Training addiction professionals in empirically supported treatments: perspectives from the treatment community.

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Hartzler, Bryan; Rabun, Carl

2014-01-01

Large-scale dissemination efforts seek to expand opportunities for the addiction treatment community to receive training in empirically supported treatments (ESTs). Prospective consumers of such training are valuable sources of input about content of interest, preferences for how training events are structured, and obstacles that deter receipt of training. In this mixed-method study, data were collected in 64 semistructured individual interviews with personnel during site visits to 16 community opioid treatment programs (OTPs). At each OTP, interviews were completed with the executive director, a clinical supervisor, and 2 direct-service clinicians. Topical interests were analyzed qualitatively in a cultural domain analysis. Likert ratings of training event preferences were analyzed via generalized linear mixed models (GLMMs), and unstructured interviewee comments were analyzed via narrative analysis. Obstacles to training receipt were analyzed qualitatively with both content coding and narrative analysis. Based on topics of reported interest, cultural domain analysis suggests as ESTs of note: Multidimensional Family Therapy, Motivational Enhancement Therapy, Relapse Prevention Therapy, "Seeking Safety," and broad addiction-focused pharmacotherapy. Regarding training event preferences, GLMMs and narrative analysis revealed clear preferences for time-distributed trainings and use of participatory activities (e.g., trainer demonstrations, role plays, small group exercises). Content coding identified cost as the primary obstacle to receipt of EST trainings, followed by lack of time, logistical challenges, and disinterest, and narrative analysis elaborated on contextual issues underlying these obstacles. As primary consumers of EST technologies, the treatment community has valuable input to offer. Dissemination efforts may be enhanced by greater consideration of their preferences for training content and event structure, as well as practical obstacles that challenge

Experiences and perspectives of community health workers from implementing treatment for schistosomiasis using the community directed intervention strategy in an informal settlement in Kisumu City, western Kenya.

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Odhiambo, Gladys O; Musuva, Rosemary M; Odiere, Maurice R; Mwinzi, Pauline N

2016-09-15

The Community Directed Intervention (CDI) strategy has been used to conduct various health interventions in Africa, including control of Neglected Tropical Diseases (NTDs). Although the CDI approach has shown good results in the control of onchocerciasis and lymphatic filariasis with respect to treatment coverage using community drug distributors, its utility in the control of schistosomiasis among urban poor is yet to be established. Using a longitudinal qualitative study, we explored the experiences, opportunities, challenges as well as recommendations of Community Health Workers (CHWs) after participation in annual mass drug administration (MDA) activities for schistosomiasis using the CDI approach in an urban setting. Unstructured open-ended group discussions were conducted with CHWs after completion of annual MDA activities. Narratives were obtained from CHWs using a digital audio recorder during the group discussions, transcribed verbatim and translated into English where applicable. Thematic decomposition of data was done using ATLAS.ti. software, and themes explored using the principle of interpretative phenomenological analysis (IPA). From the perspective of the CHWs, opportunities for implementing CDI in urban settings, included the presence of CHWs, their supervisory structures and their knowledge of intervention areas, and opportunity to integrate MDA with other health interventions. Several challenges were mentioned with regards to implementing MDA using the CDI strategy among them lack of incentives, fear of side effects, misconceptions regarding treatment and mistrust, difficulties working in unsanitary environmental conditions, insecurity, and insufficient time. A key recommendation in promoting more effective MDA using the CDI approach was allocation of more time to the exercise. Findings from this study support the feasibility of using CDI for implementing MDA for schistosomiasis in informal settlements of urban areas. Extensive community

Experiences and perspectives of community health workers from implementing treatment for schistosomiasis using the community directed intervention strategy in an informal settlement in Kisumu City, western Kenya

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Gladys O. Odhiambo

2016-09-01

Full Text Available Abstract Background The Community Directed Intervention (CDI strategy has been used to conduct various health interventions in Africa, including control of Neglected Tropical Diseases (NTDs. Although the CDI approach has shown good results in the control of onchocerciasis and lymphatic filariasis with respect to treatment coverage using community drug distributors, its utility in the control of schistosomiasis among urban poor is yet to be established. Using a longitudinal qualitative study, we explored the experiences, opportunities, challenges as well as recommendations of Community Health Workers (CHWs after participation in annual mass drug administration (MDA activities for schistosomiasis using the CDI approach in an urban setting. Methods Unstructured open-ended group discussions were conducted with CHWs after completion of annual MDA activities. Narratives were obtained from CHWs using a digital audio recorder during the group discussions, transcribed verbatim and translated into English where applicable. Thematic decomposition of data was done using ATLAS.ti. software, and themes explored using the principle of interpretative phenomenological analysis (IPA. Results From the perspective of the CHWs, opportunities for implementing CDI in urban settings, included the presence of CHWs, their supervisory structures and their knowledge of intervention areas, and opportunity to integrate MDA with other health interventions. Several challenges were mentioned with regards to implementing MDA using the CDI strategy among them lack of incentives, fear of side effects, misconceptions regarding treatment and mistrust, difficulties working in unsanitary environmental conditions, insecurity, and insufficient time. A key recommendation in promoting more effective MDA using the CDI approach was allocation of more time to the exercise. Conclusion Findings from this study support the feasibility of using CDI for implementing MDA for schistosomiasis in

Costs and cost-effectiveness of different DOT strategies for the treatment of tuberculosis in Pakistan. Directly Observed Treatment.

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Khan, M A; Walley, J D; Witter, S N; Imran, A; Safdar, N

2002-06-01

An economic study was conducted alongside a clinical trial at three sites in Pakistan to establish the costs and effectiveness of different strategies for implementing directly observed treatment (DOT) for tuberculosis. Patients were randomly allocated to one of three arms: DOTS with direct observation by health workers (at health centres or by community health workers); DOTS with direct observation by family members; and DOTS without direct observation. The clinical trial found no statistically significant difference in cure rate for the different arms. The economic study collected data on the full range of health service costs and patient costs of the different treatment arms. Data were also disaggregated by gender, rural and urban patients, by treatment site and by economic categories, to investigate the costs of the different strategies, their cost-effectiveness and the impact that they might have on patient compliance with treatment. The study found that direct observation by health centre-based health workers was the least cost-effective of the strategies tested (US dollars 310 per case cured). This is an interesting result, as this is the model recommended by the World Health Organization and International Union against Tuberculosis and Lung Disease. Attending health centres daily during the first 2 months generated high patient costs (direct and in terms of time lost), yet cure rates for this group fell below those of the non-observed group (58%, compared with 62%). One factor suggested by this study is that the high costs of attending may be deterring patients, and in particular, economically active patients who have most to lose from the time taken by direct observation. Without stronger evidence of benefits, it is hard to justify the costs to health services and patients that this type of direct observation imposes. The self-administered group came out as most cost-effective (164 dollars per case cured). The community health worker sub-group achieved the

Comparison between pathogen directed antibiotic treatment and empirical broad spectrum antibiotic treatment in patients with community acquired pneumonia: a prospective randomised study

NARCIS (Netherlands)

van der Eerden, M. M.; Vlaspolder, F.; de Graaff, C. S.; Groot, T.; Bronsveld, W.; Jansen, H. M.; Boersma, W. G.

2005-01-01

Background: There is much controversy about the ideal approach to the management of community acquired pneumonia ( CAP). Recommendations differ from a pathogen directed approach to an empirical strategy with broad spectrum antibiotics. Methods: In a prospective randomised open study performed

The Cascade of Care for an Australian Community-Based Hepatitis C Treatment Service.

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Amanda J Wade

Full Text Available Hepatitis C treatment uptake in Australia is low. To increase access to hepatitis C virus treatment for people who inject drugs, we developed a community-based, nurse-led service that linked a viral hepatitis service in a tertiary hospital to primary care clinics, and resulted in hepatitis C treatment provision in the community.A retrospective cohort study of patients referred to the community hepatitis service was undertaken to determine the cascade of care. Logistic regression analyses were used to identify predictors of hepatitis C treatment uptake.Four hundred and sixty-two patients were referred to the community hepatitis service; 344 attended. Among the 279 attendees with confirmed chronic hepatitis C, 257 (99% reported ever injecting drugs, and 124 (48% injected in the last month. Of 201 (72% patients who had their fibrosis staged, 63 (31% had F3-F4 fibrosis. Fifty-five patients commenced hepatitis C treatment; 26 (47% were current injectors and 25 (45% had F3-F4 fibrosis. Nineteen of the 27 (70% genotype 1 patients and 14 of the 26 (54% genotype 3 patients eligible for assessment achieved a sustained virologic response. Advanced fibrosis was a significant predictor of treatment uptake in adjusted analysis (AOR 2.56, CI 1.30-5.00, p = 0.006.Our community hepatitis service produced relatively high rates of fibrosis assessment, hepatitis C treatment uptake and cure, among people who inject drugs. These findings highlight the potential benefits of providing community-based hepatitis C care to people who inject drugs in Australia-benefits that should be realised as direct-acting antiviral agents become available.

Consensus methodology to determine minor ailments appropriate to be directed for management within community pharmacy.

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Nazar, Hamde; Nazar, Zachariah; Yeung, Andre; Maguire, Mike; Connelly, Alex; Slight, Sarah P

2018-01-04

National Health Service (NHS) 111, a medical helpline for urgent care used within the England and Scotland, receives significant numbers of patient calls yearly for a range of clinical conditions. Some are considered high acuity and mainly directed to urgent and emergency care. Low acuity conditions are also directed to these costly, overburdened services. Community pharmacy is a recognised setting for effective low acuity condition management and could offer an alternative. To design and evaluate a new NHS111 pathway re-directing patients with low acuity conditions to community pharmacy. Two consensus development stakeholder workshops were undertaken. A "low acuity" condition was defined as one that can be clinically assessed by a community pharmacist and requires a treatment and/or advice available within a community pharmacy. Retrospective NHS111 patient data (February-August 2016) from the North East of England and access to the NHS Pathways clinical decision support software were available to stakeholders. The NHS111 data demonstrated the volume of patient calls for these conditions that could have been redirected to community pharmacy. Stakeholders reached consensus that 64 low acuity conditions could be safely redirected to community pharmacy via NHS111. This represented approximately 35,000 patients (11.5% of total) being shifted away from the higher cost settings in the North East region alone during February-August 2016. The stakeholder group discussions provided rationale behind their classifications of conditions to ensure patient safety, the care experience and added value. The resulting definitive list of low acuity conditions that could be directed to community pharmacy via NHS111 could result in a shift of workload from urgent and emergency care settings. Future work needs to evaluate the cost, clinical outcomes, patient satisfaction of a community pharmacy referral service that has the potential to improve integration of community pharmacy in the

Primary health care in rural Malawi - a qualitative assessment exploring the relevance of the community-directed interventions approach

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Makaula Peter

2012-09-01

Full Text Available Abstract Background Primary Health Care (PHC is a strategy endorsed for attaining equitable access to basic health care including treatment and prevention of endemic diseases. Thirty four years later, its implementation remains sub-optimal in most Sub-Saharan African countries that access to health interventions is still a major challenge for a large proportion of the rural population. Community-directed treatment with ivermectin (CDTi and community-directed interventions (CDI are participatory approaches to strengthen health care at community level. Both approaches are based on values and principles associated with PHC. The CDI approach has successfully been used to improve the delivery of interventions in areas that have previously used CDTi. However, little is known about the added value of community participation in areas without prior experience with CDTi. This study aimed at assessing PHC in two rural Malawian districts without CDTi experience with a view to explore the relevance of the CDI approach. We examined health service providers’ and beneficiaries’ perceptions on existing PHC practices, and their perspectives on official priorities and strategies to strengthen PHC. Methods We conducted 27 key informant interviews with health officials and partners at national, district and health centre levels; 32 focus group discussions with community members and in-depth interviews with 32 community members and 32 community leaders. Additionally, official PHC related documents were reviewed. Results The findings show that there is a functional PHC system in place in the two study districts, though its implementation is faced with various challenges related to accessibility of services and shortage of resources. Health service providers and consumers shared perceptions on the importance of intensifying community participation to strengthen PHC, particularly within the areas of provision of insecticide treated bed nets, home case management for

Pathogen reduction requirements for direct potable reuse in Antarctica: evaluating human health risks in small communities.

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Barker, S Fiona; Packer, Michael; Scales, Peter J; Gray, Stephen; Snape, Ian; Hamilton, Andrew J

2013-09-01

Small, remote communities often have limited access to energy and water. Direct potable reuse of treated wastewater has recently gained attention as a potential solution for water-stressed regions, but requires further evaluation specific to small communities. The required pathogen reduction needed for safe implementation of direct potable reuse of treated sewage is an important consideration but these are typically quantified for larger communities and cities. A quantitative microbial risk assessment (QMRA) was conducted, using norovirus, giardia and Campylobacter as reference pathogens, to determine the level of treatment required to meet the tolerable annual disease burden of 10(-6) DALYs per person per year, using Davis Station in Antarctica as an example of a small remote community. Two scenarios were compared: published municipal sewage pathogen loads and estimated pathogen loads during a gastroenteritis outbreak. For the municipal sewage scenario, estimated required log10 reductions were 6.9, 8.0 and 7.4 for norovirus, giardia and Campylobacter respectively, while for the outbreak scenario the values were 12.1, 10.4 and 12.3 (95th percentiles). Pathogen concentrations are higher under outbreak conditions as a function of the relatively greater degree of contact between community members in a small population, compared with interactions in a large city, resulting in a higher proportion of the population being at risk of infection and illness. While the estimates of outbreak conditions may overestimate sewage concentration to some degree, the results suggest that additional treatment barriers would be required to achieve regulatory compliance for safe drinking water in small communities. Copyright © 2013 Elsevier B.V. All rights reserved.

Strategies to improve treatment coverage in community-based public health programs: A systematic review of the literature.

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Katrina V Deardorff

2018-02-01

Full Text Available Community-based public health campaigns, such as those used in mass deworming, vitamin A supplementation and child immunization programs, provide key healthcare interventions to targeted populations at scale. However, these programs often fall short of established coverage targets. The purpose of this systematic review was to evaluate the impact of strategies used to increase treatment coverage in community-based public health campaigns.We systematically searched CAB Direct, Embase, and PubMed archives for studies utilizing specific interventions to increase coverage of community-based distribution of drugs, vaccines, or other public health services. We identified 5,637 articles, from which 79 full texts were evaluated according to pre-defined inclusion and exclusion criteria. Twenty-eight articles met inclusion criteria and data were abstracted regarding strategy-specific changes in coverage from these sources. Strategies used to increase coverage included community-directed treatment (n = 6, pooled percent change in coverage: +26.2%, distributor incentives (n = 2, +25.3%, distribution along kinship networks (n = 1, +24.5%, intensified information, education, and communication activities (n = 8, +21.6%, fixed-point delivery (n = 1, +21.4%, door-to-door delivery (n = 1, +14.0%, integrated service distribution (n = 9, +12.7%, conversion from school- to community-based delivery (n = 3, +11.9%, and management by a non-governmental organization (n = 1, +5.8%.Strategies that target improving community member ownership of distribution appear to have a large impact on increasing treatment coverage. However, all strategies used to increase coverage successfully did so. These results may be useful to National Ministries, programs, and implementing partners in optimizing treatment coverage in community-based public health programs.

Barriers to implementing evidence-based practices in addiction treatment programs: comparing staff reports on Motivational Interviewing, Adolescent Community Reinforcement Approach, Assertive Community Treatment, and Cognitive-behavioral Therapy.

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Amodeo, M; Lundgren, L; Cohen, A; Rose, D; Chassler, D; Beltrame, C; D'Ippolito, M

2011-11-01

This qualitative study explored barriers to implementing evidence-based practices (EBPs) in community-based addiction treatment organizations (CBOs) by comparing staff descriptions of barriers for four EBPs: Motivational Interviewing (MI), Adolescent Community Reinforcement Approach (A-CRA), Assertive Community Treatment (ACT), and Cognitive-behavioral Therapy (CBT). The CBOs received CSAT/SAMHSA funding from 2003 to 2008 to deliver services using EBPs. Phone interview responses from 172 CBO staff directly involved in EBP implementation were analyzed using content analysis, a method for making inferences and developing themes from the systematic review of participant narratives (Berelson, 1952). Staff described different types of barriers to implementing each EBP. For MI, the majority of barriers involved staff resistance or organizational setting. For A-CRA, the majority of barriers involved specific characteristics of the EBP or client resistance. For CBT, the majority of barriers were associated with client resistance, and for ACT, the majority of barriers were associated with resources. EBP designers, policy makers who support EBP dissemination and funders should include explicit strategies to address such barriers. Addiction programs proposing to use specific EBPs must consider whether their programs have the organizational capacity and community capacity to meet the demands of the EBP selected. Copyright © 2011 Elsevier Ltd. All rights reserved.

Experiences from a community based substance use treatment centre in an urban resettlement colony in India.

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Balhara, Yatan Pal Singh; Ranjan, Rajeev; Dhawan, Anju; Yadav, Deepak

2014-01-01

Background. There are limited community based treatment services for drug dependence in India. Rural areas and urban resettlement colonies are in particular deficient in such services. Aims. The current study aimed at preliminary assessment of substance use disorder management services at a community based substance use treatment clinic in an urban resettlement colony. Methods. The study was carried out at community based substance use treatment centre in a resettlement colony in India. The records of the centre were chart reviewed. Results. A total of 754 patients were registered at the clinic during the study period. Heroin was the primary drug of abuse for 63% of the patients. The mean duration of follow-up for the patients with opioid and alcohol dependence was 13.47 (SD ± 10.37; range 0-39) months. A total of 220 patients of opioid dependence were prescribed substation or abstinence directed therapy. Buprenorphine (87), slow release oral morphine (SROM) (16), and dextropropoxyphene (98) were used for opioid substitution. Conclusion. It is possible to deliver substance use disorder treatment services in community setting. There is a need to develop area specific community based treatment services for substance abuse in socially disadvantaged populations such as urban resettlement colonies.

Community perceptions on the community-directed treatment and school-based approaches for the control of schistosomiasis and soil-transmitted helminthiasis among school-age children in Lushoto District, Tanzania.

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Massa, K; Magnussen, P; Sheshe, A; Ntakamulenga, R; Ndawi, B; Olsen, A

2009-01-01

The success of the Community-Directed Treatment (ComDT) approach in the control of onchocerciasis and filariasis has caught the attention of other disease control programmes. In this study the ComDT approach was implemented and compared with the school-based approach for control of schistosomiasis and soil-transmitted helminthiasis among school-age children in Lushoto District, Tanzania. This was a qualitative study, consisting of in-depth interviews with village leaders, community drug distributors (CDDs) and schoolteachers, as well as focus group discussions with separate groups of mothers and fathers to assess the perceptions and experiences of the villagers on the implementation of the two approaches. It was found that the villagers accepted the ComDT approach and took the responsibility of selecting the CDDs, organizing and implementing their own method of distributing drugs to the school-age children in their villages. The ComDT approach was well received and was successfully implemented in the villages. Although the villagers pointed out the limitation in reaching the non-enrolled children in the school-based approach, they also expressed satisfaction with this approach. This study suggests that the ComDT approach is well accepted and can be implemented effectively to ensure better coverage of especially non-enrolled school-age children.

Design and Implementation of a Community Health Worker HIV Treatment and Prevention Intervention in an HIV Hot Spot Fishing Community in Rakai, Uganda.

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Long, Amanda; Mbabali, Ismail; Hutton, Heidi E; Thomas, Alvin G; Bugos, Eva; Mulamba, Jeremiah; Amico, Kathy Rivet; Nalugoda, Fred; Gray, Ronald H; Wawer, Maria J; Nakigozi, Gertrude; Chang, Larry W

Innovative approaches are needed to increase engagement in HIV treatment and prevention services, particularly in HIV hot spots. Here, we detail our design, training approach, and early implementation experiences of a community-based HIV intervention called "health scouts." The intervention, utilizing a novel, theory-based approach, trained 10 community residents in an HIV hot spot fishing community to use motivational interviewing strategies and a mobile phone-based counseling application. During the first 3 months, 771 residents (median 82/health scout, range 27-160) were counseled. A directly observed Motivational Interviewing Treatment Integrity scale-based evaluation found adequate performance (median score 20/25, range 11-23). The health scout intervention was feasible to implement in a high HIV-prevalence fishing community, and its impact on HIV care outcomes will be evaluated in an ongoing cluster randomized trial. If found to be effective, it may be an important strategy for responding to HIV in high-burden settings.

Treatment of hyperthyroidism in community hospital

International Nuclear Information System (INIS)

Gossain, V.V.; Heath, R.C.; Rovner, D.R.

1989-01-01

The preferred treatment of hyperthyroidism remains controversial. Most of this data is derived from large, university-based medical centers. We report here our experience with treatment of hyperthyroidism in a community setting. This involves 144 patients with hyperthyroidism who were seen over a 10 year period at Michigan State University Clinical Center and were treated in the community hospitals and private physicians' offices, and by community surgeons. Follow-up data were available on 119 of these patients; 105 of them were hyperthyroid because of Graves' disease and multinodular goiter. Patients were encouraged to make their own decisions regarding choice of therapy, as independently as possible. Sixty-five percent of these patients were treated by 131I, 18% by antithyroid drugs, and 17% by surgery. The mean follow-up period was 2.5 years (range 2 months to 19 years). Hyperthyroidism was controlled in 84% of the patients treated by 131I and 83% of the patients treated by surgery. Forty percent of the patients treated by 131I and 33% treated by surgery became hypothyroid. Fifty percent of the patients achieved remission when treated by antithyroid drugs alone. Our results indicate that when patients are encouraged to make their own decisions regarding the treatment of hyperthyroidism, their choices are similar to those of the thyroidologists. Secondly, the results obtained with different modalities of treatment for hyperthyroidism in a community setting are similar to those obtained in university medical centers

European community direct taxation: the recent integration trends

OpenAIRE

Kalvytė, Vesta

2011-01-01

While Member States retain direct tax sovereignity and determine the tax, its base, rate, taxable subjects discretionary, fundamental differencies occur, resulting in market fragmentation and big obstacles for effective functioning of Community internal market. These differencies and the gap between harmonization in direct taxes and other spheres stipulate the need of harmonization and pressure for the Member States. However, the sole harmonization base requires the Council to act unanimously...

Centralized Drinking Water Treatment Operations Shape Bacterial and Fungal Community Structure.

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Ma, Xiao; Vikram, Amit; Casson, Leonard; Bibby, Kyle

2017-07-05

Drinking water microbial communities impact opportunistic pathogen colonization and corrosion of water distribution systems, and centralized drinking water treatment represents a potential control for microbial community structure in finished drinking water. In this article, we examine bacterial and fungal abundance and diversity, as well as the microbial community taxonomic structure following each unit operation in a conventional surface water treatment plant. Treatment operations drove the microbial composition more strongly than sampling time. Both bacterial and fungal abundance and diversity decreased following sedimentation and filtration; however, only bacterial abundance and diversity was significantly impacted by free chlorine disinfection. Similarly, each treatment step was found to shift bacterial and fungal community beta-diversity, with the exception of disinfection on the fungal community structure. We observed the enrichment of bacterial and fungal taxa commonly found in drinking water distribution systems through the treatment process, for example, Sphingomonas following filtration and Leptospirillium and Penicillium following disinfection. Study results suggest that centralized drinking water treatment processes shape the final drinking water microbial community via selection of community members and that the bacterial community is primarily driven by disinfection while the eukaryotic community is primarily controlled by physical treatment processes.

Community-based directly observed treatment for TB patients to improve HIV services: a cross-sectional study in a South African province.

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Howell, Embry M; Kigozi, N Gladys; Heunis, J Christo

2018-04-07

There is uncertainty about how directly observed treatment (DOT) support for tuberculosis (TB) can be delivered most effectively and how DOT support can simultaneously be used to strengthen human immunodeficiency virus (HIV) prevention and control among TB patients. This study describes how DOT support by community health workers (CHWs) was used in four municipalities in the Free State province - a high TB/HIV burden, poorly-resourced setting - to provide HIV outreach, referrals, and health education for TB patients. The study was part of a larger cross-sectional study of HIV counselling and testing (HCT) among 1101 randomly-selected TB patients registered at 40 primary health care (PHC) facilities (clinics and community health centres) across small town/rural and large town/urban settings. Univariate analysis of percentages, chi-square tests and t-tests for difference in means were used to describe differences between the types of TB treatment support and patient characteristics, as well as the types of - and patient satisfaction with - HIV information and referrals received from various types of treatment supporters including home-based DOT supporters, clinic-based DOT supporters or support from family/friends/employers. Multivariate logistic regression was used to predict the likelihood of not having receiving home-based DOT and of never having received HIV counselling. The independent variables include poverty-related health and socio-economic risk factors for poor outcomes. Statistical significance is shown using a 95% confidence interval and a 0.05 p-value. Despite the fact that DOT support for all TB patients was the goal of South African health policy at the time (2012), most TB patients were not receiving formal DOT support. Only 155 (14.1%) were receiving home-based DOT, while 114 (10.4%) received clinic-based DOT. TB patients receiving home-based DOT reported higher rates of HIV counselling than other patients. Public health providers should train DOT

A community-driven hypertension treatment group in rural Honduras.

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Reiger, Sheridan; Harris, Jeffrey R; Chan, Kwun Chuen Gary; Oqueli, Hector Lopez; Kohn, Marlana

2015-01-01

We formed a self-funded hypertension treatment group in a resource-poor community in rural Honduras. After training community health workers and creating protocols for standardized treatment, we used group membership fees to maintain the group, purchase generic medications in bulk on the local market, and hire a physician to manage treatment. We then assessed whether participation in the group improved treatment, medication adherence, and hypertension control. This is a program evaluation using quasi-experimental design and no control group. Using data from the 86 members of the hypertension treatment group, we analyzed baseline and follow-up surveys of members, along with 30 months of clinical records of treatment, medication adherence, and blood pressure readings. Our initial hypertension needs assessment revealed that at baseline, community hypertensives relied on the local Ministry of Health clinic as their source of anti-hypertensive medications and reported that irregular supply interfered with medication adherence. At baseline, hypertension group members were mainly female, overweight or obese, physically active, non-smoking, and non-drinking. After 30 months of managing the treatment group, we found a significant increase in medication adherence, from 54.8 to 76.2% (p<0.01), and hypertension control (<140/90 mmHg), from 31.4 to 54.7% (p<0.01). We also found a mean monthly decrease of 0.39 mmHg in systolic blood pressure (p<0.01). At the end of the 30-month observation period, the local Ministry of Health system had increased provision of low-cost anti-hypertensive medications and adopted the hypertension treatment group's treatment protocols. Formation of a self-funded, community-based hypertension treatment group in a rural, resource-poor community is feasible, and group participation may improve treatment, medication adherence, and hypertension control and can serve as a political driver for improving hypertension treatment services provided by the public

[Community pneumonia - fundamentals of diagnosing and treatment].

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Kolek, Vítězslav

Pneumonia is the most serious respiratory disease which causes more than 3 000 deaths per year in the Czech Republic. Community-acquired pneumonia is contracted in the ordinary life environment outside of hospitals, its development is caused by known infectious agents which mostly exhibit satisfactory sensitivity to antibiotics. Diagnosing, prevention and treatment of the disease are described including considerations of individual evaluation of the risk of complications and possible death. The strategy of administering antibiotics is discussed.Key words: antibiotics - community-acquired pneumonias - diagnosing - treatment.

A Community-Directed Integrated Strongyloides Control Program in Queensland, Australia

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Adrian Miller

2018-05-01

Full Text Available This paper describes two phases of a community-directed intervention to address strongyloidiasis in the remote Aboriginal community of Woorabinda in central Queensland, Australia. The first phase provides the narrative of a community-driven ‘treat-and-test’ mass drug administration (MDA intervention that was co-designed by the Community Health Service and the community. The second phase is a description of the re-engagement of the community in order to disseminate the key factors for success in the previous MDA for Strongyloides stercoralis, as this information was not shared or captured in the first phase. During the first phase in 2004, there was a high prevalence of strongyloidiasis (12% faecal examination, 30% serology; n = 944 community members tested that resulted in increased morbidity and at least one death in the community. Between 2004–2005, the community worked in partnership with the Community Health Service to implement a S. stercoralis control program, where all of the residents were treated with oral ivermectin, and repeat doses were given for those with positive S. stercoralis serology. The community also developed their own health promotion campaign using locally-made resources targeting relevant environmental health problems and concerns. Ninety-two percent of the community residents participated in the program, and the prevalence of strongyloidiasis at the time of the ‘treat-and-test’ intervention was 16.6% [95% confidence interval 14.2–19.3]. The cure rate after two doses of ivermectin was 79.8%, based on pre-serology and post-serology tests. The purpose of this paper is to highlight the importance of local Aboriginal leadership and governance and a high level of community involvement in this successful mass drug administration program to address S. stercoralis. The commitment required of these leaders was demanding, and involved intense work over a period of several months. Apart from controlling strongyloidiasis

Assessment of the ecological potential of mine-water treatment wetlands using a baseline survey of macroinvertebrate communities

International Nuclear Information System (INIS)

Batty, L.C.; Atkin, L.; Manning, D.A.C.

2005-01-01

A baseline survey of macroinvertebrate populations in two mine-water treatment wetlands, one treating a net acidic spoil heap discharge and one a net alkaline ferruginous pumped mine water, was undertaken to assess the potential of these systems to provide habitats for faunal communities. Both wetlands were found to be impoverished in comparison to natural wetlands but did sustain a macroinvertebrate community that could support higher organisms. Wetland size and water quality in terms of pH, conductivity and metal concentrations were found to be important factors in determining the quality of the populations supported. Direct toxicity to organisms was unlikely to be the main cause of lower diversity, but the smothering of organisms via the precipitation of iron hydroxides particularly in the early parts of the treatment systems affected macroinvertebrate communities. The presence of areas of open water within the planted systems was found to be important for providing habitats for macroinvertebrates and this should be both a future design and maintenance consideration for environmental managers. - Mine-water treatment wetlands can be engineered to provide habitats for ecological communities

Treatment of radioactive liquid organic waste using bacteria community

International Nuclear Information System (INIS)

Rafael Vicente de Padua Ferreira; Solange Kazumi Sakata; Maria Helena Bellini; Julio Takehiro Marumo; Fernando Dutra; Patricia Busko Di Vitta; Maria Helena Tirollo Taddei

2012-01-01

Waste management plays an important role in radioactive waste volume reduction as well as lowering disposal costs and minimizing the environment-detrimental impact. The employment of biomass in the removal of heavy metals and radioisotopes has a significant potential in liquid waste treatment. The aim of this study is to evaluate the radioactive waste treatment by using three different bacterial communities (BL, BS, and SS) isolated from impacted areas, removing radioisotopes and organic compounds. The best results were obtained in the BS and BL community, isolated from the soil and a lake of a uranium mine, respectively. BS community was able to remove 92% of the uranium and degraded 80% of tributyl phosphate and 70% of the ethyl acetate in 20 days of experiments. BL community removed 81% of the uranium and degraded nearly 60% of the TBP and 70% of the ethyl acetate. SS community collected from the sediment of Sao Sebastiao channel removed 76% of the uranium and 80% of the TBP and 70% of the ethyl acetate. Both americium and cesium were removed by all communities. In addition, the BS community showed to be more resistant to radioactive liquid waste than the other communities. These results indicated that the BS community is the most viable for the treatment of large volumes of radioactive liquid organic waste. (author)

[Nursing performance in the policy transfer of directly observed treatment of tuberculosis].

Science.gov (United States)

Souza, Káren Mendes Jorge de; Sá, Lenilde Duarte de; Silva, Laís Mara Caetano da; Palha, Pedro Fredemir

2014-10-01

Analyzing the policy transfer of directly observed treatment of tuberculosis from the perspective of nursing. This is a descriptive study with qualitative approach, which had 10 nurses of the Family Health Strategy in São Paulo as subjects. The interviews were carried out between May and June 2013, and were adopted the technique of thematic content analysis and the referential of policy transfer. On the signification of this treatment, are related the senses of disciplinary monitoring, the bond and approximation to the context of patients' lives. Operationally, nurses, community health agents and nursing technicians stand out as agents of implementation of this policy, developing multiple actions of user embracement. The nurse is evidenced as an educator in health, leader in the family health team, and capable of creating emotional bond with users. It was found that the innovations proposed in the treatment are incipient in the daily work of nurses.

