Acute Toxicity of Hypofractionated and Conventionally Fractionated (Chemo)Radiotherapy Regimens for Bladder Cancer: An Exploratory Analysis from the RAIDER Trial

AIMS

Adding concurrent (chemo)therapy to radiotherapy improves outcomes for muscle-invasive bladder cancer patients. A recent meta-analysis showed superior invasive locoregional disease control for a hypofractionated 55 Gy in 20 fractions schedule compared with 64 Gy in 32 fractions. In the RAIDER clinical trial, patients undergoing 20 or 32 fractions of radical radiotherapy were randomised (1:1:2) to standard radiotherapy or to standard-dose or escalated-dose adaptive radiotherapy. Neoadjuvant chemotherapy and concomitant therapy were permitted. We report exploratory analyses of acute toxicity by concomitant therapy-fractionation schedule combination.

MATERIALS AND METHODS

Participants had unifocal bladder urothelial carcinoma staged T2-T4a N0 M0. Acute toxicity was assessed (Common Terminology Criteria for Adverse Events) weekly during radiotherapy and at 10 weeks after the start of treatment. Within each fractionation cohort, non-randomised comparisons of the proportion of patients reporting treatment emergent grade 2 or worse genitourinary, gastrointestinal or other adverse events at any point in the acute period were carried out using Fisher's exact tests.

RESULTS

Between September 2015 and April 2020, 345 (163 receiving 20 fractions; 182 receiving 32 fractions) patients were recruited from 46 centres. The median age was 73 years; 49% received neoadjuvant chemotherapy; 71% received concomitant therapy, with 5-fluorouracil/mitomycin C most commonly used: 44/114 (39%) receiving 20 fractions; 94/130 (72%) receiving 32 fractions. The acute grade 2+ gastrointestinal toxicity rate was higher in those receiving concomitant therapy compared with radiotherapy alone in the 20-fraction cohort [54/111 (49%) versus 7/49 (14%), P < 0.001] but not in the 32-fraction cohort (P = 0.355). Grade 2+ gastrointestinal toxicity was highest for gemcitabine, with evidence of significant differences across therapies in the 32-fraction cohort (P = 0.006), with a similar pattern but no significant differences in the 20-fraction cohort (P = 0.099). There was no evidence of differences in grade 2+ genitourinary toxicity between concomitant therapies in either the 20- or 32-fraction cohorts.

CONCLUSION

Grade 2+ acute adverse events are common. The toxicity profile varied by type of concomitant therapy; the gastrointestinal toxicity rate seemed to be higher in patients receiving gemcitabine.

A 12-gene pharmacogenetic panel to prevent adverse drug reactions: an open-label, multicentre, controlled, cluster-randomised crossover implementation study

BACKGROUND

The benefit of pharmacogenetic testing before starting drug therapy has been well documented for several single gene-drug combinations. However, the clinical utility of a pre-emptive genotyping strategy using a pharmacogenetic panel has not been rigorously assessed.

METHODS

We conducted an open-label, multicentre, controlled, cluster-randomised, crossover implementation study of a 12-gene pharmacogenetic panel in 18 hospitals, nine community health centres, and 28 community pharmacies in seven European countries (Austria, Greece, Italy, the Netherlands, Slovenia, Spain, and the UK). Patients aged 18 years or older receiving a first prescription for a drug clinically recommended in the guidelines of the Dutch Pharmacogenetics Working Group (ie, the index drug) as part of routine care were eligible for inclusion. Exclusion criteria included previous genetic testing for a gene relevant to the index drug, a planned duration of treatment of less than 7 consecutive days, and severe renal or liver insufficiency. All patients gave written informed consent before taking part in the study. Participants were genotyped for 50 germline variants in 12 genes, and those with an actionable variant (ie, a drug-gene interaction test result for which the Dutch Pharmacogenetics Working Group [DPWG] recommended a change to standard-of-care drug treatment) were treated according to DPWG recommendations. Patients in the control group received standard treatment. To prepare clinicians for pre-emptive pharmacogenetic testing, local teams were educated during a site-initiation visit and online educational material was made available. The primary outcome was the occurrence of clinically relevant adverse drug reactions within the 12-week follow-up period. Analyses were irrespective of patient adherence to the DPWG guidelines. The primary analysis was done using a gatekeeping analysis, in which outcomes in people with an actionable drug-gene interaction in the study group versus the control group were compared, and only if the difference was statistically significant was an analysis done that included all of the patients in the study. Outcomes were compared between the study and control groups, both for patients with an actionable drug-gene interaction test result (ie, a result for which the DPWG recommended a change to standard-of-care drug treatment) and for all patients who received at least one dose of index drug. The safety analysis included all participants who received at least one dose of a study drug. This study is registered with ClinicalTrials.gov, NCT03093818 and is closed to new participants.

FINDINGS

Between March 7, 2017, and June 30, 2020, 41 696 patients were assessed for eligibility and 6944 (51·4 % female, 48·6% male; 97·7% self-reported European, Mediterranean, or Middle Eastern ethnicity) were enrolled and assigned to receive genotype-guided drug treatment (n=3342) or standard care (n=3602). 99 patients (52 [1·6%] of the study group and 47 [1·3%] of the control group) withdrew consent after group assignment. 652 participants (367 [11·0%] in the study group and 285 [7·9%] in the control group) were lost to follow-up. In patients with an actionable test result for the index drug (n=1558), a clinically relevant adverse drug reaction occurred in 152 (21·0%) of 725 patients in the study group and 231 (27·7%) of 833 patients in the control group (odds ratio [OR] 0·70 [95% CI 0·54-0·91]; p=0·0075), whereas for all patients, the incidence was 628 (21·5%) of 2923 patients in the study group and 934 (28·6%) of 3270 patients in the control group (OR 0·70 [95% CI 0·61-0·79]; p <0·0001).

INTERPRETATION

Genotype-guided treatment using a 12-gene pharmacogenetic panel significantly reduced the incidence of clinically relevant adverse drug reactions and was feasible across diverse European health-care system organisations and settings. Large-scale implementation could help to make drug therapy increasingly safe.

FUNDING

European Union Horizon 2020.

Pharmacogenomics decision support in the U-PGx project: Results and advice from clinical implementation across seven European countries

Background

The clinical implementation of pharmacogenomics (PGx) could be one of the first milestones towards realizing personalized medicine in routine care. However, its widespread adoption requires the availability of suitable clinical decision support (CDS) systems, which is often impeded by the fragmentation or absence of adequate health IT infrastructures. We report results of CDS implementation in the large-scale European research project Ubiquitous Pharmacogenomics (U-PGx), in which PGx CDS was rolled out and evaluated across more than 15 clinical sites in the Netherlands, Spain, Slovenia, Italy, Greece, United Kingdom and Austria, covering a wide variety of healthcare settings.

Methods

We evaluated the CDS implementation process through qualitative and quantitative process indicators. Quantitative indicators included statistics on generated PGx reports, median time from sampled upload until report delivery and statistics on report retrievals via the mobile-based CDS tool. Adoption of different CDS tools, uptake and usability were further investigated through a user survey among healthcare providers. Results of a risk assessment conducted prior to the implementation process were retrospectively analyzed and compared to actual encountered difficulties and their impact.

Results

As of March 2021, personalized PGx reports were produced from 6884 genotyped samples with a median delivery time of twenty minutes. Out of 131 invited healthcare providers, 65 completed the questionnaire (response rate: 49.6%). Overall satisfaction rates with the different CDS tools varied between 63.6% and 85.2% per tool. Delays in implementation were caused by challenges including institutional factors and complexities in the development of required tools and reference data resources, such as genotype-phenotype mappings.

