The first step in ensuring patient-centred quality of care: ask the patient.

Health providers may not be aware of their patients' needs or preferences, and patients reluctant to raise their concerns. Consequently, the first step in ensuring quality of care is to ask the patient about the care that they would like. A cross-sectional sample of 244 medical oncology outpatients were surveyed about provider-asking behaviours across six dimensions of patient-centred care defined by the Institute of Medicine. Specifically, were patients asked by clinic staff at the treatment centre about their physical and emotional symptoms, information needs to enable decision-making, preferences for involvement in decision-making, involvement of family and friends, and appointment scheduling. Patients were significantly (Cochran's χ2 (9) = 122.541, P < 0.001) less likely to be asked about emotional symptoms (35% infrequently asked), preferences for the involvement of family and friends (25% infrequently asked), and preferences for involvement in medical decision-making (23% infrequently asked). Only a minority of patients were infrequently asked about their treatment-related information needs (8%), physical symptoms (13% pain, 14% fatigue) and preferences for appointment scheduling (13%). Younger age, not Australian born and greater educational qualifications were associated with being infrequently asked. Improvements to care delivery can be made if clinic staff were to more regularly elicit patient's emotional symptoms, and their preferences for the involvement of family/friends and participation in medical decision-making.

Chemical stabilization of metals in mine wastes by transformed red mud and other iron compounds: laboratory tests.

A series of static and kinetic laboratory-scale tests were designed in order to evaluate the efficacy of transformed red mud (TRM) from bauxite refining residues, commercial zero-valent iron, and synthetic iron (III) hydroxides as sorbents/reagents to minimize the generation of acid drainage and the release of toxic elements from multi-contaminant-laden mine wastes. In particular, in some column experiments the percolation of meteoric water through a waste pile, alternated with periods of dryness, was simulated. Wastes were placed in columns together with sorbents/reagents in three different set-ups: as blended amendment (mixing method), as a bed at the bottom of the column (filtration method), or as a combination of the two previous methods. The filtration methods, which simulate the creation of a permeable reactive barrier downstream of a waste pile, are the most effective, while the use of sorbents/reagents as amendments leads to unsatisfactory results, because of the selective removal of only some contaminants. The efficacy of the filtration method is not significantly affected by the periods of dryness, except for a temporary rise of metal contents in the leachates due to dissolution of soluble salts formed upon evaporation in the dry periods. These results offer original information on advantages/limits in the use of TRM for the treatment of multi-contaminant-laden mine wastes, and represent the starting point for experimentation at larger scale.

Treatment of percolate from metal sulfide mine tailings with a permeable reactive barrier of transformed red mud.

Metal sulfide tailings of the Sardinian (Italy) abandoned Baccu Locci arsenic mine show high concentrations of aluminum, arsenic, cadmium, copper, manganese, lead, and zinc in acid percolate (pH = 4) and have been classified as "dangerous waste." This paper shows that the release of toxic metals can be strongly reduced when the tailings are placed on a reactive permeable bed (7 wt %) of porous, alkaline pellets of transformed red mud (TRM). During a laboratory percolation test, two columns with 80 kg of waste, of which one contained a bottom layer of TRM pellets, were each alimented with 600 L of de-ionized water. Comparing pH, electroconductivity, metal, and sulfate concentrations of collected percolate from both columns demonstrates efficient neutralization (pH = 7.4) and removal of metals (80 to 99%) for the column with the permeable reactive bottom layer.

Recombinant human granulocyte colony-stimulating factor administration in a case of neutropenia due to increased neutrophil sequestration.

A 55-year-old female was admitted with fever which followed an episode of pseudomembranous colitis. Despite an accurate clinical investigation, there was no evidence for specific sites of infection. Remission of fever was not obtained with antibiotic therapy (gentamycin plus carbepenem) and progressive neutropenia was observed. Neutrophils fell to 0.3 x 10(9)/1. The diagnostic approach, including a bone marrow aspirate, excluded mechanisms leading to impaired neutrophil production, and in the suspect of increased neutrophil sequestration/destruction, whole-body scintigraphy with (99m)technetium-hexamethylpropyleneamineoxime ((99m)Tc-HMPAO)-labeled autologous leukocytes was performed. As a result, a site of leukocyte sequestration localized at the medium lobe of the right lung was detected. In an attempt to enhance neutrophil functions and achieve remission of infection, recombinant human granulocyte colony-stimulating factor (Filgrastim, Granulokine 30, Roche) at the dosage of 300 microg/day, subcutaneously, was added. As a results, fever disappeared in three days, but neutrophil recovery was slower, and normalization of the absolute neutrophil count (ANC) was obtained on day +7. The results obtained in this peculiar case of neutropenia, and the kinetics of both fever and ANC, suggest the possible combination of neutrophil function enhancement and an anti-inflammatory effect of rhG-CSF.

Glycosylated and nonglycosylated recombinant human granulocyte colony-stimulating factor differently modifies actin polymerization in neutrophils.