Integrated community-directed intervention for schistosomiasis and soil transmitted helminths in western Kenya – a pilot study

Directory of Open Access Journals (Sweden)

Mwinzi Pauline NM

2012-08-01

Full Text Available Abstract Background Schistosome and soil-transmitted helminth (STH infections are recognized as major global public health problems, causing severe and subtle morbidity, including significant educational and nutritional effects in children. Although effective and safe drugs are available, ensuring access to these drugs by all those at risk of schistosomiasis and STHs is still a challenge. Community-directed intervention (CDI has been used successfully for mass distribution of drugs for other diseases such as onchocerciasis and lymphatic filariasis. A national control programme is yet to be instituted in Kenya and evidence for cost-effective strategies for reaching most affected communities is needed. This study evaluated the effectiveness and feasibility of the CDI strategy in the control of schistosomiasis and STHs, in East Uyoma location, Rarieda district, a community of western Kenya that is highly endemic for both infections. Results Pre-treatment prevalence of S. mansoni averaged 17.4% (range 5-43% in the entire location. Treatment coverage in different villages ranged from 54.19 to 96.6% by community drug distributor (CDD records. Assessment from a household survey showed coverage of 52.3 -91.9% while the proportion of homesteads (home compounds covered ranged from 54.9-98.5%. Six months after one round of drug distribution, the prevalence levels of S. mansoni, hookworm and Trichuris trichura infections were reduced by 33.2%, 69.4% and 42.6% respectively. Conclusions This study shows that CDI is an accepted and effective strategy in the mass treatment of schistosomiasis and STH infections in resource constrained communities in Kenya and may be useful in similar communities elsewhere. A controlled trial comparing CDI and school based mass drug administration to demonstarte their relative advantages is ongoing.

From lithotroph- to organotroph-dominant: directional shift of microbial community in sulphidic tailings during phytostabilization

Science.gov (United States)

Li, Xiaofang; Bond, Philip L.; Van Nostrand, Joy D.; Zhou, Jizhong; Huang, Longbin

2015-01-01

Engineering microbial diversity to enhance soil functions may improve the success of direct revegetation in sulphidic mine tailings. Therefore, it is essential to explore how remediation and initial plant establishment can alter microbial communities, and, which edaphic factors control these changes under field conditions. A long-term revegetation trial was established at a Pb-Zn-Cu tailings impoundment in northwest Queensland. The control and amended and/or revegetated treatments were sampled from the 3-year-old trial. In total, 24 samples were examined using pyrosequencing of 16S rRNA genes and various chemical properties. The results showed that the microbial diversity was positively controlled by soil soluble Si and negatively controlled by soluble S, total Fe and total As, implying that pyrite weathering posed a substantial stress on microbial development in the tailings. All treatments were dominated by typical extremophiles and lithotrophs, typically Truepera, Thiobacillus, Rubrobacter; significant increases in microbial diversity, biomass and frequency of organotrophic genera (typically Nocardioides and Altererythrobacter) were detected in the revegetated and amended treatment. We concluded that appropriate phytostabilization options have the potential to drive the microbial diversity and community structure in the tailings toward those of natural soils, however, inherent environmental stressors may limit such changes. PMID:26268667

JPSS Science Data Services for the Direct Readout Community

Science.gov (United States)

Chander, Gyanesh; Lutz, Bob

2014-01-01

The Suomi National Polar-orbiting Partnership (S-NPP) and Joint Polar Satellite System (JPSS) High Rate Data (HRD) link provides Direct Broadcast data to users in real-time, utilizing their own remote field terminals. The Field Terminal Support (FTS) provides the resources needed to support the Direct Readout communities by providing software, documentation, and periodic updates to enable them to produce data products from SNPP and JPSS. The FTS distribution server will also provide the necessary ancillary and auxiliary data needed for processing the broadcasts, as well as making orbital data available to assist in locating the satellites of interest. In addition, the FTS provides development support for the algorithm and software through GSFC Direct Readout Laboratory (DRL) International Polar Orbiter Processing Package (IPOPP) and University of Wisconsin (UWISC) Community Satellite Processing Package (CSPP), to enable users to integrate the algorithms into their remote terminals. The support the JPSS Program provides to the institutions developing and maintaining these two software packages, will demonstrate the ability to produce ready-to-use products from the HRD link and provide risk reduction effort at a minimal cost. This paper discusses the key functions and system architecture of FTS.

Nursing performance in the policy transfer of directly observed treatment of tuberculosis

Directory of Open Access Journals (Sweden)

Káren Mendes Jorge de Souza

2014-10-01

Full Text Available Objective Analyzing the policy transfer of directly observed treatment of tuberculosis from the perspective of nursing. Method This is a descriptive study with qualitative approach, which had 10 nurses of the Family Health Strategy in São Paulo as subjects. The interviews were carried out between May and June 2013, and were adopted the technique of thematic content analysis and the referential of policy transfer. Results On the signification of this treatment, are related the senses of disciplinary monitoring, the bond and approximation to the context of patients’ lives. Operationally, nurses, community health agents and nursing technicians stand out as agents of implementation of this policy, developing multiple actions of user embracement. The nurse is evidenced as an educator in health, leader in the family health team, and capable of creating emotional bond with users. Conclusion It was found that the innovations proposed in the treatment are incipient in the daily work of nurses.

Assertive community treatment for elderly people with severe mental illness.

Science.gov (United States)

Stobbe, Jolanda; Mulder, Niels C L; Roosenschoon, Bert-Jan; Depla, Marja; Kroon, Hans

2010-10-19

Adults aged 65 and older with severe mental illnesses are a growing segment of the Dutch population. Some of them have a range of serious problems and are also difficult to engage. While assertive community treatment is a common model for treating difficult to engage severe mental illnesses patients, no special form of it is available for the elderly. A special assertive community treatment team for the elderly is developed in Rotterdam, the Netherlands and tested for its effectiveness. We will use a randomized controlled trial design to compare the effects of assertive community treatment for the elderly with those of care as usual. Primary outcome measures will be the number of dropouts, the number of patients engaged in care and patient's psychiatric symptoms, somatic symptoms, and social functioning. Secondary outcome measures are the number of unmet needs, the subjective quality of life and patients' satisfaction. Other secondary outcomes include the number of crisis contacts, rates of voluntary and involuntary admission, and length of stay. Inclusion criteria are aged 65 plus, the presence of a mental disorder, a lack of motivation for treatment and at least four suspected problems with functioning (addiction, somatic problems, daily living activities, housing etc.). If patients meet the inclusion criteria, they will be randomly allocated to either assertive community treatment for the elderly or care as usual. Trained assessors will use mainly observational instruments at the following time points: at baseline, after 9 and 18 months. This study will help establish whether assertive community treatment for the elderly produces better results than care as usual in elderly people with severe mental illnesses who are difficult to engage. When assertive community treatment for the elderly proves valuable in these respects, it can be tested and implemented more widely, and mechanisms for its effects investigated. The Netherlands National Trial Register NTR1620.

Inoculation effects on root-colonizing arbuscular mycorrhizal fungal communities spread beyond directly inoculated plants

Science.gov (United States)

Krak, Karol; Vosátka, Miroslav; Püschel, David; Štorchová, Helena

2017-01-01

Inoculation with arbuscular mycorrhizal fungi (AMF) may improve plant performance at disturbed sites, but inoculation may also suppress root colonization by native AMF and decrease the diversity of the root-colonizing AMF community. This has been shown for the roots of directly inoculated plants, but little is known about the stability of inoculation effects, and to which degree the inoculant and the inoculation-induced changes in AMF community composition spread into newly emerging seedlings that were not in direct contact with the introduced propagules. We addressed this topic in a greenhouse experiment based on the soil and native AMF community of a post-mining site. Plants were cultivated in compartmented pots with substrate containing the native AMF community, where AMF extraradical mycelium radiating from directly inoculated plants was allowed to inoculate neighboring plants. The abundances of the inoculated isolate and of native AMF taxa were monitored in the roots of the directly inoculated plants and the neighboring plants by quantitative real-time PCR. As expected, inoculation suppressed root colonization of the directly inoculated plants by other AMF taxa of the native AMF community and also by native genotypes of the same species as used for inoculation. In the neighboring plants, high abundance of the inoculant and the suppression of native AMF were maintained. Thus, we demonstrate that inoculation effects on native AMF propagate into plants that were not in direct contact with the introduced inoculum, and are therefore likely to persist at the site of inoculation. PMID:28738069

Inoculation effects on root-colonizing arbuscular mycorrhizal fungal communities spread beyond directly inoculated plants.

Directory of Open Access Journals (Sweden)

Martina Janoušková

Full Text Available Inoculation with arbuscular mycorrhizal fungi (AMF may improve plant performance at disturbed sites, but inoculation may also suppress root colonization by native AMF and decrease the diversity of the root-colonizing AMF community. This has been shown for the roots of directly inoculated plants, but little is known about the stability of inoculation effects, and to which degree the inoculant and the inoculation-induced changes in AMF community composition spread into newly emerging seedlings that were not in direct contact with the introduced propagules. We addressed this topic in a greenhouse experiment based on the soil and native AMF community of a post-mining site. Plants were cultivated in compartmented pots with substrate containing the native AMF community, where AMF extraradical mycelium radiating from directly inoculated plants was allowed to inoculate neighboring plants. The abundances of the inoculated isolate and of native AMF taxa were monitored in the roots of the directly inoculated plants and the neighboring plants by quantitative real-time PCR. As expected, inoculation suppressed root colonization of the directly inoculated plants by other AMF taxa of the native AMF community and also by native genotypes of the same species as used for inoculation. In the neighboring plants, high abundance of the inoculant and the suppression of native AMF were maintained. Thus, we demonstrate that inoculation effects on native AMF propagate into plants that were not in direct contact with the introduced inoculum, and are therefore likely to persist at the site of inoculation.

Abundance and composition of indigenous bacterial communities in a multi-step biofiltration-based drinking water treatment plant.

Science.gov (United States)

Lautenschlager, Karin; Hwang, Chiachi; Ling, Fangqiong; Liu, Wen-Tso; Boon, Nico; Köster, Oliver; Egli, Thomas; Hammes, Frederik

2014-10-01

Indigenous bacterial communities are essential for biofiltration processes in drinking water treatment systems. In this study, we examined the microbial community composition and abundance of three different biofilter types (rapid sand, granular activated carbon, and slow sand filters) and their respective effluents in a full-scale, multi-step treatment plant (Zürich, CH). Detailed analysis of organic carbon degradation underpinned biodegradation as the primary function of the biofilter biomass. The biomass was present in concentrations ranging between 2-5 × 10(15) cells/m(3) in all filters but was phylogenetically, enzymatically and metabolically diverse. Based on 16S rRNA gene-based 454 pyrosequencing analysis for microbial community composition, similar microbial taxa (predominantly Proteobacteria, Planctomycetes, Acidobacteria, Bacteriodetes, Nitrospira and Chloroflexi) were present in all biofilters and in their respective effluents, but the ratio of microbial taxa was different in each filter type. This change was also reflected in the cluster analysis, which revealed a change of 50-60% in microbial community composition between the different filter types. This study documents the direct influence of the filter biomass on the microbial community composition of the final drinking water, particularly when the water is distributed without post-disinfection. The results provide new insights on the complexity of indigenous bacteria colonizing drinking water systems, especially in different biofilters of a multi-step treatment plant. Copyright © 2014 Elsevier Ltd. All rights reserved.

A collaborative community-based treatment program for offenders with mental illness.

Science.gov (United States)

Roskes, E; Feldman, R

1999-12-01

The paper describes initial results of collaboration between a mental health treatment program at a community mental health center in Baltimore and a probation officer of the U.S. federal prison system to serve the mental health needs of offenders on federal probation, parole, supervised release, or conditional release in the community. A forensic psychiatrist in the treatment program and a licensed social worker in the probation office facilitate the close working relationship between the agencies. Treatment services provided or brokered by the community mental health center staff include psychiatric and medical treatment, intensive case management, addictions treatment, urine toxicology screening, psychosocial or residential rehabilitation services, intensive outpatient care, partial hospitalization, and inpatient treatment. Among the 16 offenders referred for treatment during the first 24 months of the collaborative program, 14 were male and 14 were African American. Three of the 16 violated the terms of their release due to noncompliance with stipulated mental health treatment; only one of the three had been successfully engaged in treatment. One patient died, two completed their terms of supervision, and ten remained in treatment at the time of the report. The major strength of this collaboration is the cooperation of the treatment and monitoring agencies with the overall goal of maintaining the offender in the community. Further research is needed to confirm the effectiveness of the clinical model in reducing recidivism and retaining clients.

Cognitive adaptation training combined with assertive community treatment

DEFF Research Database (Denmark)

Hansen, Jens Peter; Østergaard, Birte; Nordentoft, Merete

2012-01-01

Cognitive adaptation training (CAT) targets the adaptive behaviour of patients with schizophrenia and has shown promising results regarding the social aspects of psychosocial treatment. As yet, no reports have appeared on the use of CAT in combination with assertive community treatment (ACT). Our...

Microbial Community Profiles in Wastewaters from Onsite Wastewater Treatment Systems Technology.

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Łukasz Jałowiecki

Full Text Available The aim of the study was to determine the potential of community-level physiological profiles (CLPPs methodology as an assay for characterization of the metabolic diversity of wastewater samples and to link the metabolic diversity patterns to efficiency of select onsite biological wastewater facilities. Metabolic fingerprints obtained from the selected samples were used to understand functional diversity implied by the carbon substrate shifts. Three different biological facilities of onsite wastewater treatment were evaluated: fixed bed reactor (technology A, trickling filter/biofilter system (technology B, and aerated filter system (the fluidized bed reactor, technology C. High similarities of the microbial community functional structures were found among the samples from the three onsite wastewater treatment plants (WWTPs, as shown by the diversity indices. Principal components analysis (PCA showed that the diversity and CLPPs of microbial communities depended on the working efficiency of the wastewater treatment technologies. This study provided an overall picture of microbial community functional structures of investigated samples in WWTPs and discerned the linkages between microbial communities and technologies of onsite WWTPs used. The results obtained confirmed that metabolic profiles could be used to monitor treatment processes as valuable biological indicators of onsite wastewater treatment technologies efficiency. This is the first step toward understanding relations of technology types with microbial community patterns in raw and treated wastewaters.

Assertive Community Treatment (ACT) – metodebeskrivelse

DEFF Research Database (Denmark)

Benjaminsen, Lars; Kirkedal Nielsen, Ian; Møller, mikkel Stamp

2017-01-01

arbejde med ACT-metoden over for en målgruppe med psykiske vanskeligheder og samtidigt misbrug i en dansk kommunal kontekst. Denne manual beskriver således vigtige elementer i Assertive Community Treatment (ACT) metoden henvendt til personer med psykiske vanskeligheder og samtidigt misbrug, som det har...

Assertive community treatment for elderly people with severe mental illness

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Mulder Niels CL

2010-10-01

Full Text Available Abstract Background Adults aged 65 and older with severe mental illnesses are a growing segment of the Dutch population. Some of them have a range of serious problems and are also difficult to engage. While assertive community treatment is a common model for treating difficult to engage severe mental illnesses patients, no special form of it is available for the elderly. A special assertive community treatment team for the elderly is developed in Rotterdam, the Netherlands and tested for its effectiveness. Methods We will use a randomized controlled trial design to compare the effects of assertive community treatment for the elderly with those of care as usual. Primary outcome measures will be the number of dropouts, the number of patients engaged in care and patient's psychiatric symptoms, somatic symptoms, and social functioning. Secondary outcome measures are the number of unmet needs, the subjective quality of life and patients' satisfaction. Other secondary outcomes include the number of crisis contacts, rates of voluntary and involuntary admission, and length of stay. Inclusion criteria are aged 65 plus, the presence of a mental disorder, a lack of motivation for treatment and at least four suspected problems with functioning (addiction, somatic problems, daily living activities, housing etc.. If patients meet the inclusion criteria, they will be randomly allocated to either assertive community treatment for the elderly or care as usual. Trained assessors will use mainly observational instruments at the following time points: at baseline, after 9 and 18 months. Discussion This study will help establish whether assertive community treatment for the elderly produces better results than care as usual in elderly people with severe mental illnesses who are difficult to engage. When assertive community treatment for the elderly proves valuable in these respects, it can be tested and implemented more widely, and mechanisms for its effects

Self-Stigma and Quality of Life among People with Mental Illness Who Receive Compulsory Community Treatment Services

Science.gov (United States)

Livingston, James

2012-01-01

The present study was designed to examine the relationship between self-stigma and quality of life over a one year time period for 71 people with mental illness who were receiving compulsory community mental health treatment. It was hypothesized that, over time, self-stigma would have the direct effect of eroding quality of life among people with…

28 CFR 550.56 - Community Transitional Drug Abuse Treatment Program (TDAT).

Science.gov (United States)

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Community Transitional Drug Abuse... JUSTICE INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.56 Community Transitional Drug Abuse Treatment Program (TDAT). (a) For inmates to successfully complete all components of...

Helping patients to reach decisions regarding their treatment: Do 'non-directive' approaches cause systematic bias?

Science.gov (United States)

MacInnes, Joy Anne; Salkovskis, Paul M; Wroe, Abigail; Hope, Tony

2015-11-01

Many patients want help in considering medical information relevant to treatment decisions they have to make or agree to. The present research investigated whether focussing on particular issues relevant to a medical treatment decision (using an apparently non-directive procedure) could systematically bias a treatment decision. In a randomized design, participants (community volunteers, n = 146) were given standard information about treatment of cardiac risk factors by medication (statins). There were four experimental interventions in which the participants focussed on the likely personal relevance of subsets of the information previously given (positive, negative, or mixed aspects) or on irrelevant information. Participants were asked to rate their anticipated likelihood of accepting treatment before and after the experimental intervention. The rating of acceptance of treatment was significantly increased by positive focussing; negative focussing did not significantly alter the decision rating. The results partially replicate similar studies in health screening decisions. Reasons for the differences in results from those obtained in screening studies are considered. It is suggested that negative focussing may have less effect in decisions in which there are few risks. Statement of contribution What is already known on this subject? Decision-making in the context of health behaviour change has been widely described, but there are few experimental studies testing hypothesised strategies. 'Non-directiveness' is often regarded as desirable because it supposedly allows exploration of the decision without influencing it. Previous studies on health screening (but not treatment) have shown that health decision outcomes can be systematically influenced by the way in which a 'non-directive' intervention is implemented. This can be accounted for by a modified subjective expected utility theory previously applied to both health screening and child vaccination decisions. What

[Involuntary treatment of mental patients in the community: legal and ethical dilemmas].

Science.gov (United States)

Mitrossili, M

2014-01-01

This article focuses on the measure of involuntary treatment of mental patients in the community, not only with regard to human rights and more specifically those of persons with mental disorders, but also with regard to ethics and deontology in mental healthcare delivery service. In this light, the important role of informed consent in psychiatry with regard to the psychiatric act is examined. Informed consent of mental patients in treatment when they are in need of voluntary or involuntary hospitalization is further examined, while emphasis is being put on the case of involuntary treatment. The Convention for Human Rights and Biomedicine (Convention of Οviedo), the European Convention of Human Rights, other documents of International Organizations (UN) and specialized national legislation (A. 2071/1992, Chapter vi, Greek law) constitute basic reference and interpretation points. The examination of consent and the demarcation of the exceptions are important issues that need to be approached. More particularly, our interest lies with the article 7 of the Convention for Human Rights and Biomedicine, which specifically refers to the protection of person who suffers from a mental disorder. The opinion that informed consent in psychiatric treatment and involuntary treatment are concepts and processes which are distinct but not always mutually exclusive is enhanced. In any case, involuntary treatment causes major dilemmas as far as informed consent in the psychiatric act is concerned, as it raises issues that affect the autonomy of the person. Today, however, there are many factors which influence public politics towards the adoption of the measure of involuntary treatment within the community. How is it that this paradoxical link is legitimized and justified: involuntary treatment and community? The enactment of the above mentioned measure in many European and North American countries has created new paths in the practice of contemporary psychiatry. Nonetheless, it

Treatment Seeking and Ebola Community Care Centers in Sierra Leone: A Qualitative Study.

Science.gov (United States)

Carter, Simone E; O'Reilly, Marion; Frith-Powell, Jack; Umar Kargbo, Alpha; Byrne, Daniel; Niederberger, Eva

2017-01-01

Ebola Treatment Units were able to provide only 60% of necessary treatment beds in Sierra Leone. As a result, the Government of Sierra Leone decided to construct Community Care Centers. These were intended to increase treatment-seeking behavior and reduce the community-level spread of Ebola by facilitating access to care closer to communities. Through qualitative data collection in 3 districts, this study seeks to understand the perceived impact that proximity to such Centers had on treatment-seeking behavior. Feedback from community members and Community Health Volunteers indicates that proximity to treatment reduced fears, especially those arising from the use of ambulances, lack of familiarity with medical Centers, and loss of contact with family members taken for treatment. Participants report that having a Center close to their home enables them to walk to treatment and witness survivors being discharged. Living close to Centers also enables communities to be involved in their design and daily operation, helping to build trust in them as acceptable treatment facilities. Further research is required to understand the appropriate design, operation, and epidemiological impact of Centers. Further investigation should incorporate the effect of an outbreak's severity and the stage (duration) of the outbreak on potential acceptance of Centers.

Developing Community Reinforcement and Family Training (CRAFT) for Parents of Treatment-Resistant Adolescents

Science.gov (United States)

Kirby, Kimberly C.; Versek, Brian; Kerwin, MaryLouise E.; Meyers, Kathleen; Benishek, Lois A.; Bresani, Elena; Washio, Yukiko; Arria, Amelia; Meyers, Robert J.

2015-01-01

We describe a project focused on training parents to facilitate their treatment-resistant adolescent's treatment entry and to manage their child after entry into community-based treatment. Controlled studies show that Community Reinforcement and Family Training (CRAFT) is a unilateral treatment that fosters treatment entry of adults; however,…

Diagnosis and Treatment of Community-Acquired Pneumonia in Children

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I.A. Karymdzhanov

2016-02-01

The initial antibiotic therapy of community-acquired pneumonia is carried out empirically. In the treatment of severe community-acquired pneumonia in children from 2 months to 5 years, the drug of choice is amoxicillin orally. Macrolides are the drugs of choice for children aged 5 to 16 years. In severe pneumonia, drugs of choice are amoxicillin clavulanate, 2nd–4th generation cephalosporins. In general, the duration of antibiotic therapy in the community-acquired pneumonia caused by typical bacteria is 7–10 days, by atypical bacteria — 10–14 days. In the real clinical practice, the errors associated with the choice of drug, route of administration, dosage, regimen of application, length of treatment are frequent during antibacterial therapy.

Do treatment manuals undermine youth–therapist alliance in community clinical practice?

OpenAIRE

Langer, David A.; McLeod, Bryce D.; Weisz, John R

2011-01-01

Objective: Some critics of treatment manuals have argued that their use may undermine the quality of the client–therapist alliance. This notion was tested in the context of youth psychotherapy delivered by therapists in community clinics. Method: Seventy-six clinically referred youths (57% female, age 8–15 years, 34% Caucasian) were randomly assigned to receive nonmanualized usual care or manual-guided treatment to address anxiety or depressive disorders. Treatment was provided in community c...

Identifying barriers to mental health system improvements: an examination of community participation in assertive community treatment programs

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Wakefield Patricia A

2011-11-01

Full Text Available Abstract Background Integrating the best available evidence into program standards is essential if system-wide improvements in the delivery of community-based mental health services are to be achieved. Since the beginning of the Assertive Community Treatment (ACT program movement, program standards have included a role for the community. In particular, ACT program standards have sought to ensure that members of the local community are involved in governance and that former clients participate in service delivery as "Peer Support Specialists". This paper reports on the extent to which ACT program standards related to community participation have been implemented and identifies barriers to full compliance. Methods Qualitative and quantitative data were collected through a telephone survey of ACT Program Coordinators in Ontario, Canada, using a census sample of the existing 66 ACT programs. A thematic approach to content analysis was used to analyze respondents' qualitative comments. Quantitative data were analyzed using SPSS 16.0 and included means, frequencies, independent t-tests and Pearson Correlations. Results An 85% response rate was achieved. Of the 33 program standards, the two that received the lowest perceived compliance ratings were the two standards directly concerning community participation. Specifically, the standard to have a functioning Community Advisory Body and the standard requiring the inclusion of a Peer Support Specialist. The three major themes that emerged from the survey data with respect to the barriers to fully implementing the Community Advisory Body were: external issues; standard related issues; and, organizational/structural related issues. The three major themes concerning barriers to implementing the Peer Support Specialist role were: human resource related issues; organizational/structural related issues; and, standard related issues. Conclusions The reasons for low compliance of ACT programs with community

Influence of technological treatments on bacterial communities in ...

African Journals Online (AJOL)

Influence of technological treatments on bacterial communities in tilapia ( Oreochromis niloticus ) as determined by 16S rDNA fingerprinting using polymerase chain reaction-denaturing gradient gel electrophoresis (PCR-DGGE)

Community Trial of a Comprehensive Psychosocial Treatment for HFASDs

Science.gov (United States)

Lopata, Christopher; Toomey, Jennifer A.; Thomeer, Marcus L.; McDonald, Christin A.; Fox, Jeffery D.; Smith, Rachael A.; Meichenbaum, David L.; Volker, Martin A.; Lee, Gloria K.; Lipinski, Alanna M.

2015-01-01

This community effectiveness trial examined the feasibility and efficacy of a comprehensive psychosocial treatment for 28 children, aged 7 to 10 years with high-functioning autism spectrum disorders (HFASDs). Treatment included instruction and therapeutic activities targeting social skills, face-emotion recognition skills, interest expansion, and…

Effect of Copper Treatment on the Composition and Function of the Bacterial Community in the Sponge Haliclona cymaeformis

KAUST Repository

Tian, R.-M.

2014-11-04

treatment on the community structure and functional gene composition, revealing that copper treatment had a selective effect on the functions of the bacterial community in the sponge. These findings suggest that copper pollution has an ecological impact on the sponge symbiont. The analysis showed that the untreated sponges hosted symbiotic autotrophic bacteria as dominant species, and the high-concentration copper treatment enriched for a heterotrophic bacterial community with enrichment for genes important for bacterial motility, supplementary cellular components, signaling and regulation, and virulence. Microscopic observation showed obvious bacterial aggregation and a reduction of sponge cell numbers in treated sponges, which suggested the formation of aggregates to reduce the copper concentration. The enrichment for functions of directional bacterial movement and supplementary cellular components and the formation of bacterial aggregates and phage enrichment are novel findings in sponge studies.

Correlates of substance abuse treatment completion among disadvantaged communities in Cape Town, South Africa

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Pasche Sonja

2010-03-01

Full Text Available Abstract Background Completion of substance abuse treatment is a proximal indicator of positive treatment outcomes. To design interventions to improve outcomes, it is therefore important to unpack the factors contributing to treatment completion. To date, substance abuse research has not examined the factors associated with treatment completion among poor, disadvantaged communities in developing countries. This study aimed to address this gap by exploring client-level factors associated with treatment completion among poor communities in South Africa. Methods Secondary data analysis was conducted on cross-sectional survey data collected from 434 persons residing in poor communities in Cape Town, South Africa who had accessed substance abuse treatment in 2006. Results Multiple regression analyses revealed that therapeutic alliance, treatment perceptions, abstinence-specific social support, and depression were significant partial predictors of treatment completion. Conclusions Findings suggest that treatment completion rates of individuals from poor South African communities can be enhanced by i improving perceptions of substance abuse treatment through introducing quality improvement initiatives into substance abuse services, ii strengthening clients' abstinence-oriented social networks and, iii strengthening the counselor-client therapeutic alliance.

Antiretroviral treatment for HIV in rural Uganda: two-year treatment outcomes of a prospective health centre/community-based and hospital-based cohort.

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Walter Kipp

Full Text Available In sub-Saharan Africa, a shortage of trained health professionals and limited geographical access to health facilities present major barriers to the expansion of antiretroviral therapy (ART. We tested the utility of a health centre (HC/community-based approach in the provision of ART to persons living with HIV in a rural area in western Uganda.The HIV treatment outcomes of the HC/community-based ART program were evaluated and compared with those of an ART program at a best-practice regional hospital. The HC/community-based cohort comprised 185 treatment-naïve patients enrolled in 2006. The hospital cohort comprised of 200 patients enrolled in the same time period. The HC/community-based program involved weekly home visits to patients by community volunteers who were trained to deliver antiretroviral drugs to monitor and support adherence to treatment, and to identify and report adverse reactions and other clinical symptoms. Treatment supporters in the homes also had the responsibility to remind patients to take their drugs regularly. ART treatment outcomes were measured by HIV-1 RNA viral load (VL after two years of treatment. Adherence was determined through weekly pill counts.Successful ART treatment outcomes in the HC/community-based cohort were equivalent to those in the hospital-based cohort after two years of treatment in on-treatment analysis (VL≤400 copies/mL, 93.0% vs. 87.3%, p = 0.12, and in intention-to-treat analysis (VL≤400 copies/mL, 64.9% and 62.0%, p = 0.560. In multivariate analysis patients in the HC/community-based cohort were more likely to have virologic suppression compared to hospital-based patients (adjusted OR = 2.47, 95% CI 1.01-6.04.Acceptable rates of virologic suppression were achieved using existing rural clinic and community resources in a HC/community-based ART program run by clinical officers and supported by lay volunteers and treatment supporters. The results were equivalent to those of a

Self-Directed Gambling Changes: Trajectory of Problem Gambling Severity in Absence of Treatment.

Science.gov (United States)

Kushnir, Vladyslav; Godinho, Alexandra; Hodgins, David C; Hendershot, Christian S; Cunningham, John A

2018-03-27

Most problem gamblers do not seek formal treatment, recovering on their own through cognitive re-appraisal or self-help strategies. Although barriers to treatment have been extensively studied, there is a paucity of research on self-directed changes in problem gambling and very few studies have examined these changes prospectively. The aim of this study was to examine the trajectory of gambling severity and behavior change over an 18-month period, among a sample of non-treatment seeking/attending problem gamblers recruited from the community (N = 204) interested in quitting or reducing gambling. Separate mixed effects models revealed that in absence of formal treatment, significant reductions in gambling severity, frequency, and amount gambled could be observed over the course of a 6 to 9-month period and that changes experienced within the first 12 months were maintained for an extended 6 months. Problem gambling severity at baseline was significantly associated with changes in severity over time, such that participants with more severe gambling problems demonstrated greater reductions in their gambling severity over time. A total of 11.1% of participants gambled within a low-risk threshold at 18 months, although 28.7% of the sample reported consecutive gambling severity scores below problem levels for the duration of 1 year or longer. The findings suggest that among problem gamblers motivated to quit or reduce their gambling, significant self-directed changes in gambling severity can occur over a relatively short time. Additional prospective studies are needed to document the role of specific self-help tools or thought processes in exacting gambling changes.