Conclusions

We demonstrated the feasibility of implementing a standardized PGx decision support solution in a multinational, multi-language and multi-center setting. Remaining challenges for future wide-scale roll-out include the harmonization of existing PGx information in guidelines and drug labels, the need for strategies to lower the barrier of PGx CDS adoption for healthcare institutions and providers, and easier compliance with regulatory and legal frameworks.

[Fitness to drive when taking medicines]

The regulations for driving fitness of people using drugs with potential influence on driving capability are embodied in the 'Regelingeisengeschiktheid 2000' (REG2000). The Health Council of the Netherlands (HCN) adviced to design more strict regulations for professional drivers. This advice has not yet been approved by the minister due to implementation complexity. The HCN recommends to follow the by the KNMP formulated advices when using category II psychostimulants or category III antidepressants, benzodiazepines, antipsychotics, antihistamines, anti-epileptics or opioids. The KNMP advices for driving participation are broadly available via the public websites www.apotheek.nl and www.rijveiligmetmedicijnen.nl. Both websites are written in accessible language level. The HCN advices to enhance scientific research concerning influence on driving fitness before approving a drug, to use standard procedures to prevent ad hoc decisions concerning driving fitness and the use of checklists for doctors when preparing driving fitness attests.

Oral adverse effects of drugs: Taste disorders

Objective

Oral healthcare professionals are frequently confronted with patients using drugs on a daily basis. These drugs can cause taste disorders as adverse effect. The literature that discusses drug‐induced taste disorders is fragmented. This article aims to support oral healthcare professionals in their decision making whether a taste disorder can be due to use of drugs by providing a comprehensive overview of drugs with taste disorders as an adverse effect.

Materials and methods

The national drug information database for Dutch pharmacists, based on scientific drug information, guidelines, and summaries of product characteristics, was analyzed for drug‐induced taste disorders. “MedDRA classification” and “Anatomic Therapeutical Chemical codes” were used to categorize the results.

Results

Of the 1,645 drugs registered in the database, 282 (17%) were documented with “dysgeusia” and 61 (3.7%) with “hypogeusia.” Drug‐induced taste disorders are reported in all drug categories, but predominantly in “antineoplastic and immunomodulating agents,” “antiinfectives for systemic use,” and “nervous system.” In ~45%, “dry mouth” coincided as adverse effect with taste disorders.

Conclusion

Healthcare professionals are frequently confronted with drugs reported to cause taste disorders. This article provides an overview of these drugs to support clinicians in their awareness, diagnosis, and treatment of drug‐induced taste disorders.

Monitoring and assessment of heavy metal contamination in a constructed wetland in Shaoguan (Guangdong Province, China): bioaccumulation of Pb, Zn, Cu and Cd in aquatic and terrestrial components

The objective of this study is to evaluate the current status of heavy metal concentrations in constructed wetland, Shaoguan (Guangdong, China). Sediments, three wetland plants (Typha latifolia, Phragmites australis, and Cyperus malaccensis), and six freshwater fish species [Carassius auratus (Goldfish), Cirrhinus molitorella (Mud carp), Ctenopharyngodon idellus (Grass carp), Cyprinus carpio (Wild common carp), Nicholsicypris normalis (Mandarin fish), Sarcocheilichthys kiangsiensis (Minnows)] in a constructed wetland in Shaoguan were collected and analyzed for their heavy metal compositions. Levels of Pb, Zn, Cu, and Cd in sediments exceeded approximately 532, 285, 11, and 66 times of the Dutch Intervention value. From the current study, the concentrations of Pb and Zn in three plants were generally high, especially in root tissues. For fish, concentrations of all studied metals in whole body of N. mormalis were the highest among all the fishes investigated (Pb 113.4 mg/kg, dw; Zn 183.1 mg/kg, dw; Cu 19.41 mg/kg, dw; 0.846 mg/kg, dw). Heavy metal accumulation in different ecological compartments was analyzed by principle component analysis (PCA), and there is one majority of grouped heavy metals concentration as similar in composition of ecological compartment, with the Cd concentration quite dissimilar. In relation to future prospect, phytoremediation technology for enhanced heavy metal accumulation by constructed wetland is still in early stage and needs more attention in gene manipulation area.

Combined effects of land reclamation, channel dredging upon the bioavailable concentration of polycyclic aromatic hydrocarbons (PAHs) in Victoria Harbour sediment, Hong Kong

The up-to-date concentration of polycyclic aromatic hydrocarbons (PAHs) in sediment materials of Victoria Harbour was investigated so as to evaluate the pollution potential associated with the reclamation projects in Hong Kong. A total of 100 sediment samples were collected at 20 locations. Except the control point in reservoir, the PAHs concentrations were detectable levels all sites (131-628.3ng/g, dw) and such values were higher than Dutch Target and Intervention Values (the New Dutch standard in 2016). The PAHs concentration indicating that construction waste and wastewater discharges were the main pollutant sources. Results of correlation in single cell gel electrophoresis assay (comet assay) studies also revealed that the PAHs concentration was highly correlated (<0.01) with DNA migration (i.e. the length of tail moment of fish cells) in 5mg/ml of PAHs. The above observation indicates that the PAHs present in the sediment may substantially effect the marine ecosystem. Although the dredged sediment can be a useful sea-filling material for land reclamation; however, the continuing leaching of PAHs and its impact on the aquatic environment need to be studied further.

On-chip clearing of arrays of 3-D cell cultures and micro-tissues

Three-dimensional (3-D) cell cultures are beneficial models for mimicking the complexities of in vivo tissues, especially in tumour studies where transport limitations can complicate response to cancer drugs. 3-D optical microscopy techniques are less involved than traditional embedding and sectioning, but are impeded by optical scattering properties of the tissues. Confocal and even two-photon microscopy limit sample imaging to approximately 100-200 μm depth, which is insufficient to image hypoxic spheroid cores. Optical clearing methods have permitted high-depth imaging of tissues without physical sectioning, but they are difficult to implement for smaller 3-D cultures due to sample loss in solution exchange. In this work, we demonstrate a microfluidic platform for high-throughput on-chip optical clearing of breast cancer spheroids using the SeeDB, Clear(T2), and ScaleSQ clearing methods. Although all three methods are able to effectively clear the spheroids, we find that SeeDB and ScaleSQ more effectively clear the sample than Clear(T2); however, SeeDB induces green autofluorescence while ScaleS causes sample expansion. Our unique on-chip implementation permits clearing arrays of 3-D cultures using perfusion while monitoring the 3-D cultures throughout the process, enabling visualization of the clearing endpoint as well as monitoring of transient changes that could induce image artefacts. Our microfluidic device is compatible with on-chip 3-D cell culture, permitting the use of on-chip clearing at the endpoint after monitoring the same spheroids during their culture. This on-chip method has the potential to improve readout from 3-D cultures, facilitating their use in cell-based assays for high-content drug screening and other applications.

Comparative assessment of water quality parameters of mariculture for fish production in Hong Kong Waters

The objective of the study is to evaluate the effect of fish cultivation on water quality in fish culture zone (FCZ) and analysed by Principle Component Analysis (PCA). 120 surface water samples were collected from Hong Kong Waters (60 samples in Victoria Harbour and another 60 in Ma Wan FCZ). Significant difference was found in dissolved oxygen (MW: 59.6%; VH: 81.3%), and Escherichia coli (MW: 465 CFU/100 ml; VH: 162.5 CFU/100 ml). Three principle components are responsible for water quality variations in the studying sites. The first component included E. coli (0.625) and dissolved oxygen (0.701). The second included E. coli (0.387) and ammonical-nitrogen (0.571). The third included E. coli (0.194) and ammonical-nitrogen (0.287). This framework provides information to assess the relative contribution of eco-aquaculture to nutrient loads and the subsequent risk of eutrophication. To conclude, a rigorous monitoring of water quality is necessary to assess point and nonpoint source pollution. Besides, appropriate remediation techniques should be used to combat water pollution and achieve sustainability.

