Chlorine and heavy metals removal from municipal solid waste incineration fly ash by electric field enhanced oxalic acid washing.

Electric field enhanced oxalic acid (H2C2O4) washing was conducted to examine the simultaneously removal efficiency of heavy metals (HMs) and chlorine, especially insoluble chlorine from municipal solid waste incineration fly ash (MSW FA). Results show that chlorine and HMs can be effectively removed with a total chlorine, As, Ni and Zn removal rate of 99.10%, 79.08%, 75.42% and 71.43%, when the electrode exchange frequencies is 40 Hz, current density is 50 mA/cm2, H2C2O4 adding amount is 0.5 mol/L and the reaction time is 4 h. Insoluble chlorine removal efficiency is up to 95.32%, much higher than reported studies. And the chlorine content in the residue is lower than 0.14%. Meanwhile, HMs removal efficiency is remarkable, 41.62%-67.51% higher than that of water washing. The high-efficient removal effect is caused by the constantly changing direction of electrons hitting the fly ash surface, which provides more escape channels for internal chlorine and HMs. These results proved that electric field enhanced oxalic acid washing could be a promising method for removing contaminants from MSWI fly ash.

Method development for determination of polyhalogenated carbazoles in industrial waste through gas chromatography/triple quadrupole tandem mass spectrometry.

RATIONALE: Polyhalogenated carbazoles (PHCZs) are dioxin-like compounds that are ubiquitous in the environment. However, their unintentional emissions from industrial sources have received little attention and there is no method available for determination of PHCZs in industrial waste. This research develops a method for determination of PHCZs in industrial waste. METHODS: In this research, a glass column packed with activated silica serves as a rapid and efficient clean-up pretreatment for purification. An isotope dilution gas chromatography/triple quadrupole tandem mass spectrometry method was established for simultaneous determination of eleven PHCZs in industrial samples. RESULTS: The regression coefficients of the standard curves for the congeners were all >0.99. The method detection limit ranged from 1.46 to 3.82 ng/mL for liquid samples and from 0.009 to 0.021 ng/g for solid samples. The precision described by the relative standard deviation ranged from 2.4% to 18.4% for liquid samples and from 5.5% to 35.8% for solid samples. The recovery ranges for the liquid and solid samples were 82%-123% and 83%-137%, respectively. 3-Chlorocarbazole (3-CCZ) and 36-dichlorocarbazole (36-CCZ) can be detected in both chemical bottom liquid from vinyl chloride production and fly ash from medical waste incineration by this method. CONCLUSIONS: An efficient method is established for determination of PHCZs from industrial waste. The discovery of 3-CCZ and 36-CCZ highlights the importance of identification of potential industrial sources of PHCZs and clarification of their contribution to environmental risks. Our method could be applied to investigate industrial emission of PHCZs.

Analysis of the heavy metals (As, Pb, Cu, Zn) by leaching and sequential extraction procedure from a municipal solid waste incinerator fly ash co-processing cement kiln plant.

The municipal solid waste incineration (MSWI) fly ash has been a major problem with the rapid development of the cities in China. And the cement rotary kiln co-processing technique is accepted as an effective method to dispose detrimental heavy metals in MSWI fly ash. This study focused on presented the total leaching content and the morphological distribution of the heavy metals in cement solid samples doped with MSWI fly ash. These samples were collected from a MSWI fly ash co-processing cement rotary kiln plant. The leaching test and the sequential extraction procedure were adopted to measure the migration characteristic of As, Pb, Cu, and Zn. In addition, the leachability of clinker samples under different simulated environmental conditions was also detected to analyze the security of the cement product doped with MSWI fly ash. This work demonstrates the feasibility of the cement rotary kiln MSWI fly ash co-processing technique and provides a scientific guidance to related plant.

[Influence of thyroid dysfunction on male sexual and reproductive functions and its mechanisms].

Thyroid dysfunction may affect the body growth metabolism and the synthesis and secretion of sex steroids. A large number of clinical and basic studies suggest that thyroid hormone abnormality can cause sexual and reproductive problems. Patients with hyperthyroidism or hypothyroidism may develop not only premature ejaculation but also erectile dysfunction. The thyroid hormone level also influences Leydig cells, Sertoli cells, and spermatogenesis. This review focuses on the association of thyroid dysfunction with male premature ejaculation, erectile dysfunction, and infertility and its mechanisms.

