A novel series of pyrrolidine heterocycles was prepared and found to show potent inhibitory activity of CCR1 binding and CCL3 mediated chemotaxis of a CCR1-expressing cell line. A potent, optimized triazole lead from this series was found to have acceptable pharmacokinetics and microsomal stability in rat and is suitable for further optimization and development.

The environment and 'green' issues are currently being promoted in the healthcare sector through recently launched initiatives. This paper considers aspects of healthcare waste management, with particular reference to waste generated in dialysis units. With dialysis being dependent upon large amounts of disposables, it generates considerable volumes of waste. This paper focuses upon a typical haemodialysis unit, evaluating and quantifying the volumes and categories of waste generated. Each haemodialysis patient on thrice weekly dialysis generates some 323 kg per year of waste, of which 271 kg is classified as clinical. This equates to 1626 kg of (solid) clinical waste per dialysis bed, which is around three times the volume of clinical waste generated per general hospital bed. Waste disposal routes are considered and this suggests that present healthcare waste paradigms are outmoded. They do not allow for flexible approaches to solving what is a dynamic problem, and there is a need for new thinking models in terms of managing the unsustainable situation of disposal in constantly growing landfills. Healthcare waste management must be considered not only in terms of the environmental impact and potential long-term health effects, but also in terms of society's future energy requirements.

Chlorine-based products are widely used in the water supply industry, and the potential for adverse effects in the haemodialysis setting is well documented. To date, the most commonly used method of chlorine removal has been granular activated carbon filters. An increasingly popular method of dechlorination is the use of high intensity, broad-spectrum UV systems to reduce both free chlorine and combined chlorine compounds (chloramines) into easily removed by-products.UV radiation has been successfully used in the pharmaceutical and food industries to destroy free chlorine and/or chloramines present in water, and kill all known spoilage microorganisms including bacteria, viruses, yeasts and moulds (and their spores). This nonchemical method can offer significant advantages and benefits compared to conventional dechlorination technologies currently employed in dialysis water systems.Whilst UV treatment at 254 nm wavelength has been routinely used for disinfection purposes in dialysis water systems, this paper considers whether UV radiation can be used as an alternative to more traditional methods of chlorine removal.

Although traditionally considered the domain of the renal technologist, many units do not have technicians or may only have part-time access to one. In these cases, it often falls to nursing staff to ensure that patients are dialysed safely. However, water quality is an area in which some nurses do not feel confident. This paper is aimed at providing information about the importance of appropriate water treatment, water testing and monitoring and the implications to the patient if the water is not checked appropriately in accordance with the guidelines.

This paper aims to overview information related to quality of dialysis fluid, water quality and standards of patient care. This article may assist in learning more about the importance of appropriate water treatment, water testing and the implications to the patient of water and dialysate quality.

Dialysis, with its high dependence upon technology, disposable products and transport requirements, presents an unusual perspective for environmental management. This study considers and compares the environmental aspects arising from the provision of haemodialysis (HD) in the hospital and home setting. Resource items were measured at two levels of aggregation--unit and individual patient. Unit level items applied to common resources used for HD and require apportioning appropriately with patient level items that could be attributable to individuals. The data was measured in standard units such as hours and number of treatments or apportioned appropriately. With equivalent emissions calculated as CO2 annually per patient for standard HD. The findings indicate that HD in the home offers a net reduction in CO2 emissions per patient annually compared to hospital based HD, and provides an overview of how healthcare provision and the use of resources can be measured, enabling refinement in environmental management plans.

PROBLEM:Assurance of adequate water quality is one of the most important aspects of ensuring a safe and effective delivery of haemodialysis. There are several different culture methods recommended in the various guidelines on the microbiological testing of water for dialysis.AIMS:The aim was to investigate whether or not there was a significant difference in the microbiological results obtained using the various recommended culture methods.METHODS:Current guidelines suggest that samples for microbiological analysis should be cultured using a low nutrient media such as Reasoner's 2A but vary in recommending temperature and time. Over a six month period, samples were sent to an independent laboratory and cultured using three different times and temperatures. Samples were cultured at 22 degrees C for 7 days (ERA-ERCA, EDTNA-ERCA), 37 degrees C for 2 days (AAMI and ISO) and 30 degrees C for 5 days (ISO, EP).RESULTS:The bacterial culture method used was R2A media at the incubation temperatures and times indicated. During an extensive microbiological survey of several water systems, the results from the laboratory gave conflicting results for the three methods. Results showed that several of sample sets returned results with a difference in recovery by a factor of between 10 and 1000.CONCLUSIONS:Culturing using the stated temperature and times produces large variations in reported levels of contamination. Culturing at the different temperatures and incubation times can produce results which may give a false sense of security by not indicating a contamination problem. Standardising on a single method is desirable in order to produce consistently valid results.

