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PubMed2026

Shifts of antibiotic resistance genes across an estuarine meandering bend and dissemination risks to offshore oceans.

Meandering is a fundamental geomorphic feature of rivers that plays a critical role in regulating pollutant attenuation. To elucidate its impact on antibiotic resistance genes (ARGs) distribution in estuarine intertidal sediments, samples were collected from both the landward side (freshwater-dominated) and the seaward side (tide-dominated) of a meander bend during ebb and flood tides. The total relative abundance of ARGs was approximately 2.7 times higher on the landward side, peaking during the ebb tide. Microbial composition analysis showed that genera Acinetobacter and Pseudomonas were dominant at the landward sites, while halophilic genera such as Marinobacter and Exiguobacterium were abundant at the seaward sites. Further analysis of metagenome-assembled genomes (MAGs) demonstrated that the dominant landward genus Acinetobacter acted as a key host of ARGs, with two of four MAGs encoding more than ten ARGs. Notably, the total relative abundance of mobile genetic elements was high but consistent between sides and tidal cycles (p > 0.05). Given this high dissemination risk, we further forecasted the ARGs transfer scenarios to oceanic settings based on a set of offshore MAGs (n = 3626). Three ARGs, i.e., acrA, vanSL, and AAC(2')-Ia, were inferred to have transfer potential, supported by neighboring MGEs detected in marine microorganisms. Analysis of the genomes of predicted recipients in the SRA database confirmed the predicted mobilizations. Together, this study highlights that the meandering planform may serve as a significant barrier, attenuating the discharge of ARGs from terrestrial sources into the marine environment.

Estuaries↗

PubMed2004

Spatial access to health care in Costa Rica and its equity: a GIS-based study.

This study assembles a geographic information system (GIS) to relate the 2000 census population (demand) with an inventory of health facilities (supply). It assesses the equity in access to health care by Costa Ricans and the impact on it by the ongoing reform of the health sector. It uses traditional measurements of access based on the distance to the closest facility and proposes a more comprehensive index of accessibility that results from the aggregation of all facilities weighted by their size, proximity, and characteristics of both the population and the facility. The weighting factors of this index were determined with an econometric analysis of clinic choice in a national household sample. Half Costa Ricans reside less than 1 km away from an outpatient care outlet and 5 km away from a hospital. In equity terms, 12-14% of population are underserved according to three indicators: having an outpatient outlet within 4 km, a hospital within 25 km, and less than 0.2 MD yearly hours per person. The data show substantial improvements in access (and equity) to outpatient care between 1994 and 2000. These improvements are linked to the health sector reform implemented since 1995. The share of the population whose access to outpatient health care (density indicator) was inequitable declined from 30% to 22% in pioneering areas where reform began in 1995-96. By contrast, in areas where reform has not occurred by 2001, the proportion underserved has slightly increased from 7% to 9%. Similar results come from a simpler index based on the distance to the nearest facility. Access to hospital care has held steady in this period. The reform achieved this result by targeting the least privileged population first, and by including such measures as new community medical offices and Basic Teams for Integrated Health Care (EBAIS) to work with these populations. The GIS platform developed for this study allows pinpointing communities with inadequate access to health care, where interventions to improve access would have the greatest impact.

Costa Rica↗

PubMed2003

Disability advocacy organizations: a descriptive framework.

PURPOSE: The purpose of this paper is to offer a descriptive framework to analyse the participation of people with disabilities in policy advocacy over the past 20 years. METHODS: The study used a qualitative research design to describe and analyse organizations participating in policy advocacy on behalf of people with disabilities in Canada between 1981 and the present. Data for the study were assembled through interviews with key informants who had participated in three policy cases: the Charter of Rights and Freedoms, 1982 (federal); the Canada Clause of the Charlottetown Accord, 1991 (federal); the Ontario Consent to Treatment, Advocacy and Substitute Decision-making bills, 1993-1995 (provincial). For each of the three cases, key informants were identified who could report with authority on the participation of individuals or groups representing people with disabilities. Interviews with key informants were conducted by the investigators, transcribed and coded to produce five dimensions along which advocates described their organizations. RESULTS: Three ideological dimensions were identified to describe organizations representing people with disabilities: purpose, tactics, and view of disability. Two practical dimensions were also identified: membership and resources. Each of these dimensions is described in detail with quotes from the interviews to illustrate. DISCUSSION AND CONCLUSIONS: These five dimensions result in a descriptive framework for discussion and comparison of organizational characteristics of advocacy organizations representing people with disabilities. Further, the framework affords a vehicle for discussion of the relative success of policy participation on issues affecting the lives of people with disabilities.