Direction of Attentional Focus in Biofeedback Treatment for /R/ Misarticulation

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McAllister Byun, Tara; Swartz, Michelle T.; Halpin, Peter F.; Szeredi, Daniel; Maas, Edwin

2016-01-01

Background: Maintaining an external direction of focus during practice is reported to facilitate acquisition of non-speech motor skills, but it is not known whether these findings also apply to treatment for speech errors. This question has particular relevance for treatment incorporating visual biofeedback, where clinician cueing can direct the…

Using growth-based methods to determine direct effects of salinity on soil microbial communities

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Rath, Kristin; Rousk, Johannes

2015-04-01

Soil salinization is a widespread agricultural problem and increasing salt concentrations in soils have been found to be correlated with decreased microbial activity. A central challenge in microbial ecology is to link environmental factors, such as salinity, to responses in the soil microbial community. That is, it can be difficult to distinguish direct from indirect effects. In order to determine direct salinity effects on the community we employed the ecotoxicological concept of Pollution-Induced Community Tolerance (PICT). This concept is built on the assumption that if salinity had an ecologically relevant effect on the community, it should have selected for more tolerant species and strains, resulting in an overall higher community tolerance to salt in communities from saline soils. Growth-based measures, such as the 3H-leucine incorporation into bacterial protein , provide sensitive tools to estimate community tolerance. They can also provide high temporal resolution in tracking changes in tolerance over time. In our study we used growth-based methods to investigate: i) at what levels of salt exposure and over which time scales salt tolerance can be induced in a non-saline soil, and (ii) if communities from high salinity sites have higher tolerance to salt exposure along natural salinity gradients. In the first part of the study, we exposed a non-saline soil to a range of salinities and monitored the development of community tolerance over time. We found that community tolerance to intermediate salinities up to around 30 mg NaCl per g soil can be induced at relatively short time scales of a few days, providing evidence that microbial communities can adapt rapidly to changes in environmental conditions. In the second part of the study we used soil samples originating from natural salinity gradients encompassing a wide range of salinity levels, with electrical conductivities ranging from 0.1 dS/m to >10 dS/m. We assessed community tolerance to salt by

Microbial Communities Shaped by Treatment Processes in a Drinking Water Treatment Plant and Their Contribution and Threat to Drinking Water Safety

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Li, Qi; Yu, Shuili; Li, Lei; Liu, Guicai; Gu, Zhengyang; Liu, Minmin; Liu, Zhiyuan; Ye, Yubing; Xia, Qing; Ren, Liumo

2017-01-01

Bacteria play an important role in water purification in drinking water treatment systems. On one hand, bacteria present in the untreated water may help in its purification through biodegradation of the contaminants. On the other hand, some bacteria may be human pathogens and pose a threat to consumers. The present study investigated bacterial communities using Illumina MiSeq sequencing of 16S rRNA genes and their functions were predicted using PICRUSt in a treatment system, including the biofilms on sand filters and biological activated carbon (BAC) filters, in 4 months. In addition, quantitative analyses of specific bacterial populations were performed by real-time quantitative polymerase chain reaction (qPCR). The bacterial community composition of post-ozonation effluent, BAC effluent and disinfected water varied with sampling time. However, the bacterial community structures at other treatment steps were relatively stable, despite great variations of source water quality, resulting in stable treatment performance. Illumina MiSeq sequencing illustrated that Proteobacteria was dominant bacterial phylum. Chlorine disinfection significantly influenced the microbial community structure, while other treatment processes were synergetic. Bacterial communities in water and biofilms were distinct, and distinctions of bacterial communities also existed between different biofilms. By contrast, the functional composition of biofilms on different filters were similar. Some functional genes related to pollutant degradation were found widely distributed throughout the treatment processes. The distributions of Mycobacterium spp. and Legionella spp. in water and biofilms were revealed by real-time quantitative polymerase chain reaction (qPCR). Most bacteria, including potential pathogens, could be effectively removed by chlorine disinfection. However, some bacteria presented great resistance to chlorine. qPCRs showed that Mycobacterium spp. could not be effectively removed by

Real-world outcomes of unrestricted direct-acting antiviral treatment for hepatitis C in Australia: The South Australian statewide experience.

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Haridy, James; Wigg, Alan; Muller, Kate; Ramachandran, Jeyamani; Tilley, Emma; Waddell, Victoria; Gordon, David; Shaw, David; Huynh, Dep; Stewart, Jeffrey; Nelson, Renjy; Warner, Morgyn; Boyd, Mark; Chinnaratha, Mohamed A; Harding, Damian; Ralton, Lucy; Colman, Anton; Liew, Danny; Iyngkaran, Guru; Tse, Edmund

2018-06-11

In March 2016, the Australian government offered unrestricted access to direct-acting antiviral (DAA) therapy for chronic hepatitis C (HCV) to the entire population. This included prescription by any medical practitioner in consultation with specialists until sufficient experience was attained. We sought to determine the outcomes and experience over the first twelve-months for the entire state of South Australia. We performed a prospective, observational study following outcomes of all treatments associated with the state's four main tertiary centres. 1909 subjects initiating DAA therapy were included, representing an estimated 90% of all treatments in the state. Overall, SVR12 was 80.4% in all subjects intended for treatment and 95.7% in those completing treatment and follow-up. 14.2% were lost to follow-up (LTFU) and did not complete SVR12 testing. LTFU was independently associated with community treatment via remote consultation (OR 1.50, 95% CI 1.04-2.18, p=0.03), prison-based treatment (OR 2.02, 95% CI 1.08-3.79, p=0.03) and younger age (OR 0.98, 95% CI 0.97-0.99, p=0.05). Of the 1534 subjects completing treatment and follow-up, decreased likelihood of SVR12 was associated with genotype 2 (OR 0.23,95% CI 0.07-0.74, p=0.01) and genotype 3 (OR 0.23 95% CI 0.12-0.43, p=<0.01). A significant decrease in treatment initiation was observed over the twelve-month period in conjunction with a shift from hospital to community-based treatment. Our findings support the high responses observed in clinical trials, however a significant gap exists in SVR12 in our real-world cohort due to LTFU. A declining treatment initiation rate and shift to community-based treatment highlights the need to explore additional strategies to identify, treat and follow-up remaining patients in order to achieve elimination targets. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Direct versus Indirect Treatment for Preschool Children who Stutter: The RESTART Randomized Trial.

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Caroline de Sonneville-Koedoot

Full Text Available Stuttering is a common childhood disorder. There is limited high quality evidence regarding options for best treatment. The aim of the study was to compare the effectiveness of direct treatment with indirect treatment in preschool children who stutter.In this multicenter randomized controlled trial with an 18 month follow-up, preschool children who stutter who were referred for treatment were randomized to direct treatment (Lidcombe Program; n = 99 or indirect treatment (RESTART-DCM treatment; n = 100. Main inclusion criteria were age 3-6 years, ≥3% syllables stuttered (%SS, and time since onset ≥6 months. The primary outcome was the percentage of non-stuttering children at 18 months. Secondary outcomes included stuttering frequency (%SS, stuttering severity ratings by the parents and therapist, severity rating by the child, health-related quality of life, emotional and behavioral problems, and speech attitude.Percentage of non-stuttering children for direct treatment was 76.5% (65/85 versus 71.4% (65/91 for indirect treatment (Odds Ratio (OR, 0.6; 95% CI, 0.1-2.4, p = .42. At 3 months, children treated by direct treatment showed a greater decline in %SS (significant interaction time x therapy: β = -1.89; t(282.82 = -2.807, p = .005. At 18 months, stuttering frequency was 1.2% (SD 2.1 for direct treatment and 1.5% (SD 2.1 for indirect treatment. Direct treatment had slightly better scores on most other secondary outcome measures, but no differences between treatment approaches were significant.Direct treatment decreased stuttering more quickly during the first three months of treatment. At 18 months, however, clinical outcomes for direct and indirect treatment were comparable. These results imply that at 18 months post treatment onset, both treatments are roughly equal in treating developmental stuttering in ways that surpass expectations of natural recovery. Follow-up data are needed to confirm these findings in the longer term

Collembola and macroarthropod community responses to carbamate, organophosphate and synthetic pyrethroid insecticides: Direct and indirect effects

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Frampton, Geoff K. [Ecology and Evolutionary Biology Group, School of Biological Sciences, University of Southampton, Bassett Crescent East, Southampton SO16 7PX (United Kingdom)]. E-mail: gkf@soton.ac.uk; Brink, Paul J. van den [Alterra, Wageningen University and Research Centre, P.O. Box 47, 6700 AA Wageningen (Netherlands); Wageningen University, Department of Aquatic Ecology and Water Quality Management, Wageningen University and Research Centre, P.O. Box 8080, 6700 DD Wageningen (Netherlands)

2007-05-15

Non-target effects on terrestrial arthropod communities of the broad-spectrum insecticides chlorpyrifos and cypermethrin and the selective insecticide pirimicarb were investigated in winter wheat fields in summer. Effects of chlorpyrifos on arthropod abundance and taxonomic richness were consistently negative whereas effects of cypermethrin were negative for predatory arthropods but positive for soil surface Collembola. Pirimicarb effects were marginal, primarily on aphids and their antagonists, with no effect on the Collembola community. Collembola-predator ratios were significantly higher following cypermethrin treatment, suggesting that cypermethrin-induced increases in collembolan abundance represent a classical resurgence. Observations in other studies suggest Collembola resurgences may be typical after synthetic pyrethroid applications. Collembola responses to insecticides differed among species, both in terms of effect magnitude and persistence, suggesting that coarse taxonomic monitoring would not adequately detect pesticide risks. These findings have implications for pesticide risk assessments and for the selection of indicator species. - Direct and indirect insecticide effects differ among closely-related arthropod taxa; resurgence of Collembola may occur widely after synthetic pyrethroid insecticide applications.

Collembola and macroarthropod community responses to carbamate, organophosphate and synthetic pyrethroid insecticides: Direct and indirect effects

International Nuclear Information System (INIS)

Frampton, Geoff K.; Brink, Paul J. van den

2007-01-01

Non-target effects on terrestrial arthropod communities of the broad-spectrum insecticides chlorpyrifos and cypermethrin and the selective insecticide pirimicarb were investigated in winter wheat fields in summer. Effects of chlorpyrifos on arthropod abundance and taxonomic richness were consistently negative whereas effects of cypermethrin were negative for predatory arthropods but positive for soil surface Collembola. Pirimicarb effects were marginal, primarily on aphids and their antagonists, with no effect on the Collembola community. Collembola-predator ratios were significantly higher following cypermethrin treatment, suggesting that cypermethrin-induced increases in collembolan abundance represent a classical resurgence. Observations in other studies suggest Collembola resurgences may be typical after synthetic pyrethroid applications. Collembola responses to insecticides differed among species, both in terms of effect magnitude and persistence, suggesting that coarse taxonomic monitoring would not adequately detect pesticide risks. These findings have implications for pesticide risk assessments and for the selection of indicator species. - Direct and indirect insecticide effects differ among closely-related arthropod taxa; resurgence of Collembola may occur widely after synthetic pyrethroid insecticide applications

TAX TREATMENT SPECIFIC TO INTRA COMMUNITY COMMERCIAL BUSINESS TRANSACTIONS - ACQUISITION AND INTRA-COMMUNITY SUPPLY OF GOODS

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Paliu -Popa Lucia

2009-11-01

Full Text Available Romania's accession to the European Union has imposed harmonize national legislation with Community law, registering significant changes in the tax area, particularly on value added tax. In order to determine the person liable to pay value added tax, related to intra-community commercial transactions, must to clarify tax matters for those operations. Given the complexity of intra-community commercial transactions and their taxation, in the following issues we will address the intra-community trade in goods, with reference to specific tax treatment of supplies and intra-community acquisitions of goods. To do this we will consider more specific situations that arise in trade relationship between EU Member States, examples that will allow us to draw some conclusions on tax matters arising in intracommunity commercial relationship

Perceptions of coercion in the community: a qualitative study of patients in a Danish assertive community treatment team

DEFF Research Database (Denmark)

Thøgersen, Marie Høgh; Morthorst, Britt; Nordentoft, Merete

2010-01-01

Assertive community treatment (ACT) has been claimed to be paternalistic and coercive, yet little is known about how patients experience the assertive aspects of ACT. To explore views on--and perceptions of--coercion of patients in Danish assertive community teams. In-depth interviews were...

Gambling severity, impulsivity, and psychopathology: comparison of treatment- and community-recruited pathological gamblers.

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Knezevic, Bojana; Ledgerwood, David M

2012-01-01

Because most studies of pathological gambling gather data from participants recruited from treatment, this study compared community and treatment-enrolled pathological gamblers (PGs) with respect to demographics, gambling severity, impulsivity, and psychopathology. One hundred six PGs were recruited as part of two larger studies in Farmington, Connecticut (n= 61) and Windsor, Ontario (n= 45) using radio advertising, word of mouth, and/or newspaper ads, as well as a gambling treatment program at each location. Community (n= 49) and treatment-enrolled (n= 57) PGs did not differ on age, education, gender, race, employment, or marital status. Treatment-enrolled PGs were more likely to report past year illegal behaviors, preoccupation with gambling, and higher scores on the Barratt Impulsiveness Scale (BIS) Attention Impulsivity subscale. Assessment of psychopathology in the Ontario study indicated that treatment-enrolled PGs were more likely to present with Major Depressive and Dysthymic Disorders. Community-recruited PGs in the Connecticut study were overall more likely to present with any substance use disorder relative to their treatment-enrolled counterparts. Our findings inform intervention and research within the field of pathological gambling. Specifically, the distressing aspects of pathological gambling, such as legal issues, preoccupation with gambling, and depression, may be present more in treatment-enrolled PGs than in those recruited from the community. Such emotional disturbances should be further explored to increase motivation and treatment adherence in PGs. In addition, due to relative absence of overall differences between the groups, research findings utilizing treatment-enrolled PGs may be a good representation of both groups. Copyright © American Academy of Addiction Psychiatry.

Individual cognitive-behavioral therapy and behavioral couples therapy in alcohol use disorder: a comparative evaluation in community-based addiction treatment centers.

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Vedel, Ellen; Emmelkamp, Paul M G; Schippers, Gerard M

2008-01-01

Alcohol abuse serves as a chronic stressor between partners and has a deleterious effect on relationship functioning. Behavioral Couples Therapy (BCT) for alcohol dependence, studied as an adjunct to individual outpatient counseling, has shown to be effective in decreasing alcohol consumption and enhancing marital functioning, but no study has directly tested the comparative effectiveness of stand-alone BCT versus an individually focused cognitive-behavioral therapy (CBT) in a clinical community sample. The present study is a randomized clinical trial evaluating the effectiveness of stand-alone BCT (n = 30) compared to individual CBT (n = 34) in the treatment of alcohol use disorders in community treatment centers in Dutch male and female alcoholics and their partners. Results show both BCT and CBT to be effective in changing drinking behavior after treatment. BCT was not found to be superior to CBT. Marital satisfaction of the spouse increased significantly in the BCT condition but not in the CBT condition, the differences being significant at the post-test. Patients' self-efficacy to withstand alcohol-related high-risk situations increased significantly in both treatment conditions, but more so in CBT than in BCT after treatment. Treatment involvement of the spouse did not increase retention. Regular practitioners in community treatment centers can effectively deliver both treatments. Stand-alone BCT is as effective as CBT in terms of reduced drinking and to some extent more effective in terms of enhancing relationship satisfaction. However, BCT is a more costly intervention, given that treatment sessions lasted almost twice as long as individual CBT sessions. Copyright 2008 S. Karger AG, Basel.

Impact of drug awareness and treatment camps on attendance at a community outreach de-addiction clinic

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Om Prakash Giri

2015-01-01

Full Text Available Background: Substance misuse is an increasing problem in urban and rural India. The utility of community-based interventions and preventive strategies are increasingly emphasized in this context. The drug de-addiction and treatment center, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, has been running a drug de-addiction and treatment clinic at Kharar Civil Hospital, Kharar, District Mohali, Punjab, since 1998. As part of an effort to enhance this community outreach program, community-based drug awareness and treatment camps have been organized since March 2004 in villages in and around Tehsil Kharar of Mohali. Aim: To study the impact of the drug awareness and treatment camps on the attendance of patients at the community outreach drug de-addiction and treatment clinic at Kharar Civil Hospital. Methods: Sociodemographic and clinical variables, including treatment outcome-related variables, of patients attending the clinic at Kharar Civil Hospital, before and after the camps were compared. Discussion and Conclusion: The study showed a positive impact on drug awareness and treatment camps held in the community on outpatient attendance at a community outreach clinic, with attendance increasing more than 1.8 times.

Wastewater treatment plant effluent introduces recoverable shifts in microbial community composition in urban streams

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Ledford, S. H.; Price, J. R.; Ryan, M. O.; Toran, L.; Sales, C. M.

2017-12-01

New technologies are allowing for intense scrutiny of the impact of land use on microbial communities in stream networks. We used a combination of analytical chemistry, real-time polymerase chain reaction (qPCR) and targeted amplicon sequencing for a preliminary study on the impact of wastewater treatment plant effluent discharge on urban streams. Samples were collected on two dates above and below treatment plants on the Wissahickon Creek, and its tributary, Sandy Run, in Montgomery County, PA, USA. As expected, effluent was observed to be a significant source of nutrients and human and non-specific fecal associated taxa. There was an observed increase in the alpha diversity at locations immediately below effluent outflows, which contributed many taxa involved in wastewater treatment processes and nutrient cycling to the stream's microbial community. Unexpectedly, modeling of microbial community shifts along the stream was not controlled by concentrations of measured nutrients. Furthermore, partial recovery, in the form of decreasing abundances of bacteria and nutrients associated with wastewater treatment plant processes, nutrient cycling bacteria, and taxa associated with fecal and sewage sources, was observed between effluent sources. Antecedent moisture conditions impacted overall microbial community diversity, with higher diversity occurring after rainfall. These findings hint at resilience in stream microbial communities to recover from wastewater treatment plant effluent and are vital to understanding the impacts of urbanization on microbial stream communities.

Assessing resources for implementing a community directed intervention (CDI) strategy in delivering multiple health interventions in urban poor communities in Southwestern Nigeria: a qualitative study.

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Ajayi, Ikeoluwapo O; Jegede, Ayodele S; Falade, Catherine O; Sommerfeld, Johannes

2013-10-24

Many simple, affordable and effective disease control measures have had limited impact due to poor access especially by the poorer populations (urban and rural) and inadequate community participation. A proven strategy to address the problem of access to health interventions is the Community Directed Interventions (CDI) approach, which has been used successfully in rural areas. This study was carried out to assess resources for the use of a CDI strategy in delivering health interventions in poorly-served urban communities in Ibadan, Nigeria. A formative study was carried out in eight urban poor communities in the Ibadan metropolis in the Oyo State. Qualitative methods comprising 12 focus group discussions (FGDs) with community members and 73 key informant interviews (KIIs) with community leaders, programme managers, community-based organisations (CBOs), non-government organisations (NGOs) and other stakeholders at federal, state and local government levels were used to collect data to determine prevalent diseases and healthcare delivery services, as well as to explore the potential resources for a CDI strategy. All interviews were audio recorded. Content analysis was used to analyse the data. Malaria, upper respiratory tract infection, diarrhoea and measles were found to be prevalent in children, while hypertension and diabetes topped the list of diseases among adults. Healthcare was financed mainly by out-of-pocket expenses. Cost and location were identified as hindrances to utilisation of health facilities; informal cooperatives (esusu) were available to support those who could not pay for care. Immunisation, nutrition, reproductive health, tuberculosis (TB) and leprosy, environmental health, malaria and HIV/AIDs control programmes were the ongoing interventions. Delivery strategies included house-to-house, home-based treatment, health education and campaigns. Community participation in the planning, implementation and monitoring of development projects was

Comparison of microbial community shifts in two parallel multi-step drinking water treatment processes.

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Xu, Jiajiong; Tang, Wei; Ma, Jun; Wang, Hong

2017-07-01

Drinking water treatment processes remove undesirable chemicals and microorganisms from source water, which is vital to public health protection. The purpose of this study was to investigate the effects of treatment processes and configuration on the microbiome by comparing microbial community shifts in two series of different treatment processes operated in parallel within a full-scale drinking water treatment plant (DWTP) in Southeast China. Illumina sequencing of 16S rRNA genes of water samples demonstrated little effect of coagulation/sedimentation and pre-oxidation steps on bacterial communities, in contrast to dramatic and concurrent microbial community shifts during ozonation, granular activated carbon treatment, sand filtration, and disinfection for both series. A large number of unique operational taxonomic units (OTUs) at these four treatment steps further illustrated their strong shaping power towards the drinking water microbial communities. Interestingly, multidimensional scaling analysis revealed tight clustering of biofilm samples collected from different treatment steps, with Nitrospira, the nitrite-oxidizing bacteria, noted at higher relative abundances in biofilm compared to water samples. Overall, this study provides a snapshot of step-to-step microbial evolvement in multi-step drinking water treatment systems, and the results provide insight to control and manipulation of the drinking water microbiome via optimization of DWTP design and operation.

Directly observed therapy for treating tuberculosis

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Karumbi, Jamlick; Garner, Paul

2015-01-01

Background Tuberculosis (TB) requires at least six months of treatment. If treatment is incomplete, patients may not be cured and drug resistance may develop. Directly Observed Therapy (DOT) is a specific strategy, endorsed by the World Health Organization, to improve adherence by requiring health workers, community volunteers or family members to observe and record patients taking each dose. Objectives To evaluate DOT compared to self-administered therapy in people on treatment for active TB or on prophylaxis to prevent active disease. We also compared the effects of different forms of DOT. Search methods We searched the following databases up to 13 January 2015: the Cochrane Infectious Diseases Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library; MEDLINE; EMBASE; LILACS and mRCT. We also checked article reference lists and contacted relevant researchers and organizations. Selection criteria Randomized controlled trials (RCTs) and quasi-RCTs comparing DOT with routine self-administration of treatment or prophylaxis at home. Data collection and analysis Two review authors independently assessed risk of bias of each included trial and extracted data. We compared interventions using risk ratios (RR) with 95% confidence intervals (CI). We used a random-effects model if meta-analysis was appropriate but heterogeneity present (I2 statistic = 50%). We assessed the quality of the evidence using the GRADE approach. Main results Eleven trials including 5662 participants met the inclusion criteria. DOT was performed by a range of people (nurses, community health workers, family members or former TB patients) in a variety of settings (clinic, the patient's home or the home of a community volunteer). DOT versus self-administered Six trials from South Africa, Thailand, Taiwan, Pakistan and Australia compared DOT with self-administered therapy for treatment. Trials included DOT at home by family members

Direction of attentional focus in biofeedback treatment for /r/ misarticulation.

Science.gov (United States)

McAllister Byun, Tara; Swartz, Michelle T; Halpin, Peter F; Szeredi, Daniel; Maas, Edwin

2016-07-01

Maintaining an external direction of focus during practice is reported to facilitate acquisition of non-speech motor skills, but it is not known whether these findings also apply to treatment for speech errors. This question has particular relevance for treatment incorporating visual biofeedback, where clinician cueing can direct the learner's attention either internally (i.e., to the movements of the articulators) or externally (i.e., to the visual biofeedback display). This study addressed two objectives. First, it aimed to use single-subject experimental methods to collect additional evidence regarding the efficacy of visual-acoustic biofeedback treatment for children with /r/ misarticulation. Second, it compared the efficacy of this biofeedback intervention under two cueing conditions. In the external focus (EF) condition, participants' attention was directed exclusively to the external biofeedback display. In the internal focus (IF) condition, participants viewed a biofeedback display, but they also received articulatory cues encouraging an internal direction of attentional focus. Nine school-aged children were pseudo-randomly assigned to receive either IF or EF cues during 8 weeks of visual-acoustic biofeedback intervention. Accuracy in /r/ production at the word level was probed in three to five pre-treatment baseline sessions and in three post-treatment maintenance sessions. Outcomes were assessed using visual inspection and calculation of effect sizes for individual treatment trajectories. In addition, a mixed logistic model was used to examine across-subjects effects including phase (pre/post-treatment), /r/ variant (treated/untreated), and focus cue condition (internal/external). Six out of nine participants showed sustained improvement on at least one treated /r/ variant; these six participants were evenly divided across EF and IF treatment groups. Regression results indicated that /r/ productions were significantly more likely to be rated accurate post

A Community-Engaged Assessment of Barriers and Facilitators to Rapid Stroke Treatment

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Nemeth, Lynne S.; Jenkins, Carolyn; Jauch, Edward C.; Conway, Sharon; Pearlman, Adam; Spruill, Ida J.; Brown, Lynette J.; Linnen, Joyce; Linnen, Florene; Andrews, Jeannette O.

2016-01-01

Treatment for acute ischemic stroke must be initiated within hours of stroke symptom onset, and the sooner it is administered, the better. In South Carolina, 76% of the population can access expert stroke care, and rural hospitals may provide specialized treatment using telemedicine, but many stroke sufferers seek care too late to achieve full benefit. Using a community-engaged approach in a southern rural community, we explored barriers and facilitators to early stroke care and implications for improvement. The Community-Engaged Assessment to facilitate Stroke Elimination (CEASE) study was guided by a community advisory group to ensure community centeredness and local relevance. In a qualitative descriptive study, eight focus groups were conducted including 52 individuals: recent stroke survivors, family members, emergency medical personnel, hospital emergency department staff, primary care providers, and community leaders. From analysis of focus group transcripts came six themes: lack of trust in healthcare system and providers; weak relationships fueled by poor communication; low health literacy; financial limitations related to health care; community-based education; and faith as a message of hope. A hierarchy model for improving early community-based stroke care was developed through consensus dialogue by community representatives and the research team. This model can be used to inform a community-partnered, stake-holder-informed intervention to improve stroke care in a rural southern community with the goal of improving stroke education, care, and outcome. PMID:27545591

Exploring health providers’ and community perceptions and experiences with malaria tests in South-East Nigeria: a critical step towards appropriate treatment

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Ezeoke Ogochukwu P

2012-11-01

Full Text Available Abstract Background The adoption of ACT as the first line treatment for uncomplicated malaria in Nigeria has concentrated attention on the role of testing in appropriate malaria treatment. There are calls at both national and global level for malaria treatment to be based on test result, but it is still unclear how testing can be incorporated into treatment-seeking and practices of health providers. This study explored community members and health providers’ perceptions and experiences with malaria tests in south east Nigeria. Methods The study was conducted in urban and rural areas of Enugu state in south-eastern Nigeria. A total of 18 focus group discussions with 179 community members including sub-groups of primary caregivers, adult men and adult women aged 15 years and above. Twenty- six (26 In-depth interviews were held with public and private health providers involved in prescribing medicines at public and private health facilities in the study area. Results Both providers and community members were familiar with malaria tests and identified malaria tests as an important step to distinguish malaria from other illnesses with similar symptoms and as a means of delivering appropriate treatment. However, the logic of test-directed treatment was undermined by cost of test and a lack of testing facilities but above all concerns over the reliability of negative test results, with community members and providers observing inconsistencies between results and symptoms, and providers attributing inaccurate results to incompetencies of technicians. Recognition of malaria symptoms was deemed most important in determining the use of antimalarial drugs rather than the result of a malaria test. Conclusion The results highlight important areas of intervention to promote appropriate malaria treatment. If tests are to play a role in patient management, demand and supply side interventions are needed to change people’s attitude towards malaria test

Projecting the long-term impact of school- or community-based mass-treatment interventions for control of Schistosoma infection.

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Xiaoxia Wang

Full Text Available Schistosomiasis remains a significant health burden in many areas of the world. Morbidity control, focused on limiting infection intensity through periodic delivery of anti-schistosomal medicines, is the thrust of current World Health Organization guidelines (2006 for reduction of Schistosoma-related disease. A new appreciation of the lifetime impact of repeated Schistosoma infection has directed attention toward strategies for greater suppression of parasite infection per se, with the goal of transmission interruption. Variations in drug schedules involving increased population coverage and/or treatment frequency are now undergoing field trials. However, their relative effectiveness in long-term infection suppression is presently unknown.Our study used available field data to calibrate advanced network models of village-level Schistosoma transmission to project outcomes of six different community- or school age-based programs, as compared to the impact of current 2006 W.H.O. recommended control strategies. We then scored the number of years each of 10 typical villages would remain below 10% infection prevalence (a practicable level associated with minimal prevalence of disease. All strategies that included four annual treatments effectively reduced community prevalence to less than 10%, while programs having yearly gaps ('holidays' failed to reach this objective in half of the communities. Effective post-program suppression of infection prevalence persisted in half of the 10 villages for 7-10 years, whereas in five high-risk villages, program effects on prevalence lasted zero to four years only.At typical levels of treatment adherence (60 to 70%, current WHO recommendations will likely not achieve effective suppression of Schistosoma prevalence unless implemented for ≥6 years. Following more aggressive 4 year annual intervention, some communities may be able to continue without further intervention for 8-10 years, while in higher

Electricity Generation and Community Wastewater Treatment by Microbial Fuel Cells (MFCs)

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Rakthai, S.; Potchanakunakorn, R.; Changjan, A.; Intaravicha, N.; Pramuanl, P.; Srigobue, P.; Soponsathien, S.; Kongson, C.; Maksuwan, A.

2018-05-01

The attractive solution to the pressing issues of energy production and community wastewater treatment was using of Microbial Fuel Cells (MFCs). The objective of this research was to study the efficiency of electricity generation and community wastewater treatment of MFCs. This study used an experimental method completely randomized design (CRD), which consisted of two treatment factors (4×5 factorial design). The first factor was different solution containing organic matter (T) and consisting of 4 level factors including T1 (tap water), T2 (tap water with soil), T3 (50 % V/V community wastewater with soil), and T4 (100% community wastewater with soil). The second factor was the time (t), consisting of 5 level factors t1 (day 1), t2 (day 2), t3 (day 3), t4 (day 4), and t5 (day 5). There were 4 experimental models depending on containing organic matter (T1-T4). The parameter measured consisted of Open Circuit Voltage (OCV), Chemical Oxygen Demand (COD), Total Dissolve Solid (TDS), acidity (pH), Electric Conductivity (EC) and number of bacteria. Data were analysed by ANOVA, followed by Duncan test. The results of this study showed that, the T3 was the highest voltage at 0.816 V (P<0.05) and T4, T2, and Ti were 0.800, 0.797 and 0.747 V, respectively. The T3 was the lowest COD at 24.120 mg/L and T4 was 38.067 mg/L (P<0.05). The best model for electricity generation and community wastewater treatment by Microbial Fuel Cells was T3. This model generated highest voltage at 0.816 V, and reduction of COD at 46.215%.

Mental Health Treatment Seeking Among Veteran and Civilian Community College Students.

Science.gov (United States)

Fortney, John C; Curran, Geoffrey M; Hunt, Justin B; Lu, Liya; Eisenberg, Daniel; Valenstein, Marcia

2017-08-01

A Web-based survey examined treatment seeking among community college students to inform the design of engagement interventions. Veteran and civilian community college students (N=765) were screened for mental disorders and reported perceptions of treatment need, effectiveness, and stigma, as well as service use. Regression analysis identified predictors of pharmacotherapy and psychotherapy use. Of the 511 students who screened positive for a current mental disorder or reported a perceived need for treatment (149 veterans and 362 civilians), 30% reported past-year use of psychotropic medications. Predictors were perceived treatment need (odds ratio [OR]=7.81, p<.001) and the perception that psychotropic medications are effective (OR=3.38, p=.012). Eleven percent of participants reported past-year psychotherapy use, and predictors were a positive screen for posttraumatic stress disorder (OR=2.78, p=.04) and poorer financial status. Modifiable barriers, including perceived need for and effectiveness of treatment, were correlated with pharmacotherapy use and should be targeted by engagement interventions.

Bacterial community composition of a wastewater treatment system reliant on N{sub 2} fixation

Energy Technology Data Exchange (ETDEWEB)

Reid, N.M.; Bowers, T.H.; Lloyd-Jones, G. [Scion, Rotorua (New Zealand)

2008-05-15

The temporal stability and change of the dominant phylogenetic groups of the domain bacteria were studied in a model plant-based industrial wastewater treatment system showing high levels of organic carbon removal supported by high levels of N{sub 2} fixation. Community profiles were obtained through terminal restriction fragment length polymorphism analysis and cloning of 16S rRNA amplicons followed by sequencing. Bacterial community profiles showed that ten common terminal restriction fragments made up approximately 50% of the measured bacterial community. As much as 42% of the measured bacterial community could be monitored by using quantitative PCR and primers that targeted three dominant operational taxonomic units. Despite changes in wastewater composition and dissolved oxygen levels, the bacterial community composition appeared stable and was dominated by {alpha}-Proteobacteria and {beta}-Proteobacteria, with a lesser amount of the highly diverse bacterial phylum Bacteroidetes. A short period of considerable change in the bacterial community composition did not appear to affect treatment performance indicating functional redundancy in this treatment system. (orig.)