Core-shell hydrogel beads with extracellular matrix for tumor spheroid formation

Creating multicellular tumor spheroids is critical for characterizing anticancer treatments since they may provide a better model of the tumor than conventional monolayer culture. Moreover, tumor cell interaction with the extracellular matrix can determine cell organization and behavior. In this work, a microfluidic system was used to form cell-laden core-shell beads which incorporate elements of the extracellular matrix and support the formation of multicellular spheroids. The bead core (comprising a mixture of alginate, collagen, and reconstituted basement membrane, with gelation by temperature control) and shell (comprising alginate hydrogel, with gelation by ionic crosslinking) were simultaneously formed through flow focusing using a cooled flow path into the microfluidic chip. During droplet gelation, the alginate acts as a fast-gelling shell which aids in preventing droplet coalescence and in maintaining spherical droplet geometry during the slower gelation of the collagen and reconstituted basement membrane components as the beads warm up. After droplet gelation, the encapsulated MCF-7 cells proliferated to form uniform spheroids when the beads contained all three components: alginate, collagen, and reconstituted basement membrane. The dose-dependent response of the MCF-7 cell tumor spheroids to two anticancer drugs, docetaxel and tamoxifen, was compared to conventional monolayer culture.

Medication incidents related to automated dose dispensing in community pharmacies and hospitals--a reporting system study

Introduction

Automated dose dispensing (ADD) is being introduced in several countries and the use of this technology is expected to increase as a growing number of elderly people need to manage their medication at home. ADD aims to improve medication safety and treatment adherence, but it may introduce new safety issues. This descriptive study provides insight into the nature and consequences of medication incidents related to ADD, as reported by healthcare professionals in community pharmacies and hospitals.

Methods

The medication incidents that were submitted to the Dutch Central Medication incidents Registration (CMR) reporting system were selected and characterized independently by two researchers.

Main Outcome Measures

Person discovering the incident, phase of the medication process in which the incident occurred, immediate cause of the incident, nature of incident from the healthcare provider's perspective, nature of incident from the patient's perspective, and consequent harm to the patient caused by the incident.

Results

From January 2012 to February 2013 the CMR received 15,113 incidents: 3,685 (24.4%) incidents from community pharmacies and 11,428 (75.6%) incidents from hospitals. Eventually 1 of 50 reported incidents (268/15,113 = 1.8%) were related to ADD; in community pharmacies more incidents (227/3,685 = 6.2%) were related to ADD than in hospitals (41/11,428 = 0.4%). The immediate cause of an incident was often a change in the patient's medicine regimen or relocation. Most reported incidents occurred in two phases: entering the prescription into the pharmacy information system and filling the ADD bag.

Conclusion

A proportion of incidents was related to ADD and is reported regularly, especially by community pharmacies. In two phases, entering the prescription into the pharmacy information system and filling the ADD bag, most incidents occurred. A change in the patient's medicine regimen or relocation was the immediate causes of an incident.

Assessment of heavy metals/metalloid (As, Pb, Cd, Ni, Zn, Cr, Cu, Mn) concentrations in edible fish species tissue in the Pearl River Delta (PRD), China

The major aim of this study was to investigate heavy metal content of edible fish in the PRD. Eleven species of fish (consisting of 711 individuals) [catfish (Clarias fuscus), tilapia (Oreochromis mossambicus), grass carp (Ctenopharyngodon idellus), bighead carp (Aristichthys nobilis), mandarin fish (Siniperca kneri), snakehead (Channa asiatiea), black bass (Micropterus salmoides), mangrove snapper (Lutjanus griseus), star snapper (Lutjanu stellatus), snubnose pompano (Trachinotus blochii) and orange-spotted grouper (Epinephelus coioides)] were collected for the analyses of heavy metals. Overall concentrations (mg/kg, ww) in the fish muscles were: As (0.03-1.53), Pb (0.03-8.62), Cd (0.02-0.06), Ni (0.44-9.75), Zn (15.7-29.5), Cr (0.22-0.65), Cu (0.79-2.26), Mn (0.82-6.91). Significant level of Pb were found in tilapia at all locations. It is recommended that heavy metal concentrations in different fish species must be determined on a regular basis in the future so as to reduce human health risks from acute and chronic food intoxication.

Classification of medication incidents associated with information technology

INTRODUCTION

Information technology (IT) plays a pivotal role in improving patient safety, but can also cause new problems for patient safety. This study analyzed the nature and consequences of a large sample of IT-related medication incidents, as reported by healthcare professionals in community pharmacies and hospitals.

METHODS

The medication incidents submitted to the Dutch central medication incidents registration (CMR) reporting system were analyzed from the perspective of the healthcare professional with the Magrabi classification. During classification new terms were added, if necessary.

MAIN MEASURES

The principal source of the IT-related problem, nature of error. Additional measures: consequences of incidents, IT systems, phases of the medication process.

RESULTS

From March 2010 to February 2011 the CMR received 4161 incidents: 1643 (39.5%) from community pharmacies and 2518 (60.5%) from hospitals. Eventually one of six incidents (16.1%, n=668) were related to IT; in community pharmacies more incidents (21.5%, n=351) were related to IT than in hospitals (12.6%, n=317). In community pharmacies 41.0% (n=150) of the incidents were about choosing the wrong medicine. Most of the erroneous exchanges were associated with confusion of medicine names and poor design of screens. In hospitals 55.3% (n=187) of incidents concerned human-machine interaction-related input during the use of computerized prescriber order entry. These use problems were also a major problem in pharmacy information systems outside the hospital.

CONCLUSIONS

A large sample of incidents shows that many of the incidents are related to IT, both in community pharmacies and hospitals. The interaction between human and machine plays a pivotal role in IT incidents in both settings.

Mixed arbuscular mycorrhizal (AM) fungal application to improve growth and arsenic accumulation of Pteris vittata (As hyperaccumulator) grown in As-contaminated soil

A greenhouse pot experiment was conducted to study the effects of three types of single inoculum [indigenous mycorrhizas (IM) isolated from As mine, Glomus mosseae (GM) and Glomus intraradices (GI)] and two types of mixed inoculum (mixed with IM and either GM or GI) on the growth response of Pteris vittata (hyperaccumulator) and Cynodon dactylon (non-hyperaccumulator) at three levels of As concentrations (0, 100 and 200mgkg(-1)). Both mycorrhizal plants exhibited significantly higher biomass, and N and P accumulation in its tissue than the control. Among the mycorrhizal inoculum, the mixed inoculum IM/GM promoted substantially higher mycorrhizal colonization and arsenate reductase activity in P. vittata than C. dactylon, among all As levels. The portion of Paris arbuscular mycorrhizal structure (observed in colonized roots) together with the highest As translocation factor of 10.2 in P. vittata inoculated with IM/GM was also noted. It was deduced that IM/GM inoculum may be the best choice for field inoculation at any contaminated lands as the inoculum exhibited better adaptation to variable environmental conditions and hence benefited the host plants.

A nationwide medication incidents reporting system in The Netherlands

OBJECTIVE

Many Dutch hospitals have established internal systems for reporting incidents. However, such internal systems do not allow learning from incidents that occur in other hospitals. Therefore a multicenter, information technology (IT) supported reporting system named central medication incidents registration (CMR) was developed. This article describes the architecture, implementation and current status of the CMR in The Netherlands and compare it with similar systems in other countries.

SYSTEM DESCRIPTION

Adequate IT is required to sufficiently support a multicenter reporting system. The CMR system consists of a website, a database, a web-based reporting form, an application to import reports generated in other reporting systems, an application to generate an overview of reported medication incidents, and a national warning system for healthcare providers.