Characterization of a cetyltrimethyl ammonium bromide-modified sorbent for removal of perfluorooctane sulphonate from water.

This study was carried out to develop a cost-effective and practicable sorbent for application in abrupt perfluorooctane sulphonate (PFOS) pollution accidents. The main merit of this work was that a waste material, namely construction and demolition (C&D) waste, was employed as a raw base material for the sorbent synthesis. The waste material underwent alkaline fusion-hydrothermal synthesis and a cationic surfactant cetyltrimethyl ammonium bromide (CTAB) modification process to form a CTAB-modified sorbent (CMCDSS). Experimental results showed that PFOS concentrations and solution pH had significant effect on the PFOS sorption on construction and demolition waste synthesized sorbent (CDSS) and CMCDSS (using 0.2CMCDSS as representative). PFOS could be effectively and rapidly adsorbed on CMCDSS, and sorption equilibrium was achieved within 2.5 h. The sorption amounts of PFOS on CMCDSSs enhanced along with the increase in CTAB loading amounts. Moreover, the CMCDSS can be applied effectively under acidic condition at pH 2-6 and various removal mechanisms were clarified at different sorption conditions. Accordingly, this work developed a novel and applicable material for dealing with abrupt environmental PFOS contamination accidents.

A nationwide survey of nurses' attitudes toward music therapy and their need for education in its application.

BACKGROUND: Music therapy is increasingly used to help heal patients. However, there is a significant gap in the literature about nurses' attitudes toward and need for education in music therapy for nursing practice. This cross-sectional study was conducted to describe nurses' attitudes toward music therapy and determine their need for education in music therapy. METHODS: Participants included 1,197 nurses who were recruited from hospitals in different regions of Taiwan. RESULTS: Participants expressed positive attitudes toward music therapy. Most participants were willing to learn about music therapy. "Skill in using musical instruments" was the most frequently identified educational need. Further study of the discrepancy between the attitudes toward "performing music therapy" and "learning music therapy" is needed to clarify why nurses expected that they would receive no support for attending music therapy education. CONCLUSION: Given participants' attitudes toward music therapy and their motivation for learning, nursing administrators and educators may consider developing policies to further the advancement of music therapy in educational programs and practice.

Concentrations, congener patterns, and correlations of unintentional persistent organic pollutants in cement kilns co-processing hazardous waste.

Emissions from two typical cement kilns co-processing different kind of hazardous waste were analyzed for 143 congeners of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs), polychlorinated biphenyls, polychlorinated naphthalenes, polybrominated dibenzo-p-dioxins and dibenzofurans, and polybrominated diphenyl ethers. The congener distributions in different process stages were investigated. One of the plants co-processed waste chemical reagents from laboratories. The emission factor (TEQ basis) for the plant was 2.09 ng WHO2005 TEQ/t, with the kiln head and the kiln back end contributing 1.18, 0.91 ng WHO2005 TEQ/t, respectively. The other plant co-processed municipal waste incineration fly ash. The emission factor for the plant was 0.12 ng WHO2005 TEQ/t, with the kiln head and the kiln back end contributing 0.022, and 0.10 ng WHO2005 TEQ/t. These results indicate that co-processing of waste containing reagents from laboratories may lead to higher emission levels than co-processing of other types of waste. The congener patterns of persistent organic pollutants (POPs) in ash samples from the humidifier tower were similar to those in samples from the bag filter at the kiln back end. The correlation coefficients of five pollutants between the humidifier and bag filters samples were generally high, which indicated that conditions in those two stages similarly favored the formation of these POPs. Comparison of the concentrations for different process stages suggested that the main stage for formation of unintentional POPs was the humidifier tower. These results improve our understanding of emission characteristics and could be used for simultaneous control of multiple POPs.

Effects of music intervention with nursing presence and recorded music on psycho-physiological indices of cancer patient caregivers.