Phospholipid fatty acid patterns of microbial communities in paddy soil under different fertilizer treatments

Institute of Scientific and Technical Information of China (English)

ZHANG Qi-chun; WANG Guang-huo; YAO Huai-ying

2007-01-01

The microbial communities under irrigated rice cropping with different fertilizer treatments, including control (CK), PK, NK, NP, NPK fertilization, were investigated using phospholipid fatty acid (PLFA) profile method. The results of this study revealed that the fertilizer practice had an impact on the community structure of specific microbial groups. The principal components analysis (PCA) showed that proportion of the actinomycete PLFAs (10Me 18:0 and 10Me 16:0) were the lowest in the PK treatment and the highest in the NPK treatment, which means that soil nitrogen status affected the diversity of actinomycetes, whereas nitrogen cycling was related to the actinomycets. Under CK treatment, the ratio of Gram-positive to Gram-negative bacteria was lower compared with that in fertilizer addition treatments, indicating that fertilizer application stimulated Gram-positive bacterial population in paddy soil. The fatty acid 18:2ω6, 9, which is considered to be predominantly of fungal origin, was at low level in all the treatments. The ratio of cy19:0 to 18:1ω7, which has been proposed as an indicator of stress conditions, decreased in PK treatment. Changes of soil microbial community under different fertilizer treatments of paddy soil were detected in this study; however, the causes that lead to changes in the microbial community still needs further study.

The Impact of System Level Factors on Treatment Timeliness: Utilizing the Toyota Production System to Implement Direct Intake Scheduling in a Semi-Rural Community Mental Health Clinic

Science.gov (United States)

Weaver, A.; Greeno, C.G.; Goughler, D.H.; Yarzebinski, K.; Zimmerman, T.; Anderson, C.

2013-01-01

This study examined the effect of using the Toyota Production System (TPS) to change intake procedures on treatment timeliness within a semi-rural community mental health clinic. One hundred randomly selected cases opened the year before the change and one hundred randomly selected cases opened the year after the change were reviewed. An analysis of covariance (ANCOVA) demonstrated that changing intake procedures significantly decreased the number of days consumers waited for appointments (F(1,160)=4.9; p=.03) from an average of 11 days to 8 days. The pattern of difference on treatment timeliness was significantly different between adult and child programs (F(1,160)=4.2; p=.04), with children waiting an average of 4 days longer than adults for appointments. Findings suggest that small system level changes may elicit important changes and that TPS offers a valuable model to improve processes within community mental health settings. Results also indicate that different factors drive adult and children’s treatment timeliness. PMID:23576137

The impact of system level factors on treatment timeliness: utilizing the Toyota Production System to implement direct intake scheduling in a semi-rural community mental health clinic.

Science.gov (United States)

Weaver, Addie; Greeno, Catherine G; Goughler, Donald H; Yarzebinski, Kathleen; Zimmerman, Tina; Anderson, Carol

2013-07-01

This study examined the effect of using the Toyota Production System (TPS) to change intake procedures on treatment timeliness within a semi-rural community mental health clinic. One hundred randomly selected cases opened the year before the change and 100 randomly selected cases opened the year after the change were reviewed. An analysis of covariance demonstrated that changing intake procedures significantly decreased the number of days consumers waited for appointments (F(1,160) = 4.9; p = .03) from an average of 11 to 8 days. The pattern of difference on treatment timeliness was significantly different between adult and child programs (F(1,160) = 4.2; p = .04), with children waiting an average of 4 days longer than adults for appointments. Findings suggest that small system level changes may elicit important changes and that TPS offers a valuable model to improve processes within community mental health settings. Results also indicate that different factors drive adult and children's treatment timeliness.

The perceived stress and turnover intention of direct-care staff of community residential facilities

OpenAIRE

Lightle, Kevin Eugene

1990-01-01

This study examines turnover among direct-care staff of community residential facilities. Turnover is of concern as the projected rate indicated by direct-care staff is 34%. A review of personnel records project an annual turnover rate of 40%. Stress is examined for its relationship to turnover. The Maslach Burnout Inventory is used to measure the perceived stress level of staff. Results indicate direct-care staff are not stressed to the point of burnout in two of ...

Biomass, Leaf Area, and Resource Availability of Kudzu Dominated Plant Communities Following Herbicide Treatment

Energy Technology Data Exchange (ETDEWEB)

L.T. Rader

2001-10-01

Kudzu is an exotic vine that threatens the forests of the southern U.S. Five herbicides were tested with regard to their efficacy in controlling kudzu, community recover was monitored, and interactions with planted pines were studied. The sites selected were old farm sites dominated by kudzu.These were burned following herbicide treatment. The herbicides included triclopyr, clopyralid, metsulfuron, tebuthiuron, and picloram plus 2,4-D. Pine seedlings were planted the following year. Regression equations were developed for predicting biomass and leaf area. Four distinct plant communities resulted from the treatments. The untreated check continued to be kudzu dominated. Blackberry dominated the clopyradid treatment. Metsulfron, trychlopyr and picloram treated sites resulted in herbaceous dominated communities. The tebuthiuron treatment maintained all vegetation low.

Directly observed therapy for treating tuberculosis

OpenAIRE

Karumbi, Jamlick; Garner, Paul

2015-01-01

Background Tuberculosis (TB) requires at least six months of treatment. If treatment is incomplete, patients may not be cured and drug resistance may develop. Directly Observed Therapy (DOT) is a specific strategy, endorsed by the World Health Organization, to improve adherence by requiring health workers, community volunteers or family members to observe and record patients taking each dose. Objectives To evaluate DOT compared to self-administered therapy in people on treatment for active TB...

Processes underlying treatment success and failure in assertive community treatment.

Science.gov (United States)

Stull, Laura G; McGrew, John H; Salyers, Michelle P

2012-02-01

Processes underlying success and failure in assertive community treatment (ACT), a widely investigated treatment model for persons with severe mental illness, are poorly understood. The purpose of the current study was to examine processes in ACT by (1) understanding how consumers and staff describe the processes underlying treatment success and failure and (2) comparing processes identified by staff and consumers. Investigators conducted semi-structured interviews with 25 staff and 23 consumers from four ACT teams. Both staff and consumers identified aspects of the ACT team itself as the most critical in the process of consumer success. For failure, consumers identified consumer characteristics as most critical and staff identified lack of social relationships. Processes underlying failure were not viewed as merely the opposite of processes underlying success. In addition, there was notable disagreement between staff and consumers on important processes. Findings overlap with critical ingredients identified in previous studies, including aspects of the ACT team, social involvement and employment. In contrast to prior studies, there was little emphasis on hospitalizations and greater emphasis on not abusing substances, obtaining wants and desires, and consumer characteristics.

Host-Directed Therapeutics as a Novel Approach for Tuberculosis Treatment.

Science.gov (United States)

Kim, Ye-Ram; Yang, Chul-Su

2017-09-28

Despite significant efforts to improve the treatment of tuberculosis (TB), it remains a prevalent infectious disease worldwide owing to the limitations of current TB therapeutic regimens. Recent work on novel TB treatment strategies has suggested that directly targeting host factors may be beneficial for TB treatment. Such strategies, termed host-directed therapeutics (HDTs), focus on host-pathogen interactions. HDTs may be more effective than the currently approved TB drugs, which are limited by the long durations of treatment needed and the emergence of drug-resistant strains. Targets of HDTs include host factors such as cytokines, immune checkpoints, immune cell functions, and essential enzyme activities. This review article discusses examples of potentially promising HDTs and introduces novel approaches for their development.

Guiding therapy and adjunctive treatment in community-acquired pneumonia

NARCIS (Netherlands)

Spoorenberg, S.M.C.

2018-01-01

Background: Despite the availability of effective antibiotics and vaccines, community-acquired pneumonia (CAP) remains the cause of significant morbidity and mortality worldwide.A major problem is that in absence of full spectrum rapid microbiology diagnostics, the antibiotic treatment at start is

Interest communities and flow roles in directed networks: the Twitter network of the UK riots.

Science.gov (United States)

Beguerisse-Díaz, Mariano; Garduño-Hernández, Guillermo; Vangelov, Borislav; Yaliraki, Sophia N; Barahona, Mauricio

2014-12-06

Directionality is a crucial ingredient in many complex networks in which information, energy or influence are transmitted. In such directed networks, analysing flows (and not only the strength of connections) is crucial to reveal important features of the network that might go undetected if the orientation of connections is ignored. We showcase here a flow-based approach for community detection through the study of the network of the most influential Twitter users during the 2011 riots in England. Firstly, we use directed Markov Stability to extract descriptions of the network at different levels of coarseness in terms of interest communities, i.e. groups of nodes within which flows of information are contained and reinforced. Such interest communities reveal user groupings according to location, profession, employer and topic. The study of flows also allows us to generate an interest distance, which affords a personalized view of the attention in the network as viewed from the vantage point of any given user. Secondly, we analyse the profiles of incoming and outgoing long-range flows with a combined approach of role-based similarity and the novel relaxed minimum spanning tree algorithm to reveal that the users in the network can be classified into five roles. These flow roles go beyond the standard leader/follower dichotomy and differ from classifications based on regular/structural equivalence. We then show that the interest communities fall into distinct informational organigrams characterized by a different mix of user roles reflecting the quality of dialogue within them. Our generic framework can be used to provide insight into how flows are generated, distributed, preserved and consumed in directed networks.

Treatment technology for removing radon from small community water supplies

International Nuclear Information System (INIS)

Kinner, N.E.; Quern, P.A.; Schell, G.S.; Lessard, C.E.; Clement, J.A.

1989-01-01

Radon contamination of drinking water primarily affects individual homeowners and small communities using ground-water supplies. Presently, three types of treatment processes have been used to remove radon: granular activated carbon adsorption (GAC), diffused-bubble aeration, and packed-tower aeration. In order to obtain data on these treatment alternatives for small communities water supplies, a field evaluation study was conducted on these three processes as well as on several modifications to aeration of water in storage tanks considered to be low cost/low technology alternatives. The paper presents the results of these field studies conducted at a small mobile home park in rural New Hampshire. The conclusion of the study was that the selection of the appropriate treatment system to remove radon from drinking water depends primarily upon: (1) precent removal of process; (2) capital operating and maintenance costs; (3) safety (radiation); and (4) raw water quality (Fe, Mn, bacteria and organics)

Community knowledge, attitudes and practices on pulmonary ...

African Journals Online (AJOL)

Background: We planned to raise public awareness and decentralize directly observed tuberculosis treatment at village level using volunteer community members in order to reduce prolonged delays in seeking care and improve compliance to tuberculosis treatment. We do not know the magnitude of tuberculosis ...

Influence of microbial community diversity and function on pollutant removal in ecological wastewater treatment.

Science.gov (United States)

Bai, Yaohui; Huo, Yang; Liao, Kailingli; Qu, Jiuhui

2017-10-01

Traditional wastewater treatments based on activated sludge often encounter the problems of bulking and foaming, as well as malodor. To solve these problems, new treatment technologies have emerged in recent decades, including the ecological wastewater treatment process, which introduces selected local plants into the treatment system. With a focus on the underlying mechanisms of the ecological treatment process, we explored the microbial community biomass, composition, and function in the treatment system to understand the microbial growth in this system and its role in pollutant removal. Flow cytometry analysis revealed that ecological treatment significantly decreased influent bacterial quantity, with around 80% removal. 16S rRNA gene sequencing showed that the ecological treatment also altered the bacterial community structure of the wastewater, leading to a significant change in Comamonadaceae in the effluent. In the internal ecological system, because most of microbes aggregate in the plant rhizosphere and the sludge under plant roots, we selected two plant species (Nerium oleander and Arundo donax) to study the characteristics of rhizosphere and sludge microbes. Metagenomic results showed that the microbial community composition and function differed between the two species, and the microbial communities of A. donax were more sensitive to seasonal effects. Combined with their greater biomass and abundance of metabolic genes, microbes associated with N. oleander showed a greater contribution to pollutant removal. Further, the biodegradation pathways of some micropollutants, e.g., atrazine, were estimated.

Submerged macrophytes mitigate direct and indirect insecticide effects in freshwater communities.

Science.gov (United States)

Brogan, William R; Relyea, Rick A

2015-01-01

Understanding how ecological interactions mitigate the impacts of perturbations such as pesticides in biological communities is an important basic and applied question for ecologists. In aquatic ecosystems, new evidence from microcosm experiments suggests that submerged macrophytes can buffer cladocerans from pulse exposures to the widely used insecticide malathion, and that mitigation increases with macrophyte density. However, whether these results scale up to more complex aquatic communities where ecological interactions such as competition can alter toxicity is unknown. Further, macrophyte abilities to mitigate different insecticide exposure scenarios (i.e. single versus repeated pulses) have never been tested. To address these gaps, we performed a factorial mesocosm experiment examining the influence of four macrophyte treatments (0, 10, 50, or 100 Elodea Canadensis shoots planted per mesocosm) crossed with three malathion exposure scenarios (no insecticide, single pulse, repeated pulses) on aquatic communities containing zooplankton, phytoplankton, periphyton, two snail species, and larval amphibians. In the absence of macrophytes, single malathion pulses caused short-term declines in cladoceran abundance followed by their rapid recovery, which precluded any indirect effects (i.e. trophic cascades). However, repeated malathion pulses caused cladoceran extinctions, resulting in persistent phytoplankton blooms and reduced abundance of one snail species. In contrast, with macrophytes present, even at low density, malathion had no effect on any taxa. We also discovered novel effects of macrophytes on the benthic food web. In the two highest macrophyte treatments, we observed trends of reduced periphyton biomass, decreased abundance of one snail species, and decreased amphibian time to and mass at metamorphosis. To our knowledge, this is the first evidence of negative submerged macrophyte effects on amphibians, a taxa of global conservation concern. Our findings

Submerged Macrophytes Mitigate Direct and Indirect Insecticide Effects in Freshwater Communities

Science.gov (United States)

Brogan, William R.; Relyea, Rick A.

2015-01-01

Understanding how ecological interactions mitigate the impacts of perturbations such as pesticides in biological communities is an important basic and applied question for ecologists. In aquatic ecosystems, new evidence from microcosm experiments suggests that submerged macrophytes can buffer cladocerans from pulse exposures to the widely used insecticide malathion, and that mitigation increases with macrophyte density. However, whether these results scale up to more complex aquatic communities where ecological interactions such as competition can alter toxicity is unknown. Further, macrophyte abilities to mitigate different insecticide exposure scenarios (i.e. single versus repeated pulses) have never been tested. To address these gaps, we performed a factorial mesocosm experiment examining the influence of four macrophyte treatments (0, 10, 50, or 100 Elodea Canadensis shoots planted per mesocosm) crossed with three malathion exposure scenarios (no insecticide, single pulse, repeated pulses) on aquatic communities containing zooplankton, phytoplankton, periphyton, two snail species, and larval amphibians. In the absence of macrophytes, single malathion pulses caused short-term declines in cladoceran abundance followed by their rapid recovery, which precluded any indirect effects (i.e. trophic cascades). However, repeated malathion pulses caused cladoceran extinctions, resulting in persistent phytoplankton blooms and reduced abundance of one snail species. In contrast, with macrophytes present, even at low density, malathion had no effect on any taxa. We also discovered novel effects of macrophytes on the benthic food web. In the two highest macrophyte treatments, we observed trends of reduced periphyton biomass, decreased abundance of one snail species, and decreased amphibian time to and mass at metamorphosis. To our knowledge, this is the first evidence of negative submerged macrophyte effects on amphibians, a taxa of global conservation concern. Our findings

Submerged macrophytes mitigate direct and indirect insecticide effects in freshwater communities.

Directory of Open Access Journals (Sweden)

William R Brogan

Full Text Available Understanding how ecological interactions mitigate the impacts of perturbations such as pesticides in biological communities is an important basic and applied question for ecologists. In aquatic ecosystems, new evidence from microcosm experiments suggests that submerged macrophytes can buffer cladocerans from pulse exposures to the widely used insecticide malathion, and that mitigation increases with macrophyte density. However, whether these results scale up to more complex aquatic communities where ecological interactions such as competition can alter toxicity is unknown. Further, macrophyte abilities to mitigate different insecticide exposure scenarios (i.e. single versus repeated pulses have never been tested. To address these gaps, we performed a factorial mesocosm experiment examining the influence of four macrophyte treatments (0, 10, 50, or 100 Elodea Canadensis shoots planted per mesocosm crossed with three malathion exposure scenarios (no insecticide, single pulse, repeated pulses on aquatic communities containing zooplankton, phytoplankton, periphyton, two snail species, and larval amphibians. In the absence of macrophytes, single malathion pulses caused short-term declines in cladoceran abundance followed by their rapid recovery, which precluded any indirect effects (i.e. trophic cascades. However, repeated malathion pulses caused cladoceran extinctions, resulting in persistent phytoplankton blooms and reduced abundance of one snail species. In contrast, with macrophytes present, even at low density, malathion had no effect on any taxa. We also discovered novel effects of macrophytes on the benthic food web. In the two highest macrophyte treatments, we observed trends of reduced periphyton biomass, decreased abundance of one snail species, and decreased amphibian time to and mass at metamorphosis. To our knowledge, this is the first evidence of negative submerged macrophyte effects on amphibians, a taxa of global conservation concern

Barriers to community-based drug dependence treatment: implications for police roles, collaborations and performance indicators

Science.gov (United States)

Ma, Yi; Du, Chunhua; Cai, Thomas; Han, Qingfeng; Yuan, Huanhuan; Luo, Tingyan; Ren, Guoliang; Mburu, Gitau; Wang, Bangyuan; Golichenko, Olga; Zhang, Chaoxiong

2016-01-01

Introduction Worldwide, people who use drugs (PWUD) are among the populations at highest risk for HIV infection. In China, PWUD are primarily sentenced to compulsory detainment centres, in which access to healthcare, including HIV treatment and prevention services, is limited or non-existent. In 2008, China's 2008 Anti-Drug Law encouraged the development and use of community-based drug dependence rehabilitation, yet there is limited evidence evaluating the efficacy and challenges of this model in China. In this study, we explore these challenges and describe how cooperation between law enforcement and health departments can meet the needs of PWUD. Methods In 2015, we conducted semi-structured, in-depth interviews with all four staff members and 16 clients of the Ping An Centre No. 1 for community-based drug treatment, three local police officers and three officials from the local Centre for Disease Control. Interviews explored obstacles in implementing community-based drug dependence treatment and efforts to resolve these difficulties. Transcripts were coded and analyzed with qualitative data analysis software (MAXQDA 11). Results We identified three challenges to community-based drug treatment at the Ping An Centre No. 1: (1) suboptimal coordination among parties involved, (2) a divergence in attitudes towards PWUD and harm reduction between law enforcement and health officials and (3) conflicting performance targets for police and health officials that undermine the shared goal of treatment. We also identified the take-home methadone maintenance treatment model at the Ping An Centre No. 1 as an example of an early successful collaboration between the police, the health department and PWUD. Conclusions To overcome barriers to effective community-based drug treatment, we recommend aligning the goals of law enforcement and public health agencies towards health-based performance indicators. Furthermore, tensions between PWUD and police need to be addressed and trust

A systems approach to understanding the identification and treatment of sport-related concussion in community rugby union.

Science.gov (United States)

Clacy, Amanda; Goode, Natassia; Sharman, Rachael; Lovell, Geoff P; Salmon, Paul

2017-07-04

The aim of the present study was to utilise a systems thinking approach to explore the perceived responsibilities for identifying and treating concussion held by different actors across the community rugby system (e.g., players, coaches, parents, medics, referees, and management), as well as their role-specific concussion management strategies. A systems approach was taken to assess what different stakeholders within rugby systems perceive their roles to be regarding concussion identification and treatment. Through an online survey, 118 members of the amateur (community) rugby union system were asked about their role-specific concussion management responsibilities and strategies. Respondents included players, parents, medics, coaches, club managers, administrators, and volunteers. The majority of respondents indicated that they were able to identify the symptoms of rugby-related concussion, however, only medics stated their responsibility to use formal concussion assessments (e.g., SCAT2). A smaller number of the respondents indicated that they were involved in treating concussion within their current role/s (majority of which were medics). This study illustrated that the current challenges in the identification and treatment of rugby-related concussion in community sport may be due to role/responsibility confusion and possible overreliance on field-side medics. These findings offer insight into the possible limitations of the current concussion management guidelines and may offer empirically based direction for future revisions. Copyright © 2017 Elsevier Ltd. All rights reserved.

A randomized controlled trial of prison-initiated buprenorphine: prison outcomes and community treatment entry.

Science.gov (United States)

Gordon, Michael S; Kinlock, Timothy W; Schwartz, Robert P; Fitzgerald, Terrence T; O'Grady, Kevin E; Vocci, Frank J

2014-09-01

Buprenorphine is a promising treatment for heroin addiction. However, little is known regarding its provision to pre-release prisoners with heroin dependence histories who were not opioid-tolerant, the relative effectiveness of the post-release setting in which it is provided, and gender differences in treatment outcome in this population. This is the first randomized clinical trial of prison-initiated buprenorphine provided to male and female inmates in the US who were previously heroin-dependent prior to incarceration. A total of 211 participants with 3-9 months remaining in prison were randomized to one of four conditions formed by crossing In-Prison Treatment Condition (received buprenorphine vs. counseling only) and Post-release Service Setting (at an opioid treatment center vs. a community health center). Outcome measures were: entered prison treatment; completed prison treatment; and entered community treatment 10 days post-release. There was a significant main effect (p=.006) for entering prison treatment favoring the In-Prison buprenorphine Treatment Condition (99.0% vs. 80.4%). Regarding completing prison treatment, the only significant effect was Gender, with women significantly (pPrison buprenorphine Treatment Condition (47.5% vs. 33.7%). Buprenorphine appears feasible and acceptable to prisoners who were not opioid-tolerant and can facilitate community treatment entry. However, concerns remain with in-prison treatment termination due to attempted diversion of medication. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Effects of using winter grazing as a fuel treatment on Wyoming big sagebrush plant communities

Science.gov (United States)

More frequent wildfires and incidences of mega-fires have increased the pressure for fuel treatments in sagebrush (Artemisia) communities. Winter grazing has been one of many fuel treatments proposed for Wyoming big sagebrush (A. tridentata Nutt. subsp. wyomingensis Beetle and A. Young) communitie...

Associations Among Depressive Symptoms, Wellness, Patient Involvement, Provider Cultural Competency, and Treatment Nonadherence: A Pilot Study Among Community Patients Seen at a University Medical Center.

Science.gov (United States)

Hooper, Lisa M; Huffman, Lauren E; Higginbotham, John C; Mugoya, George C T; Smith, Annie K; Dumas, Tia N

2018-02-01

Treatment nonadherence is a pernicious problem associated with increasing rates of chronic diseases, escalating healthcare costs, and rising mortality in some patients. Although researchers have suggested numerous factors related to treatment nonadherence, several understudied aspects warrant attention, such as primary-care settings, provider cultural competence, and patient involvement. Adding to the research base, the present pilot study examined 88 primarily Black American and White American community patients from a large university medical center in the southern part of the United States. The study explored two research questions: (a) To what extent are there associations among depressive symptoms, wellness, patient involvement, cultural competency, and treatment nonadherence in a racially diverse community patient population? And (b) to what extent do the study exploratory variables and background characteristics predict treatment nonadherence, both separately and jointly? Depressive symptoms, the patient's perception of a provider's cultural competence, and marital/partnered status were found to be statistically significantly associated with treatment nonadherence, but not entirely in the directions expected.

Integration of treatment wetlands as sustainable wastewater management systems for small communities

Energy Technology Data Exchange (ETDEWEB)

Dahab, M.F.; Surampalli, R.Y. [Univ. of Nebraski-Lincoln, Dept. of Civil Engineering, Lincoln, NE (United States)

2002-06-15

This paper discuses the applicability as well as the integration of the constructed wetlands technology within the environmental infrastructure in small communities. To that end, a case study involving the use of Constructed wetlands (CW) for waste management in the Nebraska plains is presented. CW systems have been shown to be effective treatment alternatives in resource-limited small communities; and hence, can contribute to improving the economic well-being and the sustainability of many small communities. The paper specifically discusses the performance of subsurface-flow constructed wetlands systems used as the wastewater treatment process for a small community in eastern Nebraska and outlines operational experience gained through five years of plant operation. The results show that effective and sufficient CW seasonal removals of TSS, VSS, CBOD{sub 5}, COD, and fecal coliform were achieved. Wastewater temperatures seemed to affect CBOD{sub 5} and COD removal rates. Nitrogen and phosphorus reductions were not as effective and varied seasonally, as well as with wastewater temperature. The addition of a sand filter, to aid in further nitrification and disinfection following CW treatment, markedly improved the performance of the wetlands system. After a few years of operation, the performance of the system was dampened by apparent clogging and subsequent eruption of wastewater at the head-end of the treatment cells. While clogging was partially caused by biomass build-up in the wetlands substrate, visual observations suggest that excessive vegetation and relaxed maintenance may also be responsible. (author)

Integration of treatment wetlands as sustainable wastewater management systems for small communities

International Nuclear Information System (INIS)

Dahab, M.F.; Surampalli, R.Y.

2002-01-01

This paper discuses the applicability as well as the integration of the constructed wetlands technology within the environmental infrastructure in small communities. To that end, a case study involving the use of Constructed wetlands (CW) for waste management in the Nebraska plains is presented. CW systems have been shown to be effective treatment alternatives in resource-limited small communities; and hence, can contribute to improving the economic well-being and the sustainability of many small communities. The paper specifically discusses the performance of subsurface-flow constructed wetlands systems used as the wastewater treatment process for a small community in eastern Nebraska and outlines operational experience gained through five years of plant operation. The results show that effective and sufficient CW seasonal removals of TSS, VSS, CBOD 5 , COD, and fecal coliform were achieved. Wastewater temperatures seemed to affect CBOD 5 and COD removal rates. Nitrogen and phosphorus reductions were not as effective and varied seasonally, as well as with wastewater temperature. The addition of a sand filter, to aid in further nitrification and disinfection following CW treatment, markedly improved the performance of the wetlands system. After a few years of operation, the performance of the system was dampened by apparent clogging and subsequent eruption of wastewater at the head-end of the treatment cells. While clogging was partially caused by biomass build-up in the wetlands substrate, visual observations suggest that excessive vegetation and relaxed maintenance may also be responsible. (author)

Microbial community functional structure in response to antibiotics in pharmaceutical wastewater treatment systems.

Science.gov (United States)

Zhang, Yu; Xie, Jianping; Liu, Miaomiao; Tian, Zhe; He, Zhili; van Nostrand, Joy D; Ren, Liren; Zhou, Jizhong; Yang, Min

2013-10-15

It is widely demonstrated that antibiotics in the environment affect microbial community structure. However, direct evidence regarding the impacts of antibiotics on microbial functional structures in wastewater treatment systems is limited. Herein, a high-throughput functional gene array (GeoChip 3.0) in combination with quantitative PCR and clone libraries were used to evaluate the microbial functional structures in two biological wastewater treatment systems, which treat antibiotic production wastewater mainly containing oxytetracycline. Despite the bacteriostatic effects of antibiotics, the GeoChip detected almost all key functional gene categories, including carbon cycling, nitrogen cycling, etc., suggesting that these microbial communities were functionally diverse. Totally 749 carbon-degrading genes belonging to 40 groups (24 from bacteria and 16 from fungi) were detected. The abundance of several fungal carbon-degrading genes (e.g., glyoxal oxidase (glx), lignin peroxidase or ligninase (lip), manganese peroxidase (mnp), endochitinase, exoglucanase_genes) was significantly correlated with antibiotic concentrations (Mantel test; P functional genes have been enhanced by the presence of antibiotics. However, from the fact that the majority of carbon-degrading genes were derived from bacteria and diverse antibiotic resistance genes were detected in bacteria, it was assumed that many bacteria could survive in the environment by acquiring antibiotic resistance and may have maintained the position as a main player in nutrient removal. Variance partitioning analysis showed that antibiotics could explain 24.4% of variations in microbial functional structure of the treatment systems. This study provides insights into the impacts of antibiotics on microbial functional structure of a unique system receiving antibiotic production wastewater, and reveals the potential importance of the cooperation between fungi and bacteria with antibiotic resistance in maintaining the

Transcranial direct current stimulation as a treatment for auditory hallucinations.

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Sanne eKoops

2015-03-01

Full Text Available Auditory hallucinations (AH are a symptom of several psychiatric disorders, such as schizophrenia. In a significant minority of patients, AH are resistant to antipsychotic medication. Alternative treatment options for this medication-resistant group are scarce and most of them focus on coping with the hallucinations. Finding an alternative treatment that can diminish AH is of great importance.Transcranial direct current stimulation (tDCS is a safe and non-invasive technique that is able to directly influence cortical excitability through the application of very low electric currents. A 1-2 mA direct current is applied between two surface electrodes, one serving as the anode and the other as the cathode. Cortical excitability is increased in the vicinity of the anode and reduced near the cathode. The technique, which has only a few transient side effects and is cheap and portable, is increasingly explored as a treatment for neurological and psychiatric symptoms. It has shown efficacy on symptoms of depression, bipolar disorder, schizophrenia, Alzheimer’s disease, Parkinson’s disease, epilepsy and stroke. However, the application of tDCS as a treatment for AH is relatively new. This article provides an overview of the current knowledge in this field and provides guidelines for future research.

Cost-effective non-surgical treatment of chronic pressure ulcers in the community.

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Dale, Megan; Cox-Martin, Bill; Shaw, Paula; Carolan-Rees, Grace

2014-03-01

The Salisbury Pressure Ulcer Outreach Service successfully treats patients with chronic pressure ulcers that have not healed during routine community treatment. These patients have grade 4 pressure ulcers, involving extensive destruction, or damage to muscle and bone. A combination of scientific, seating and tissue viability expertise with a holistic approach results in non-surgical healing for 70% of patients. For those who still require surgery, outcomes are more successful with this approach, resulting in low recurrence rates. Prior to creation of the outreach service, patients were referred directly for surgical closure, resulting in high recurrence levels and long waiting lists. The authors compared costs of the Pressure Ulcer Outreach Service with the previous system of surgical closure. The model base case found that the Pressure Ulcer Outreach Service saved £8588 per patient, and that cost savings could be even greater if the outreach service was extended into preventative work.

Community-based rehabilitation offers cost-effective epilepsy treatment in rural Guinea-Bissau

NARCIS (Netherlands)

van Diessen, Eric; van der Maas, Frank; Cabral, Vladimir; Otte, Willem M

Treatment of epilepsy in low-income countries is a challenge considering the lack of resources, availability of antiepileptic drugs, and cultural beliefs. We used a community-based rehabilitation (CBR) service for the detection, monitoring, and treatment of epilepsy. A local network of trained

Therapeutic Engagement as a Predictor of Retention in Adolescent Therapeutic Community Treatment

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Abdel-Salam, Sami; Gunter, Whitney D.

2014-01-01

The adolescent drug problem places a huge toll on society and a heavy burden on the criminal justice system. Research regarding the benefits of therapeutic community (TC) treatment for adolescents has shown it to be effective. Despite the ability of therapeutic communities to lower drug relapse and reduce criminality, a great deal remains unknown…

Current and Emerging Directions in the Treatment of Eating Disorders

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Tiffany A. Brown

2012-01-01

Full Text Available Eating disorders are a significant source of psychiatric morbidity in young women and demonstrate high comorbidity with mood, anxiety, and substance use disorders. Thus, clinicians may encounter eating disorders in the context of treating other conditions. This review summarizes the efficacy of current and emerging treatments for anorexia nervosa (AN, bulimia nervosa (BN, and binge eating disorder (BED. Treatment trials were identified using electronic and manual searches and by reviewing abstracts from conference proceedings. Family based therapy has demonstrated superiority for adolescents with AN but no treatment has established superiority for adults. For BN, both 60 mg fluoxetine and cognitive behavioral therapy (CBT have well-established efficacy. For BED, selective serotonin reuptake inhibitors, CBT, and interpersonal psychotherapy have demonstrated efficacy. Emerging directions for AN include investigation of the antipsychotic olanzapine and several novel psychosocial treatments. Future directions for BN and BED include increasing CBT disseminability, targeting affect regulation, and individualized stepped-care approaches.