Canada↗

PubMed1999

Principles underlying a model policy on relationships between staff and service recipients in a mental health system.

OBJECTIVE: The authors participated in a work group to produce a model policy addressing the boundaries of relationships between staff and recipients of service in a public mental health system that provides and regulates services in a variety of treatment settings. METHODS: The chief medical officer of the New York State Office of Mental Health assembled a work group of administrators, clinicians, state officials, and a representative of service recipients. The group reviewed the professional literature and existing ethics guidelines and policies addressing relationships between staff members and service recipients and made recommendations for a new policy. RESULTS AND CONCLUSIONS: The work group formulated five guiding principles: prevention of the exploitation of recipients of services by staff; the right of recipients to be treated as competent autonomous human beings; recognition that certain developmental stages, treatment settings, and pre-existing relationships increase a service recipient's vulnerability to exploitation and call for more stringent regulation of staff actions; acceptance of a spectrum of permissible relationships for staff and recipients outside of the relationship dictated by the staff member's job description; and recognition of the difference between a relationship focused on treatment or service provision and other professional relationships between providers and current or former recipients. The principles were used to develop a model policy on relationships between staff and recipients that addresses both the organizational complexity and the recipient-centered rehabilitation model of a large state-operated mental health system.

Community Mental Health Centers↗

PubMed2004

Technological advances in powered wheelchairs.

During the last 40 years, there have been revolutionary advances in power wheelchairs. These unique wheelchair systems, designed for the physically immobile patient, have become extremely diversified, allowing the user to achieve different positions, including tilt, recline, and, more recently, passive standing. Because of this wide diversity of powered wheelchair products, there is a growing realization of the need for certification of wheeled mobility suppliers. Legislation in Tennessee (Consumer Protection Act for Wheeled Mobility) passed in 2003 will ensure that wheeled mobility suppliers must have Assistive Technology Supplier certification and maintain their continuing education credits when fitting individuals in wheelchairs for long-term use. Fifteen other legislative efforts are currently underway in general assemblies throughout the US. Manufacturers, dealers, hospitals, and legislators are working toward the ultimate goal of passing federal legislation delineating the certification process of wheeled mobility suppliers. The most recent advance in the design of powered wheelchairs is the development of passive standing positions. The beneficial effects of passive standing have been documented by comprehensive scientific studies. These benefits include reduction of seating pressure, decreased bone demineralization, increased bladder pressure, enhanced orthostatic circulatory regulation, reduction in muscular tone, decrease in upper extremity muscle stress, and enhanced functional status in general. In February 2003, Permobil, Inc., introduced the powered Permobil Chairman 2K Stander wheelchair, which can tilt, recline, and stand. Other companies are now manufacturing powered wheelchairs that can achieve a passive standing position. These wheelchairs include the Chief SR Powerchair, VERTRAN, and LifeStand Compact. Another new addition to the wheelchair industry is the iBOT, which can elevate the user to reach cupboards and climb stairs but has no passive standing capabilities. In addition, the physically immobile patient must be seated on an ERGODYNAMIC Seating System 2000, which is inflated by the alternating pressure compressor 8080. This seating system has a deep center seam between the two ischial-support chambers, which provides a recess for the coccyx. The pre-ischial crossbar compartment inflates during each cycle to prevent the pelvis from slipping forward. It is essential that the physician of the immobile patient order two ERGODYNAMIC Seating Systems 2000 because the patient must have an additional seating system in the case one leaks. Moreover, two compressors are necessary because each compressor must be serviced after 2500 hours of use. For the protection of the consumer, these pressure relief systems must be supplied and serviced by a Certified Rehabilitation Technology Supplier such as Wheelchair Works Inc. Despite the indisputable scientific evidence of the medical benefits of passive standing for the immobile user, few individuals have access to these revolutionary wheelchairs. Consequently, it is mandatory that the medical community, headed by specialists in physical and occupational therapy as well as rehabilitation medicine, CRTS, and manufacturers collaborate in a national education campaign to convince Medicare/Medicaid and all commercial insurance companies to approve immediately these assisted technologies. This program is essential so that the physically immobilized patient can achieve the undisputed physical benefits of passive standing.

Electricity↗

PubMed1997

Advances in the study of marine viruses.