AIMS AND OBJECTIVES: To compare the effects of music intervention with nursing presence and recorded music on blood volume pulse amplitude, the low/high frequency ratio component of heart rate variability, depression, anxiety and sleep quality in cancer patient caregivers; to compare the participants evaluation of these two forms of musical intervention. BACKGROUND: Presence is one of the activities of caring. However, little is known about the effect of music intervention with nursing presence on psycho-physiological indices. DESIGN: Randomised crossover controlled trial. METHOD: Thirty-four female participants were randomly assigned to a music intervention with nursing presence/recorded music sequence or recorded music/music intervention with nursing presence sequence. Each intervention lasted 30 minutes and was held at the participant's home. The music intervention with nursing presence consisted of an erhu and recorder performance. In the recorded music session, participants listened to prerecorded music for 30 minutes. Continuous measurements of blood volume pulse and low/high frequency ratio were taken throughout the procedure. Depression, anxiety and sleep quality were measured before and after each intervention. RESULTS: Both music intervention with nursing presence and recorded music interventions had beneficial effects on anxiety, depression and blood volume pulse amplitude. Significant differences between the two interventions were also observed for anxiety. Music intervention with nursing presence was more effective in lessening anxiety and on improving the ease of getting to sleep compared with recorded music (p < 0·05). All participants reported that they preferred music intervention with nursing presence to recorded music. Significant differences were found in music evaluation scores between the two interventions in terms of harmony and friendliness (p < 0·05). CONCLUSIONS: Both music interventions were beneficial, as measured on psycho-physiological indices. The music intervention with nursing presence provided a more friendly music experience to the listeners. RELEVANCE TO CLINICAL PRACTICE: The findings provide evidence for nurses that the therapeutic use of music and nursing presence as a research-based nursing intervention for the welfare of caregivers.

Degradation of COD in antibiotic wastewater by a combination process of electrochemistry, hydroxyl-functionalized ball-milled zero-valent iron/Fe3O4 and Oxone.

In this study, the significant iron-based material, hydroxyl-functionalized ball-milled zero-valent iron/Fe3O4 (HFB-ZVI/Fe3O4) was employed for the experiments. The performance of the Electro + HFB-ZVI/Fe3O4 + Oxone system for the degradation of chemical oxygen demand (COD) in antibiotic wastewater was investigated. A direct current was applied between a graphite plate anode and two iron plate cathodes, and a series of operational parameters, such as applied electric current, the dosage of HFB-ZVI/Fe3O4 composite, the dosage of Oxone, and initial solution pH, were explored to evaluate the oxidation process. The application of electric current enhanced the gradual degradation of COD and the increase of current intensity accelerated COD degradation. The neutral condition was favourable for the rapid degradation of COD in a short reaction time by the Electro + HFB-ZVI/Fe3O4 + Oxone process and promoted the degradation efficiency of COD. An increase of electric current gradually decreased the reaction solution pH, the larger the electric current applied in the reaction process, the lower the final pH of the reaction solution. Under the optimal experimental conditions (1 g/L HFB-ZVI/Fe3O4 composite, 0.3 g/L Oxone, current intensity = 500 mA, initial solution pH = 7.85), Electro + HFB-ZVI/Fe3O4 + Oxone achieved 99% COD degradation in antibiotic wastewater. Radicals quenching experiments indicated the contribution to COD degradation by hydroxyl radicals (HO•), sulphate radicals (SO4•-) and other oxidants were 66.03%, 24.014% and 9.756%, respectively. The possible mechanism of COD degradation in the Electro + HFB-ZVI/Fe3O4 + Oxone system was also discussed in this study. The findings in this work provided useful information for the treatment of wastewater.

The effect of music on biochemical markers and self-perceived stress among first-line nurses: a randomized controlled crossover trial.

AIM: The aim of this study was to examine the effects of music on stress indices and to examine the association between music preference and stress. BACKGROUND: Although clinical studies have demonstrated the effectiveness of music on stress, study results have been inconsistent. At the time of writing, no known publications had investigated the effects of preferred music on workers in high-stress professions such as nursing. METHODS: Using a randomized crossover controlled trial, 54 nurses were randomly assigned to a music/chair rest sequence or chair rest/music sequence during the period February to June 2006. Each intervention lasted for 30 minutes. Participants in the music condition listened to self-selected soothing music using headphones for 30 minutes. In the chair rest condition, participants sat quietly for 30 minutes. Serial measurements of participants' heart rate, mean arterial pressure, finger temperature and cortisol levels were taken with a BP monitor and chemillumincent immunoassay every 15 minutes throughout the procedure. FINDINGS: Compared with chair rest, participants had a lower perceived stress level, cortisol, heart rate, mean arterial pressure and higher finger temperature while listening to music (P < 0·05). Significant differences were also found between the two conditions in terms of post-test heart rate, cortisol levels, finger temperature and mean arterial pressure (P < 0·05). Music preference scores ranged between 7 and 10, with a mean score of 8·81 (sd = 1·05), and was significantly associated with mean arterial pressure, cortisol levels, self-perceived stress and finger temperature. CONCLUSION: The findings provided evidence for nurses to use soothing music as a research-based nursing intervention for stress reduction.

