To determine the effectiveness and cost-effectiveness of a program to provide screening for tuberculosis infection and directly observed preventive therapy (DOPT) in methadone maintenance clinics, we determined completion rates of screening for tuberculosis infection, medical evaluation, and preventive therapy, as well as the number of active tuberculosis cases and tuberculosis-related deaths prevented, in five clinics in San Francisco, California. Between 1990 and 1995, a total of 2,689 clients (of whom 18% were HIV-seropositive) were screened at least once. Of eligible clients, 99% received tuberculin skin tests, 96% received a medical examination, 91% began isoniazid preventive therapy, and 82% completed preventive therapy. Program effectiveness was enhanced by close collaboration between public health and methadone maintenance programs and the use of incentives and enablers. Over a 3-yr follow-up period, only one verified case of tuberculosis was reported among clients with a positive tuberculin skin test, thereby preventing as much as 95% of expected tuberculosis cases. Over 10 yr, we estimate the program would prevent 30.0 (52%) of 57.7 expected cases of tuberculosis, and 7.6 (57%) of 13.4 expected tuberculosis-related deaths. The program cost $771,569, but averted an estimated $876,229, for a net savings of $104,660 (average of $3, 724 per case prevented). Our study demonstrates that when effectively implemented, screening for tuberculosis infection and DOPT in methadone maintenance clinics is a highly cost-effective approach to prevent tuberculosis.

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To ensure the maintenance of a safe working environment, and provide data of interest to operations personnel, a fixed air sampling system (FASS) has been installed at the Hot Fuel Examination Facility/North at Argonne National Laboratory's Idaho site. A design requirement is that the system be operated with a minimum number of personhours. Sixty-six sampling stations are located throughout the facility to gather data from areas where personnel are normally present without respiratory protection. The effectiveness of in-cell contamination-control programs and materials-handling procedures can be evaluated. Long-term trends are valuable guides to improving radiological controls while airborne activities are still well below operational guidelines. Since the beginning of operation in August 1976, the concentrations have averaged between 1 x lo-'' and 5 x to 4 X pCi/cm3 for P-y emitters Such values are well below the radiation concentration guides. pCi/cm3 for (Y emitters and from 4 X