the benefits anticipated.

Communication↗

The availability of research journals in South African academic medical libraries.

Biomedical researchers depend on the journals of science as a primary source of information. The spiralling cost of journals threatens the ability of libraries to provide their users' information needs. In this study the availability of a representative sample of journals used by South African biomedical researchers was determined at each of the seven medical faculty libraries. The application of a standardised document delivery test is described and the results are interpreted in terms of: (i) the capability index, which includes material obtainable through inter-library loans; and (ii) an availability index, or measure of the probability that a user will find an item without delay in his/her own library. The current status of availability of biomedical journals was found to be high at all the libraries; indeed, the scores compare favourably with results obtained at academic libraries overseas. There is, however, real concern that the financial crisis in tertiary education will cause the situation to deteriorate. Repetition of this test is recommended to monitor the (probably declining) level of journal availability. The information would support efforts to rationalise and subsequently strengthen academic medical libraries' collective holdings as a strategic national resource.

Costs and Cost Analysis↗

In vitro activity of readily available household materials against HIV-1: is bleach enough?

This report describes experiments assessing the effectiveness against HIV of potential disinfecting agents that are commonly available to IDU when they are sharing syringes. We exposed cell-free HIV, HIV-infected cells, and HIV-infected blood containing known quantities of HIV to household cleaning agents, alcohols, peroxide, and highly acidic materials for 1 min, in order to examine the effects of these materials on the infectivity of the HIV. Undiluted liquid laundry bleach and dilute liquid dish detergent reduced the number of culturable HIV to an undetectable level under the experimental conditions used. Diluted bleach was not completely effective. Other potential disinfecting agents, including ethanol, isopropyl alcohol, and hydrogen peroxide, were unable to disinfect high numbers of HIV-infected cells or infected blood. Liquid dish detergent warrants further study as a possible acceptable alternative to bleach. Our data provide support for recommendations to IDU that they disinfect shared syringes every time between users with full-strength liquid laundry bleach to reduce their risk of acquiring or transmitting HIV. When bleach is not available, liquid dish detergent or other available disinfecting agents such as rubbing alcohol, hydrogen peroxide, or high alcohol content beverages are more effective than water at disinfecting HIV, recognizing that these materials are less effective than bleach. Although these materials are effective, they should not be viewed as a substitute for decreased sharing of injection equipment by IDU, or increased availability of sterile needles and syringes.

1-Propanol↗

Platelet count and platelet factor 3 (PF-3) availability in sickle cell disease.

In view of the effect of red blood cell membrane on platelet factor 3 release in sickle cell disease, platelet count and platelet factor 3 (PF-3) availability were measured in 30 sickle cell patients in a stable state and 15 with thrombocytosis, and these were compared with 60 non-sickle cell individuals as controls. There were no significant differences in platelet counts, but there was a slightly higher PF-3 availability in sickle cell patients not in crisis than in the controls (P < 0.025). Sickle cell patients with thrombocytosis made PF-3 available more readily than did the control individuals and sickle cell patients not in crisis (P < 0.001). We conclude that sickle cell patients are capable of making platelet factor 3 readily available for coagulation activation, and this may play a decisive role in vaso-occlusive crisis.

Anemia, Sickle Cell↗

The availability of health information in South Africa.

The South African Medical Research Council (MRC) has provided access to on-line health and biomedical information since 1976, when the MRC became an international partner of NLM. This was done to support research and health care when the Institute of Biomedical Communication was established. The institute has since reorganized and is now the Information Systems Division in the Research Systems Support Group MRC. he MRC and medical libraries in South Africa are able to access various automated services via telecommunication. The major systems available are MEDLARS, DIALOG, DATASTAR and BRS, with ECRI being the latest addition; most used are MEDLARS and DIALOG. New technologies (e.g., CD-ROM) have given more people access. This technology is not available to many people working in Primary Health Care (PHC), as they do not have access to computer networks. Beyond on-line is statistical and printed information, called "Gray Literature," not accessible through on-line systems as it is not published in conventional sources used to build databases. With a shift to Essential National Health Research and the focus on PHC and preventative medicine, demand for health information and "gray literature" is growing. The MRC collects and produces this material and has its own database called SAMED, which is to be made available to others as our contribution to health. It is hoped to make this available for inclusion in the proposed African Index Medicus presently investigated by the World Health Organization. Africa as a continent, and South Africa as a country, are experiencing major changes in health care and medical practice, and inevitably, provision of health information services. With South Africa's re-entry into the global village and its acceptance by the rest of Africa, it can be a key player in information provision to the rest of the continent. The MRC, as a major provider of Health information, can play a vital role in the information flow throughout Africa by continuously improving and expanding its services. A large proportion of South Africans live in rural areas where health care is provided by clinics not linked to information networks. This does not mean these clinics are excluded from the use of information. The major challenge is to find the ways and means of getting the relevant information to these clinics. Information is needed to help with patient care and continuing education. With this in mind, the MRC is evaluating different formats in which information can be supplied. Due to the lack of computer literacy, facilities, and financial constraints, it is better to supply printed information. With the spread of technology through the country and continent, it can be assumed that information flow and transfer will be more rapid. Repackaging of information means that it is possible to get the relevant information to the right people at the right time. The first such package developed is for hospital managers. With the help from experts in the field of PHC, it is hoped to develop packages aimed specifically at the CHWs and other workers in the field. All packages developed by the MRC are backed by a document provision service, using the most cost-effective route to obtain documents. A printed product must comply with certain criteria; these are: 1) purpose for which the information is needed; 2) kind of information needed and the format in which it is needed; 3) when the information is needed; 4) is the information to be supplied on an ongoing basis i.e., updated with latest information; 5) cost involved; and 6) how to get the information to the relevant user.