Sleep disorder in Taiwanese nurses: a random sample survey.

This study determined the prevalence of and factors associated with insomnia in rotating-shift nurses. A two-stage, cross-sectional, hospital-based study was conducted in eastern Taiwan. Participants were randomly-sampled, rotating-shift nurses (n=661), ranging in age from 21 to 62 years, with a mean age of 31.86 (standard deviation=8.09). Insomnia disorder was identified using the Pittsburgh Sleep Quality Index. Nurses completed the self-reported Index, together with other questionnaires designed by the researchers for the purpose of the study. The prevalence of insomnia disorder was 59% (n=390). Multivariate logistic regression analyses revealed that poor sleepers are more likely to have higher anxiety, feelings of depression, and a poor working atmosphere. Anxiety, depression, and working atmosphere are independent predictors of insomnia. These results suggest that it is crucial to implement a more appropriate shift system and to develop prevention programs for nurses with insomnia to improve their occupational health.

TDP-43 aggregation induced by oxidative stress causes global mitochondrial imbalance in ALS.

Amyotrophic lateral sclerosis (ALS) was initially thought to be associated with oxidative stress when it was first linked to mutant superoxide dismutase 1 (SOD1). The subsequent discovery of ALS-linked genes functioning in RNA processing and proteostasis raised the question of how different biological pathways converge to cause the disease. Both familial and sporadic ALS are characterized by the aggregation of the essential DNA- and RNA-binding protein TDP-43, suggesting a central role in ALS etiology. Here we report that TDP-43 aggregation in neuronal cells of mouse and human origin causes sensitivity to oxidative stress. Aggregated TDP-43 sequesters specific microRNAs (miRNAs) and proteins, leading to increased levels of some proteins while functionally depleting others. Many of those functionally perturbed gene products are nuclear-genome-encoded mitochondrial proteins, and their dysregulation causes a global mitochondrial imbalance that augments oxidative stress. We propose that this stress-aggregation cycle may underlie ALS onset and progression.

Removal of heavy metals in medical waste incineration fly ash by Na2EDTA combined with zero-valent iron and recycle of Na2EDTA: Acolumnar experiment study.

In this study, an effective circulating system was developed to remove heavy metals in medical waste incineration (MWI) fly ash. MWI fly ash (MWIFA)-column experiments were performed to remove Cu, Pb, Zn, Cd, and Ni from MWIFA using EDTA disodium (Na2EDTA). Iron-column experiments were conducted to study the removal effect of zero-valent iron on the five heavy metals from washing wastewater. Toxicity Characteristic Leaching Procedure (TCLP) test method was employed to evaluate heavy metals toxicity of MWIFA residues generated after 0-0.2 mol/L Na2EDTA solution treated. After being washed by 0.2 mol/L Na2EDTA solution, TCLP leaching values of Cu, Pb, Zn, Cd, and Ni were the lowest and satisfied the standard (GB 5085.3-2007), and the leaching values were 58.4 ± 2.0 mg/L, 2.81 ± 0.14 mg/L, 64.3 ± 4.0 mg/L, 0.156 ± 0.005 mg/L, 0.381 ± 0.006 mg/L. Concentrations of Cu, Pb, Zn, Cd, and Ni in iron-column effluent were reduced by 99.7%, 91.6%, 91.6%, 75.4%, and 75.7%, respectively. Na2EDTA was recovered and recycled to the removal of heavy metals from MWIFA. Comparing new Na2EDTA solution with recycled Na2EDTA solution, recycled Na2EDTA and water could be reutilized to dispose MWIFA. The removal efficiencies of Cu, Pb, Zn, Cd, and Ni by recycled 0.2 mol/L Na2EDTA solution were 67.1%, 68.8%, 63.2%, 73.9%, 50.7%, respectively, the removal efficiencies using recovered Na2EDTA decreased by 2.6%, 3.9%, 3.3%, 4.2%, and 1.6%, respectively. Successive batch experiments were also conducted to evaluate industrialization potential and reusable times for recycled Na2EDTA. After four recirculation cycles, extraction efficiencies of Pb and Cd (removal efficiency at different cycles divided by removal efficiency of new Na2EDTA) declined toward 80%. Results from this research indicated that this circulating system possessed industrialization potential. Implications: An effective circulating system was developed to remove heavy metals in MWI fly ash (MWIFA). Integration of Na2EDTA with Fe0 promoted the removal of heavy metals from MWIFA. Na2EDTA, NaCl and water were stepwise extracted from iron-column effluent, respectively. Recovered Na2EDTA can still effectively remove heavy metals from MWIFA. Results from this research indicated that this circulating system possessed industrialization potential.