This paper outlines ways of creating more interactive videoconference sessions. Videoconference technology is now widely available in the community. Health promoters need to have the ability to conduct interactive sessions using the technology effectively to maximise its potential. The knowledge and skill needed is akin to setting up a live performance: scriptwriting, choreography, preparing sets, lighting and sound. Getting the basics right and understanding the potential gives health promoters the ability to interact effectively with the audience across the sites. Simple strategies can greatly improve a videoconference session, and most of these strategies do not require a high level of technical expertise or a multitude of support staff; they can be harnessed by any health professional with an interest in getting the best out of a videoconference session. The more complex the presentation the more planning and practice time is needed to ensure that all of the information is delivered and feedback received in the time scheduled.

The analysis of liquid hazardous waste (LHW) prior to disposal using high temperature incineration or as an alternative fuel is required for process and regulatory control. The typical requirement of the industry sector is rapid screening to support decisions on the most appropriate treatment of the waste. This paper reports the use of high resolution EDXRF spectrometry for the analysis of halides and toxic heavy elements using a new rapid technique incorporating an unique sample preparation methodology. Calibrations are developed using traceable certified 1000 mg 1-T aqueous standards and pure organic solvents. Samples are stabilised in an alumina matrix and measured against a suitable calibration. The benefits of this new technique are: Ease of obtaining calibration standards Removal of sample history - i.e. control of matrix effects Minimisation of analyte loss during sample preparation Wide range of matrix types measurable using a single calibration - e.g. clean solvents to turbid sewage sludge Accuracy of measurement - typically within 10% relative in the concentration range lo- 1 OOmg kg1 with a precision better than 5% relative Speed of analysis - for >20 elements typically ~15 minutes from receipt of sample. Results presented in this paper show high resolution EDXRF to be ideally suited to the analysis of LHW due to good heavy element detection in the atomic number range 30 - 82 (Zn - Pb). Detection limits achieved using rapid screening EDXRF and the new alumina sample preparation technique are in the range 3- 17 mg kg-1 for heavy elements and below the working calibration range for Cl, P, and S. These limits satisfy typical requirements for process and regulatory control which are of importance in the analytical range >O. 1 %m/m for P, S & Cl and >50 mg kg-1 for the heavier elements.

The application of national or state alcohol harm-prevention programs at a regional level can be inappropriate. The involvement of local communities is critical if harm-prevention responses are to be sensitive to local needs. Unfortunately, individuals and agencies usually have little idea of the impact of alcohol at the local level. Alcohol consumption and harm data have been gathered for Geraldton and Bunbury, two regional centres of comparable size in Western Australia. The indices of harm presented include the nature and cost of hospital morbidity attributable to alcohol, and drink-driving charges. In Geraldton, the impact of alcohol tends to be acute and affects young adults, particularly young males. In Bunbury, the consequences of alcohol use tend to be more chronic in nature and affect older adults. These findings have been used to inform local harm-prevention responses, but more than that, this study is a practical example of how available data can be aggregated at a community level to illustrate local alcohol use and harm. This method can be replicated in any community that wants to understand better the effects of alcohol in its own local context.

In December 1990, the National Centre for Research into the Prevention of Drug Abuse was invited to evaluate the School Development in Health Education Project (SDHE), a national program tested in Western Australia (WA) in 1991. A formative evaluation indicated the project was moderately successful in achieving the objectives in the operational plan. Schools involved reported the project was successful, and they agreed to continue health planning meetings during 1992. The evaluation also indicated that while most schools achieved macro-level change, they achieved little at the micro level. A significant outcome for SDHE WA was the successful application for three-year funding to continue and expand the project as the West Australian School Health program (WASH). Recommendations generated from the SDHE evaluation produced a shift in emphasis for the WASH program from the "action research" orientation of the national program to more content-based professional development. This study highlights the important role formative evaluation can play in developing and refining health education programs.

This paper reports a trial which assessed the clinical effectiveness of adding a behavioural self-management programme to the existing management of chronic headache by general practitioners (GPs). Eighty-seven chronic headache sufferers, referred to the study by 35 GPs, were randomly allocated to either a self-care group or a GP-control group. Headaches, drug usage, visits to health-care providers and time off work were self-monitored daily by all subjects for 4 weeks prior to intervention, for 4 weeks during intervention, and for 4 weeks immediately after intervention. Additionally, self-monitoring was carried out for two further 4-week periods, one at 6 months and one at 12 months post intervention. Headache records showed that the self-care program significantly enhanced GP management. This effect was well maintained. However, drug usage, visits to health-care providers and time off work did not differ significantly between the treatment and control groups. ‘No-show’ rates, defined as those referred by a GP but who did not attend, were high—largely due to time requirements of the self-care program. However, drop-out rates, defined as those who left the self-care groups were low. It was concluded that this behavioural self-management program was a clinically effective adjunct to general practice management of headache but its use is likely to be limited due to problems of patient enrollment.

Insomnia is a common problem in medical practice. When the patient says 'Doctor I can't sleep at night' the cause should be identified from stress, psychological disturbance, physical symptoms, disease, drugs or environmental or idiopathic factors. A behavioural strategy focusing on relaxation and methods for stimulus control is presented.