Computer Communication Networks↗

[Variation in reporting of available places in the neonatal intensive care units and consequences for efficiency, fairness and quality of care].

OBJECTIVE: To determine whether the national information system on available beds in neonatal intensive care units (NICUs) leads to fair distribution and good efficiency and quality of care. SETTING: Two out of the ten NICUs in the Netherlands. DESIGN: Descriptive. METHODS: Data were gathered through observations and 18 interviews with among others neonatologists, gynaecologists and paediatricians. Another 19 doctors were interviewed by phone after a patient they had referred was refused. Interviews were analysed by means of Kwalitan, a computer programme for analysis of qualitative research. RESULTS: When a patient could not be admitted in his own region, the information system was often used to find out which NICUs had a bed available. Sometimes a NICU was called that, according to the information system, did not have a place available. Reasons were: the information was not up to date and not all available beds were reported. This last reason had to do with the wish to keep a bed free for patients from the NICU's own region. Because most doctors were aware of this, they sometimes negotiated about beds, which was time-consuming. CONCLUSION: The information system was used often, but was working below optimal level, resulting in diminished efficiency. This was primarily caused by the priority given to patients of the own region, which had to do with quality of care considerations. The existing variation in use of the priority policy deserves attention from the viewpoint of procedural justice.

Bed Occupancy↗

Acetylcholine release and choline availability in rat hippocampus: effects of exogenous choline and nicotinamide.

The influence of choline availability on acetylcholine (ACh) release in the hippocampus of the awake rat was investigated using the microdialysis procedure. Three treatments enhancing choline availability for basal and atropine-evoked ACh release were evaluated: acute administration of choline chloride (20 mg/kg i.p.); pretreatment of animals with nicotinamide (10 mmol/kg s.c.) 2 hr before atropine injection and dietary choline supplementation (5-fold increase of choline intake for 15-18 days). Although acute choline administration led to a short-lasting (15 min) increase of basal choline efflux by 25% and nicotinamide caused a long-lasting (5 hr) increase by 105%, neither one affected basal ACh release. However, basal release of choline (1.38 pmol/min) and of ACh (114 fmol/min) in the hippocampus was slightly increased in choline-supplemented animals (choline: 1.92 pmol/min; ACh: 140 fmol/min). In untreated animals, atropine administration caused a 3-fold increase of ACh efflux that lasted approximately 2.5 hr. All treatments, acute or chronic choline and nicotinamide, led to significant increases of the maximum and duration of atropine-evoked ACh release. Total atropine-evoked ACh efflux (area under the curve) was increased 2- to 3-fold, with the largest effect evoked by the combination of nicotinamide and choline. The results clearly demonstrate that, under stimulated conditions, hippocampal ACh release could be facilitated when the availability of choline for ACh synthesis was enhanced by dietary or pharmacological means. Under certain conditions, significant effects of increased choline availability on ACh release can be revealed in the absence of an overall increase of extracellular choline.

Acetylcholine↗

The availability of unavailable information.

Currently, developers of decision-support systems try to integrate these systems with the electronic medical record. The drawback is a limited amount of recorded medical data. System developers who face the choice between designing an integrated 'non-inquisitive' system and an integrated 'inquisitive' system need insight into the availability of information that is being missed by the support system. Therefore, we have investigated in a simulation study, the reasons why information that was being missed from the electronic medical records of patients with asthma/COPD by reviewers, had not been recorded by general practitioners. Important reasons were: the physicians had not recorded the information explicitly, they assumed the requested information to be common knowledge, and the information was available elsewhere in the electronic medical record. Also, we investigated the reasons why information that was being missed, could not be made available by the physicians. Important reasons were: the decision had been made by another decision maker, or the physician had not recorded the information at the time of the encounter. In addition to insight into the availability of missing information, system developers need to have insight into the significance of this information for the quality of the decision support, before the final choice between a non-inquisitive and an inquisitive design can be made.

Asthma↗