Free viruses are abundant in the world's oceans. With this realization has come renewed interest in marine viruses and the role viruses play in structuring marine planktonic communities, primarily members of the microbial assemblage. The principal means of studying marine viruses has been by electron microscopy. This review discusses the use of microscopy to study free viruses and compares the ultrastructure of free viruses with bacteriophages and viruses which have been cultured from marine hosts. Many of the free viruses are smaller than typical cultured bacteriophages, which suggests that either many native phages are smaller than cultured phages or that many of the free viruses may be members of those phage families with smaller size classes or, in some cases, that many free viruses may be eukaryotic viruses. Some of the forms currently considered free viruses may be "defective phage" or "phage ghosts," noninfectious particles produced by bacteria, or virus-sized inorganic/organic colloids and warrant further study. Gross virus ultrastructure cannot be used as the sole criterion for determining marine virus diversity, since, as with many microbes, many unrelated viruses have similar morphological characters. Determination of DNA or RNA content as well as studies of protein and DNA relatedness of marine viruses will be needed if we are to understand the complexity of marine virus assemblages. Another important direction for future work is the need for marine bacteriophage/host and virus/host systems in order to study the biology of virus infection.

Bacteriophages↗

PubMed2002

Polio eradication--global initiative; strategy challenged in Kerala, India.

The 'polio eradication initiative' launched by the World Health Assembly in 1988, although successfully implemented in several countries, could not achieve the goal of global eradication by the year 2000. It has components on strengthening routine immunization system, observance of National Immunization Days (NIDs) and strengthening of surveillance for Acute Flaccid Paralysis (AFP). Recently, this strategy was challenged in Kerala, India. Kerala has excellent health indicators compared with other Indian states. In 1999, Intensified Pulse Polio Immunization (IPPI) was introduced with four NIDs throughout India. More than 2000 doctors working under the Kerala Government challenged the strategy, demanding its redesign. Zero prevalence of polio for 2 years, near-complete coverage of children by the routine system, probable business interests of vaccine manufactures and suppliers, dubious interests of officials, and weakening of the routine system by concentrating more on NIDs were all cited as reasons for discontinuing current strategy. The authorities, citing the success stories of polio eradication by the global initiative in several countries, discard the allegations as baseless. They alleged that the medical officers who were on strike demanding higher pay and better conditions were using the 'polio issue' to win their strike. The incidence of two polio cases in Malappuram in northern Kerala during September 2000 has further complicated the issue. As the controversy continues it is felt that the 'eradication initiative' will have to be revisited.

Child, Preschool↗

PubMed2000

Health policy-making in central and eastern Europe: lessons from the inaction on injuries?

The burden of disease due to injuries has elicited virtually no public health response in the countries of central and eastern Europe, even though injuries have long been a much greater problem in the east of Europe than in the west, with children especially affected. This paper seeks to identify factors that have inhibited policy development on this topic and to draw lessons for health policy development in this region more generally. Several factors emerge. Deaths from injuries have had low visibility. Data have not been assembled in a way that would facilitate identification of the burden of disease that they constitute. Those organizations responsible for public health, whether within government or at local level, were typically very weak with little capacity either to identify the nature and scale of threats to the health of their populations or to develop strategies to address them. There was uncertainty about ownership, with fragmentation of responsibility but no tradition of intersectoral working. Non-governmental organizations, which have placed injuries on the health policy agenda in the west, are weak or non-existent. International donors, who could have had a role, have focused on issues such as health care reform. This analysis provides a potential framework for examining policy responses, or lack thereof, to other health challenges in this region. It highlights the need for a better understanding of the potential for using available data, which, in turn, requires a major strengthening of capacity. However, in many countries, there is a need for new ways of working, involving a broadening of the sense of ownership, with clearly designated responsibilities but designed in ways that encourage rather than inhibit intersectoral action. There is also a need to develop non-governmental organizations that have sufficient capacity to undertake their own analyses and to place issues on the agenda.

Child↗

PubMed2006

Language awareness in the bilingual healthcare setting: a national survey.

