Impact of pharmacy-based syringe access on injection practices among injecting drug users in Minnesota, 1998 to 1999

In Minnesota, state legislation, enacted July 1998, provided for voluntary pharmacy sales of syringes/needles without a prescription for an accompanying drug. The goal was to stem HIV transmission among injecting drug users (IDUs) by providing greater access to sterile syringes. We used a pre/post evaluation design to investigate the impact of less restrictive syringe/possession laws on IDUs' HIV-related syringe practices. Independent cross-sectional samples of IDUs were recruited from street sites and a correctional facility immediately before and 1 year after enactment of the laws. Of the 671 IDUs interviewed, 570 (270 prelegislation and 300 postlegislation) had injected at least once in the 30 days before the interview. IDUs were more likely to purchase syringes at pharmacies after enactment of the laws (odds ratio [OR], 2.66; 95% confidence interval [CI], 1.83-3.85), yet did not change their behaviors regarding carrying unused syringes (OR, 0.90; 95% CI, 0.63-1.28). After adjusting for speedball injection and criminal history, syringe sharing decreased among IDUs (adjusted OR, 0.67; 95% CI, 0.45-1.00) yet syringe reuse remained the same (adjusted OR, 0.67; 95% CI, 0.40-1.11). Safe disposal of syringes did not differ significantly across the sampling periods (adjusted OR, 1.32; 95% CI, 0.84-2.06). Increased access to pharmacy syringes offers a first step at reducing HIV-related syringe practices but must be coupled with strong HIV prevention messages, drug treatment referrals, and safe syringe disposal options.

A biological phosphorus removal potential test for wastewaters

A simple test was proposed to assess whether phosphorus in a wastewater can be removed using a biological phosphorus removal (BPR) process. The test includes the measurement of phosphorus release during 2 hours of the anaerobic stage in a batch reactor containing phosphorus-accumulating organisms (PAOs) and estimation of the effluent phosphorus concentration using biochemical relationships. The BPR potential test developed allowed for the successful evaluation of BPR feasibility for five wastewater samples. The BPR potential test was validated by comparing the test results with the effluent phosphorus concentrations measured in a sequencing batch reactor (SBR). An effluent phosphorus concentration of 1.9 mg P/L predicted for the BPR potential test performed was close to the effluent phosphorus concentration of 1.8 mg P/L obtained from an SBR on the same day. During the anaerobic stage, phosphorus release was significantly affected by the sludge concentration initially, but became insignificant after 2 hours. The initial sludge concentration affected the phosphorus release rate; thus, it is recommended that the BPR potential test be conducted at a target mixed liquor volatile suspended solids concentration. It is also recommended that the BPR potential test be conducted at the site where the PAO-containing sludge is available and the wastewater sample can be delivered at 4 degrees C in less than 24 hours. The PAOs in different sludges had almost identical phosphorus release after 2 hours; however, the characteristics of facultative bacteria in sludges affected the phosphorus release. If the wastewater is prefermented for at least 3 days before the BPR potential test, the amount of phosphorus released by various PAO-containing sludges is expected to be identical.

Ototoxicity and irradiation: additional etiologies of hearing loss in adults

A brief review of the effects of the seven groups of substances and chemicals known to affect hearing and/or the vestibular system is followed by a more detailed discussion of cisplatin (cisplatinum). An illustrative case study is included that exemplifies a recent finding of some recovery of hearing following withdrawal of cisplatin chemotherapy. Some suggestions for reducing the potential for ototoxicity are also presented. The article continues with a discussion of the effects of irradiation on hearing and the ear and an illustrative case study. Included are some reported results from patients in the Ukraine who were exposed to excessive radiation as a result of the Chernobyl nuclear disaster. A discussion of the effects on the ear and the vestibular system caused by the interaction between chemotherapy and irradiation treatment is followed by the warning that, with the recent successes these treatments have had in the war against cancer, more patients with hearing loss triggered by these techniques will be seen in audiology clinics. These factors are now one of the newest and more frequent etiologic factors for hearing loss in adults in this decade.