CURRENT STATUS

From the start of CMR 90 of all 93 (96.8%) hospitals and 872 of 1948 (44.8%) community pharmacies participated. Between March 2006 and March 2010 the CMR comprised 15,694 reports of incidents. In the period from March 2010 to March 2011, 1642 reports were submitted by community pharmacies in CMR and the hospitals submitted 2517 reports. CMR is similar to various systems in other countries, but it seems to use more IT applications.

DISCUSSION

The CMR is developing into a nationwide reporting system of medication incidents in The Netherlands, in which hospitals, community pharmacies, mental healthcare organizations and general practitioners participate.

CONCLUSION

The architecture of the system met the requirements of a nationwide reporting system across different healthcare providers.

Synergistic effects of arbuscular mycorrhizal fungi and phosphate rock on heavy metal uptake and accumulation by an arsenic hyperaccumulator

The effects of arbuscular mycorrhizal (AM) fungi and phosphate rock on the phytorextraction efficiency of a hyperaccumulator (Pteris vittata) and a non-hyperaccumulator (Cynodon dactylon) plant were studied. Both seedlings were planted in As contaminated soil under different treatments [(1) control (contaminated soil only), (2) indigenous mycorrhizas (IM), (3) mixed AM inoculum [indigenous mycorrhiza + Glomus mosseae (IM/Gm)] and (4) IM/Gm + phosphate rock (P rock)] with varying intensities (40%, 70% and 100%) of water moisture content (WMC). Significant As reduction in soil (23.8% of soil As reduction), increase in plant biomass (17.8 g/pot) and As accumulation (2054 mg/kg DW) were observed for P. vittata treated with IM/Gm + PR at 100% WMC level. The overall results indicated that the synergistic effect of mycorrhiza and P rock affected As subcellular distribution of the hyperaccumulator and thereby altered its As removal efficiency under well-watered conditions.

Medication errors: the importance of safe dispensing

1. Although rates of dispensing errors are generally low, further improvements in pharmacy distribution systems are still important because pharmacies dispense such high volumes of medications that even a low error rate can translate into a large number of errors. 2. From the perspective of pharmacy organization and quality assurance, pharmacists should intensify their checking of prescriptions, in order to reduce prescription errors, and should implement strategies to communicate adequately with patients, in order to prevent administration errors. More and better studies are still needed in these areas. 3. More research is also required into: dispensing errors in out-patient health-care settings, such as community pharmacies in the USA and Europe; dispensing errors in hospitals and out-patient health-care settings in middle- and low-income countries; and the underlying causes of dispensing errors.

Risk assessment of residual DDTs in freshwater and marine fish cultivated around the Pearl River Delta, China

Six species of freshwater fish collected from 10 fishponds in Shunde and Zhongshan, China, four species of marine fishes collected from different mariculture farms [four in Hong Kong (Tung Lung Chau, Ma Wan, Cheung Chau and Kat O) and two in mainland China (Daya Bay and Shenzhen)] together with feed (both trash fish and commercial pellets) and sediment were analyzed for DDTs. Total DDTs in freshwater fish flesh decreased in the order of: carnivores [1742 microg/kg lipid weight (l.w.)] > herbivores (165 microg/kg, l.w.) > omnivores (42.5 microg/kg, l.w.), with the highest concentration detected in mandarin fish (Siniperca chuatsi) (2641 microg/kg, l.w.). For marine fish, snubnose pompano (Trachinotus blochii) and orange-spotted grouper (Epinephelus coioides) collected in Ma Wan contained elevated levels of total DDTs (2590 and 2034 microg/kg l.w., respectively). Trash fish used in both freshwater and marine fish farms contained significantly higher levels (86.5-641 microg/kg l.w.) (p < 0.05) of DDTs than in commercial pellets, but correlations between DDT levels in fish feed and muscle were not significant. The elevated biota-sediment accumulating factor for tilapia (Tilapia mossambicus) (24.1) indicated that accumulation of DDTs from sediment to the fish was evident. It can be concluded that trash fish should not be used for fish culture in order to lower the level of residual DDTs in fish muscle.

Adsorption kinetics of Pb and Cd by two plant growth promoting rhizobacteria

A bench study was carried out to characterize the kinetics of two plant growth promoting rhizobacteria (PGPR) Azotobacter chroococcum and Bacillus megaterium to adsorb heavy metals from solution. Adsorption of Pb(2+) and Cd(2+) by bacterial cells was processed quickly with an equilibration achieved within 5 min. The adsorptions were fitted well with Freundlich and Langmuir isotherm models. The comparison of isotherm parameters indicated that A. chroococcum had a stronger capacity to bind metal ions than B. megaterium, with an average increase of 59.8% for Pb(2+) and 75.6% for Cd(2+), respectively. Both bacteria had a stronger affinity to Pb(2+) than Cd(2+) since Pb(2+) was more easily bound with the phosphoryl groups on the cell surface than Cd(2+). This demonstrated that the presence of bacteria in the rhizosphere may result in the reduction of mobile ions in soil solution.

Microfluidic system for controlled gelation of a thermally reversible hydrogel

The integration of cell culture and characterization onto a miniaturized platform promises to benefit many applications such as tissue engineering, drug screening, and those involving small, precious cell populations. This paper presents the controlled on-chip gelation of a thermally-reversible hydrogel. Channel design and flowrate control are crucial in determining hydrogel geometry, while integrated temperature control triggers reversible gel formation. Formation of hydrogel droplets through shearing of immiscible flows is demonstrated with subsequent on-chip gelation. The temperature of phase transition occurs between 32degC-34degC, well within the range for mammalian cell encapsulation and culture.

Phase contrast imaging of breast tumours with synchrotron radiation

Even though the potential of phase contrast (PC) imaging has been demonstrated in a number of biological tissue samples, the availability of free-space propagation phase contrast images of real breast tumours is still limited. The aim of this study was to obtain phase contrast images of two different pathological breast specimens containing tumours of differing morphological type at two synchrotron radiation (SR) facilities, and to assess any qualitative improvements in the evaluation and characterisation of the masses through the use of phase contrast imaging. A second aim was to assess the effects of parameters such as detector resolution, beam energy and sample-to-detector distance on image quality using the same breast specimens, as to date these effects have been modelled and discussed only for geometric phantoms. At each synchrotron radiation facility a range of images was acquired with different detectors and by varying the above parameters. Images of the same samples were also acquired with the absorption-based approach to allow a direct comparison and estimation of the advantages specifically ascribable to the PC technique.

Interaction of higher plant (jute), electrofused bacteria and mycorrhiza on anthracene biodegradation

The interaction of bacteria, mycorrhiza and jute (Corchotus capsulari, a higher plant) to reduce anthracene in different concentrations of spiked soils was investigated. Dominant indigenous bacterium (Pseudomonas sp.) isolated in the rhizosphere of jute was electrofused with anthracene degraders (Sphingomonas paucimobilis and Pseudomonas aeruginosa) which were able to produce different types of biosurfactants. The highest population (56 x 10(5)CFU/g) was found in the planted soil with the inoculation of mixtures of electrofused anthracene degraders after 7 days. The growth of anthracene degraders in the spiked soil was improved by gene transfer from indigenous bacteria. After 35 days, enhanced anthracene removals were observed in inoculated soils planted with jute (65.5-75.2%) compared with unplanted soil without inoculation (12.5%). The interaction of jute and electrofused S. paucimobilis enabled the greatest reduction of soil anthracene with or without the addition of P. aeruginosa. Mycorrhizal colonization was not significantly inhibited by anthracene in soils up to 150 mg/kg. Inoculation of jute with Glomus mosseae and Glomus intraradices improved plant growth and enhanced anthracene removal in the presence of electrofused S. paucimobilis.