BACKGROUND: The significance of effective interpersonal communication in healthcare is well established, as is the importance of overcoming language barriers. This has a particular bearing for minority language speakers, where denying language choice can compromise the quality of healthcare provision. Nevertheless, there is limited empirical research exploring language awareness in healthcare and the factors that influence language choice for minority language speakers. OBJECTIVES: This paper reports on the nurses, midwives and health visitors (NMHV) data set of the first phase of a large-scale national study, commissioned by the Welsh Assembly Government, to examine the nature and extent of Welsh language awareness amongst healthcare professionals in Wales, UK. DESIGN: The study involved a questionnaire survey of healthcare professionals working in the public, private and voluntary sectors of healthcare. PARTICIPANTS: A stratified random sample of 3358 healthcare professionals was surveyed, of which 1842 (55%) were nurses, midwives and health visitors. The researcher-designed self-administered questionnaire was distributed by post to participants between July and September 2003. A total of 1042 (57%) NMHV returned their questionnaires for analysis. RESULTS: A strong positive correlation is identified between the NMHV use of the Welsh language in practice and their Welsh language proficiency (p<.01); language attitudes (p<.01); and language region (p<.01). Mean language attitude scores are more positive than expected, particularly amongst those with limited Welsh language proficiency and those working in regions with the lowest proportions of Welsh speakers. CONCLUSIONS: In view of the universal drive for culturally and linguistically appropriate healthcare practice, the findings have important implications for bilingual and multilingual healthcare settings worldwide. The evidence emerging from this survey confirms that cross-cultural communication is enhanced by NMHV language attitudes as well as their proficiency levels. Language awareness training is therefore recommended as a way of enhancing care delivery for minority language speakers.

Adult↗

PubMed2026

Genome-Resolved Metagenomics Revealed the Functional Potential of Core Novel and Known Genera Key to Processes in Full-Scale Aerobic Granular Sludge Plants.

Microbial communities are critical for nutrient removal in aerobic granular sludge (AGS) wastewater treatment plants (WWTPs). Despite the stable long-term operation of full-scale AGS WWTPs, the microbial populations and functional traits sustaining stable long-term performance remain poorly resolved. To address this gap, the recovered MAG catalog from nine full-scale AGS WWTPs across five countries was analyzed. From this catalog, 74 high-quality core MAGs were identified and used for downstream taxonomic characterization and functional analyses. These high-quality core MAGs spanned 48 established and 7 novel genera, representing 31 known and 43 novel species. Functional analysis linked core MAGs to key WWTP processes: polyphosphate accumulation (9), glycogen accumulation (12), denitrification (62), and nitrification (1). These included four novel MAGs with glycogen-accumulating (3) and polyphosphate-accumulating (1) potential and 11 capable of nitrous oxide reduction, critical for mitigating greenhouse gas emissions. Ca. Phosphoribacter was the most abundant genus, highlighting its underestimated role caused by misclassification as Tetrasphaera in 16S rRNA surveys. Specifically, Ca. P. hodrii was the dominant species, exhibiting enhanced sugar uptake and amino acid synthesis as likely drivers of its enrichment in the AGS WWTPs. Overall, this study resolves for the first time the taxa and functional traits consistently enriched in full-scale AGS systems, enabling a shift from an empirical performance assessment toward biologically informed process interpretation.

Sewage↗

PubMed1998

Are preoperative antibiotics administered preoperatively?

Ideally antibiotics should be administered preoperatively within 2 hours of skin incision to ensure adequate tissue concentrations, especially when a vascular prosthesis is used. The quality of patient outcomes may be adversely affected when key processes, by degrees, fail to meet patient care objectives. This study was designed to incorporate the concepts of total quality management to determine how effectively this goal was achieved, and, after review of those measured results, what process improvements could be instituted to meet the established requirements for the administration of antibiotics. The study was then repeated on a yearly basis to determine what effect these improvement measures had on antibiotic administration. Three time periods were established for determining when antibiotics were administered. The "early" period was more than 2 hr preoperatively. "Preoperative" was from 2 hr before surgery until the time of incision and "perioperative" was after the time of incision. Group 1 consisted of the first 100 patients undergoing vascular procedures in 1992. After the data were collected, a multidisciplinary team of nurses, pharmacists, and surgeons was assembled to determine the step by step desired process flow from order received to actual medication administration. The team then reviewed each step of the process to identify variations relative to data obtained. An action plan was developed to implement the agreed upon improvement plan. After improvements were implemented, groups 2, 3, 4, and 5 consisted of the first 100 vascular procedures of 1993, 1994, 1995, and 1996. Group 1 had only 26% of antibiotics administered during the preoperative period and 74% during the perioperative period. Problems identified were: surgeons ordered the antibiotics when the patient was in the operating room, cefamandole and vancomycin required at least 1 hr to infuse, nurses were not aware of the need for preoperative infusion, and the pharmacy did not supply the antibiotics in a timely fashion. Educational inservices were held for all parties involved, and cefazolin was used in place of cefamandole because it could be given as a bolus. Results were: group 1, early, 0%; preoperative, 26%; perioperative, 74%; P = N/A; group 2, early, 0%, preoperative, 90%; perioperative, 10%; group 3, early, 7%; preoperative, 93%; perioperative, 0%; group 4, early 0%; preoperative, 100%; perioperative, 0%; and group 5, early, 0%; preoperative, 100%; perioperative, 0%; P = 0.0001 for groups 2-5 (versus group 1). It was surprising how often antibiotics were administered incorrectly in a busy vascular practice. By focusing on the process of care delivery, a continuous quality improvement team implemented simple changes that resulted in significant improvements. We are now conducting a study to determine what effect these process improvements had on our infection rate.