Deliberate self-harm and relationship to alcohol use at an emergency department in eastern Taiwan.

Suicide incidence has increased dramatically in recent years in Taiwan. In 2004, 3,468 lives were lost due to suicide and the total mortality was 15.3/100,000. It is well known that alcohol drinking raises the risk of deliberate self-harm (DSH), especially among psychologically distressed subjects. This study investigated the characteristics of DSH patients and their association with acute alcohol drinking. Since 2004, an injury surveillance system has been set up in a medical center, collecting the minimal information recommended by the World Health Organization. Attending nurses collected information and assessed each injured patient as to whether he/she smelled of alcohol. Medical records of DSH injuries were reviewed for confirmation of any prior DSH and any known mental disorder was checked. Of 11,837 injuries, 123 (1.0%) were DSH. Those who were first-time DSH patients (n = 115) were studied. About half of the patients were female and 83.5% were aged between 20 and 54 years. More than half of the DSH incidents occurred at home and 80.1% cases were stabbing or cutting injuries. Injuries were defined as alcohol-related based on the report of "alcohol odor'' or "intoxicated'' by the nurse or a positive blood alcohol test. In total, 55 (47.8%) DSH injuries were found to be alcohol-related. The proportion of alcohol-related injuries was highest (60.0%) in the age range 45-64 years. Of those patients who tested positive for alcohol (n = 21), the mean blood alcohol concentration was 211.2 mg/dL (standard deviation, 79.1). Most subjects were discharged from the emergency department (75.7%). Only 20 DSH patients (17.1%) went on to receive a psychiatric consultation. DSH is not uncommon in eastern Taiwan. Half of our cases were associated with alcohol use. Males had the same risk of injuring themselves and were more likely than females to adopt "severe" methods to injure themselves. Further studies into the causes of DSH or parasuicide attempts are needed. Psychiatric consultation is essential in caring for DSH patients and in preventing suicide. ADSH injury also offers an opportunity to recognize alcohol problems.

Alcohol-related Injuries at an emergency department in Eastern Taiwan.

BACKGROUND/PURPOSE: Injuries are major causes of mortality and morbidity in Taiwan. Alcohol involvement often plays a role in injuries. The purpose of this study was to determine the prevalence of alcohol-related injuries at an emergency department in Eastern Taiwan and their associated factors. METHODS: All injured patients who made emergency visits between October 2002 and September 2003 were enrolled. For each patient, the attending nurse completed an injury-coding sheet, which included the results of an assessment of whether the patient had an alcohol odor or alcohol consumption related behavior. Nurses recorded suspicion of alcohol consumption based on possible categories of "no alcohol odor", "alcohol odor", "intoxicated", "suspected" or "unknown". Blood alcohol testing was also performed based on the decision of the attending physician. Injuries were defined as alcohol-related based on the report of "alcohol odor" or "intoxicated" by the nurse or a positive blood alcohol test. Logistic regression was used to assess the significance of the association of possible related factors with alcohol-related injury. RESULTS: A total of 8822 eligible visits were studied and 14% were classified as alcohol-related. The proportion of alcohol-related injuries was 14.9% for vehicle-related injuries, and 51.3% for assaults. Male, young to middle aged, aboriginal ethnicity and visits after midnight were factors associated with increased likelihood of alcohol-related injuries. Multiple logistic regression analysis revealed that the three factors most significantly associated with alcohol-related injuries were visits after midnight (odds ratio, OR, 7.5; 95% confidence interval, CI, 6.4-8.9], assaults (OR, 3.4; 95% CI, 2.3-4.8), and head injuries (OR, 2.7; 95% CI, 2.3-3.2). CONCLUSION: Injuries were alcohol related in one out of seven patients this study from an emergency department in eastern Taiwan. Ongoing epidemiologic monitoring of the prevalence and nature of alcohol abuse among patients visiting the ED are urgently needed.