Consumer-Directed Community Care: Race/Ethnicity and Individual Differences in Preferences for Control

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Sciegaj, Mark; Capitman, John A.; Kyriacou, Corrine Kay

2004-01-01

Purpose. Even though consumer-directed care models are being advocated for use among elder populations, there are few data on the extent of elder interest in participating in the management of community long-term-care services, who they want involved in making these decisions, or their perceptions regarding the relative importance of different…

Permanence of Two Self-Managed Treatments of Overweight in University and Community Populations

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And Others; Hall, Robert G.

1974-01-01

Males and females from community and university samples were assigned to two self-management treatments, nonspecific, or no-treatment controls. At six month follow-up, differences were not significant. Results are discussed in terms of conceptualizations of self-management and the utility of treatments employed. (Author)

Heat treatment of a direct composite resin: influence on flexural strength

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Caroline Lumi Miyazaki

2009-09-01

Full Text Available The purpose of this study was to evaluate the flexural strength of a direct composite, for indirect application, that received heat treatment, with or without investment. One indirect composite was used for comparison. For determination of the heat treatment temperature, thermogravimetric analysis (TGA and differential scanning calorimetry (DSC were performed, considering the initial weight loss temperature and glass transition temperature (Tg. Then, after photoactivation (600 mW/cm² - 40 s, the specimens (10 x 2 x 2 mm were heat-treated following these conditions: 170ºC for 5, 10 or 15 min, embedded or not embedded in investment. Flexural strength was assessed as a means to evaluate the influence of different heat treatment periods and investment embedding on mechanical properties. The data were analyzed by ANOVA and Tukey's test (α = 0.05. TGA showed an initial weight loss temperature of 180ºC and DSC showed a Tg value of 157°C. Heat treatment was conducted in an oven (Flli Manfredi, Italy, after 37°C storage for 48 h. Flexural strength was evaluated after 120 h at 37°C storage. The results showed that different periods and investment embedding presented similar statistical values. Nevertheless, the direct composite resin with treatments presented higher values (178.7 MPa compared to the indirect composite resin (146.0 MPa and the same direct composite submitted to photoactivation only (151.7 MPa. Within the limitations of this study, it could be concluded that the heat treatment increased the flexural strength of the direct composite studied, leading to higher mechanical strength compared to the indirect composite.

Evolution of microbial communities during electrokinetic treatment of antibiotic-polluted soil.

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Li, Hongna; Li, Binxu; Zhang, Zhiguo; Zhu, Changxiong; Tian, Yunlong; Ye, Jing

2018-02-01

The evolution of microbial communities during the electrokinetic treatment of antibiotic-polluted soil (EKA) was investigated with chlortetracycline (CTC), oxytetracycline (OTC) and tetracycline (TC) as template antibiotics. The total population of soil microorganisms was less affected during the electrokinetic process, while living anti-CTC, anti-OTC, anti-TC and anti-MIX bacteria were inactivated by 10.48%, 31.37%, 34.76%, and 22.08%, respectively, during the 7-day treatment compared with antibiotic-polluted soil without an electric field (NOE). Accordingly, samples with NOE treatment showed a higher Shannon index than those with EKA treatment, indicating a reduction of the microbial community diversity after electrokinetic processes. The major taxonomic phyla found in the samples of EKA and NOE treatment were Proteobacteria, Bacteroidetes, Firmicutes and Actinobacteria. And the distribution of Actinobacteria, Cyanobacteria, and Chloroflexi was greatly decreased compared with blank soil. In the phylum Proteobacteria, the abundance of Alphaproteobacteria was greatly reduced in the soils supplemented with antibiotics (from 13.40% in blank soil to 6.43-10.16% after treatment); while Betaproteobacteria and Deltaproteobacteria showed a different trend with their abundance increased compared to blank soil, and Gammaproteobacteria remained unchanged for all treatments (2.36-2.78%). The varied trends for different classes indicated that the major bacterial groups changed with the treatments due to their different adaptability to the antibiotics as well as to the electric field. SulI being an exception, the reduction ratio of the observed antibiotic resistance genes (ARGs) including tetC, tetG, tetW, tetM, intI1, and sulII in the 0-2cm soil sampled with EKA versus NOE treatment reached 55.17%, 3.59%, 99.26%, 89.51%, 30.40%, and 27.92%, respectively. Finally, correlation analysis was conducted between antibiotic-resistant bacteria, ARGs and taxonomic bacterial classes. It

Directly Observed Treatment Short Course (DOTS) appears to have ...

African Journals Online (AJOL)

Directly Observed Treatment Short Course (DOTS) appears to have reduced the self-care role of pulmonary tuberculosis patient: evidence from a correctional study between Personal Health Beliefs (PHB) and Self Care Practices (SCP)

Community unit performance: factors associated with childhood diarrhea and appropriate treatment in Nyanza Province, Kenya

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Yoshito Kawakatsu

2017-02-01

Full Text Available Abstract Background The government of Kenya launched its community health strategy in 2006 to improve certain aspects of its community health program. Under the strategy, community units (CUs were established as level one of the Kenyan health system. A core member at this level is the community health worker (CHW. The objective of this study was to assess the relationship among the performance of the CUs, the prevalence of childhood diarrhea and appropriate treatment for it by controlling individual and community-level factors. Methods The main dataset used in this study was the 2011 Nyanza Province county-based Multiple Indicator Cluster Survey (MICS. In addition, based on the list of community units in Nyanza Province, Kenya, we identified the area’s CUs and their performance. MICS data and data on CUs were merged using sub-location names. There were 17 individual and two community-level independent variables in this study. Bivariate analysis and a multilevel logistic regression were performed. Results Factors significantly associated with a lower prevalence of diarrhea among children under five were the child’s increasing age, middle-aged household heads, children who received more attention, water treatment and rural versus urban area residence, while male children and highly performing CUs were significantly associated with a higher prevalence of diarrhea. In addition, middle wealth index, severity of diarrhea and middle- and high-CU performance were significantly associated with appropriate treatment for childhood diarrhea. Conclusions Although this study found that children living in areas of high CU performance were more likely to have diarrhea, these areas would have been identified as being more at risk for diarrhea prevalence and other health concerns, prioritized for the establishment of a CU and allocated more resources to improve the performance of CUs. A higher CU performance was significantly associated with the appropriate

Community unit performance: factors associated with childhood diarrhea and appropriate treatment in Nyanza Province, Kenya.

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Kawakatsu, Yoshito; Tanaka, Junichi; Ogawa, Kazuya; Ogendo, Kenneth; Honda, Sumihisa

2017-02-16

The government of Kenya launched its community health strategy in 2006 to improve certain aspects of its community health program. Under the strategy, community units (CUs) were established as level one of the Kenyan health system. A core member at this level is the community health worker (CHW). The objective of this study was to assess the relationship among the performance of the CUs, the prevalence of childhood diarrhea and appropriate treatment for it by controlling individual and community-level factors. The main dataset used in this study was the 2011 Nyanza Province county-based Multiple Indicator Cluster Survey (MICS). In addition, based on the list of community units in Nyanza Province, Kenya, we identified the area's CUs and their performance. MICS data and data on CUs were merged using sub-location names. There were 17 individual and two community-level independent variables in this study. Bivariate analysis and a multilevel logistic regression were performed. Factors significantly associated with a lower prevalence of diarrhea among children under five were the child's increasing age, middle-aged household heads, children who received more attention, water treatment and rural versus urban area residence, while male children and highly performing CUs were significantly associated with a higher prevalence of diarrhea. In addition, middle wealth index, severity of diarrhea and middle- and high-CU performance were significantly associated with appropriate treatment for childhood diarrhea. Although this study found that children living in areas of high CU performance were more likely to have diarrhea, these areas would have been identified as being more at risk for diarrhea prevalence and other health concerns, prioritized for the establishment of a CU and allocated more resources to improve the performance of CUs. A higher CU performance was significantly associated with the appropriate treatment. It was suggested that CHWs could have a positive effect on

Survey on education and training of medical physicists in the member states of the European Community with reference to the patient directive (84/466/Euratom)

International Nuclear Information System (INIS)

Schmitt-Hannig, A.

1991-01-01

Article 5 of Directive 84/466/Euratom mentions the availability of a qualified expert in radiophysics to sophisticated departments of radiotherapy and nuclear medicine. Since the qualified expert has a major and direct role to play in the protection of the patient undergoing medical examination or treatment involving ionizing radiation, his presence in the hospital and the training he has received are considerable aspects of radiation protection in the medical domain. The application of Article 5 of Directive 84/466/Euratom is of great importance for the protection of the patient undergoing medical examination or treatment involving ionizing radiation. This report, developed to evaluate the actual application of this article, reveals that although in several Member States the concept of the qualified expert in radiophysics has already been introduced into national law, in practice a need for further harmonization clearly emerges. On the availability of training facilities, the situation in the Community is rather positive, but the formal recognition of training and education of medical physicists by government bodies is still in a developing stage

Relationship power and sexual risk among women in community-based substance abuse treatment.

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Campbell, Aimee N C; Tross, Susan; Dworkin, Shari L; Hu, Mei-Chen; Manuel, Jennifer; Pavlicova, Martina; Nunes, Edward V

2009-11-01

Relationship power has been highlighted as a major factor influencing women's safer sex practices. Little research, however, has specifically examined relationship power in drug-involved women, a population with increased risk for HIV transmission. Using baseline data from a National Institute on Drug Abuse Clinical Trials Network multisite trial of a women's HIV prevention intervention in community-based drug treatment programs, this paper examined the association between sexual relationship power and unprotected vaginal or anal sex. The Sexual Relationship Power Scale, a measure of relationship control and decision-making dominance, was used to assess the association between power and unprotected sex in relationships with primary male partners. It was hypothesized that increased relationship power would be associated with decreased unprotected sexual occasions, after controlling for relevant empirical and theoretical covariates. Findings show a more complex picture of the association between power and sexual risk in this population, with a main effect in the hypothesized direction for decision-making dominance but not for relationship control. Possible explanations for these findings are discussed, and future research directions for examining power constructs and developing interventions targeting relationship power among drug-involved women are suggested.

Impact of 3 years ivermectin treatment on onchocerciasis in Yanomami communities in the Brazilian Amazon.

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Banic, Dalma M; Calvão-Brito, Regina H S; Marchon-Silva, Verônica; Schuertez, Joana C; de Lima Pinheiro, Luís Renerys; da Costa Alves, Marilene; Têva, Antônio; Maia-Herzog, Marilza

2009-11-01

In the current study, it was assessed, for the first time, the effect of ivermectin treatment administered twice a year on the prevalence and morbidity of onchocerciasis in the hyperendemic Yanomami communities of the Roraima State (Brazil). Physical and parasitological examinations were carried out every 6 months until six drug rounds of treatment were completed. The coverage during the six rounds of ivermectin treatment ranged from 89% to 92% of the eligible Yanomami population. Overall, comparison of results at pre-treatment with results after six rounds of treatment, the prevalence of infection had declined from 87% to 42% (P0.05, for both). These findings suggest that mass population treatment should continue without interruption and achieve higher levels of drug coverage in order to alleviate disease manifestations and interrupt infection transmission to hasten the elimination of onchocerciasis in Yanomami communities. In addition, the sensitivity of iliac crest snips for parasitological assessment in epidemiological surveillance of Yanomami communities may increase the acceptance of the population in biopsy sampling and seems to be a good choice for assessing the success of control programs.

Fixed and dynamic predictors of treatment process in therapeutic communities for substance abusers in Belgium.

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Goethals, Ilse; Vanderplasschen, Wouter; Vandevelde, Stijn; Broekaert, Eric

2012-10-11

Research on substance abuse treatment services in general reflects substantial attention to the notion of treatment process. Despite the growing popularity of process studies, only a few researchers have used instruments specifically tailored to measure the therapeutic community (TC) treatment process, and even fewer have investigated client attributes in relation to early TC treatment process experiences. The aim of the current study is to address this gap by exploring clients' early in-treatment experiences and to determine the predictors that are related to the treatment process, using a TC-specific multidimensional instrument. Data was gathered among 157 adults in five TCs in Flanders (Belgium). Descriptive statistics were used to explore clients' early in-treatment experiences and multiple linear regressions were conducted to determine the fixed and dynamic predictors of Community Environment and Personal Development and Change (two indicators of TC treatment process). Clients reveal a more positive first-month response to TC social processes than to personal-development processes that require self-reflection and insight. The variance in clients' ratings of Community Environment was primarily due to dynamic client factors, while the variance in clients' ratings of Personal Development and Change was only related to fixed client factors. Suitability for treatment was the strongest predictor of Community Environment ratings, whereas a judicial referral more strongly predicted Personal Development and Change scores. Special attention should be devoted to suitability for treatment as part of motivational assessment as this seems to be a very strong predictor of how clients react to the initiation stage of TC treatment. To help improve clients' (meta-)cognitive skills needed to achieve insight and self-reflection and perhaps speed up the process of recovery, the authors suggest the introduction of (meta-)cognitive training strategies in the pre-program and/or the

Erythema-directed digital photography for the enhanced evaluation of topical treatments for acne vulgaris.

Science.gov (United States)

Micali, G; Dall'Oglio, F; Tedeschi, A; Lacarrubba, F

2018-01-31

Erythema-directed digital photography is a novel method for evaluating the efficacy and tolerability of topical acne treatments. Here, we describe three case reports in which erythema-directed digital photography was used to evaluate acne before and after up to 12 weeks of treatment with clindamycin 1%/tretinoin 0.025% (Clin-RA). Erythema-directed digital photography was used to evaluate acne in three patients with mild-to-moderate facial acne, two of whom had refused to continue previous topical acne treatment (benzoyl peroxide 5% and clindamycin 1%/benzoyl peroxide 5%) due to persistent irritation. Acne lesions and erythema were evaluated using standard clinical photography and erythema-directed digital photography (VISIA-CR ™ system) before and after 8-12 weeks of treatment with Clin-RA. Erythema-directed digital photography revealed background erythema from previous topical acne treatments that was not evident from standard clinical photographs and allowed a better visualization of both inflammatory and non-inflammatory lesions. In all patients, there was a clear improvement in background erythema and a reduction in acne lesions following treatment with Clin-RA. This study has demonstrated for the first time that erythema-directed digital photography can enhance the evaluation of the efficacy and tolerability of topical acne treatments. These cases show that Clin-RA was associated with improved efficacy and tolerability vs previous treatments with topical monotherapy (benzoyl peroxide 5%) or a topical fixed-dose combination (clindamycin 1%/benzoyl peroxide 5%). © 2018 The Authors. Skin Research and Technology Published by John Wiley & Sons Ltd.

Soil microbial community responses to acid exposure and neutralization treatment.

Science.gov (United States)

Shin, Doyun; Lee, Yunho; Park, Jeonghyun; Moon, Hee Sun; Hyun, Sung Pil

2017-12-15

Changes in microbial community induced by acid shock were studied in the context of potential release of acids to the environment due to chemical accidents. The responses of microbial communities in three different soils to the exposure to sulfuric or hydrofluoric acid and to the subsequent neutralization treatment were investigated as functions of acid concentration and exposure time by using 16S-rRNA gene based pyrosequencing and DGGE (Denaturing Gradient Gel Electrophoresis). Measurements of soil pH and dissolved ion concentrations revealed that the added acids were neutralized to different degrees, depending on the mineral composition and soil texture. Hydrofluoric acid was more effectively neutralized by the soils, compared with sulfuric acid at the same normality. Gram-negative ß-Proteobacteria were shown to be the most acid-sensitive bacterial strains, while spore-forming Gram-positive Bacilli were the most acid-tolerant. The results of this study suggest that the Gram-positive to Gram-negative bacterial ratio may serve as an effective bio-indicator in assessing the impact of the acid shock on the microbial community. Neutralization treatments helped recover the ratio closer to their original values. The findings of this study show that microbial community changes as well as geochemical changes such as pH and dissolved ion concentrations need to be considered in estimating the impact of an acid spill, in selecting an optimal remediation strategy, and in deciding when to end remedial actions at the acid spill impacted site. Copyright © 2017 Elsevier Ltd. All rights reserved.

Evaluation of direct membrane filtration and direct forward osmosis as concepts for compact and energy-positive municipal wastewater treatment.

Science.gov (United States)

Hey, Tobias; Bajraktari, Niada; Davidsson, Åsa; Vogel, Jörg; Madsen, Henrik Tækker; Hélix-Nielsen, Claus; Jansen, Jes la Cour; Jönsson, Karin

2018-02-01

Municipal wastewater treatment commonly involves mechanical, biological and chemical treatment steps to protect humans and the environment from adverse effects. Membrane technology has gained increasing attention as an alternative to conventional wastewater treatment due to increased urbanization. Among the available membrane technologies, microfiltration (MF) and forward osmosis (FO) have been selected for this study due to their specific characteristics, such as compactness and efficient removal of particles. In this study, two treatment concepts were evaluated with regard to their specific electricity, energy and area demands. Both concepts would fulfil the Swedish discharge demands for small- and medium-sized wastewater treatment plants at full scale: (1) direct MF and (2) direct FO with seawater as the draw solution. The framework of this study is based on a combination of data obtained from bench- and pilot-scale experiments applying direct MF and FO, respectively. Additionally, available complementary data from a Swedish full-scale wastewater treatment plant and the literature were used to evaluate the concepts in depth. The results of this study indicate that both concepts are net positive with respect to electricity and energy, as more biogas can be produced compared to that using conventional wastewater treatment. Furthermore, the specific area demand is significantly reduced. This study demonstrates that municipal wastewater could be treated in a more energy- and area-efficient manner with techniques that are already commercially available and with future membrane technology.

Comparative efficacy of amoxicillin, cefuroxime and clarithromycin in the treatment of community acquired pneumonia in children

International Nuclear Information System (INIS)

Aurangzeb, B.; Hameed, A.

2003-01-01

Objective: To compare the clinical response to amoxicillin, cefuroxime and clarithromycin in the treatment of community-acquired pneumonia in children and to see the cost effectiveness of each treatment. Subjects and Methods: Patients between 3 to 72 months of age, admitted in the hospital with community acquired pneumonia, were randomly divided into three groups 1,2,3. They were started on amoxicillin, cefuroxime and clarithromycin respectively. The patients were assessed daily. If there was no clinical improvements at 48 hours the antibiotic was changed. ANOVA statistical test was applied to see the clinical response to the treatment in the three groups. Cost effectiveness of the treatment was compared. Results: There was no statistical difference in the clinical response at 48 hours of initiating treatment and discharge (p>0.01 each). The mean hospital stay in group 1 and 2 was 3.3 days and group 3 was 3.2 days respectively (p>0.01). Ninety-seven percent patients in group 1 and 3, and 95% patients in group 2 showed clinical improvement. The cost of treatment of community acquired pneumonia for 8 days was Rs. 496/-, 730/-, 1018/- for amoxicillin, clarithromycin and cefuroxime respectively. Conclusion: Amoxicillin was found in the most cost effective followed by clarithromycin and cefuroxime respectively in the treatment of non-severe and severe community-acquired pneumonia. (author)

Cost and cost-effectiveness of smear-positive tuberculosis treatment by Health Extension Workers in Southern Ethiopia: a community randomized trial.

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Daniel G Datiko

Full Text Available UNLABELLED: Treatments by HEWs in the health posts and general health workers at health facility were compared along a community-randomized trial. Costs were analysed from societal perspective in 2007 in US $ using standard methods. We prospectively enrolled smear positive patients, and calculated cost-effectiveness as the cost per patient successfully treated. The total cost for each successfully treated smear-positive patient was higher in health facility ($158.9 compared with community ($61.7. Community-based treatment reduced the total, patient and caregiver cost by 61.2%, 68.1% and 79.8%, respectively. Involving HEWs added a total cost of $8.80 (14.3% of total cost on health service per patient treated in the community. CONCLUSIONS/SIGNIFICANCE: Community-based treatment by HEWs costs only 39% of what treatment by general health workers costs for similar outcomes. Involving HEWs in TB treatment is a cost effective treatment alternative to the health service, to the patients and the family. There is an economic and public health reason to consider involving HEWs in TB treatment in Ethiopia. However, community-based treatment requires initial investment to start its implementation, training and supervision. TRIAL REGISTRATION: ClinicalTrials.gov NCT00803322.

Treatment of Pancreatic and Periampullary Cancers at a Community Hospital: Successful Application of Tertiary Care Treatment Standards

Science.gov (United States)

Moesinger, Robert C.; Davis, Jan W.; Hill, Britani; Johnston, W. Cory; Gray, Carl; Johnson, Harold; Ingersoll, Leslye; Whipple, Gary; Reilly, Mark; Harris, Robert; Hansen, Vincent

2011-01-01

Background. The treatment of pancreatic cancer and other periampullary neoplasms is complex and challenging. Major high-volume cancer centers can provide excellent multidisciplinary care of these patients but almost two-thirds of pancreatic cancer patients are treated at low volume centers. There is very little published data from low volume community cancer programs in regards to the treatment of periampullary cancer. In this study, a review of comprehensive periampullary cancer care at two low volume hospitals with comparison to national standards is presented. Methods. This is a retrospective review of 70 consecutive patients with periampullary neoplasms who underwent surgery over a 5-year period (2006–2010) at two community hospitals. Results. There were 51 successful resections of 70 explorations (73%) including 34 Whipple procedures. Mortality rate was 2.9%. Comparison of these patients to national standards was made in terms of operative mortality, resectability rate, administration of adjuvant therapy, clinical trial participation and overall survival. The results in these patients were comparable to national standards. Conclusions. With adequate commitment of resources and experienced surgical and oncologic practitioners, community cancer centers can meet national tertiary care standards in terms of pancreatic and periampullary cancer care. PMID:22312532

The role of culture in substance abuse treatment programs for American Indian and Alaska Native communities.

Science.gov (United States)

Legha, Rupinder Kaur; Novins, Douglas

2012-07-01

Culture figures prominently in discussions regarding the etiology of alcohol and substance abuse in American Indian and Alaska Native (AI/AN) communities, and a substantial body of literature suggests that it is critical to developing meaningful treatment interventions. However, no study has characterized how programs integrate culture into their services. Furthermore, reports regarding the associated challenges are limited. Twenty key informant interviews with administrators and 15 focus groups with clinicians were conducted in 18 alcohol and substance abuse treatment programs serving AI/AN communities. Transcripts were coded to identify relevant themes. Substance abuse treatment programs for AI/AN communities are integrating culture into their services in two discrete ways: by implementing specific cultural practices and by adapting Western treatment models. More important, however, are the fundamental principles that shape these programs and their interactions with the people and communities they serve. These foundational beliefs and values, defined in this study as the core cultural constructs that validate and incorporate AI/AN experience and world view, include an emphasis on community and family, meaningful relationships with and respect for clients, a homelike atmosphere within the program setting, and an “open door” policy for clients. The primary challenges for integrating these cultural practices include AI/AN communities' cultural diversity and limited socioeconomic resources to design and implement these practices. The prominence of foundational beliefs and values is striking and suggests a broader definition of culture when designing services. This definition of foundational beliefs and values should help other diverse communities culturally adapt their substance abuse interventions in more meaningful ways.

Results from a Community-Based Smoking Cessation Treatment Program for LGBT Smokers

Directory of Open Access Journals (Sweden)

Alicia K. Matthews

2013-01-01

Full Text Available Introduction. Little is known about lesbian, gay, bisexual, and transgender (LGBT people’s response to smoking cessation interventions. This descriptive study examined the benefits of a community-based, culturally tailored smoking cessation treatment program for LGBT smokers. Methods. A total of N=198 LGBT individuals recruited from clinical practice and community outreach participated in group-based treatment. Sessions were based on the American Lung Association’s “Freedom from Smoking Program” (ALA-FFS and were tailored to LGBT smokers’ needs. Seven-day smoking point prevalence abstinence served as the primary outcome. Results. Participants (M age = 40.5 were mostly White (70.4% and male (60.5% and had at least a college degree (58.4%. Forty-four percent scored in the moderate range on the Fagerström Test for Nicotine Dependence pretreatment, and 42.4% completed treatment (≥75% sessions. Higher educational attainment and use of nicotine replacement therapy (NRT were associated with treatment completion. Self-reported quit rates were 32.3% at posttreatment assessment. Treatment attendance (OR = 2.45, use of NRT (OR = 4.24, and lower nicotine dependency (OR = 0.73 were positively associated with quitting smoking. Conclusions. Results suggest the benefits of offering LGBT smokers culturally tailored smoking cessation treatments. Future research could improve outcomes by encouraging treatment attendance and promoting NRT uptake.

Experience of the application of direct democracy and mediate participation’s possibilities in territorial communities of Ukraine

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N. M. Nahorna

2016-10-01

Taking into consideration such situation, the application of direct democracy and mediate participation’s possibilities in territorial communities of Ukraine appears to be more and more relevant for scientifically theoretical apprehension and practical introduction of the modern Ukraine’s political life. Thus, we consider that the improvement of the mechanisms of direct democracy and mediate citizens’ participation should become an important task of state’s policy in the process of raise of the Ukrainian political system efficiency. At the present stage of political transformations they are an actual instrument of influencing the population, aimed at the increase of control of the governmental institutions between the elections periods. Indisputably, such experience of the application of direct democracy and mediate participation’s possibilities in territorial communities of Ukraine together with the necessary improvement of legal sphere and the raise of the efficiency of the direct democracy’s mechanisms practical implementation will positively influence the development of social and political life and will allow to use the main means of the realization of direct democracy at the local level and at the national level effectively and will stimulate the participation of population in the political process.

Assertive community treatment and associations with delinquency.

Science.gov (United States)

van Vugt, Maaike D; Kroon, Hans; Delespaul, Philippe A E G; Mulder, Cornelis L

This article draws on a prospective longitudinal study in which Assertive Community Treatment (ACT) model fidelity and patient outcomes were assessed in twenty outpatient treatment teams. 530 severely mentally ill patients participated in the study. Delinquency outcomes were assessed three times during a two-year follow-up period. At baseline, 49% of the patients had a recent criminal history, meaning that they had at least one reported contact with the police and/or the justice system in the past year. Patients with a recent criminal history had more serious psychosocial problems at baseline compared to those without a recent criminal history. Delinquency outcomes showed improvement over time, but this was not associated with ACT model fidelity. The study shows an association for homelessness and criminal activity. The persistent criminal activities of some of the patients showed that for this group extra interventions are needed that specifically target reduction of criminal behavior. Copyright © 2016 Elsevier Ltd. All rights reserved.

Community-Based Psychosocial Treatment Has an Impact on Social Processing and Functional Outcome in Schizophrenia

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Eszter Varga

2018-06-01

Full Text Available Schizophrenic patients have serious impairments in social cognition, which often persists after significant reduction in clinical symptoms. Community-based psychosocial treatments aim to recover social functioning for mentally ill individuals. Our aim was to examine prospective changes in social cognition and functional outcomes in two groups of schizophrenic patients involved in two forms of community-based psychosocial treatments namely case management (CM and community-based club (CC compared to a matched, treatment as usual (TAU group of patients. We hypothesized that CC and CM groups would exhibit better functional and social cognitive outcomes after a 6-month long psychosocial treatment period. Seventy-five patients participated either in CC, CM or TAU. Both CC and CM took part in community-based psychosocial treatment programs including trainings, such as communication and assertiveness trainings. In addition, CC provided group therapeutic treatments and a continuously available day care where patients had the possibility to participate in various social interactions. All participants were in remission, and on maintenance antipsychotic treatment. Participants were assessed on all study variables at two time points: baseline and after 6 months with a battery of questionnaires that examined affective face perception, affective prosody perception, pragmatic language comprehension and ToM. Our results showed that functional outcomes improved significantly in the CC as well as in the CM groups, in contrast to the TAU group. While analyzing summary scores of social cognition, it was found that only the CC group increased its performance in social cognition. In addition, a significant between-group difference in social cognitive function was found after 6 months between the three groups, with the CC group performing best. When investigating associations between changes in social cognition and changes in functional outcomes during a 6-month long

[Medical treatment support to tuberculous patients--from the standpoint of community support].

Science.gov (United States)

2001-11-01

A symposium with "Medical Treatment Support to Tuberculous Patients--From the standpoint of community support" as its theme was held at the 76th Annual Meeting of the Japanese Society for Tuberculosis (April 20, 2001). "Once, It is infected with tuberculosis, one have to complete medication with a sensitive antituberculosis drug by observing the prescribed dose and duration for successful treatment". For this to be promoted community, it is necessary that (1) to manage patient's medication by medical facilities, (2) to support patient's medication by health center and (3) to support patient's living by welfare offices. Not that each facilities takes such responsibilities alone, but various community must fulfill them continuously in liaison with one another. On what measures should be taken to that end, reports based on practical examples from Nagoya City, Yokohama City and Kanagawa Prefecture have been compiled as follows. 1. It was in-office liaison by conference that supported the DOTS activities of health nurses. 2. It is cooperating, without health, medical treatment, and welfare going out, as follows. (1) A system for hospitals and clinics to carry out DOTS treatment consistently has been kept in good condition. (2) For a patient to take a drug in front of a nurse has become common, causing the patients to be motivated. (3) Assignment of MSW and nurses in charge of DOTS sent from hospitals has make it possible to offer or exchange information smoothly among those concerned. (4) A system for many persons concerned to support patients timely has been kept in good condition. This resulted in an increase in the cure rate of tuberculosis in the areas which have day laborers' lodgings. 3. By DOTS for in-patients, the number of self-discharges has decreased by 1/3, and the treatment completion rate was 94%. 4. In promotion of DOTS for the patients who have health problems other than tuberculosis, the role MSW plays is great. 5. As conditions for supporting DOTS

Seasonal variations of microbial community in a full scale oil field produced water treatment plant

Directory of Open Access Journals (Sweden)

Q. Xie

2016-01-01

Full Text Available This study investigated the microbial community in a full scale anaerobic baffled reactor and sequencing batch reactor system for oil-produced water treatment in summer and winter. The community structures of fungi and bacteria were analyzed through polymerase chain reaction–denaturing gradient gel electrophoresis and Illumina high-throughput sequencing, respectively. Chemical oxygen demand effluent concentration achieved lower than 50 mg/L level after the system in both summer and winter, however, chemical oxygen demand removal rates after anaerobic baffled reactor treatment system were significant higher in summer than that in winter, which conformed to the microbial community diversity. Saccharomycotina, Fusarium, and Aspergillus were detected in both anaerobic baffled reactor and sequencing batch reactor during summer and winter. The fungal communities in anaerobic baffled reactor and sequencing batch reactor were shaped by seasons and treatment units, while there was no correlation between abundance of fungi and chemical oxygen demand removal rates. Compared to summer, the total amount of the dominant hydrocarbon degrading bacteria decreased by 10.2% in anaerobic baffled reactor, resulting in only around 23% of chemical oxygen demand was removed in winter. Although microbial community significantly varied in the three parallel sulfide reducing bacteria, the performance of these bioreactors had no significant difference between summer and winter.

Seasonal variations of microbial community in a full scale oil field produced water treatment plant

International Nuclear Information System (INIS)

Xie, Q.; Bai, S.; Li, Y.; Liu, L.; Wang, S.; Xi, J.

2016-01-01

This study investigated the microbial community in a full scale anaerobic baffled reactor and sequencing batch reactor system for oil-produced water treatment in summer and winter. The community structures of fungi and bacteria were analyzed through polymerase chain reaction–denaturing gradient gel electrophoresis and Illumina high throughput sequencing, respectively. Chemical oxygen demand effluent concentration achieved lower than 50 mg/L level after the system in both summer and winter, however, chemical oxygen demand removal rates after anaerobic baffled reactor treatment system were significant higher in summer than that in winter, which conformed to the microbial community diversity. Saccharomycotina, Fusarium, and Aspergillus were detected in both anaerobic baffled reactor and sequencing batch reactor during summer and winter. The fungal communities in anaerobic baffled reactor and sequencing batch reactor were shaped by seasons and treatment units, while there was no correlation between abundance of fungi and chemical oxygen demand removal rates. Compared to summer, the total amount of the dominant hydrocarbon degrading bacteria decreased by 10.2% in anaerobic baffled reactor, resulting in only around 23% of chemical oxygen demand was removed in winter. Although microbial community significantly varied in the three parallel sulfide reducing bacteria, the performance of these bioreactors had no significant difference between summer and winter.