Metal concentrations of common freshwater and marine fish from the Pearl River Delta, south China

Sediments and fish, including tilapia (Oreochromis mossambicus), bighead carp (Aristichthys nobilis), grass carp (Ctenopharyngodon idellus), and mandarin fish (Siniperca chuatsi) were collected from different fish ponds in the Pearl River Delta (Tanzhou, Sanjiao, Guangzhou, Shipai, Changan, and Mai Po) for the analysis of metalloids and heavy metals [arsenic (As), cadmium (Cd), chromium (Cr), mercury (Hg), and lead (Pb)]. The pollution of As in pond sediments was great; however, As in the edible parts of pond fish were within the international permissible safety levels for human consumption. Axial muscles from 10 species each of freshwater and marine fish purchased from markets in Hong Kong were also analyzed for As, Cd, Cr, Cu, Hg, Ni, Pb and Zn. Freshwater fish contained 0.24 to 2.13 mg/kg As, 0.10 to 0.17 mg/kg Cd, 0.09 to 0.36 mg/kg Cr, 0.06 to 0.35 mg/kg Cu, 0.07 to 0.34 mg/kg Hg, 0.04 to 0.36 mg/kg Ni, 0.11 to 0.52 mg/kg Pb, and 2.67 to 19.1 mg/kg Zn (wet weight). Marine fish had higher Hg and lower Pb concentrations than freshwater fish. A few fish species had average concentrations greater than the international standards for Cd and Pb established by the European Union and the China National Standard Management Department. Total Hg concentrations in 10 of 20 market fish species were generally greater than those of the World Health Organization's recommended limit of 0.2 mg/kg for at-risk groups, such as children and pregnant women. Daily intake through fish consumption of these metals were compared with the Provisional Tolerable Weekly Intake proposed by the Joint Food and Agriculture Organization/World Health Organization Expert Committee on Food Additives. There appears to be potential threat to local people from Hg contamination because of the high marine fish consumption rate (142 g/d/person).

Heavy metals concentrations of surface dust from e-waste recycling and its human health implications in southeast China

The recycling of printed circuit boards in Guiyu, China, a village intensely involved in e-waste processing, may present a significant environmental and human health risk. To evaluate the extent of heavy metals (Cd, Co, Cr, Cu, Ni, Pb, Zn) contamination from printed circuit board recycling, surface dust samples were collected from recycling workshops, adjacent roads, a schoolyard, and an outdoor food market. ICP-OES analyses revealed elevated mean concentrations in workshop dust (Pb 110,000, Cu 8360, Zn 4420, and Ni 1500 mg/kg) and in dust of adjacent roads (Pb 22,600, Cu 6170, Zn 2370, and Ni 304 mg/kg). Lead and Cu in road dust were 330 and 106, and 371 and 155 times higher, respectively, than non e-waste sites located 8 and 30 km away. Levels at the schoolyard and food market showed that public places were adversely impacted. Risk assessment predicted that Pb and Cu originating from circuit board recycling have the potential to pose serious health risks to workers and local residents of Guiyu, especially children, and warrants an urgent investigation into heavy metal related health impacts. The potential environmental and human health consequences due to uncontrolled e-waste recycling in Guiyu serves as a case study for other countries involved in similar crude recycling activities.

Physiological and biochemical responses of rice (Oryza sativa L.) to phenanthrene and pyrene

Phenanthrene (Phe) and pyrene (Pyr) are two typical polycyclic aromatic hydrocarbons (PAHs) found in contaminated soil. This study investigated physiological and biochemical responses of rice (Oryza sativa L.) to PAH stress after they were planted in soils contaminated with Phe and Pyr, in the presence or absence of a PAH-degrading bacteria (Acinetobacteria sp.). A number of parameters including biomass and water, chlorophyll and chlorophyll a/b ratio, electrolyte leakage, activities of superoxide dismutase (SOD) and peroxidase, and soluble carbohydrate and soluble protein contents were monitored. Results show that rice plants have good resistance and tolerance to lower levels of PAHs stress, while adding high levels of PAHs to soils resulted in adverse effects on rice plants such as a reduction in biomass and damage to photosynthetic function. Water content and SOD activities were the most sensitive indicators of PAH stress among the observed parameters. Inoculation with PAH-degrading bacteria promoted growth and photosynthesis of rice.

Exposure to polybrominated diphenyl ethers associated with consumption of marine and freshwater fish in Hong Kong

Concentrations of polybrominated diphenyl ethers (PBDEs) in market fish have not previously been reported in Hong Kong. Axial and ventral muscles from 10 each common species of freshwater and marine fish purchased from markets in Hong Kong were analyzed for 22 PBDEs. Among the 10 freshwater fish species, spotted snakehead (Channa maculate) contained the highest level of PBDEs in ventral muscle (130 ng g(-1) wet wt.). For marine fish, bigeye (Priacanthus macracanthus) showed significantly higher levels of PBDEs (60.7 ng g(-1)wet wt. in ventral tissue) than all other marine species. The levels of PBDEs in fish samples ranged from 0.53 to 130 ng g(-1)wetwt. The tetrabrominated congener BDE-47 and pentabrominated BDE-99 were the predominant congeners, which accounted for 27% and 30%, respectively, of the total PBDEs. Daily PBDE intake was calculated according to the different fish consumption rate for Hong Kong consumers, and the results ranged from 222 to 1198 ng day(-1) for marine fish and 403-2170 ng day(-1) for freshwater fish. The daily PBDE intake from fish reported here were higher than those reported from the United States (8.94-15.7 ng day(-1)) and Europe (14-23.1 ng day(-1)).

Comparative toxicity of hydrophobic contaminants to microalgae and higher plants

To enable rapid and sensitive screening of phytotoxic compounds in terrestrial system, a 4 day solid-phase microalgal bioassay was developed. Three species of microalgae (Selenastrum capricornutum, Chlorococcum hypnosporum and Chlorococcum meneghini) were chosen to investigate their responses to DDTs (DDT, DDD and DDE) and PAHs (naphthalene, phenanthrene and pyrene) spiked sands. The bioassay results showed that PAHs and DDTs were toxic to microalgae in a 4-day exposure tests but not to seed germination of ryegrass (Lolium perenne). Phenanthrene was the most phytotoxic. Among three investigated endpoints, fluorescence emissions by microalgae were less sensitive than cell density (optical density OD(650)) and chlorophyll a concentration as endpoints. In general, S. capricornutum was the most sensitive species for PAHs (EC(50) for phenanthrene = 9.4 mg kg(-1)), while C. meneghini for DDTs (EC(50) for DDE = 20.0 mg kg(-1)). Comparison of the microalgal tests with US EPA standard seed germination/root elongation test (using Lolium perenne) demonstrated the superior screening potential of phytotoxic hydrophobic compounds using the proposed bioassay. Using OD(650) as the endpoint, EC(10) of selected microalgae for PAHs and DDTs were 0.43-64.3 mg kg(-1) and 0.67-117 mg kg(-1) respectively, which were much lower than the EC(10) of L. perenne for both PAHs (94-187 mg kg(-1)) and DDTs (113-483 mg kg(-1)). The results encourage further studies involving wider types of vascular plants and more comparison with standard phytotoxicity tests from different authorities using contaminated soils to verify the effectiveness of the microalgal bioassay.