Using hyperaccumulator plants to phytoextract soil Ni and Cd.

Two strategies of phytoextraction have been shown to have promise for practical soil remediation: domestication of natural hyperaccumulators and bioengineering plants with the genes that allow natural hyperaccumulators to achieve useful phytoextraction. Because different elements have different value, some can be phytomined for profit and others can be phytoremediated at lower cost than soil removal and replacement. Ni phytoextraction from contaminated or mineralized soils offers economic return greater than producing most crops, especially when considering the low fertility or phytotoxicity of Ni rich soils. Only soils that require remediation based on risk assessment will comprise the market for phytoremediation. Improved risk assessment has indicated that most Zn + Cd contaminated soils will not require Cd phytoextraction because the Zn limits practical risk from soil Cd. But rice and tobacco, and foods grown on soils with Cd contamination without corresponding 100-fold greater Zn contamination, allow Cd to readily enter food plants and diets. Clear evidence of human renal tubular dysfunction from soil Cd has only been obtained for subsistence rice farm families in Asia. Because of historic metal mining and smelting, Zn + Cd contaminated rice soils have been found in Japan, China, Korea, Vietnam and Thailand. Phytoextraction using southern France populations of Thlaspi caerulescens appears to be the only practical method to alleviate Cd risk without soil removal and replacement. The southern France plants accumulate 10-20-fold higher Cd in shoots than most T. caerulescens populations such as those from Belgium and the UK. Addition of fertilizers to maximize yield does not reduce Cd concentration in shoots; and soil management promotes annual Cd removal. The value of Cd in the plants is low, so the remediation service must pay the costs of Cd phytoextraction plus profits to the parties who conduct phytoextraction. Some other plants have been studied for Cd phytoextraction, but annual removals are much lower than the best T. caerulescens. Improved cultivars with higher yields and retaining this remarkable Cd phytoextraction potential are being bred using normal plant breeding techniques.

Maternal demographic and psyhosocial factors associated with low birth weight in eastern Taiwan.

The relationship between birth weight and maternal sociodemographic characteristics was examined in a sample from two teaching hospitals in eastern Taiwan. Using a structured questionnaire, we conducted face-to-face interviews with women at antenatal clinics between 1998 and 1999 in Hualien City. One year later, we took the outcome of pregnancy from medical records and birth certificates from the Public Health Bureau of Hualien County. Of the 1,128 single live births, 6.8% had low birth weight (LBW) using the World Health Organization cut-off of 2,500 g. LBW was more common in teenage (< 20 years), older (> 30 years), first-time, and unmarried mothers; those with basic/intermediate educational attainment; and residents of aboriginal districts. Teenage pregnancies were more likely than those in adults to be unplanned, and such mothers had smoking or alcohol-drinking behavior. Prevention of teenage pregnancy is crucial to lower LBW rates in eastern Taiwan. For adult mothers, basic or intermediate educational attainment, residence in an aboriginal district, and first-term pregnancy were significant factors associated with LBW, after adjustment for other psychosocial attributes, such as psychologic distress and poor family support. Thus, we should pay more attention when caring for pregnant women with such sociodemographic characteristics, and ensure that they have adequate prenatal care and can adopt a healthy lifestyle.

Effects of music videos on sleep quality in middle-aged and older adults with chronic insomnia: a randomized controlled trial.

Listening to soothing music has been used as a complementary therapy to improve sleep quality. However, there is no empirical evidence for the effects of music videos (MVs) on sleep quality in adults with insomnia as assessed by polysomnography (PSG). In this randomized crossover controlled trial, we compared the effects of a peaceful Buddhist MV intervention to a usual-care control condition before bedtime on subjective and objective sleep quality in middle-aged and older adults with chronic insomnia. The study was conducted in a hospital's sleep laboratory. We randomly assigned 38 subjects, aged 50-75 years, to an MV/usual-care sequence or a usual-care/MV sequence. After pretest data collection, testing was held on two consecutive nights, with subjects participating in one condition each night according to their assigned sequence. Each intervention lasted 30 min. Sleep was assessed using PSG and self-report questionnaires. After controlling for baseline data, sleep-onset latency was significantly shorter by approximately 2 min in the MV condition than in the usual-care condition (p = .002). The MV intervention had no significant effects relative to the usual care on any other sleep parameters assessed by PSG or self-reported sleep quality. These results suggest that an MV intervention may be effective in promoting sleep. However, the effectiveness of a Buddhist MV on sleep needs further study to develop a culturally specific insomnia intervention. Our findings also suggest that an MV intervention can serve as another option for health care providers to improve sleep onset in people with insomnia.