Evaluation of direct membrane filtration and direct forward osmosis as concepts for compact and energy-positive municipal wastewater treatment

DEFF Research Database (Denmark)

Hey, Tobias; Bajraktari, Niada; Davidsson, Åsa

2018-01-01

electricity, energy and area demands. Both concepts would fulfil the Swedish discharge demands for small- and medium-sized wastewater treatment plants at full scale: (1) direct MF and (2) direct FO with seawater as the draw solution. The framework of this study is based on a combination of data obtained from...... positive with respect to electricity and energy, as more biogas can be produced compared to that using conventional wastewater treatment. Furthermore, the specific area demand is significantly reduced. This study demonstrates that municipal wastewater could be treated in a more energy- and area...

Implementation of integrated therapies for comorbid post-traumatic stress disorder and substance use disorders in community substance abuse treatment programs.

Science.gov (United States)

Killeen, Therese K; Back, Sudie E; Brady, Kathleen T

2015-05-01

The high prevalence of trauma and post-traumatic stress disorder (PTSD) in individuals with substance use disorders (SUDs) presents a number of treatment challenges for community treatment providers and programs in the USA. Although several evidence-based, integrated therapies for the treatment of comorbid PTSD/SUD have been developed, rates of utilisation of such practices remain low in community treatment programs. The goal of this article was to review the extant literature on common barriers that prevent adoption and implementation of integrated treatments for PTSD/SUD among substance abuse community treatment programs. Organisational, provider-level and patient-level factors that drive practice decisions were discussed, including organisational philosophy of care policies, funding and resources, as well as provider and patient knowledge and attitudes related to implementation of new integrated treatments for comorbid PTSD and SUD. Understanding and addressing these community treatment challenges may facilitate use of evidence-based integrated treatments for comorbid PTSD and SUD. © 2015 Australasian Professional Society on Alcohol and other Drugs.

Adding evidence-based interventions to assertive community treatment : a feasibility study

NARCIS (Netherlands)

Sytema, Sjoerd; Jörg, Frederike; Nieboer, Roeline; Wunderink, Lex

OBJECTIVE: This 24-month study, conducted in The Netherlands, examined the feasibility of enhancing the effectiveness of assertive community treatment (ACT) by adding evidence-based interventions. METHODS: A total of 159 patients were randomly assigned to two ACT teams, one providing standard ACT

DIRECT PULP CAPPING IN TREATMENT OF REVERSIBLE PULPITIS IN PRIMARY TEETH- CLINICAL PROTOCOL

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Nina Milcheva

2016-10-01

Full Text Available The pulp of primary teeth is identical morphologically and physiologically to that of permanent teeth and it is capable to answer to pathological stimuli by producing tertiary dentin. When the inflammation of the pulp is in its reversible stage vital methods of treatment are indicated in order to stimulate the healing processes in it and protect its vitality. In Bulgaria the most popular method of treatment of inflammation diseases of the pulp in primary dentition is the mortal amputation. The biological way of treatment is not very common even in cases where there are indications for it. Purpose: The aim of this paper is to present the approbated by us protocol for application of direct pulp capping for treatment of reversible pulpitis in primary teeth. Material and methods: On the base of world experience and our contemporary meta- analysis of the researches published in the last 15 years concerning the problems of diagnostics. We determined clinical and radiographic diagnostic criteria for reversible pulpitis in primary teeth and indications for application of direct pulp capping as a method of treatment. We give clinical steps for application of the method and summarized the clinical and radiographic criteria for success after treatment. Results/conclusion: We gather all the information for applying direct pulp cappingfor treatment of reversible pulpitis in primary dentition. We offer the method of direct pulp capping as a clinical protocol “step by step” and illustrated by scheme which can be useful for students and dentists in their everyday practice.

Effects of solar PAR and UV radiation on tropical biofouling communities

KAUST Repository

Dobretsov, SV

2010-03-08

We investigated the effect of solar ultraviolet radiation (UVR) and photosynthetically active radiation (PAR) on the development of tropical micro- and macrofouling communities for 30 d. The experimental design involved 3 treatments: full spectrum (PAR+UVR), PAR only, and minimal light (reduced PAR and UVR). Terminal restriction fragment length polymorphism analysis demonstrated that different light conditions resulted in the formation of highly different microbial communities. The lowest densities of bacteria were found under the full spectrum treatment, while the lowest densities of diatoms were found in the minimal light treatment. Macrofouling communities consisted of 13 species and differed among light treatments. In the presence of UVR, communities had low species diversity, evenness, and richness, while in minimal light and PAR treatments, communities had high species diversity, evenness, and richness. Similarity percentage (SIMPER) analysis revealed that the tubeworm Hydroides elegans, the alga Ulva (Enteromorpha) sp., and the bivalve Perna viridis were the species responsible for most of the dissimilarities in macrofouling communities among treatments. While densities of H. elegans were similar in the PAR and minimal light treatments, this polychaete had higher growth rates under minimal light conditions. We conclude that UVR and PAR directly control the development of shallow micro- and macrofouling communities by inhibiting the recruitment and growth of sensitive species and promoting the growth of resistant species, but also that these forms of solar radiation influence the surface cues available to competent larvae by altering the development of the microbial community.

Factors affecting the attrition of community-directed distributors of ivermectin, in an onchocerciasis-control programme in the Imo and Abia states of south-eastern Nigeria.

Science.gov (United States)

Emukah, E C; Enyinnaya, U; Olaniran, N S; Akpan, E A; Hopkins, D R; Miri, E S; Amazigo, U; Okoronkwo, C; Stanley, A; Rakers, L; Richards, F O; Katabarwa, M N

2008-01-01

In areas of Nigeria where onchocerciasis is endemic, community-directed distributors (CDD) distribute ivermectin annually, as part of the effort to control the disease. Unfortunately, it has been reported that at least 35% of the distributors who have been trained in Nigeria are unwilling to participate further as CDD. The selection and training of new CDD, to replace those unwilling to continue, leads to annual expense that the national onchocerciasis-programme is finding difficult to meet, given other programme priorities and the limited resources. If the reported levels of attrition are true, they seriously threaten the sustainability of community-directed treatment with ivermectin (CDTI) in Nigeria. In 2002, interviews were held with 101 people who had been trained as CDD, including those who had stopped serving their communities, from 12 communities in south-eastern Nigeria that had high rates of CDD attrition. The results showed that, although the overall reported CDD attrition was 40.6%, the actual rate was only 10.9%. The CDD who had ceased participating in the annual rounds of ivermectin blamed a lack of incentives (65.9%), the demands of other employment (14.6%), the long distances involved in the house-to-house distribution (12.2%) or marital duties (7.3%). Analysis of the data obtained from all the interviewed CDD showed that inadequate supplies of ivermectin (P<0.01), lack of supervision (P<0.05) and a lack of monetary incentives (P<0.001) led to significant increases in attrition. Conversely, CDD retention was significantly enhanced when the distributors were selected by their community members (P<0.001), supervised (P<0.001), supplied with adequate ivermectin tablets (P<0.05), involved in educating their community members (P<0.05), and/or involved in other health programmes (P<0.001). Although CDD who were involved in other health programmes were relatively unlikely to cease participating in the distributions, they were more likely to take longer

Associations Between Quality of Life and Functioning in an Assertive Community Treatment Population.

Science.gov (United States)

Clausen, Hanne; Landheim, Anne; Odden, Sigrun; Heiervang, Kristin Sverdvik; Stuen, Hanne Kilen; Killaspy, Helen; Šaltytė Benth, Jurate; Ruud, Torleif

2015-11-01

Level of functioning is positively associated with subjective quality of life for people with severe mental illness, but a detailed relationship between functioning and satisfaction with various life domains is largely unknown, and this gap prompted this study. Demographic and clinical data were obtained from 149 patients engaged with 12 assertive community treatment teams in Norway. Multivariate regression analyses were used to explore associations between subjective quality of life and patient characteristics. Analyses confirmed positive associations between quality of life and age, functioning, and weekly contact with family and friends and a negative association with anxiety and depressive symptoms. Positive associations between several areas of practical and social functioning and satisfaction with related life domains also were found. Although a causal direction of the associations between functioning and life satisfaction has not been determined in this study, the positive findings might indicate that programs aiming to improve functioning could affect patients' quality of life.

Involuntary admission may support treatment outcome and motivation in patients receiving assertive community treatment.

Science.gov (United States)

Kortrijk, Hans Erik; Staring, A B P; van Baars, A W B; Mulder, C L

2010-02-01

Patients with severe mental illness who are treated in assertive community treatment (ACT) teams are sometimes involuntarily admitted when they are dangerous to themselves or others, and are not motivated for treatment. However, the consequences of involuntary admission in terms of psychosocial outcome and treatment motivation are largely unknown. We hypothesized that involuntary admission would improve psychosocial outcome and not adversely affect their treatment motivation. In the context of routine 6-monthly outcome monitoring in the period January 2003-March 2008, we used the Health of the Nation Outcome Scales (HoNOS) and a motivation-for-treatment scale to assess 260 severely mentally ill patients at risk for involuntary admission. Mixed models with repeated measures were used for data analyses. During the observation period, 77 patients (30%) were involuntarily admitted. Relative to patients who were not involuntarily admitted, these patients improved significantly in HoNOS total scores (F = 17,815, df = 1, p < 0.001) and in motivation for treatment (F = 28.139, df = 1, p < 0.001). Patients who were not involuntarily admitted had better HoNOS and motivation scores at baseline, but did not improve. Involuntary admission in the context of ACT was associated with improvements in psychosocial outcome and motivation for treatment. There are no indications that involuntary admission leads to deterioration in psychosocial outcome or worsening of motivation for treatment.

Profile of tobacco users amongst treatment seekers: A comparison between clinic and community sample

Directory of Open Access Journals (Sweden)

Savita Malhotra

2017-01-01

Full Text Available Background and objectives: Despite the huge burden of tobacco use or addiction, there has been a glaring scarcity of resources to tackle the problem. Although some of the tobacco users want to quit, very few have the opportunity to seek help from available treatment facilities. The study aimed to find out the profile of treatment seekers from clinic and community programs and also to compare the two groups. Method: This is a cross sectional, retrospective study of subjects enrolled in the clinic and various community outreach programs of a Tobacco Cessation Centre from the year 2002-2011. Modified intake form developed by the WHO was administered to the subjects. Results: Significant difference was found between the two groups with regard to the age of treatment seeking, education and socio economic status. Older subjects reported in greater numbers to the clinic, whereas younger subjects belonged to the community group. Community group had lower level of education, belonged to lower or upper lower socio economic status whereas clinic group had higher level of education and were from the middle or upper socio economic status. Curiosity (Z score = 3.2,P = 0.001 played a significant role in initiating the use in clinic group whereas role model (Z score = 5.1, P = <0.0001 and low self esteem (Z score = 2.0, P = 0.023 were significantly associated with community sample. Presence of medical complications (Z score = 12.5, P = <0.0001, awareness of physical harm of nicotine (Z score = 5.0, P = <0.0001 and awareness of addiction was significantly more in the clinic group. Interpretation and Conclusions: The difference in the socio-demographic and clinical profile of tobacco users in these two treatment groups is noteworthy, and is expected to offer useful information for the clinicians and as well as for the policy makers.

Drivers of microbial community composition in mesophilic and thermophilic temperature-phased anaerobic digestion pre-treatment reactors.

Science.gov (United States)

Pervin, Hasina M; Dennis, Paul G; Lim, Hui J; Tyson, Gene W; Batstone, Damien J; Bond, Philip L

2013-12-01

Temperature-phased anaerobic digestion (TPAD) is an emerging technology that facilitates improved performance and pathogen destruction in anaerobic sewage sludge digestion by optimising conditions for 1) hydrolytic and acidogenic organisms in a first-stage/pre-treatment reactor and then 2) methogenic populations in a second stage reactor. Pre-treatment reactors are typically operated at 55-65 °C and as such select for thermophilic bacterial communities. However, details of key microbial populations in hydrolytic communities and links to functionality are very limited. In this study, experimental thermophilic pre-treatment (TP) and control mesophilic pre-treatment (MP) reactors were operated as first-stages of TPAD systems treating activated sludge for 340 days. The TP system was operated sequentially at 50, 60 and 65 °C, while the MP rector was held at 35 °C for the entire period. The composition of microbial communities associated with the MP and TP pre-treatment reactors was characterised weekly using terminal-restriction fragment length polymorphism (T-RFLP) supported by clone library sequencing of 16S rRNA gene amplicons. The outcomes of this approach were confirmed using 454 pyrosequencing of gene amplicons and fluorescence in-situ hybridisation (FISH). TP associated bacterial communities were dominated by populations affiliated to the Firmicutes, Thermotogae, Proteobacteria and Chloroflexi. In particular there was a progression from Thermotogae to Lutispora and Coprothermobacter and diversity decreased as temperature and hydrolysis performance increased. While change in the composition of TP associated bacterial communities was attributable to temperature, that of MP associated bacterial communities was related to the composition of the incoming feed. This study determined processes driving the dynamics of key microbial populations that are correlated with an enhanced hydrolytic functionality of the TPAD system. Copyright © 2013 Elsevier Ltd. All rights

Effect of a community-based delivery of intermittent preventive treatment of malaria in pregnancy on treatment seeking for malaria at health units in Uganda

DEFF Research Database (Denmark)

Mbonye, A K; Schultz Hansen, K; Bygbjerg, I C

2008-01-01

whether traditional birth attendants, drug-shop vendors, community reproductive health workers and adolescent peer mobilizers can administer IPTp with sulphadoxine-pyrimethamine (SP) to pregnant women, reach those at greatest risk of malaria, and increase access and compliance with IPTp. STUDY DESIGN...... of the intervention on access to malaria treatment, antenatal care, other services and related costs. RESULTS: More women (67.5%) received two doses of SP through the community approach compared with health units (39.9%; P... in the community had sought malaria treatment (70.3%), suggesting the possibility that the novel approach had a positive impact on care seeking for malaria. Similarly, utilization of antenatal care, insecticide-treated nets and delivery care by women in the community was high. The total costs per woman receiving...

Effect of a community-based delivery of intermittent preventive treatment of malaria in pregnancy on treatment seeking for malaria at health units in Uganda

DEFF Research Database (Denmark)

Mbonye, Anthony; Hansen, Kristian Schultz; Bygbjerg, Ib

2008-01-01

whether traditional birth attendants, drug-shop vendors, community reproductive health workers and adolescent peer mobilizers can administer IPTp with sulphadoxine-pyrimethamine (SP) to pregnant women, reach those at greatest risk of malaria, and increase access and compliance with IPTp. Study design...... of the intervention on access to malaria treatment, antenatal care, other services and related costs. Results: More women (67.5%) received two doses of SP through the community approach compared with health units (39.9%; P... in the community had sought malaria treatment (70.3%), suggesting the possibility that the novel approach had a positive impact on care seeking for malaria. Similarly, utilization of antenatal care, insecticide-treated nets and delivery care by women in the community was high. The total costs per woman receiving...

Community-directed mass drug administration is undermined by status seeking in friendship networks and inadequate trust in health advice networks

NARCIS (Netherlands)

Chami, Goylette F.; Kontoleon, Andreas A.; Bulte, Erwin; Fenwick, Alan; Kabatereine, Narcis B.; Tukahebwa, Edridah M.; Dunne, David W.

2017-01-01

Over 1.9 billion individuals require preventive chemotherapy through mass drug administration (MDA). Community-directed MDA relies on volunteer community medicine distributors (CMDs) and their achievement of high coverage and compliance. Yet, it is unknown if village social networks influence

Community-directed mass drug administration is undermined by status seeking in friendship networks and inadequate trust in health advice networks

NARCIS (Netherlands)

Chami, Goylette F.; Kontoleon, Andreas A.; Bulte, Erwin; Fenwick, Alan; Kabatereine, Narcis B.; Tukahebwa, Edridah M.; Dunne, David W.

2017-01-01

Over 1.9 billion individuals require preventive chemotherapy through mass drug administration (MDA). Community-directed MDA relies on volunteer community medicine distributors (CMDs) and their achievement of high coverage and compliance. Yet, it is unknown if village social networks influence

Innovation in a Learning Health Care System: Veteran-Directed Home- and Community-Based Services.

Science.gov (United States)

Garrido, Melissa M; Allman, Richard M; Pizer, Steven D; Rudolph, James L; Thomas, Kali S; Sperber, Nina R; Van Houtven, Courtney H; Frakt, Austin B

2017-11-01

A path-breaking example of the interplay between geriatrics and learning healthcare systems is the Veterans Health Administration's (VHA's) planned roll-out of a program for providing participant-directed home- and community-based services to veterans with cognitive and functional limitations. We describe the design of a large-scale, stepped-wedge, cluster-randomized trial of the Veteran-Directed Home- and Community-Based Services (VD-HCBS) program. From March 2017 through December 2019, up to 77 Veterans Affairs Medical Centers will be randomized to times to begin offering VD-HCBS to veterans at risk of nursing home placement. Services will be provided to community-dwelling participants with support from Aging and Disability Network Agencies. The VHA Partnered Evidence-based Policy Resource Center (PEPReC) is coordinating the evaluation, which includes collaboration from operational stakeholders from the VHA and Administration for Community Living and interdisciplinary researchers from the Center of Innovation in Long-Term Services and Supports and the Center for Health Services Research in Primary Care. For older veterans with functional limitations who are eligible for VD-HCBS, we will evaluate health outcomes (hospitalizations, emergency department visits, nursing home admissions, days at home) and healthcare costs associated with VD-HCBS availability. Learning healthcare systems facilitate diffusion of innovation while enabling rigorous evaluation of effects on patient outcomes. The VHA's randomized rollout of VD-HCBS to veterans at risk of nursing home placement is an example of how to achieve these goals simultaneously. PEPReC's experience designing an evaluation with researchers and operations stakeholders may serve as a framework for others seeking to develop rapid, rigorous, large-scale evaluations of delivery system innovations targeted to older adults. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Youth motivation as a predictor of treatment outcomes in a community mental health system.

Science.gov (United States)

Merrill, Brett M; Warren, Jared S; Garcia, Darren J; Hardy, Sam A

2017-03-01

The purpose of this study was to examine the relationship between youth motivation and psychotherapy outcomes in routine community mental health settings. One hundred fifty youth, ages 12-17, from three community mental health clinics completed the Youth Outcome Questionnaire and Treatment Support Measure at frequent intervals over the course of treatment. Increases in motivation followed a curvilinear trajectory. On average, youth motivation significantly increased over the course of therapy according to both self- and parent reports (p motivation over the course of therapy was negatively associated with the slope for mental health symptoms (p motivation did not predict overall change or the rate of change in symptoms. However, there was significant individual variability in patterns of youth motivation. Our findings demonstrate that youth show increases in motivation over the course of therapy with most gains occurring in the first few sessions. Because increases in motivation over the course of therapy were related to decreases in mental health symptoms, further research is needed to examine how treatment interventions or other factors such as parent motivation may moderate this relationship. Additional research examining the likely complex relationship between initial youth motivation and treatment outcomes in community mental health settings is needed.

Current approaches and future directions in the treatment of leprosy

Directory of Open Access Journals (Sweden)

Worobec SM

2012-08-01

Full Text Available Sophie M WorobecDepartment of Dermatology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USAAbstract: This review surveys current treatments and future treatment trends in leprosy from a clinical perspective. The World Health Organization provides a multidrug treatment regimen that targets the Mycobacterium leprae bacillus which causes leprosy. Several investigational drugs are available for the treatment of drug-resistant M. leprae. Future directions in leprosy treatment will focus on: the molecular signaling mechanism M. leprae uses to avoid triggering an immune response; prospective studies of the side effects experienced during multiple-drug therapy; recognition of relapse rates post-completion of designated treatments; combating multidrug resistance; vaccine development; development of new diagnostic tests; and the implications of the recent discovery of a genetically distinct leprosy-causing bacillus, Mycobacterium lepromatosis.Keywords: epidemiology, leprosy, Hansen’s disease, multidrug resistance, multidrug therapy

Community Sewage Sensors towards Evaluation of Drug Use Trends: Detection of Cocaine in Wastewater with DNA-Directed Immobilization Aptamer Sensors

Science.gov (United States)

Yang, Zhugen; Castrignanò, Erika; Estrela, Pedro; Frost, Christopher G.; Kasprzyk-Hordern, Barbara

2016-02-01

Illicit drug use has a global concern and effective monitoring and interventions are highly required to combat drug abuse. Wastewater-based epidemiology (WBE) is an innovative and cost-effective approach to evaluate community-wide drug use trends, compared to traditional population surveys. Here we report for the first time, a novel quantitative community sewage sensor (namely DNA-directed immobilization of aptamer sensors, DDIAS) for rapid and cost-effective estimation of cocaine use trends via WBE. Thiolated single-stranded DNA (ssDNA) probe was hybridized with aptamer ssDNA in solution, followed by co-immobilization with 6-mercapto-hexane onto the gold electrodes to control the surface density to effectively bind with cocaine. DDIAS was optimized to detect cocaine at as low as 10 nM with a dynamic range from 10 nM to 5 μM, which were further employed for the quantification of cocaine in wastewater samples collected from a wastewater treatment plant in seven consecutive days. The concentration pattern of the sampling week is comparable with that from mass spectrometry. Our results demonstrate that the developed DDIAS can be used as community sewage sensors for rapid and cost-effective evaluation of drug use trends, and potentially implemented as a powerful tool for on-site and real-time monitoring of wastewater by un-skilled personnel.

Community-Based Addiction Treatment Staff Attitudes about the Usefulness of Evidence-Based Addiction Treatment and CBO Organizational Linkages to Research Institutions

Science.gov (United States)

Lundgren, Lena; Krull, Ivy; Zerden, Lisa de Saxe; McCarty, Dennis

2011-01-01

This national study of community-based addiction-treatment organizations' (CBOs) implementation of evidence-based practices explored CBO Program Directors' (n = 296) and clinical staff (n = 518) attitudes about the usefulness of science-based addiction treatment. Through multivariable regression modeling, the study identified that identical…

Influence of salinity on fungal communities in a submerged fixed bed bioreactor for wastewater treatment

NARCIS (Netherlands)

Cortés-Lorenzo, C.; González-Martínez, A.; Smidt, H.; González-López, J.; Rodelas, B.

2016-01-01

Salinity is known to influence the performance of biological wastewater treatment plants. While its impact on bacterial communities has been thoroughly studied, its influence on fungal communities has been largely overlooked. To address this knowledge gap, we assessed the effect of saline

Translucency changes of direct esthetic restorative materials after curing, aging and treatment

Directory of Open Access Journals (Sweden)

Yong-Keun Lee

2016-11-01

Full Text Available The purpose of this article was to review the changes in translucency of direct esthetic restorative materials after curing, aging and treatment. As a criterion for the evaluation of clinical translucency changes, visual perceptibility threshold in translucency parameter difference (ΔTP of 2 was used. Translucency changes after curing were perceivable depending on experimental methods and products (largest ΔTP in resin composites = 15.9. Translucency changes after aging were reported as either relatively stable or showed perceivable changes by aging protocols (largest ΔTP in resin composites = -3.8. Translucency changes after curing, aging and treatment were perceivable in several products and experimental methods. Therefore, shade matching of direct esthetic materials should be performed considering these instabilities of translucency in direct esthetic materials.

Quality of life among dots (directly observed treatment short course ...

African Journals Online (AJOL)

Quality of life among dots (directly observed treatment short course) cured patients: ... which is a specific instrument and covers four domains of health i.e. physical, ... thereby necessitating measures for the improvement of the overall health of ...

Direct versus indirect treatment for preschool children who stutter: The RESTART randomized trial

NARCIS (Netherlands)

C. de Sonneville (Caroline); E.A. Stolk (Elly); T. Rietveld (Toni); M.-C. Franken (Marie-Christine)

2015-01-01

textabstractObjective Stuttering is a common childhood disorder. There is limited high quality evidence regarding options for best treatment. The aim of the study was to compare the effectiveness of direct treatment with indirect treatment in preschool children who stutter. Methods In this

A hospital-based child and adolescent overweight and obesity treatment protocol transferred into a community healthcare setting

DEFF Research Database (Denmark)

Mollerup, Pernille Maria; Gamborg, Michael Orland; Trier, Cæcilie

2017-01-01

BACKGROUND: Due to the pandemic of child and adolescent overweight and obesity, improvements in overweight and obesity treatment availability and accessibility are needed. METHODS: In this prospective study, we investigated if reductions in body mass index (BMI) standard deviation scores (SDS......) and waist circumference (WC) would occur during 1.5 years of community-based overweight and obesity treatment based upon an effective hospital-based overweight and obesity treatment protocol, The Children's Obesity Clinics' Treatment protocol. Height, weight, and WC were measured at all consultations...... was invested per child per year. CONCLUSION: BMI SDS and WC were reduced after 1.5 years of treatment. Hence, this community-based overweight and obesity treatment program may help accommodate the need for improvements in treatment availability and accessibility....

Staff and consumer perspectives on defining treatment success and failure in assertive community treatment.

Science.gov (United States)

Stull, Laura G; McGrew, John H; Salyers, Michelle P

2010-09-01

Although assertive community treatment (ACT) has been consistently recognized as effective, there has been little research as to what constitutes success in ACT. The purpose of this study was to understand how ACT consumers and staff define treatment success and failure and to examine whether definitions varied between staff and consumers. Investigators conducted semistructured interviews with 25 staff and 23 consumers from four ACT teams. Across perspectives, success and failure were most clearly related to consumer factors. Other themes included having basic needs met, being socially involved, and taking medications. Reduced hospitalizations were mentioned infrequently. Consumers were more likely than staff to identify the level or type of treatment as defining success and failure, whereas staff were more likely than consumers to discuss substance abuse when defining failure and improved symptoms when defining success. Success in ACT should be viewed more broadly than reduced hospitalizations and include domains such as social involvement.

Population dynamics of iron-oxidizing communities in pilot plants for the treatment of acid mine waters.

Science.gov (United States)

Heinzel, Elke; Janneck, Eberhard; Glombitza, Franz; Schlömann, Michael; Seifert, Jana

2009-08-15

The iron-oxidizing microbial community in two pilot plants for the treatment of acid mine water was monitored to investigate the influence of different process parameters such as pH, iron concentration, and retention time on the stability of the system to evaluate the applicability of this treatment technology on an industrial scale. The dynamics of the microbial populations were followed using T-RFLP (terminal restriction fragment length polymorphism) over a period of several months. For a more precise quantification, two TaqMan assays specific for the two prominent groups were developed and the relative abundance of these taxa in the iron-oxidizing community was verified by real-time PCR. The investigations revealed that the iron-oxidizing community was clearly dominated by two groups of Betaproteobacteria affiliated with the poorly known and not yet recognized species "Ferrovum myxofaciens" and with strains related to Gallionella ferruginea, respectively. These taxa dominated the microbial community during the whole investigation period and accelerated the oxidation of ferrous iron despite the changing characteristics of mine waters flowing into the plants. Thus, it is assumed that the treatment technology can also be applied to other mine sites and that these organisms play a crucial role in such treatment systems.

Directives and recommendations of the European Communities on health protection against ionizing radiations

International Nuclear Information System (INIS)

1977-11-01

The CNEN has published a third edition, with comments, of the Directives and Recommendations of the European Communities on health protection against ionizing radiations, following their revision in 1976. This revision takes account of recent developments in the ICRP recommendations which serve as guidelines in the legislation of many countries for establishing general radiation protection principles as well as basic criteria and technical standards. The new Directive, while keeping to the basic principles established in 1959, introduces new methods for improved medical surveillance of workers; also, the previous difference between occupationally exposed workers and those occasionally exposed is eliminated. Finally, a new concept of critical groups is introduced as regards protection of the population, as a basis for its protection. (NEA) [fr

Metagenomic analysis of an ecological wastewater treatment plant's microbial communities and their potential to metabolize pharmaceuticals.

Science.gov (United States)

Balcom, Ian N; Driscoll, Heather; Vincent, James; Leduc, Meagan

2016-01-01

Pharmaceuticals and other micropollutants have been detected in drinking water, groundwater, surface water, and soil around the world. Even in locations where wastewater treatment is required, they can be found in drinking water wells, municipal water supplies, and agricultural soils. It is clear conventional wastewater treatment technologies are not meeting the challenge of the mounting pressures on global freshwater supplies. Cost-effective ecological wastewater treatment technologies have been developed in response. To determine whether the removal of micropollutants in ecological wastewater treatment plants (WWTPs) is promoted by the plant-microbe interactions, as has been reported for other recalcitrant xenobiotics, biofilm microbial communities growing on the surfaces of plant roots were profiled by whole metagenome sequencing and compared to the microbial communities residing in the wastewater. In this study, the concentrations of pharmaceuticals and personal care products (PPCPs) were quantified in each treatment tank of the ecological WWTP treating human wastewater at a highway rest stop and visitor center in Vermont. The concentrations of detected PPCPs were substantially greater than values reported for conventional WWTPs likely due to onsite recirculation of wastewater. The greatest reductions in PPCPs concentrations were observed in the anoxic treatment tank where Bacilli dominated the biofilm community. Benzoate degradation was the most abundant xenobiotic metabolic category identified throughout the system. Collectively, the microbial communities residing in the wastewater were taxonomically and metabolically more diverse than the immersed plant root biofilm. However, greater heterogeneity and higher relative abundances of xenobiotic metabolism genes was observed for the root biofilm.

Direct and Moderating Effects of Community Context on the Psychological Well-Being of African American Women

Science.gov (United States)

Cutrona, Carolyn E.; Russell, Daniel W.; Hessling, Robert M.; Brown, P. Adama; Murry, Velma

2007-01-01

The effects of community characteristics on well-being were examined among 709 African American women. Direct and moderating effects of neighborhood characteristics on distress were tested. Aggregate-level ratings of neighborhood cohesion and disorder were significantly related to distress, although the relation between cohesion and distress became nonsignificant when individual risk factors were statistically controlled. Aggregate-level neighborhood variables interacted significantly with individual risk and resource variables in the prediction of distress, consistent with trait-situation interaction theories (D. Magnusson & N. S. Endler, 1977). Community cohesion intensified the benefits of a positive life outlook. Community disorder intensified both the benefits of personal resources and the detrimental effects of personal risk factors. Results showed evidence of resilience among African American women. PMID:11138756

Utility of repeated praziquantel dosing in the treatment of schistosomiasis in high-risk communities in Africa: a systematic review.

Directory of Open Access Journals (Sweden)

Charles H King

2011-09-01

Full Text Available Controversy persists about the optimal approach to drug-based control of schistosomiasis in high-risk communities. In a systematic review of published studies, we examined evidence for incremental benefits from repeated praziquantel dosing, given 2 to 8 weeks after an initial dose, in Schistosoma-endemic areas of Africa.We performed systematic searches of electronic databases PubMed and EMBASE for relevant data using search terms 'schistosomiasis', 'dosing' and 'praziquantel' and hand searches of personal collections and bibliographies of recovered articles. In 10 reports meeting study criteria, improvements in parasitological treatment outcomes after two doses of praziquantel were greater for S. mansoni infection than for S. haematobium infection. Observed cure rates (positive to negative conversion in egg detection assays were, for S. mansoni, 69-91% cure after two doses vs. 42-79% after one dose and, for S. haematobium, 46-99% cure after two doses vs. 37-93% after a single dose. Treatment benefits in terms of reduction in intensity (mean egg count were also different for the two species-for S. mansoni, the 2-dose regimen yielded an weighted average 89% reduction in standardized egg counts compared to a 83% reduction after one dose; for S. haematobium, two doses gave a 93% reduction compared to a 94% reduction with a single dose. Cost-effectiveness analysis was performed based on Markov life path modeling.Although schedules for repeated treatment with praziquantel require greater inputs in terms of direct costs and community participation, there are incremental benefits to this approach at an estimated cost of $153 (S. mansoni-$211 (S. haematobium per additional lifetime QALY gained by double treatment in school-based programs. More rapid reduction of infection-related disease may improve program adherence, and if, as an externality of the program, transmission can be reduced through more effective coverage, significant additional benefits are

Effects of Youth´s Exposure to Community Violence: The MORE Project

Directory of Open Access Journals (Sweden)

Michele Cooley-Strickland

2011-07-01

Full Text Available Research on chronic community violence exposure focuses on ethnic minority, impoverished, and crime-ridden communities while treatment and prevention focuses on the perpetrators of the violence, not on the youth who are its direct or indirect victims. School-based treatment and preventive interventions are needed for children at elevated risk for exposure to community violence. This paper describes The Multiple Opportunities to Reach Excellence (MORE Project, a longitudinal, community epidemiological study currently being fielded to better understand the impact of children´s chronic exposure to community violence on their emotional, behavioral, substance use, and academic functioning with an overarching goal to identify malleable risk and protective factors which can be targeted in preventive and intervention programs.