Screening of PAHs and DDTs in sand and acrisols soil by a rapid solid-phase microalgal bioassay

Previously we have demonstrated the rapid screening potential of a newly developed solid-phase microalgal bioassay with spiked sands. In this paper, we report further comparative results using both PAHs and DDTs spiked sands and field-collected acrisols soils. Toxicity responses obtained from standard higher plant tests with three species of plants (Lolium perenne, Cynodon dactylon and Brassica chinensis) were compared with those obtained from a cocktail of microalgae (Selenastrum capricornutum, Chlorococcum hypnosporum and the indigenous Chlorococcum meneghini). The 5-day seed germination/root elongation tests were not sensitive at all in contrast to the 4-day solid-phase microalgal tests and the 28-day early seedling growth tests in both spiked sands and contaminated soils. Sensitivities of microalgal tests were generally higher than the seedling growth tests in spiked sands. Concerning the assays with contaminated soil, the responses of microalgae and higher plants varied. However, the results demonstrated that microalgae could generally act as effective surrogates to screen xenobiotic compounds at toxic level to higher plants, with the local species C. meneghini especially sensitive to reveal phytotoxic effects. This promising rapid screening solution is possible to be used in accompany with standard seedling growth tests when assessing phytotoxicities of contaminated areas, especially for acrisols soil.

Pollutants in Hong Kong soils: polycyclic aromatic hydrocarbons

An extensive soil survey was carried out to study the polycyclic aromatic hydrocarbon (PAH) contaminations in 138 soil samples collected throughout Hong Kong. Results demonstrated that there were low levels of PAH contaminations (median of summation operator 16US EPA PAHs=140 microg kg(-1)) for all land uses (urban park, greening area, country park, rural area, restored landfill, agricultural farmland, orchard farm, crematorium, industrial and near highway area). However, localized hotspots were identified with summation operator 16PAH concentrations as high as 19,500 microg kg(-1) in one urban park. These findings were also confirmed by multivariate analysis. Comparison of PAH profiles showed a widespread domination of its 4-ring member. The major contribution was vehicular emissions from petroleum, and however at the hotspots, the improper disposal of used motor oils. In general, the pollution levels for all the land uses were below the recommended values for residential and general purposes stated in soil quality guidelines such as Netherlands and Denmark except certain identified hotspots. The potential health hazards imposed by these hotspots were alarming, and their existence (3 out of 138 samples) suggested that sole monitoring of atmospheric PAHs may not adequately address the hidden risks to human in urban city.

Residual levels of DDTs and PAHs in freshwater and marine fish from Hong Kong markets and their health risk assessment

Axial and ventral muscle from 10 each species of freshwater and marine fish purchased from markets in Hong Kong were analyzed for dichlorodiphenyltrichloroethane (total DDTs including DDE, DDD and DDT) and polycyclic aromatic hydrocarbons (PAHs). Among the 10 freshwater fish species, rice field eel (Monopterus albus) showed significantly higher levels of DDTs in both ventral (125 ng/g wet wt) and axial muscle (127 ng/g wet wt) than the other species. The highest concentration of PAHs was detected in catfish (Clarias fuscus), with 24.8 ng/g in ventral muscle and 9.1 ng/g in axial muscle. As to marine fish, snubnose pompano (Trachinotus blochii) showed significantly higher levels of DDT and its metabolites (1018 ng/g in ventral and 409 ng/g wet wt in axial tissues) than all other marine fish species. The overall concentrations of PAHs in marine fish species were 15.5-57.0 ng/g (axial muscle) and 18.1-118 ng/g wet wt (ventral muscle) where yellow seafin (Acanthopeyrus latus) and golden threadfin bream (Nemipterus virgatus) exhibited the highest concentrations of PAHs in the axial and ventral muscles, respectively. In general, results showed that levels of PAHs in Hong Kong market fish was low and do not expect to cause any concern for human consumption. However, the levels of DDTs in fish samples ranged from 1.10 to 1018 ng/g wet wt, and based on a fish consumption rate of 142.2g/day to calculate the screening value of 14.4 ng/g wet wt for human consumption (USEPA, 2000. Guidance for assessing chemical contaminant, data for use in fish advisories, vol. 1: fish sampling and analysis, third ed. EPA 823-R-95-007. Office of Water, Washington, DC), there were 9 out of 20 (45%) muscle samples of freshwater fish species and 14 out of 20 (70%) muscle samples of marine fish species had elevated levels of DDTs exceeded the screening value. It was also suggested to use ventral muscle for detecting concentrations of persistent organic pollutants in fish.

Interactions of rice (Oryza sativa L.) and PAH-degrading bacteria (Acinetobacter sp.) on enhanced dissipation of spiked phenanthrene and pyrene in waterlogged soil

The effects of cultivation of rice (Oryza sativa L.) and PAH-degrading bacteria (Acinetobacter sp.) separately, and in combination, on the dissipation of spiked phenanthrene and pyrene (0, 50+50, 100+100, 200+200 mg kg(-1)) in waterlogged soil were studied using pot trials. The population of introduced PAH-degrading bacteria remained at 10(5) CFU g(-1) dry soil after 20 days of treatment with Acinetobacter sp. only, but increased to 10(6) when planted with rice simultaneously. Shoot and root biomass of rice when grown alone was adversely affected by spiked PAHs, but significantly increased by 2-55% and 8-409%, respectively, when inoculated with Acinetobacter sp.. Phenanthrene and pyrene concentrations in roots ranged from 1-27 and 20-98 mg kg(-1), respectively, while their concentrations in shoots were generally lower than 0.2 mg kg(-1). The dissipation of phenanthrene was mainly due to abiotic loss as 70-78% phenanthrene was lost from the control soil at the end of 80 days, while removal of 86-87% phenanthrene had been achieved after 40 days in the treatment co-cultivated with Acinetobacter sp. and rice. Compared with the control where only 6-15% of pyrene was removed from soil, a much higher dissipation of pyrene (43-62%) was attained for the treatments co-cultivated with Acinetobacter sp. and rice at the end of 80 days. The results demonstrated that co-cultivation of rice and PAH-degrading bacteria may have a great potential to accelerate the bioremediation process of PAH-contaminated soil under waterlogged conditions.

Influence of bacteria on Pb and Zn speciation, mobility and bioavailability in soil: A laboratory study

A soil column experiment was carried out to investigate the effects of inoculation of bacteria on metal bioavailability, mobility and potential leachability through single chemical extraction, consequential extraction and in situ soil solution extraction technologies. Results showed that bacteria inoculated, including Azotobacter chroococcum, Bacillus megaterium and Bacillus mucilaginosus, may pose both positive and negative impacts on bioavailability and mobility of heavy metals in soil, depending on the chemical nature of the metals. The activities of bacteria led to an increase of water dissolved organic carbon (DOC) concentration and a decrease of pH value, which enhanced metal mobility and bioavailability (e.g. an increase of water-soluble and HOAc-soluble Zn). On the other hand, bacteria could immobilize metals (e.g. a great reduction of water-soluble Pb) due to the adsorption by bacterial cell walls and possible sedimentation reactions with phosphate or other anions produced through bacterial metabolism.

Distribution of polycyclic aromatic hydrocarbons in soils at Guiyu area of China, affected by recycling of electronic waste using primitive technologies

The concentration, distribution, profile and possible source of polycyclic aromatic hydrocarbons (PAHs) in soil were studied in Guiyu, an electronic waste (E-waste) recycling center, using primitive technologies in Southeast China. Sixteen USEPA priority PAHs were analyzed in 49 soil samples (0-10 cm layer) in terms of individual and total concentrations, together with soil organic matter (SOM) concentrations. The concentrations of a sum of 16 PAHs ranged from 44.8 to 3206 microgkg(-1) (dry weight basis), in the descending order of E-waste open burning sites (2065 microgkg(-1))>areas near burning sites (851microgkg(-1))>rice fields (354 microgkg(-1))>reservoir areas (125microgkg(-1)). The dominant PAHs were naphthalene, phenanthrene and fluoranthene, which were mainly derived from incomplete combustion of E-waste (e.g. wire insulations and PVC materials), and partly from coal combustion and motorcycle exhausts. All individual and total PAH concentrations were significantly correlated with SOM except for naphthalene and acenaphthylene. Principal component analysis was performed, which indicated that PAHs were mainly distributed into three groups in accordance with their ring numbers and biological and anthropogenic source. In conclusion, PAH concentrations in the Guiyu soil were affected by the primitive E-waste recycling activities.