Feasibility of identification of alcohol intoxication by nurses in emergency departments.

Vehicle-related injuries are the major cause of death and injuries in Hualien County, and driving under the influence of alcohol plays a major role in such crashes. From December 1997 to May 1998, we determined the blood alcohol concentrations (BAC) of injured individuals from vehicle crashes at two emergency departments in Hualien. Nurses were asked to record whether the patient presented with an alcohol odor. The accuracy of detection by nurses was assessed from the BAC and groups with increased prevalence were identified for screening. Of 945 patients assessed, 505 (53.4%) tested positive by BAC and 320 (33.9%) were identified with an alcohol odor. With a BAC threshold of more than 50 mg/dL, detection sensitivity was 75.4%, specificity was 90.4%, and accuracy was 85.0% (95% confidence interval: 82.7, 87.3). Patients with an alcohol odor were significantly more likely to be men, aborigines, or head-injured patients. The accuracy of detection showed no significant difference by gender, head injury, or driver status. We suggest that detection of alcohol odor by nurses may be a feasible assessment of the role of alcohol in road traffic accidents. This may provide essential data for injury prevention strategies and programs.

The risk factors for ultrasound-diagnosed non-alcoholic fatty liver disease among adolescents.

INTRODUCTION: Non-alcoholic fatty liver disease (NAFLD) is garnering increasing interest and acceptance as one of the most important causes of chronic liver disease. The aim of this study was to investigate the risk factors for NAFLD among selected adolescent students in Hualien City, Taiwan. MATERIALS AND METHODS: A stratified random sampling scheme was carried out among 1724 adolescent students aged 12 or 13 years old in Hualien City. In total, 220 students (normal: overweight: obese = 97:48:75) agreed to join the study. They underwent physical examination, laboratory tests and ultrasonography examination of the liver. Diagnosis of NAFLD in this study was based on sonographic evidence of a fatty liver and testing negative for serum HBsAg and anti- HCV antibody. RESULTS: Of the 220 participants, 4 were excluded because they tested positive for HBsAg or anti-HCV antibody. NAFLD was detected in 86 (39.8%) out of the 216 subjects. The rate of NAFLD in the adolescents increased progressively from 16.0% in the normal group to 50.5% in the overweight group, and 63.5% among the obese subjects. Compared to their normal counterparts, adolescents with NAFLD had a significantly higher weight, body mass index (BMI), waist circumference, levels of alanine aminotransferase (ALT), triglyceride and nonhigh- density-lipoprotein (non-HDL) cholesterol. However, among the participants with NAFLD, only 20 (23.3%) showed ALT abnormality but there was an increasing trend of ALT abnormality as the severity of fatty liver increased. In addition, the higher ALT, Homeostasis model assessment- insulin resistance (HOMA-IR), cholesterol, triglyceride, and non-HDL levels and lower HDL-C as the severity of fatty liver increased. In a stepwise logistic regression analysis, the most significant factor associated with the presence of NAFLD was weight category. When compared with their normal counterparts, overweight and obese adolescents had a 4.14 and 5.98 times the risk of having NAFLD, respectively. Elevated ALT was the second most important factor as adolescents with elevated ALT were more likely to have NAFLD (odds ratio = 3.32, 95% CI: 1.16 to 9.50). Non-HDL cholesterol level was the third most important factor associated with NAFLD with a 3.81-fold increase in risk incurred for every l n (1 mg/dL) increment. CONCLUSIONS: Obesity, ALT abnormality and elevated non-HDL-cholesterol are risk factors for NAFLD in adolescents. However, only 23.3% of the adolescents with NAFLD showed an abnormality for ALT. Therefore, ALT alone is not a sufficient indicator; and it is recommended that ultrasonography of the liver should be part of the routine health examination of obese adolescents.