Co-clustering directed graphs to discover asymmetries and directional communities.

Science.gov (United States)

Rohe, Karl; Qin, Tai; Yu, Bin

2016-10-21

In directed graphs, relationships are asymmetric and these asymmetries contain essential structural information about the graph. Directed relationships lead to a new type of clustering that is not feasible in undirected graphs. We propose a spectral co-clustering algorithm called di-sim for asymmetry discovery and directional clustering. A Stochastic co-Blockmodel is introduced to show favorable properties of di-sim To account for the sparse and highly heterogeneous nature of directed networks, di-sim uses the regularized graph Laplacian and projects the rows of the eigenvector matrix onto the sphere. A nodewise asymmetry score and di-sim are used to analyze the clustering asymmetries in the networks of Enron emails, political blogs, and the Caenorhabditis elegans chemical connectome. In each example, a subset of nodes have clustering asymmetries; these nodes send edges to one cluster, but receive edges from another cluster. Such nodes yield insightful information (e.g., communication bottlenecks) about directed networks, but are missed if the analysis ignores edge direction.

Ignored fungal community in activated sludge wastewater treatment plants: diversity and altitudinal characteristics.

Science.gov (United States)

Niu, Lihua; Li, Yi; Xu, Lingling; Wang, Peifang; Zhang, Wenlong; Wang, Chao; Cai, Wei; Wang, Linqiong

2017-02-01

Fungi are important contributors to the various functions of activated sludge wastewater treatment plants (WWTPs); however, the diversity and geographic characteristics of fungal populations have remained vastly unexplored. Here, quantitative polymerase chain reaction and 454 pyrosequencing were combined to investigate the abundance and diversity of the activated sludge fungal communities from 18 full-scale municipal WWTPs in China. Phylogenetic taxonomy revealed that the members of the fungal communities were assigned to 7 phyla and 195 genera. Ascomycota and Basidiomycota were the most abundant phyla, dominated by Pluteus, Wickerhamiella, and Penicillium. Twenty-three fungal genera, accounting for 50.1 % of the total reads, were shared by 18 WWTPs and constituted a core fungal community. The fungal communities presented similar community diversity but different community structures across the WWTPs. Significant distance decay relationships were observed for the dissimilarity in fungal community structure and altitudinal distance between WWTPs. Additionally, the community evenness increased from 0.25 to 0.7 as the altitude increased. Dissolved oxygen and the C/N ratio were determined to be the most dominant contributors to the variation in fungal community structure via redundancy analysis. The observed data demonstrated the diverse occurrence of fungal species and gave a marked view of fungal community characteristics based on the previously unexplored fungal communities in activated sludge WWTPs.

Adapting Evidence-Based Mental Health Treatments in Community Settings: Preliminary Results from a Partnership Approach

Science.gov (United States)

Southam-Gerow, Michael A.; Hourigan, Shannon E.; Allin, Robert B., Jr.

2009-01-01

This article describes the application of a university-community partnership model to the problem of adapting evidence-based treatment approaches in a community mental health setting. Background on partnership research is presented, with consideration of methodological and practical issues related to this kind of research. Then, a rationale for…

Service users' expectations of treatment and support at the Community Mental Health Centre in their recovery.

Science.gov (United States)

Biringer, Eva; Davidson, Larry; Sundfør, Bengt; Ruud, Torleif; Borg, Marit

2017-09-01

Focus on service users' needs, coping and empowerment, user involvement, and comprehensiveness are supposed to be key elements of the Community Mental Health Centres in Norway. Taking a user-oriented approach means acknowledging the individual's own expectations, aims and hopes. However, studies that have investigated service users' expectations of treatment and support at Community Mental Health Centres are hard to find. The aim of the study was therefore to explore service users' expectations at the start of treatment at a Community Mental Health Centre. Within a collaborative framework, taking a hermeneutic-phenomenological approach, ten service users participated in in-depth interviews about their expectations, hopes and aims for treatment and recovery. The participants sought help due to various mental health issues that had interfered with their lives and created disability and suffering. A data-driven stepwise approach in line with thematic analysis was used. The study was approved by the Norwegian Social Science Data Services. The following four main themes representing participants' expectations at the start of treatment were elicited: hope for recovery, developing understanding, finding tools for coping and receiving counselling and practical assistance. Participants' expectations about treatment were tightly interwoven with their personal aims and hopes for their future life, and expectations were often related to practical and financial problems, the solution of which being deemed necessary to gain a safe basis for recovery in the long run. The transferability of the results may be limited by the small number of participants. The study emphasises how important it is that service users' personal aims and expectations guide the collaborative treatment process. In addition to providing treatment aimed at improving symptoms, Community Mental Health Centres should take a more comprehensive approach than today by providing more support with family issues

Treatment Plans in Psychiatric Community Housing Programs : Do They Reflect Rehabilitation Principles?

NARCIS (Netherlands)

de Heer-Wunderink, Charlotte; Visser, Ellen; Caro-Nienhuis, Annemarie D.; van Weeghel, Jaap; Sytema, Sjoerd; Wiersma, Durk

2012-01-01

Objective: This study examined the extent to which treatment plans of service users of community housing programs measure up to rehabilitation principles according to the Choose-Get-Keep model of psychiatric rehabilitation. The study evaluates whether these plans correspond with service-user and

Community intervention to promote rational treatment of acute respiratory infection in rural Nepal.

Science.gov (United States)

Holloway, Kathleen A; Karkee, Shiba B; Tamang, Ashalal; Gurung, Yam Bahadur; Kafle, Kumud K; Pradhan, Ramesh; Reeves, Barnaby C

2009-01-01

To evaluate a community education program about treatment of acute respiratory infection (ARI). First, community case definitions for severe and mild ARI were developed. The intervention was then evaluated using a controlled before-and-after design. Household surveys collected data about ARI treatment in 20 clusters, each based around a school and health facility. Treatment indicators included percentages of cases attending health facilities and receiving antibiotics. The intervention consisted of an education program in schools culminating in street theater performances, discussions with mothers after performances and training for community leaders and drug retailers by paramedics. The intervention was conducted in mid-2003. Indicators were measured before the intervention in Nov/Dec 2002 and again in Dec 2003/Jan 2004. Two thousand and seven hundred and nineteen households were surveyed and 3654 under-fives were identified, of whom 377 had severe ARI. After implementing the intervention, health post (HP) attendance rose by 13% in under-fives with severe ARI and fell by 9% in under-fives with mild ARI (test of interaction, P = 0.01). Use of prescribed antibiotics increased in under-fives with severe ARI by 21% but only by 1% in under-fives with mild ARI (test of interaction, P = 0.38). Irrespective of ARI severity, the use of non-prescribed antibiotics dropped by 5% (P = 0.002), and consultation with female community health volunteers (FCHVs)and use of safe home remedies increased by 6.7% (P not estimated) and 5.7% (P = 0.008) respectively. The intervention was implemented using local structures and in difficult circumstances, yet had a moderate impact. Thus it has the potential to effect large scale changes in behaviour and merits replication elsewhere.

Motivation and treatment credibility predict alliance in cognitive behavioral treatment for youth with anxiety disorders in community clinics.

Science.gov (United States)

Fjermestad, K W; Lerner, M D; McLeod, B D; Wergeland, G J H; Haugland, B S M; Havik, O E; Öst, L-G; Silverman, W K

2017-11-16

We examined whether motivation and treatment credibility predicted alliance in a 10-session cognitive behavioral treatment delivered in community clinics for youth anxiety disorders. Ninety-one clinic-referred youths (mean age  = 11.4 years, standard deviation = 2.1, range 8-15 years, 49.5% boys) with anxiety disorders-rated treatment motivation at pretreatment and perceived treatment credibility after session 1. Youths and therapists (YT) rated alliance after session 3 (early) and session 7 (late). Hierarchical linear models were applied to examine whether motivation and treatment credibility predicted YT early alliance, YT alliance change, and YT alliance agreement. Motivation predicted high early YT alliance, but not YT alliance change or alliance agreement. Youth-rated treatment credibility predicted high early youth alliance and high YT positive alliance change, but not early therapist alliance or alliance agreement. Conclusion Efforts to enhance youth motivation and treatment credibility early in treatment could facilitate the formation of a strong YT alliance. © 2017 Wiley Periodicals, Inc.

Community Oncologists' Decision-Making for Treatment of Older Patients With Cancer.

Science.gov (United States)

Mohile, Supriya G; Magnuson, Allison; Pandya, Chintan; Velarde, Carla; Duberstein, Paul; Hurria, Arti; Loh, Kah Poh; Wells, Megan; Plumb, Sandy; Gilmore, Nikesha; Flannery, Marie; Wittink, Marsha; Epstein, Ronald; Heckler, Charles E; Janelsins, Michelle; Mustian, Karen; Hopkins, Judith O; Liu, Jane; Peri, Srihari; Dale, William

2018-03-01

Background: This study's objectives were to describe community oncologists' beliefs about and confidence with geriatric care and to determine whether geriatric-relevant information influences cancer treatment decisions. Methods: Community oncologists were recruited to participate in 2 multisite geriatric oncology trials. Participants shared their beliefs about and confidence in caring for older adults. They were also asked to make a first-line chemotherapy recommendation (combination vs single-agent vs no chemotherapy) for a hypothetical vignette of an older patient with advanced pancreatic cancer. Each oncologist received one randomly chosen vignette that varied on 3 variables: age (72/84 years), impaired function (yes/no), and cognitive impairment (yes/no). Other patient characteristics were held constant. Logistic regression models were used to identify associations between oncologist/vignette-patient characteristics and treatment decisions. Results: Oncologist response rate was 61% (n=305/498). Most oncologists agreed that "the care of older adults with cancer needs to be improved" (89%) and that "geriatrics training is essential" (72%). However, decision to treat: younger age (adjusted odds ratio [aOR], 5.01; 95% CI, 2.73-9.20), normal cognition (aOR, 5.42; 95% CI, 3.01-9.76), and being functionally intact (aOR, 3.85; 95% CI, 2.12-7.00). Accounting for all vignettes across all scenarios, 161 oncologists (52%) said they would offer chemotherapy. All variables were independently associated with prescribing single-agent over combination chemotherapy (older age: aOR, 3.22; 95% CI 1.43-7.25, impaired cognition: aOR, 3.13; 95% CI, 1.36-7.20, impaired function: aOR, 2.48; 95% CI, 1.12-5.72). Oncologists' characteristics were not associated with decisions about providing chemotherapy. Conclusion: Geriatric-relevant information, when available, strongly influences community oncologists' treatment decisions. Copyright © 2018 by the National Comprehensive Cancer Network.

On the treatment of exchange effects in direct reactions

International Nuclear Information System (INIS)

Bencze, G.; Chandler, C.; Argonne National Lab., IL; New Mexico Univ., Albuquerque

1985-01-01

Exchange effects in direct reactions are investigated in the framework of the general algebraic theory of identical particle scattering. It is shown that effects due to the permutation symmetry of the system can be separated from the treatment of reaction dynamics. Dynamical aspects of the problem are investigated within the framework of the channel coupling class of N-body theories. (orig.)

Increased Mental Health Treatment Financing, Community-Based Organization's Treatment Programs, and Latino-White Children's Financing Disparities.

Science.gov (United States)

Snowden, Lonnie R; Wallace, Neal; Cordell, Kate; Graaf, Genevieve

2017-09-01

Latino child populations are large and growing, and they present considerable unmet need for mental health treatment. Poverty, lack of health insurance, limited English proficiency, stigma, undocumented status, and inhospitable programming are among many factors that contribute to Latino-White mental health treatment disparities. Lower treatment expenditures serve as an important marker of Latino children's low rates of mental health treatment and limited participation once enrolled in services. We investigated whether total Latino-White expenditure disparities declined when autonomous, county-level mental health plans receive funds free of customary cost-sharing charges, especially when they capitalized on cultural and language-sensitive mental health treatment programs as vehicles to receive and spend treatment funds. Using Whites as benchmark, we considered expenditure pattern disparities favoring Whites over Latinos and, in a smaller number of counties, Latinos over Whites. Using segmented regression for interrupted time series on county level treatment systems observed over 64 quarters, we analyzed Medi-Cal paid claims for per-user total expenditures for mental health services delivered to children and youth (under 18 years of age) during a study period covering July 1, 1991 through June 30, 2007. Settlement-mandated Medicaid's Early Periodic Screening, Diagnosis and Treatment (EPSDT) expenditure increases began in the third quarter of 1995. Terms were introduced to assess immediate and long term inequality reduction as well as the role of culture and language-sensitive community-based programs. Settlement-mandated increased EPSDT treatment funding was associated with more spending on Whites relative to Latinos unless plans arranged for cultural and language-sensitive mental health treatment programs. However, having programs served more to prevent expenditure disparities from growing than to reduce disparities. EPSDT expanded funding increased proportional

Ammonia oxidizing bacteria community dynamics in a pilot-scale wastewater treatment plant.

Directory of Open Access Journals (Sweden)

Xiaohui Wang

Full Text Available BACKGROUND: Chemoautotrophic ammonia oxidizing bacteria (AOB have the metabolic ability to oxidize ammonia to nitrite aerobically. This metabolic feature has been widely used, in combination with denitrification, to remove nitrogen from wastewater in wastewater treatment plants (WWTPs. However, the relative influence of specific deterministic environmental factors to AOB community dynamics in WWTP is uncertain. The ecological principles underlying AOB community dynamics and nitrification stability and how they are related are also poorly understood. METHODOLOGY/PRINCIPAL FINDINGS: The community dynamics of ammonia oxidizing bacteria (AOB in a pilot-scale WWTP were monitored over a one-year period by Terminal Restriction Fragment Length Polymorphism (T-RFLP. During the study period, the effluent ammonia concentrations were almost below 2 mg/L, except for the first 60 days, indicting stable nitrification. T-RFLP results showed that, during the test period with stable nitrification, the AOB community structures were not stable, and the average change rate (every 15 days of AOB community structures was 10% ± 8%. The correlations between T-RFLP profiles and 10 operational and environmental parameters were tested by Canonical Correlation Analysis (CCA and Mantel test. The results indicated that the dynamics of AOB community correlated most strongly with Dissolved Oxygen (DO, effluent ammonia, effluent Biochemical Oxygen Demand (BOD and temperature. CONCLUSIONS/SIGNIFICANCE: This study suggests that nitrification stability is not necessarily accompanied by a stable AOB community, and provides insight into parameters controlling the AOB community dynamics within bioreactors with stable nitrification.

Community-based management versus traditional hospitalization in treatment of drug-resistant tuberculosis: a systematic review and meta-analysis.

Science.gov (United States)

Williams, Abimbola Onigbanjo; Makinde, Olusesan Ayodeji; Ojo, Mojisola

2016-01-01

Multidrug drug resistant Tuberculosis (MDR-TB) and extensively drug resistant Tuberculosis (XDR-TB) have emerged as significant public health threats worldwide. This systematic review and meta-analysis aimed to investigate the effects of community-based treatment to traditional hospitalization in improving treatment success rates among MDR-TB and XDR-TB patients in the 27 MDR-TB High burden countries (HBC). We searched PubMed, Cochrane, Lancet, Web of Science, International Journal of Tuberculosis and Lung Disease, and Centre for Reviews and Dissemination (CRD) for studies on community-based treatment and traditional hospitalization and MDR-TB and XDR-TB from the 27 MDR-TB HBC. Data on treatment success and failure rates were extracted from retrospective and prospective cohort studies, and a case control study. Sensitivity analysis, subgroup analyses, and meta-regression analysis were used to explore bias and potential sources of heterogeneity. The final sample included 16 studies involving 3344 patients from nine countries; Bangladesh, China, Ethiopia, Kenya, India, South Africa, Philippines, Russia, and Uzbekistan. Based on a random-effects model, we observed a higher treatment success rate in community-based treatment (Point estimate = 0.68, 95 % CI: 0.59 to 0.76, p   18 months, and regimen with drugs >5 reported higher treatment success rate. In the meta-regression model, age of patients, adverse events, treatment duration, and lost to follow up explains some of the heterogeneity of treatment effects between studies. Community-based management improved treatment outcomes. A mix of interventions with DOTS-Plus throughout therapy and treatment duration > 18 months as well as strategies in place for lost to follow up and adverse events should be considered in MDR-TB and XDR-TB interventions, as they influenced positively, treatment success.

Function assertive community treatment (FACT) and psychiatric service use in patients diagnosed with severe mental illness

NARCIS (Netherlands)

Drukker, M.; van Os, J.; Sytema, S.; Driessen, G.; Visser, E.; Delespaul, Ph.

Aim. Previous work suggests that the Dutch variant of assertive community treatment (ACT), known as Function ACT (FACT), may be effective in increasing symptomatic remission rates when replacing a system of hospital-based care and separate community-based facilities. FACT guidelines propose a

Quality of life improves in children and adolescents during a community-based overweight and obesity treatment.

Science.gov (United States)

Mollerup, Pernille M; Nielsen, Tenna R H; Bøjsøe, Christine; Kloppenborg, Julie T; Baker, Jennifer L; Holm, Jens-Christian

2017-06-01

The quality of life is compromised in children and adolescents with overweight or obesity. The aim of this study was to evaluate whether the quality of life improves during a community-based overweight and obesity treatment, and whether improvements depend on reductions in the degree of obesity. Quality of life was assessed using the Pediatric Quality of Life Inventory (PedsQL) 4.0 in children and adolescents aged 3-18 years with overweight or obesity [body mass index (BMI) ≥85th percentile] upon entry into a community-based chronic care overweight and obesity treatment based upon The Children's Obesity Clinic's Treatment protocol, and upon follow-up after 10-30 months of treatment. Height and weight were measured at each consultation and converted into a BMI standard deviation score (SDS). Upon entry, 477 children (212 boys) completed a PedsQL, and 317 (143 boys) completed another PedsQL after a median of 13 months of treatment. Quality of life improved (p quality of life (p ≤ 0.047). However, improvements also occurred in children and adolescents with low socioeconomic status or who increased their BMI SDS (p quality of life occurred in children and adolescents during a community-based overweight and obesity treatment, even in children and adolescents who increased their BMI SDS. Thus, improvements may be due to the treatment itself and not exclusively to reductions in BMI SDS. Clinicaltrials.gov, ID-no.: NCT02013843.

Professional Implications of the Expansion of Retail-Based Clinics into Community Pharmacies

National Research Council Canada - National Science Library

Devine, Joshua W

2007-01-01

.... These clinics, which are staffed by physicians' assistants or nurse practitioners, often are located directly within community pharmacies offering rapid diagnosis and treatment for a limited number of health problems...

Significance of microcystin production by benthic communities in water treatment systems of arid zones.

Science.gov (United States)

Hurtado, I; Aboal, M; Zafra, E; Campillo, D

2008-02-01

The study of the dynamics of phytobenthic and phytoplankton communities was undertaken, during a year, in the regulation reservoir associated with a water treatment plant (WTP), which provides the city of Murcia (Spain) with drinking water. Water samples were collected in different stages of the treatment. In the reservoir, the presence of dissolved and intracellular microcystins is constant, both in benthos and in plankton. The collected samples show a positive correlation between the dissolved microcystins and the benthic ones in the reservoir itself, as well as in an upstream reservoir (Ojós Reservoir). The treatment process (ozone+clarification+ozone+activated carbon) is very effective in the removal of toxins, and the drinking water produced is totally free of microcystins. The incorporation of the benthic communities in the routine check for the presence of microcystins is recommended, since it is not compulsory according to the current legislation.

Depression Screening at a Community Health Fair: Descriptives and Treatment Linkage.

Science.gov (United States)

Opperman, Kiel J; Hanson, Devin M; Toro, Paul A

2017-08-01

Health fairs are a cost-efficient platform for dissemination of preventive services to vulnerable populations. Effectiveness of depression screenings and associated treatment linkage via community health fairs warrants investigation. This study offers the first examination of a depression screening at a community health fair in 261 adult men (18-87years). The PHQ-9 was administered via interview by graduate students and on-site psychiatric nurses were available for a brief consultation for those interested. Over a quarter of participants screened positive for at least moderate depressive symptomatology. Of those who screened positive, 35.8% met with an on-site psychiatric nurse for a consultation. At six-month follow-up, none of the participants given a referral made an appointment at the community mental health agency. This suggests the importance of providing on-site clinician consultations at health fairs and the need for a more coordinated system to schedule future appointments while at the event. Community health fairs reach vulnerable populations, such as those who are uninsured and who have not spoken with a professional about mental health concerns. By conducting depression screening and providing onsite access to a mental health consultation at community health fairs, participants are better able to identify their depressive symptoms and are introduced to ways to treat depression. Copyright © 2017 Elsevier Inc. All rights reserved.

Development of a Single Locus Sequence Typing (SLST) Scheme for Typing Bacterial Species Directly from Complex Communities.

Science.gov (United States)

Scholz, Christian F P; Jensen, Anders

2017-01-01

The protocol describes a computational method to develop a Single Locus Sequence Typing (SLST) scheme for typing bacterial species. The resulting scheme can be used to type bacterial isolates as well as bacterial species directly from complex communities using next-generation sequencing technologies.

Development of an improved compact package plant for small community waste-water treatment

CSIR Research Space (South Africa)

Hulsman, A

1993-01-01

Full Text Available The challenges facing the design and operation of small community wastewater treatment plants are discussed. The package plant concept is considered and the consequent development of a compact intermittently aerated activated sludge package plant...

Improvement of silicon direct bonding using surfaces activated by hydrogen plasma treatment

CERN Document Server

Choi, W B; Lee Jae Sik; Sung, M Y

2000-01-01

The plasma surface treatment, using hydrogen gas, of silicon wafers was studied as a pretreatment for silicon direct bonding. Chemical reactions of the hydrogen plasma with the surfaces were used for both surface activation and removal of surface contaminants. Exposure of the silicon wafers to the plasma formed an active oxide layer on the surface. This layer was hydrophilic. The surface roughness and morphology were examined as functions of the plasma exposure time and power. The surface became smoother with shorter plasma exposure time and lower power. In addition, the plasma surface treatment was very efficient in removing the carbon contaminants on the silicon surface. The value of the initial surface energy, as estimated by using the crack propagation method, was 506 mJ/M sup 2 , which was up to about three times higher than the value for the conventional direct bonding method using wet chemical treatments.

Follow-up at a Dutch addiction hospital and effectiveness of therapeutic community treatment.

Science.gov (United States)

van de Velde, J C; Schaap, G E; Land, H

1998-06-01

This paper reports on inpatient treatment of addicts. Attention is paid to the Therapeutic Community (TC) model employed with alcoholics. A sample of 881 patients was assessed at intake and was followed up. The results demonstrate that the patients improved on a variety of outcome measures. Some associations were found between patient variables and improvement. Treatment variables predicting a positive outcome were sustained treatment in a TC and attending AA meetings. The relative efficacy of TCs, originally created by drug users, holds for alcoholics as well. It is concluded that an important precondition to a positive treatment outcome is the continuity of the treatment process. Pursuing that continuity seems to be an excellent mediate goal for both addicts and treatment personnel.

Treatment of Biofilm Communities: An Update on New Tools from the Nanosized World

Directory of Open Access Journals (Sweden)

Federico Bertoglio

2018-05-01

Full Text Available Traditionally regarded as single cell organisms, bacteria naturally and preferentially build multicellular communities that enable them to react efficiently to external stimuli in a coordinated fashion and with extremely effective outcomes. These communities are bacterial biofilms, where single cells or microcolonies are embedded in self-built Extracellular Polymeric Substance (EPS, composed of different macromolecules, e.g., polysaccharides, proteins, lipids, and extracellular DNA (eDNA. Despite being the most common form in nature and having many biotechnologically useful applications, biofilm is often regarded as a life-threatening form of bacterial infection. Since this form of bacterial life is intrinsically more resistant to antibiotic treatment and antimicrobial resistance is reaching alarming levels, we will focus our attention on how nanotechnology made new tools available to the medical community for the prevention and treatment of these infections. After a brief excursus on biofilm formation and its main characteristics, different types of nanomaterials developed to prevent or counteract these multicellular forms of bacterial infection will be described. A comparison of different classifications adopted for nanodrugs and a final discussion of challenges and future perspectives are also presented.

Melding Infant Mental Health and Multisystemic Therapy Approaches to Community-Based Treatment

Science.gov (United States)

Willoughby, Jay C.; Carubia, Beau A.; Murgolo, Marisa A.; Carter, Debbie R.; Frankel, Karen A.

2013-01-01

A recent partnership between the Irving Harris Program in Child Development and Infant Mental Health and the Community Based Psychiatry Program at University of Colorado Hospital joined two different approaches to child mental health treatment: infant mental health and multisystemic therapy (MST). This article illustrates the compatibility of…

Assertive community treatment: facilitators and barriers to implementation in routine mental health settings.

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Mancini, Anthony D; Moser, Lorna L; Whitley, Rob; McHugo, Gregory J; Bond, Gary R; Finnerty, Molly T; Burns, Barbara J

2009-02-01

This study identified barriers and facilitators to the high-fidelity implementation of assertive community treatment. As part of a multistate implementation project for evidence-based practices, training and consultation were provided to 13 newly implemented assertive community treatment teams in two states. Model fidelity was assessed at baseline and at six, 12, 18, and 24 months. Key informant interviews, surveys, and monthly on-site visits were used to monitor implementation processes related to barriers and facilitators. Licensing processes of the state mental health authority provided critical structural supports for implementation. These supports included a dedicated Medicaid billing structure, start-up funds, ongoing fidelity monitoring, training in the model, and technical assistance. Higher-fidelity sites had effective administrative and program leadership, low staff turnover, sound personnel practices, and skilled staff, and they allocated sufficient resources in terms of staffing, office space, and cars. Lower-fidelity sites were associated with insufficient resources, prioritization of fiscal concerns in implementation, lack of change culture, poor morale, conflict among staff, and high staff turnover. In cross-state comparisons, the specific nature of fiscal policies, licensing processes, and technical assistance appeared to influence implementation. State mental health authorities can play a critical role in assertive community treatment implementation but should carefully design billing mechanisms, promote technical assistance centers, link program requirements to fidelity models, and limit bureaucratic requirements. Successful implementation at the organizational level requires committed leadership, allocation of sufficient resources, and careful hiring procedures.

Characteristics of microbial community functional structure of a biological coking wastewater treatment system.

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Joshi, Dev Raj; Zhang, Yu; Zhang, Hong; Gao, Yingxin; Yang, Min

2018-01-01

Nitrogenous heterocyclic compounds are key pollutants in coking wastewater; however, the functional potential of microbial communities for biodegradation of such contaminants during biological treatment is still elusive. Herein, a high throughput functional gene array (GeoChip 5.0) in combination with Illumina HiSeq2500 sequencing was used to compare and characterize the microbial community functional structure in a long run (500days) bench scale bioreactor treating coking wastewater, with a control system treating synthetic wastewater. Despite the inhibitory toxic pollutants, GeoChip 5.0 detected almost all key functional gene (average 61,940 genes) categories in the coking wastewater sludge. With higher abundance, aromatic ring cleavage dioxygenase genes including multi ring1,2diox; one ring2,3diox; catechol represented significant functional potential for degradation of aromatic pollutants which was further confirmed by Illumina HiSeq2500 analysis results. Response ratio analysis revealed that three nitrogenous compound degrading genes- nbzA (nitro-aromatics), tdnB (aniline), and scnABC (thiocyanate) were unique for coking wastewater treatment, which might be strong cause to increase ammonia level during the aerobic process. Additionally, HiSeq2500 elucidated carbozole and isoquinoline degradation genes in the system. These findings expanded our understanding on functional potential of microbial communities to remove organic nitrogenous pollutants; hence it will be useful in optimization strategies for biological treatment of coking wastewater. Copyright © 2017. Published by Elsevier B.V.

Performance Assessment of Full-Scale Wastewater Treatment Plants Based on Seasonal Variability of Microbial Communities via High-Throughput Sequencing.

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Tang Liu

Full Text Available Microbial communities of activated sludge (AS play a key role in the performance of wastewater treatment processes. However, seasonal variability of microbial population in varying AS-based processes has been poorly correlated with operation of full-scale wastewater treatment systems (WWTSs. In this paper, significant seasonal variability of AS microbial communities in eight WWTSs located in the city of Guangzhou were revealed in terms of 16S rRNA-based Miseq sequencing. Furthermore, variation redundancy analysis (RDA demonstrated that the microbial community compositions closely correlated with WWTS operation parameters such as temperature, BOD, NH4+-N and TN. Consequently, support vector regression models which reasonably predicted effluent BOD, SS and TN in WWTSs were established based on microbial community compositions. This work provided an alternative tool for rapid assessment on performance of full-scale wastewater treatment plants.

Role of Nurses in Community Mental Health Centers: Example of England

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Beyhan Bag

2012-12-01

Full Text Available The goal of the community mental health centers, which constitute the core of community based mental health service model, is to register the patients who live in a certain geographical region and have serious mental disorder in the center, to observe them regularly and to bring them back to community by providing their rehabilitation and treatment. The practice of community based mental health, which English health service carries out in one hand for the psychiatry patients’ treatment and care, has many benefits, such as minimizing the sequence of going to hospital. The community mental health nurse, who works as an incidence manager, takes on the responsibility of treatment and care of the patient in the place where he/she lives, and the directly protective effect of this responsibility is an unquestionable fact. With this practice, the process of taking cure in hospital and the cost of treatment and care decrease. In our country, this sub-field of psychiatry is still in its incipient stage. Being familiar with the successful model practices in different countries may constitute a good model for the community mental health nursing practices which are on the first level in our country. For this purpose, the role of the nurses who work for the community mental health service in England is presented in this study.

Bacterial Community Structure Shifted by Geosmin in Granular Activated Carbon System of Water Treatment Plants.

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Pham, Ngoc Dung; Lee, Eun-Hee; Chae, Seon-Ha; Cho, Yongdeok; Shin, Hyejin; Son, Ahjeong

2016-01-01

We investigated the relation between the presence of geosmin in water and the bacterial community structure within the granular activated carbon (GAC) system of water treatment plants in South Korea. GAC samples were collected in May and August of 2014 at three water treatment plants (Sungnam, Koyang, and Yeoncho in Korea). Dissolved organic carbon and geosmin were analyzed before and after GAC treatment. Geosmin was found in raw water from Sungnam and Koyang water treatment plants but not in that from Yeoncho water treatment plant. Interestingly, but not surprisingly, the 16S rRNA clone library indicated that the bacterial communities from the Sungnam and Koyang GAC systems were closely related to geosmin-degrading bacteria. Based on the phylogenetic tree and multidimensional scaling plot, bacterial clones from GAC under the influence of geosmin were clustered with Variovorax paradoxus strain DB 9b and Comamonas sp. DB mg. In other words, the presence of geosmin in water might have inevitably contributed to the growth of geosmin degraders within the respective GAC system.