A comparative study on metal sorption by brown seaweed

This study compared the sorption of Ag, Cd, Co, Cd, Mn, Ni, Pb and Zn by a Ca-treated Sargassum biomass at pH 5.0, under low and high ionic strength (IS) conditions. The sorption isotherms of As [As(V)] and Cr [Cr(III) and Cr(VI)] were also determined at low IS. The isotherm data for the eight cationic metals and Cr(III) were well fitted by Langmuir equations. Generally, the maximum metal uptake (Umax) followed: Cr(III) > Pb approximately Cu > Ag approximately Zn approximately Cd > Ni approximately Mn approximately Co >> Cr(VI) >> As(V) at low IS and Pb > Cu > Co > Mn approximately Cd > Zn approximately Ag > Ni at high IS. As(V) did not bind to the seaweed at pH 5.0. The results indicated that sorption of Pb was not affected by the increasing IS, though the percentage of free Pb ions in the water was greatly reduced as predicted by the speciation model. High IS lowered Umax by 10-36% (except Co and Pb), and lowered the affinity constant of the metal by 33-91% for all cationic metals, as compared to low IS. Moreover, the removal efficiency of the cationic metals and Cr decreased exponentially with initial metal concentrations and was lower at high IS. Ion-exchange was the mechanism responsible for the cationic metal sorption onto the seaweed, and Na ion interfered with the cationic metal binding through electrostatic interaction. In conclusion, this study showed the differential binding capacity of the Sargassm biomass for different metals and oxidation states and the differential effects of IS. According to the present results, Sargassum may be considered a good biosorbent for cationic metals (especially Pb) in both low and high-salt containing wastewater.

Effects of inoculation of plant growth-promoting rhizobacteria on metal uptake by Brassica juncea

A greenhouse study was carried out with Brassica juncea to critically evaluate effects of bacterial inoculation on the uptake of heavy metals from Pb-Zn mine tailings by plants. Application of plant growth-promoting rhizobacteria, including nitrogen-fixing bacteria and phosphate and potassium solubilizers, might play an important role in the further development of phytoremediation techniques. The presence of these beneficial bacteria stimulated plant growth and protected the plant from metal toxicity. Inoculation with rhizobacteria had little influence on the metal concentrations in plant tissues, but produced a much larger above-ground biomass and altered metal bioavailability in the soil. As a consequence, higher efficiency of phytoextraction was obtained compared with control treatments.

Kinetic studies on phosphorus sorption by selected soil amendments for septic tank effluent renovation

A systematic kinetic study of phosphorus (P) sorption by various materials in the soil infiltration system of septic tanks was undertaken by following the time course of P sorption by sorbents in contact with various P solutions over periods up to 360 days. Uptake of P seemed to consist of two distinct stages. Initial uptake was very rapid and this phase was completed in 4 days or less. A slower removal stage followed for some materials over many months. Phosphorus sorption during the fast reaction stage appeared to be associated with the soluble Ca content of the materials. The fast reaction of calcareous materials accounted for the bulk (>70%) of the total P removed. Merribrook loamy sand exhibited the highest proportion of P sorption during the slow phase. It should be noted, however, that for solution P concentrations in the range found in typical effluents (approximately 20 mg L(-1)) the fast reaction phase seemed to be responsible for virtually all P removed. None of the six kinetic formulae examined possessed the sophistication and detail needed to portray accurately the time course of P sorption for all the sorbents investigated. The Elovich equation and the kinetic modification of the Freundlich isotherm expression appeared to provide a reasonable fit of the experimental data.

Risk assessment of heavy metal contamination in shrimp farming in Mai Po Nature Reserve, Hong Kong

An ecological survey was carried out to determine the sediment concentrations of nutrients and heavy metals and bioaccumulation of heavy metals in fish and shrimp including tilapia (Oreochromis mossambicus x O. nilotica), grey mullet (Mugil cephalus), gei wai shrimp (Metapenaeus ensis) and caridean shrimp (Macrobrachium nipponensis) in the traditional tidal shrimp ponds (gei wais) of Mai Po Nature Reserve, Hong Kong. The sediments collected from the landward sites contained higher nutrient contents, as well as zinc (Zn), chromium (Cr), copper (Cu), nickel (Ni) and cadmium (Cd) than those collected from the seaward sites, but vice versa for lead (Pb) and mercury (Hg). However, the concentrations of all metals were exceptionally high in the two sites located outside the reserve, suggesting that waters from Deep Bay might be the possible source of metal contamination affecting the reserve. All metals studied seemed to accumulate in the viscera of fish. Body size was the determining factor for the accumulation of heavy metals in caridean shrimp and gei wai shrimp but not fish. Concentrations of the metals studied in tissues of grey mullet and gei wai shrimp were found to be safe for human consumption. Concentrations of Cr in tilapia whole body (0.68-1.10 mg kg(-1) wet weight) were close to or over the guideline value of 1 mg kg(-1) set by the Food Adulteration (Metallic Contamination) Regulations of Hong Kong. Tilapia flesh and small caridean shrimp collected from gei wais were contaminated by Cr and Pb but still fit for human consumption. Caution is required if large caridean shrimp is to be consumed in large amounts continuously because the concentration of Pb exceeded the maximum permitted concentration (6 mg kg(-1)). The rather high Cr concentrations in tilapia whole body should not be overlooked as the fish will serve as a food source for migratory birds visiting the site.

Phase contrast X-ray imaging of mice and rabbit lungs: a comparative study

The significant degree of X-ray phase contrast created by air-tissue interfaces, coupled with the poor radiographic contrast of conventional chest radiographs, makes the inflated lung an ideal candidate for investigating the potential diagnostic improvement afforded by phase contrast X-ray imaging. In small animals these methods highlight the lung airways and lobe boundaries and reveal the lung tissue as a speckled intensity pattern not seen in other soft tissues. We have compared analyser-based and propagation-based phase contrast imaging modalities, together with conventional radiographic imaging, to ascertain which technique shows the greatest image enhancement for various lung sizes. The conventional radiographic image of a mouse was obtained on a Siemens Nova 3000 mammography system, whilst phase contrast images of mice and rabbit chests were acquired at the medical imaging beamline (20B2) at the SPring-8 synchrotron radiation research facility in Japan. For mice aged 1 day, 1 week and 1 month old it was determined that analyser-based imaging showed the greatest overall image contrast, however, for an adult rabbit both techniques yielded excellent contrast. The success of these methods in creating high quality images for rabbit lungs raises the possibility of improving human lung imaging using phase contrast techniques.

The residual dynamic of polycyclic aromatic hydrocarbons and organochlorine pesticides in fishponds of the Pearl River delta, South China

Hong Kong and South China are the most developed regions within China. The industrialization in these areas has resulted in severe environmental problems. Sediment and biotic samples including tilapia (Oreochromis mossambicus), bighead carp (Aristichthys nobilis), grass carp (Ctenopharyngodon idellus), crucian carp (Carassius auratus) and mandarin fish/fresh water grouper (Siniperca chuatsi) were collected from different fishponds in the Pearl River Delta (Tanzhou, Sanjiao, Guangzhou, Shipai, Changan and Mai Po) for the analysis of polycyclic aromatic hydrocarbons (PAHs) and organochlorine (OC) pesticides. Mandarin fish, which belongs to the highest trophic level, accumulated the highest concentrations of PAHs and DDTs among all fish species. The levels of DDTs in fish samples ranged from 1.5 to 62ng g-1 (wet wt.), with more than 30% of the fish samples exceeding the limit of 14.4ng g-1 (wet wt.) for human consumption recommended by US EPA (2000). Levels of PAHs in fish samples ranged from 1.91 to 224.03ng g-1 (wet wt.), but the potency-weighted total concentrations of PAHs in all muscle tissues were below the guideline value of 0.67ng g-1 (wet wt.) for human consumption set by US EPA (2000). The guideline value calculated was based on a tissue consumption rate of 142.2g day-1 (4-5 meals per week), which is a more protective rate for populations with a high consumption of fish, like Chinese and Asians. The effect of lipid content in PAHs and DDTs accumulation in fish tissue was not significant in general.