Antibiotic Prophylaxis↗

PubMed2005

Spectrum and prognostic significance of arrhythmias on ambulatory Holter electrocardiogram in hypertrophic cardiomyopathy.

OBJECTIVES: The goal of this study was to assemble a profile and assess the significance of arrhythmias in a nontertiary-based hypertrophic cardiomyopathy (HCM) cohort. BACKGROUND: Hypertrophic cardiomyopathy is associated with arrhythmia-related consequences, particularly sudden death. Ventricular tachyarrhythmias on Holter electrocardiograms (ECG) have been reported as markers for sudden death in highly selected HCM populations. METHODS: We assessed the profile of ventricular and supraventricular ectopy and bradyarrhythmia on ambulatory 24-h Holter ECG and also related these findings to clinical outcome in 178 HCM patients. RESULTS: Of the 178 study patients, 157 (88%) had premature ventricular complexes (PVCs), including 21 (12%) with >/=500 PVCs, 74 (42%) had couplets, 67 (37%) had supraventricular tachycardia (SVT), and 56 (31%) had nonsustained ventricular tachycardia (NSVT). Mean number of PVCs was 330 +/- 763 (range 1 to 5,435) and increased with age (p < 0.01); NSVT was associated with greater left ventricular hypertrophy (p = 0.01) and severe symptoms (New York Heart Association functional classes III and IV) (p = 0.04); SVT occurred more commonly in patients with outflow obstruction (p = 0.02). Over a follow-up of 5.5 +/- 3.4 years, 11 (6%) patients died suddenly (annual mortality rate, 1.1%) including 5 patients with NSVT. For sudden death, NSVT on Holter ECG had negative and positive predictive values of 95% and 9%, and sensitivity and specificity of 45% and 69%, respectively. CONCLUSIONS: In this nontertiary-based HCM cohort, ventricular and supraventricular tachyarrhythmias were particularly frequent and demonstrated a broad spectrum on ambulatory (Holter) ECG. Paradoxically, despite such a highly arrhythmogenic substrate, sudden death events proved to be relatively uncommon. Ventricular tachyarrhythmias had a low positive and relatively high negative predictive value for sudden death in this HCM population.

Adolescent↗

PubMed2006

Convergence of service, policy, and science toward consumer-driven mental health care.

BACKGROUND: A common theme is emerging in sentinel reports on the United States health care system. Consumer relevance and demands on service systems and practices are influencing how mental health care is delivered and how systems will be shaped in the future. AIMS OF THE STUDY: The present report seeks to assemble a confluence of consumer-driven themes from noteworthy reports on the state of the mental health system in the U.S. It also explores innovative efforts, promising practices, collaborative efforts, as well as identification of barriers to consumer-directed care, with possible solutions. METHOD: The report reviews the relevant public mental health policy and data used in published work. RESULTS: The findings indicate an increasing public and private interest in promoting consumer-driven care, even though historical systems of care predominate, and often create, barriers to wide-spread redesign of a consumer-centered mental health care system. Innovative consumer-driven practices are increasing as quality, choice, and self-determination become integral parts of a redesigned U.S. mental health care system. DISCUSSION AND LIMITATIONS: The use of consumer-driven approaches in mental health is limited at best. These programs challenge industry norms and traditional practices. Limitations include the need for additional and thorough evaluations of effectiveness (cost and clinical) and replicability of consumer-directed programs. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Consumer-driven services indicate that mental health consumers are expecting to be more participative in their mental health care. This expectation will influence how traditional mental health services and providers become more consumer-centric and meet the demand. IMPLICATIONS FOR HEALTH POLICIES: Public and private interest in consumer-driven health care range from creating cost-conscious consumers to individualized control of recovery. The health care sector should seek to invest more resources in the provision of consumer-driven health care programs. The results of this study have implications and are informative for other countries where consumer-directed care is delivered in either the private or public health care systems. IMPLICATIONS FOR FURTHER RESEARCH: More research is needed to obtain further evidence on the use of consumer-driven services and their overall effectiveness.

Community Participation↗