AIM: Several neutrophil functions can be modified by rhG-CSF administration. Neutrophil morphology changes in the course of treatment with Filgrastim (nonglycosylated rhG-CSF), along with impairment of chemotaxis. Both morphology and chemotaxis are not affected by treatment with Lenograstim (glycosylated rhG-CSF). Thus, we evaluated actin polymerization in neutrophils induced by treatment with the two forms of rhG-CSF. In fact, actin polymerization is crucial for neutrophil motility. MATERIALS AND METHODS: We evaluated twelve healthy subjects undergoing peripheral blood stem cells (PBSC) mobilization for allogeneic transplantation to HLA-identical siblings. Neutrophils were isolated by peripheral venous blood before and after administration of either Filgrastim (six PBSC donors) or Lenograstim (six PBSC donors). Actin polymerization was investigated by a flow cytometric assay, using FITC-phalloidin as a specific probe for F-actin, and two parameters were measured: spontaneous actin polymerization in resting neutrophils; fMLP-stimulated actin polymerization. Results were expressed as relative F-actin content. Fifteen blood donors were studied as a control group. RESULTS: Filgrastim administration induced an increased relative F-actin content in resting neutrophils; however, no further actin polymerization was observed after fMLP stimulation. Neutrophils from subjects treated with Lenograstim showed a normal behaviour in terms of both spontaneous and stimulated actin polymerization. CONCLUSIONS: Glycosylated and nonglycosylated rhG-CSF differently affect actin polymerization in newly generated neutrophils. Such effects may explain some previous findings concerning both morphology and chemotactic properties and may be due to different effects of the two forms of rhG-CSF on proteins involved in neutrophil motility regulation.

Chromatin pattern by variogram analysis.

Many cytological processes such as cell proliferation, differentiation, transformation, apoptosis, etc., are accompanied by specific chromatin changes, usually identified on the basis of the relative content of euchromatin and heterochromatin. In order to achieve a quantitative, non-subjective evaluation of the chromatin pattern, two different approaches may be undertaken, one consisting in the analysis of the several morphological features of chromatin grains (size, shape, density, arrangement, and distribution), and the second consisting in the analysis of the chromatin globally considered as a coherent texture. Although the second approach appears to be simpler and more suitable, methods of texture analysis--including those specifically designed for the analysis of the chromatin pattern--are rarely applied due mainly to the unsuitability of sampling procedures and the excessive crypticism of results. As an alternative to traditional texture analysis, we suggest a method supported by a sound mathematical theory and approximately 30 years of applications in the field of geostatistics. The method, called variogram, analyzes the intrinsic structure of data sampled at different distance intervals and directions, and outputs easily understandable results. Recently, variogram analysis has successfully been exported from geostatistics to other fields (for example, ecology and epidemiology) that make use of spatially referenced variables. Based on the fact that pixels represent a perfect array of data ordered at regular distance intervals and directions, the variogram can be adopted to explore nuclear images and recognize chromatin patterns. Variograms of different nuclei can be summarized by multivariate methods without the need of previous standardization of data. This allows comparison and discrimination of chromatin patterns from mixed cell populations. Preliminary data obtained from young neurons undergoing massive apoptosis reveal a self-consistent map of nuclear changes correlated to the degenerative process.

Immunoperoxidase localization of HSV2 antigens in cervical dysplasia and carcinoma.

The AA. have evaluated by means of the immunohistochemical technique the incidence of herpetic phlogosis in 76 women with neoplastic pathologies of the uterine cervix. The patients were submitted to cytologic, colposcopic and histologic examination for CIN. The HSV2 positivity by immunohistochemical method was demonstrated in 53 (35.3%) cases of CIN and invasive carcinoma. The results confirm the frequent association between HSV2 and cervical carcinoma and they support a specific therapeutic approach to be made in the prevention and clinical management of the carcinoma.

[Automatic determination of triglyceride, cholesterol, glucose and serum uric acid in the screening for preventive medicine (author's transl)]. / Determinazione automatica di trigliceridi, colesterolo, glucosio, acido urico: prospettive d'impiego in screening di medicina preventiva.

A centrifuge speed analyzer, used for triglyceride, cholesterol, glucose and serum uric acid determinations, was tested as to linearity, precision, steadiness and accuracy requirements. The results were compared to those obtained by other techniques. Automatic techniques were proved to comply with reliability and practicability requirements, necessary during the screenings for preventive medicine. The centrifuge speed analyzer seems to be particularly fit for the primary prevention trials of coronary heart disease, since the follow-up studies require repeated laboratory examinations.

Soil decontamination at the Montevecchio-Levante mine site with experimental washing and leaching techniques.

The soils in the neighbourhood of the Rio Montevecchio-Sitzerri, a stream that flows in the valley below the tailings pond of the Montevecchio-Levante mineral processing plant (SW Sardinia, Italy) are severely contaminated by heavy metals, to the extent that traditional land uses are compromised. Consequently urgent measures are needed both to abate the pollution at source and rehabilitate the contaminated land. This paper is concerned with the problem of soil decontamination using washing and leaching techniques. Laboratory experiments have been conducted in mechanically agitated reactors, using citric acid and acetic acid solutions and brine of hydrochloric acid and calcium chloride. The influence of both reagent concentration and solid-to-liquid ratio has been assessed, and in the most significant cases, the attack kinetics has been determined. The tests showed the brine to be the most effective for removing metals from the soils. Based on the findings of the investigations, the possibility of decontamination by heap leaching has been simulated in the laboratory using the column technique.

Subcellular heterogeneity of mitochondrial membrane potential: relationship with organelle distribution and intercellular contacts in normal, hypoxic and apoptotic cells.

The subcellular heterogeneity of mitochondrial membrane potential (mDelta psi) was investigated in confluent and sub-confluent cultures of four cell types (human astrocytes, HEp-2, MDCK and Vero cells) in normal growth conditions, hypoxia and apoptosis. The distribution of high-polarized mitochondria, detected by the potential-sensitive probe JC-1, was found to depend on: (1) the proximity to the cell edge; (2) the local absence of cell-cell contacts; and (3) the local absence of acidic vesicles. Both hypoxia and apoptosis produced a general mDelta psi increase with different redistributions of high-polarized mitochondria. Hypoxic cells maintained high-polarized mitochondria for over 24 hours, until cells underwent necrosis. On the other hand, apoptotic cells showed an unexpected convergence of high-polarized mitochondria into an extremely packed mass at one side of the nucleus, in a stage preceding nuclear condensation, but correlated to the retraction of cell-cell contacts.