Assessment of contamination by percolation of septic tank effluent through natural and amended soils

Fly ash has been found to be a potential material for the treatment of municipal and industrial wastewater, and may be useful in the treatment of septic tank effluent. Laboratory columns (30 cm) were used to determine the sorption capacity and hydraulic properties of lagoon fly ash, loamy sand, sand, and sand amended by lagoon fly ash (30 and 60%) and red mud gypsum (20%). The removal of chemical oxygen demand (COD) was high in all column effluents (71-93%). Extent of nitrification was high in Spearwood sand, Merribrook loamy sand and 20% red mud gypsum amended Spearwood sand. However, actual removal of nitrogen (N) was high in columns containing lagoon fly ash. Unamended Spearwood sand possessed only minimal capacity for P sorption. Merribrook loamy sand and red mud gypsum amended sand affected complete P removal throughout the study period of 12 weeks. Significant P leakage occurred from lagoon fly ash amended sand columns following 6-10 weeks of operation. Neither lagoon fly ash nor red mud gypsum caused any studied heavy metal contamination including manganese (Mn), lead (Pb), zinc (Zn), cadmium (Cd) and chromium (Cr) of effluent. It can be concluded that Merribrook loamy sand is better natural soil than Spearwood sand as a filter medium. The addition of lagoon fly ash enhanced the removal of P in Spearwood sand but the efficiency was lower than with red mud gypsum amendment.

Direct-to-consumer communication on prescription only medicines via the Internet in the Netherlands, a pilot study Opinion of the pharmaceutical industry, patient associations and support groups

OBJECTIVE

Investigation of the current application of direct-to-consumer (DTC) communication on prescription only medicines via the Intemet in the Netherlands.

METHOD

Questionnaires were sent by e-mail to 43 Dutch innovative pharmaceutical industries and 130 Patient Association and Support Groups (PASGs).

RESULTS

In this pilot study, the response of the pharmaceutical industry was rather low but the impression is that they were willing to invest in DTC communication. The majority of the websites of PASGs did not link to websites of pharmaceutical companies. The PASGs had no opinion whether patients can make a good distinction between DTC advertising and information on websites of the pharmaceutical industry nor about the quality. PASGs did not think unambiguously about the impact on the patient-doctor relationship.

CONCLUSION

The impact of DTC communication on prescription only medicines via the internet is not yet clear in the Netherlands.

Assessment of metal and nutrient concentrations in river water and sediment collected from the cities in the Pearl River Delta, South China

The effects of anthropogenic activities, industrialization and urbanization on the accumulation of heavy metals and nutrients in sediments and water of rivers in the Pearl River Delta region were examined. Most sediments were seriously contaminated with Cd, Pb, and Zn in accordance with the classification by Hong Kong Environmental Protection Department. Total phosphorus (P) and nitrogen (N) concentrations in sediments ranged from 0.02% to 0.12% and 0.06% to 0.64%, respectively. High carbon (C), N, P and sulphur (S) levels at Yuen Long Creek were related to the discharge of industrial effluents along the river. The enrichment of P and ammoniacal-nitrogen (NH4+-N) in water were obvious. For most sites, the P concentration exceeded 0.1 mg/l, which is the recommended concentration in flowing water to encourage excessive growth of aquatic plants. Nine out of the 16 sites studied had NH4+-N concentration over 2 mg/l. The rivers in the south of Deep Bay (Hong Kong) had high nutrient exports compared with the rivers in the east region and western oceanic water. The concentrations of nitrate-nitrogen NO3--N in surface water were under the maximum contaminant level in public drinking water supplies (10 mg/l) except for one site. Although the concentrations of heavy metals in overlying water were low, their accumulations were significant. High contents of nickel (Ni) and zinc (Zn) in water were found at certain locations, suggesting the occurrence of some local contamination. These preliminary results indicated that river and sediment transported pollutants is likely one of the factors for the water quality degradation of Deep Bay water.

Toxicity assessment of sediments containing tributyltin around Hong Kong harbour

Rather high levels of tributyltin (TBT) in sediments were found in certain areas around the Hong Kong coastline. Sediments from two contaminated sites (Tsing Yi and Yam O) and two clean sites were used to study the release of TBT contaminants from resuspended sediment to the water column by elutriate tests. The chemical analysis data of elutriates were compared with the effective or lethal concentrations from the toxicity tests of spiked solution using marine microalga (Dunaliella tertiolecta) and benthic invertebrate (Melita koreana) to assess the potential ecotoxicological impacts arising from the dredging work. Concentrations of TBT in filtered sediment elutriates were mostly below 0.002 microg/l which suggested that very little of TBT was released in soluble form. The lethal toxicity of TBT for the invertebrate expressing as 10 day-LC(50) was 2.31 microg/l for TBT and the alga expressing as 48 h-EC(50) was 0.46 microg/l. The results of this evaluation demonstrated that the release of TBT from two contaminated sites during dredging was unlikely to attain the effective or lethal concentrations on the two test species.

Sintering of dental porcelain: effect of time and temperature on appearance and porosity

OBJECTIVE

Mechanical condensation of powder-method dental porcelains can only achieve a limited effect--the majority of consolidation and porosity elimination is achieved by sintering. However, there is a surprising lack of information on the process in the literature, and the effects of the two basic conditions of sintering, time and temperature, are very poorly described despite theoretical expectations. The present study was to investigate the effects of these conditions on porosity and to consider its relationship to the recognizable firing stages of low and high biscuit, and other aspects of appearance, with a view to schedule recommendations.

METHODS

The variation of appearance, pore form and percentage porosity with sintering time and temperature was studied for five dental dentine porcelains, two aluminous: Alpha (Vita Zahnfabrik, Bad Säckingen, Germany) and Vitadur-N (Vita); and three feldspathic: Omega (Vita), VMK68 (Vita) and Carmen (Esprident, Ispringen, Germany). Disc specimens were sintered for 0-1000 min over 750-1100 degrees C in a systematic search pattern to establish limits of acceptable appearance (high biscuit to not quite slumped). Porosity was measured using an image analyser on specimens fired for sintering times of 24 and 30 s; 1, 3, 6 and 30 min; 1, 5, 10, 15 and 20 h; with sintering temperatures from 750 to 950 degrees C for Carmen and 800-1050 degrees C for the others, all with 50 degrees C increments. Measurements were made on a ground and polished surface (1 microm diamond), five fields on each of five specimens per condition. The percentage porosity, pore count, median pore area and pore size distribution were analyzed.

RESULTS

The boundaries of the acceptable appearance areas in maps of sintering temperature vs. sintering time were clearly delineated; analysis showed that they may be related to the activation energy of the diffusive processes occurring during sintering. Minimum porosity was obtained at high temperature and short time, close to but not consistently coincident with the manufacturers' recommendations. There is also a conductivity-related minimum sintering time at high temperatures. The theoretical reduction on prolonging sintering at high temperature was not a general result, and porosity increased markedly in the feldspathic porcelains, particularly VMK-68.

SIGNIFICANCE

The reduction of porosity of dentine porcelain is much more sensitive to temperature than to time. It is possible systematically to identify optimum conditions using the present approach. Detailed study of the effects of formulation on the sintering process may be made by reference to the activation energy.