Exponential cluster synchronization in directed community networks via adaptive nonperiodically intermittent pinning control

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Zhou, Peipei; Cai, Shuiming; Jiang, Shengqin; Liu, Zengrong

2018-02-01

In this paper, the problem of exponential cluster synchronization for a class of directed community networks is investigated via adaptive nonperiodically intermittent pinning control. By constructing a novel piecewise continuous Lyapunov function, some sufficient conditions to guarantee globally exponential cluster synchronization are derived. It is noted that the derived cluster synchronization criteria rely on the control rates, but not the control widths or the control periods, which facilitates the choice of the control periods in practical applications. A numerical example is finally presented to show the effectiveness of the obtained theoretical results.

Reasons for the treatment of users of crack in a therapeutic community

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Maycon Rogério Seleghim

2015-07-01

Full Text Available Objective: Knowing the motivation of crack users for treatment in hospital environments. Method: Descriptive and qualitative search, using the design of some cases. Twenty male crack users, aged over 18 years old, hospitalized in a Therapeutic Community in Southern Brazil, were interviewed. A semi-structured interview was used and the data were analyzed by their thematic content. Results: Were found three categories that reflect the treatment motivations: perception of the crack harmful consequences; the compulsive use of drugs as the treatment initiation; and, the family participation looking for a treatment. Conclusion: Significant events (turning points favored the interruption of the crack use and the family assumed a very important place to the users behavior in relation to the use of the drug, exclusively. Descriptors: Street drugs, Crack Cocaine, Substance Abuse Treatment Centers, Family.

Obesity and orthodontic treatment: is there any direct relationship?

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Alberto Consolaro

Full Text Available ABSTRACT Obesity is a wide-spread condition directly or indirectly connected with an increase in the prevalence of a variety of human diseases. It affects over 50% of the western overall population. In 2017, a thorough analysis of 204 studies on obesity and cancer revealed that the condition increases the risk of the following types of cancer: stomach, colon, rectal, bile duct, pancreatic, esophagus, breast, endometrial, ovarian, kidney and multiple myeloma. The first study aiming at establishing a connection between obesity and the rate of induced orthodontic tooth movement was conducted by Saloom et al; however, it could not effectively nor significantly reveal any direct influence or effect. Despite being identified during the first week, differences could not be explained and treatment time remained unchanged. In spite of lack of studies in the literature on the connection between obesity and the rate of induced tooth movement, in clinical practice, courses or specialized training, we should not have protocols changed nor adopt any measures or expect significant differences between normal-weight and obese individuals. It should be emphasized that unsuccessful cases or cases of root resorption associated with treatment should not be assigned to obesity, since scientific data is insufficient to do so.

Comparing antiretroviral treatment outcomes between a prospective community-based and hospital-based cohort of HIV patients in rural Uganda

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Alibhai Arif

2011-11-01

Full Text Available Abstract Background Improved availability of antiretroviral therapy in sub-Saharan Africa is intended to benefit all eligible HIV-infected patients; however in reality antiretroviral services are mainly offered in urban hospitals. Poor rural patients have difficulty accessing the drugs, making the provision of antiretroviral therapy inequitable. Initial tests of community-based treatment programs in Uganda suggest that home-based treatment of HIV/AIDS may equal hospital-based treatment; however the literature reveals limited experiences with such programs. The research This intervention study aimed to; 1 assess the effectiveness of a rural community-based ART program in a subcounty (Rwimi of Uganda; and 2 compare treatment outcomes and mortality in a rural community-based antiretroviral therapy program with a well-established hospital-based program. Ethics approvals were obtained in Canada and Uganda. Results and outcomes Successful treatment outcomes after two years in both the community and hospital cohorts were high. All-cause mortality was similar in both cohorts. However, community-based patients were more likely to achieve viral suppression and had good adherence to treatment. The community-based program was slightly more cost-effective. Per capita costs in both settings were unsustainable, representing more than Uganda’s Primary Health Care Services current expenditures per person per year for all health services. The unpaid community volunteers showed high participation and low attrition rates for the two years that this program was evaluated. Challenges and successes Key successes of this study include the demonstration that antiretroviral therapy can be provided in a rural setting, the creation of a research infrastructure and culture within Kabarole’s health system, and the establishment of a research collaboration capable of enriching the global health graduate program at the University of Alberta. Challenging questions about the

Cost effectiveness of Tuberculosis Treatment from the Patients ...

African Journals Online (AJOL)

... Directly Observed Treatment Short course is more cost effective from the patients' point of view. DOTS needs to be re-focused out of the hospitals and clinics and made community based in view of the increasing TB caseload occasioned by HI V/AIDS. Key Words: Cost effectiveness, Tuberculosis treatment, personal cost, ...

Community participation for malaria elimination in tafea province, vanuatu: part ii. social and cultural aspects of treatment-seeking behaviour

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Riley Ian

2011-07-01

Full Text Available Abstract Background Early diagnosis and prompt effective case management are important components of any malaria elimination strategy. Tafea Province, Vanuatu has a rich history of traditional practices and beliefs, which have been integrated with missionary efforts and the introduction of modern constructions of health. Gaining a detailed knowledge of community perceptions of malarial symptomatology and treatment-seeking behaviours is essential in guiding effective community participation strategies for malaria control and elimination. Method An ethnographic study involving nine focus group discussions (FGD, 12 key informant interviews (KII and seven participatory workshops were carried out on Tanna Island, Vanuatu. Villages in areas of high and low malaria transmission risk were selected. Four ni-Vanuatu research officers, including two from Tanna, were trained and employed to conduct the research. Data underwent thematic analysis to examine treatment-seeking behaviour and community perceptions of malaria. Results Malaria was perceived to be a serious, but relatively new condition, and in most communities, identified as being apparent only after independence in 1980. Severe fever in the presence of other key symptoms triggered a diagnosis of malaria by individuals. Use of traditional or home practices was common: perceived vulnerability of patient and previous experience with malaria impacted on the time taken to seek treatment at a health facility. Barriers to health care access and reasons for delay in care-seeking included the availability of health worker and poor community infrastructure. Conclusion Due to programme success of achieving low malaria transmission, Tafea province has been identified for elimination of malaria by 2012 in the Government of Vanuatu Malaria Action Plans (MAP. An effective malaria elimination programme requires interactions between the community and its leaders, malaria workers and health providers for success in

Use of a cancer registry is preferable to a direct-to-community approach for recruitment to a cohort study of wellbeing in women newly diagnosed with invasive breast cancer

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Farrugia Helen

2008-05-01

Full Text Available Abstract Background Breast cancer (BC mortality is declining such that the number of survivors of BC in the community is increasing. BC survivors report a range of sequelae from their cancer and its management beyond the period of their immediate treatment. Previous studies to document these have generally been small, clinic-based or commenced years after diagnosis. We have recruited a large cohort of women newly diagnosed with invasive BC from the community who will be followed for five years in order to systematically document the physical, psychological and socio-economic consequences of BC and its treatment. The aim of this manuscript is to describe the issues encountered in the recruitment of this community-based study population. Methods Women residing in the southern Australian state of Victoria newly diagnosed with invasive BC were recruited to this cohort study using two approaches: directly from the community using an advertising campaign and contemporaneously using an invitation to participate from the Victorian Cancer Registry (VCR. Results Over the two and half year recruitment period, 2135 women were recruited and agreed to receive the enrollment questionnaire (EQ. Of these, 1684 women were eligible and completed an EQ, with the majority of participants having been recruited through the VCR (n = 1321. Only 16% of women contacted by the VCR actively refused participation following a letter of invitation and phone follow-up. The age distribution and tumour characteristics of participants are consistent with state-wide data and their residential postcodes include 400 of a possible 699. Recruitment through a direct community awareness program aimed at women with newly diagnosed invasive BC was difficult, labour-intensive and expensive. Barriers to the recruitment process were identified. Conclusion Most of the women in this study were recruited through a state-based cancer registry. Limitations to recruitment occurred because we

Providers' perspectives of factors influencing implementation of evidence-based treatments in a community mental health setting: A qualitative investigation of the training-practice gap.

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Marques, Luana; Dixon, Louise; Valentine, Sarah E; Borba, Christina P C; Simon, Naomi M; Wiltsey Stirman, Shannon

2016-08-01

This study aims to elucidate relations between provider perceptions of aspects of the consolidated framework for implementation research (Damschroder et al., 2009) and provider attitudes toward the implementation of evidence-based treatments (EBTs) in an ethnically diverse community health setting. Guided by directed content analysis, we analyzed 28 semistructured interviews that were conducted with providers during the pre-implementation phase of a larger implementation study for cognitive processing therapy for posttraumatic stress disorder (Resick et al., 2008). Our findings extend the existing literature by also presenting provider-identified client-level factors that contribute to providers' positive and negative attitudes toward EBTs. Provider-identified client-level factors include the following: client motivation to engage in treatment, client openness to EBTs, support networks of family and friends, client use of community and government resources, the connection and relationship with their therapist, client treatment adherence, client immediate needs or crises, low literacy or illiteracy, low levels of education, client cognitive limitations, and misconceptions about therapy. These results highlight the relations between provider perceptions of their clients, provider engagement in EBT training, and subsequent adoption of EBTs. We present suggestions for future implementation research in this area. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Characterization of shifts of koala (Phascolarctos cinereus intestinal microbial communities associated with antibiotic treatment

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Katherine E. Dahlhausen

2018-03-01

Full Text Available Koalas (Phascolarctos cinereus are arboreal marsupials native to Australia that eat a specialized diet of almost exclusively eucalyptus leaves. Microbes in koala intestines are known to break down otherwise toxic compounds, such as tannins, in eucalyptus leaves. Infections by Chlamydia, obligate intracellular bacterial pathogens, are highly prevalent in koala populations. If animals with Chlamydia infections are received by wildlife hospitals, a range of antibiotics can be used to treat them. However, previous studies suggested that koalas can suffer adverse side effects during antibiotic treatment. This study aimed to use 16S rRNA gene sequences derived from koala feces to characterize the intestinal microbiome of koalas throughout antibiotic treatment and identify specific taxa associated with koala health after treatment. Although differences in the alpha diversity were observed in the intestinal flora between treated and untreated koalas and between koalas treated with different antibiotics, these differences were not statistically significant. The alpha diversity of microbial communities from koalas that lived through antibiotic treatment versus those who did not was significantly greater, however. Beta diversity analysis largely confirmed the latter observation, revealing that the overall communities were different between koalas on antibiotics that died versus those that survived or never received antibiotics. Using both machine learning and OTU (operational taxonomic unit co-occurrence network analyses, we found that OTUs that are very closely related to Lonepinella koalarum, a known tannin degrader found by culture-based methods to be present in koala intestines, was correlated with a koala’s health status. This is the first study to characterize the time course of effects of antibiotics on koala intestinal microbiomes. Our results suggest it may be useful to pursue alternative treatments for Chlamydia infections without the use of

Characterization of shifts of koala (Phascolarctos cinereus) intestinal microbial communities associated with antibiotic treatment.

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Dahlhausen, Katherine E; Doroud, Ladan; Firl, Alana J; Polkinghorne, Adam; Eisen, Jonathan A

2018-01-01

Koalas ( Phascolarctos cinereus ) are arboreal marsupials native to Australia that eat a specialized diet of almost exclusively eucalyptus leaves. Microbes in koala intestines are known to break down otherwise toxic compounds, such as tannins, in eucalyptus leaves. Infections by Chlamydia , obligate intracellular bacterial pathogens, are highly prevalent in koala populations. If animals with Chlamydia infections are received by wildlife hospitals, a range of antibiotics can be used to treat them. However, previous studies suggested that koalas can suffer adverse side effects during antibiotic treatment. This study aimed to use 16S rRNA gene sequences derived from koala feces to characterize the intestinal microbiome of koalas throughout antibiotic treatment and identify specific taxa associated with koala health after treatment. Although differences in the alpha diversity were observed in the intestinal flora between treated and untreated koalas and between koalas treated with different antibiotics, these differences were not statistically significant. The alpha diversity of microbial communities from koalas that lived through antibiotic treatment versus those who did not was significantly greater, however. Beta diversity analysis largely confirmed the latter observation, revealing that the overall communities were different between koalas on antibiotics that died versus those that survived or never received antibiotics. Using both machine learning and OTU (operational taxonomic unit) co-occurrence network analyses, we found that OTUs that are very closely related to Lonepinella koalarum , a known tannin degrader found by culture-based methods to be present in koala intestines, was correlated with a koala's health status. This is the first study to characterize the time course of effects of antibiotics on koala intestinal microbiomes. Our results suggest it may be useful to pursue alternative treatments for Chlamydia infections without the use of antibiotics or the

Direct and indirect effects of climate change on a prairie plant community.

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Peter B Adler

2009-09-01

Full Text Available Climate change directly affects species by altering their physical environment and indirectly affects species by altering interspecific interactions such as predation and competition. Recent studies have shown that the indirect effects of climate change may amplify or counteract the direct effects. However, little is known about the the relative strength of direct and indirect effects or their potential to impact population persistence.We studied the effects of altered precipitation and interspecific interactions on the low-density tiller growth rates and biomass production of three perennial grass species in a Kansas, USA mixed prairie. We transplanted plugs of each species into local neighborhoods of heterospecific competitors and then exposed the plugs to a factorial manipulation of growing season precipitation and neighbor removal. Precipitation treatments had significant direct effects on two of the three species. Interspecific competition also had strong effects, reducing low-density tiller growth rates and aboveground biomass production for all three species. In fact, in the presence of competitors, (log tiller growth rates were close to or below zero for all three species. However, we found no convincing evidence that per capita competitive effects changed with precipitation, as shown by a lack of significant precipitation x competition interactions.We found little evidence that altered precipitation will influence per capita competitive effects. However, based on species' very low growth rates in the presence of competitors in some precipitation treatments, interspecific interactions appear strong enough to affect the balance between population persistence and local extinction. Therefore, ecological forecasting models should include the effect of interspecific interactions on population growth, even if such interaction coefficients are treated as constants.

Obstacles to prompt and effective malaria treatment lead to low community-coverage in two rural districts of Tanzania

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Dillip Angel

2008-09-01

Full Text Available Abstract Background Malaria is still a leading child killer in sub-Saharan Africa. Yet, access to prompt and effective malaria treatment, a mainstay of any malaria control strategy, is sub-optimal in many settings. Little is known about obstacles to treatment and community-effectiveness of case-management strategies. This research quantified treatment seeking behaviour and access to treatment in a highly endemic rural Tanzanian community. The aim was to provide a better understanding of obstacles to treatment access in order to develop practical and cost-effective interventions. Methods We conducted community-based treatment-seeking surveys including 226 recent fever episodes in 2004 and 2005. The local Demographic Surveillance System provided additional household information. A census of drug retailers and health facilities provided data on availability and location of treatment sources. Results After intensive health education, the biomedical concept of malaria has largely been adopted by the community. 87.5% (78.2–93.8 of the fever cases in children and 80.7% (68.1–90.0 in adults were treated with one of the recommended antimalarials (at the time SP, amodiaquine or quinine. However, only 22.5% (13.9–33.2 of the children and 10.5% (4.0–21.5 of the adults received prompt and appropriate antimalarial treatment. Health facility attendance increased the odds of receiving an antimalarial (OR = 7.7 but did not have an influence on correct dosage. The exemption system for under-fives in public health facilities was not functioning and drug expenditures for children were as high in health facilities as with private retailers. Conclusion A clear preference for modern medicine was reflected in the frequent use of antimalarials. Yet, quality of case-management was far from satisfactory as was the functioning of the exemption mechanism for the main risk group. Private drug retailers played a central role by complementing existing formal health

Microbial community and treatment ability investigation in AOAO process for the optoelectronic wastewater treatment using PCR-DGGE biotechnology.

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Chen, Hsi-Jien; Lin, Yi-Zi; Fanjiang, Jen-Mao; Fan, Chihhao

2013-04-01

This study aimed to explore the microbial community variation and treatment ability of a full-scale anoxic-aerobic-anoxic-aerobic (AOAO) process used for optoelectronic wastewater treatment. The sludge samples in the biological treatment units were collected and subsequently subjected to polymerase chain reaction (PCR) amplification and denaturing gradient gel electrophoresis identification and the wastewater components such as BOD5 and NH3-N were evaluated during the processes. The group specific primers selected were targeting at the kingdom Bacteria, the Acidobacterium, the α-proteobacteria, the β-proteobacteria ammonia oxidizers, Actinobacteria and methyllotrophs, and the 16S rDNA clone libraries were established. Ten different clones were obtained using the Bacteria primers and eight different clones were obtained using the β-proteobacteria ammonia oxidizer primers. Over 95 % of BOD5 and 90 % of NH3-N were removed from the system. The microbial community analysis showed that the Janthinobacterium sp. An8 and Nitrosospira sp. were the dominant species throughout the AOAO process. Across the whole clone library, six clones showed closely related to Janthinobacterium sp. and these species seemed to be the dominant species with more than 50 % occupancy of the total population. Nitrosospira sp. was the predominant species within the β-proteobacteria and occupied more than 30 % of the total population in the system. These two strains were the novel species specific to the AOAO process for optoelectronic treatment, and they were found strongly related to the system capability of removing aquatic contaminants by inspecting the wastewater concentration variation across the system.

Separate treatment of hospital and urban wastewaters: A real scale comparison of effluents and their effect on microbial communities.

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Chonova, Teofana; Keck, François; Labanowski, Jérôme; Montuelle, Bernard; Rimet, Frédéric; Bouchez, Agnès

2016-01-15

Hospital wastewaters (HWW) contain wider spectrum and higher quantity of pharmaceuticals than urban wastewaters (UWW), but they are generally discharged in sewers without pretreatment. Since traditional urban wastewater treatment plants (WWTP) are not designed to treat HWWs, treated effluents may still contain pollutants that could impair receiving aquatic environments. Hence, a better understanding of the effect of pharmaceuticals in the environment is required. Biofilms are effective "biological sensors" for assessing the environmental effects of pharmaceuticals due to their ability to respond rapidly to physical, chemical and biological fluctuations by changes in their structure and composition. This study evaluated the efficiency of biological treatment with conventional activated sludge system performed parallel on HWW and UWW. Furthermore, six successive monthly colonizations of biofilms were done on autoclaved stones, placed in grid-baskets in the hospital treated effluents (HTE) and urban treated effluents (UTE). The biomass of these biofilms as well as the structure and diversity of their bacterial communities were investigated. Results showed better treatment efficiency for phosphate and nitrite/nitrate during the treatment of UWW. Pharmaceuticals from all investigated therapeutic classes (beta-blockers, nonsteroidal anti-inflammatory drugs, antibiotics, analgesics and anticonvulsants) were efficiently removed, except for carbamazepine. The removal efficiency of the antibiotics, NSAIDs and beta-blockers was higher during the treatment of HWW. HTE and UTE shaped the bacterial communities in different ways. Higher concentrations of pharmaceuticals in the HTE caused adapted development of the microbial community, leading to less developed biomass and lower bacterial diversity. Seasonal changes in solar irradiance and temperature, caused changes in the community composition of biofilms in both effluents. According to the removal efficiency of pharmaceuticals

Effect of High-Intensity Wildfire and Silvicultural Treatments on Reptile Communities in Sand-Pine Scrub

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Cathryn H. Greenberg; Daniel G. Neary; Larry D. Harris

1994-01-01

We tested whether the herpetofuunal response to clearcutting followed by site preparation was similar to high-intensity wildfire foIlowed by salvage logging in sand- pine scrub. Herpetofaunal communities were compared in three replicated 5- to 7-yearpost-disturbance treatments and mature sand-pine forest. The three disturbance treatments were (1) high-intensity...

Moral Decision-Making among Assertive Community Treatment (ACT) Case Managers

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Lerbæk, Birgitte; Aagaard, Jørgen; Andersen, Mette Braendstrup

2015-01-01

The context of care in assertive community treatment (ACT) can be precarious and generate ethical issues involving the principles of autonomy and paternalism. This focus group study examined case managers' situated accounts of moral reasoning. Our findings show how they expressed strong moral...... obligation towards helping the clients. Their moral reasoning reflected a paternalistic position where, on different occasions, the potential benefits of their interventions would be prioritised at the expense of protecting the clients' personal autonomy. The case managers' reasoning emphasised situational...

Self-administered Versus Directly Observed Once-Weekly Isoniazid and Rifapentine Treatment of Latent Tuberculosis Infection

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Belknap, Robert; Holland, David; Feng, Pei-Jean; Millet, Joan-Pau; Caylà, Joan A.; Martinson, Neil A.; Wright, Alicia; Chen, Michael P.; Moro, Ruth N.; Scott, Nigel A.; Arevalo, Bert; Miró, José M.; Villarino, Margarita E.; Weiner, Marc; Borisov, Andrey S.

2017-01-01

Background Expanding latent tuberculosis treatment is important to decrease active disease globally. Once-weekly isoniazid and rifapentine for 12 doses is effective but limited by requiring direct observation. Objective To compare treatment completion and safety of once-weekly isoniazid and rifapentine by self-administration versus direct observation. Design An open-label, phase 4 randomized clinical trial designed as a noninferiority study with a 15% margin. Seventy-five percent or more of study patients were enrolled from the United States for a prespecified subgroup analysis. (ClinicalTrials.gov: NCT01582711) Setting Outpatient tuberculosis clinics in the United States, Spain, Hong Kong, and South Africa. Participants 1002 adults (aged ≥18 years) recommended for treatment of latent tuberculosis infection. Intervention Participants received once-weekly isoniazid and rifapentine by direct observation, self-administration with monthly monitoring, or self-administration with weekly text message reminders and monthly monitoring. Measurements The primary outcome was treatment completion, defined as 11 or more doses within 16 weeks and measured using clinical documentation and pill counts for direct observation, and self-reports, pill counts, and medication event–monitoring devices for self-administration. The main secondary outcome was adverse events. Results Median age was 36 years, 48% of participants were women, and 77% were enrolled at the U.S. sites. Treatment completion was 87.2% (95% CI, 83.1% to 90.5%) in the direct-observation group, 74.0% (CI, 68.9% to 78.6%) in the self-administration group, and 76.4% (CI, 71.3% to 80.8%) in the self-administration–with–reminders group. In the United States, treatment completion was 85.4% (CI, 80.4% to 89.4%), 77.9% (CI, 72.7% to 82.6%), and 76.7% (CI, 70.9% to 81.7%), respectively. Self-administered therapy without reminders was noninferior to direct observation in the United States; no other comparisons met

Quality of life improves in children and adolescents during a community-based overweight and obesity treatment

DEFF Research Database (Denmark)

Mollerup, Pernille M; Nielsen, Tenna R H; Bøjsøe, Christine

2017-01-01

PURPOSE: The quality of life is compromised in children and adolescents with overweight or obesity. The aim of this study was to evaluate whether the quality of life improves during a community-based overweight and obesity treatment, and whether improvements depend on reductions in the degree...... of obesity. METHODS: Quality of life was assessed using the Pediatric Quality of Life Inventory (PedsQL) 4.0 in children and adolescents aged 3-18 years with overweight or obesity [body mass index (BMI) ≥85th percentile] upon entry into a community-based chronic care overweight and obesity treatment based...... upon The Children's Obesity Clinic's Treatment protocol, and upon follow-up after 10-30 months of treatment. Height and weight were measured at each consultation and converted into a BMI standard deviation score (SDS). RESULTS: Upon entry, 477 children (212 boys) completed a PedsQL, and 317 (143 boys...

Mental health literacy among refugee communities: differences between the Australian lay public and the Iraqi and Sudanese refugee communities.

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May, Samantha; Rapee, Ronald M; Coello, Mariano; Momartin, Shakeh; Aroche, Jorge

2014-05-01

This study investigated differences in mental health knowledge and beliefs between participants from the Iraqi and Sudanese refugee communities, and Australian-born individuals, in Sydney, Australia. Ninety-seven participants were given vignettes of characters describing symptoms of major depressive disorder and posttraumatic stress. They were required to identify psychological symptoms as disorders, rate beliefs about the causes of and helpful treatments for these disorders, and rate attitude statements regarding the two characters. Australian participants recognized the presented symptoms as specific mental disorders significantly more than Iraqi and Sudanese participants did, and reported causal and treatment beliefs which were more congruent with expert beliefs as per the western medical model of mental disorder. The Sudanese group endorsed supernatural and religious causal beliefs regarding depression and posttraumatic stress symptoms most often; but both Sudanese and Iraqi participants strongly supported options from the supernatural and religious treatment items. However, evidence for pluralistic belief systems was also found. Although sampling was non-random, suggesting caution in the interpretation of results, it appears that the mental health literacy of lay Australians may be more aligned with the western medical model of mental disorder than that of Iraqi and Sudanese refugee communities. Mental health literacy support needs of Iraqi and Sudanese refugee communities resettled in western countries such as Australia might include education about specific symptoms and causes of mental disorder and the effectiveness of psychiatric treatments. These findings provide useful directions for the promotion of optimal service utilization among such communities.

Sewage treatment processes: The methodology for the resort communities; Tecnologias de Depuracion: la metodologia de seleccion para poblaciones turisticas

Energy Technology Data Exchange (ETDEWEB)

Nieves de la Vega, G.; Kovacs, Z. [AQUA/PLAN, S.A. (Spain)

1995-06-01

The selection of adequate sewage treatment processes for resort communities has to be based upon a detailed knowledge of the characteristics of sewerage discharges. In order to define a methodology, the most representative variables such as climatology, seasonal variation, required treatment efficiency, sewage characteristics and availability of land, are identified. A wide range of available treatment processes is defined and the relationship between variables and priority criteria is analysed. Finally, a decision-diagram allowing the selection of the most adequate treatment process in each particular case is presented. The methodology is applied to mountain resort communities. (Author)

What is SAMHSA Doing to Help Communities Make Good Decisions About the Allocation of Scarce Treatment Resources?

National Research Council Canada - National Science Library

Iguchi, Maetin

2000-01-01

.... For example, a single person may be enrolled in drug treatment, may be getting treatment for depression at a community mental health center, may be on Medicaid, and could be involved with a criminal...

Evidence for the Treatment of Osteoporosis with Vitamin D in Residential Care and in the Community Dwelling Elderly

Directory of Open Access Journals (Sweden)

John A. A. Geddes

2013-01-01

Full Text Available Introduction. Vitamin D is common treatment for osteoporosis. Both age >70 years and living in residential care are associated with increased fracture risk. Community dwelling elderly are a heterogeneous group who may have more similatiry with residential care groups than younger community dwelling counterparts. Aims. To review the evidence for cholecalciferol or ergocalciferol tretment of osteoporosis in either community dwelling patients aged ≥70 years of age, or redidential care patients. Secondly endpoints were changes in bone mineral denisty, and in bone turnover markers. Methods. We performed a literature search using search terms for osteoporosis and vitamin D. Treatment for at least one year was required. Results. Only one residential care study using cholecalciferol, showed non-vertebral and hip fracture reduction in vitamin D deficient subjects. In the community setting one quasi randomised study using ergocalciferol showed reduction in total but not hip or non-vertebral fracture, and a second randomised study showed increased hip fracture risk. Three studies reported increases in hip bone mineral denisty. Discussion. A minority of studies demonstrated a fracture benefit form vitamin D and one suggested possible harm in a community setting. Current practice should be to only offer this treatment to subjects identified as deficient.

Plants used for treatment of dysentery and diarrhoea by the Bhoxa community of district Dehradun, Uttarakhand, India.

Science.gov (United States)

Gairola, Sumeet; Sharma, Jyotsana; Gaur, R D; Siddiqi, T O; Painuli, R M

2013-12-12

Dysentery and diarrhoea are major causes of morbidity and mortality in rural communities of developing world. The Bhoxa community is an important primitive indigenous community of Uttarakhand, India. In this paper we have tried to scientifically enumerate ethnomedicinal plants and herbal preparations used by Bhoxa community to treat dysentery and diarrhoea, and discuss their antidiarrhoeal properties in the light of previous ethnomedicinal, pharmacological, microbiological and phytochemical studies. To record plants and herbal preparations used by Bhoxa community of district Dehradun, Uttarakhand, India in treatment of dysentery and diarrhoea, and to discuss antidiarrhoeal and antimicrobial properties of the recorded plants. Ethnomedicinal survey was conducted in different villages of Bhoxa community located in district Dehradun, Uttarakhand, India. Thirty Bhoxa traditional healers were interviewed to collect information on plants used by them for treating dysentery and diarrhoea. For each of the recorded plant species the use value (UV) and fidelity level (FL) was calculated. Detailed literature survey was conducted to summarize ethnomedicinal, pharmacological, microbiological and phytochemical information on the medicinal plants listed in the present study. Fifty medicinal plants (45 genera and 30 families) were used by Bhoxa community to treat dysentery and diarrhoea, among which 27 species were used for dysentery, 41 for diarrhoea and 18 for both dysentery and diarrhoea. Three plants viz., Dioscorea bulbifera L., Euphorbia thymifolia L. and Prunus persica (L.) Stokes, recorded in the present survey have been reported for the first time in treatment of dysentery and diarrhoea by any indigenous communities in India. FL and UV values revealed that most preferred species for the treatment of dysentery and diarrhoea by Bhoxa community are Euphorbia hirta L. followed by Holarrhena pubescens Wall., Helicteres isora L. and Cassia fistula L. Earlier pharmacological

Spanish-Language Community-Based Mental Health Treatment Programs, Policy-Required Language-Assistance Programming, and Mental Health Treatment Access Among Spanish-Speaking Clients

Science.gov (United States)

McClellan, Sean R.

2013-01-01

Objectives. We investigated the extent to which implementing language assistance programming through contracting with community-based organizations improved the accessibility of mental health care under Medi-Cal (California’s Medicaid program) for Spanish-speaking persons with limited English proficiency, and whether it reduced language-based treatment access disparities. Methods. Using a time series nonequivalent control group design, we studied county-level penetration of language assistance programming over 10 years (1997–2006) for Spanish-speaking persons with limited English proficiency covered under Medi-Cal. We used linear regression with county fixed effects to control for ongoing trends and other influences. Results. When county mental health plans contracted with community-based organizations, those implementing language assistance programming increased penetration rates of Spanish-language mental health services under Medi-Cal more than other plans (0.28 percentage points, a 25% increase on average; P language-related disparities. Conclusions. Mental health treatment programs operated by community-based organizations may have moderately improved access after implementing required language assistance programming, but the programming did not reduce entrenched disparities in the accessibility of mental health services. PMID:23865663

Spanish-language community-based mental health treatment programs, policy-required language-assistance programming, and mental health treatment access among Spanish-speaking clients.

Science.gov (United States)

Snowden, Lonnie R; McClellan, Sean R

2013-09-01

We investigated the extent to which implementing language assistance programming through contracting with community-based organizations improved the accessibility of mental health care under Medi-Cal (California's Medicaid program) for Spanish-speaking persons with limited English proficiency, and whether it reduced language-based treatment access disparities. Using a time series nonequivalent control group design, we studied county-level penetration of language assistance programming over 10 years (1997-2006) for Spanish-speaking persons with limited English proficiency covered under Medi-Cal. We used linear regression with county fixed effects to control for ongoing trends and other influences. When county mental health plans contracted with community-based organizations, those implementing language assistance programming increased penetration rates of Spanish-language mental health services under Medi-Cal more than other plans (0.28 percentage points, a 25% increase on average; P language-related disparities. Mental health treatment programs operated by community-based organizations may have moderately improved access after implementing required language assistance programming, but the programming did not reduce entrenched disparities in the accessibility of mental health services.

Successful treatment of massive pulmonary embolism with prolonged catheter-directed thrombolysis.

LENUS (Irish Health Repository)

Kelly, Peter

2012-02-03

This is a case report of a young woman who presented with an extensive pulmonary embolism and echocardiographic evidence of right ventricular dysfunction. Although hemodynamically stable, the patient\\'s clinical condition failed to improve with standard heparin anticoagulation. Successful local catheter-directed thrombolysis was performed over an extended period of 48 h with regular monitoring of response to therapy by computed tomography-pulmonary angiography and echocardiography. To our knowledge, treatment of a pulmonary embolism by catheter-directed thrombolytic infusion over an extended period of 48 h has not previously been described.

Efficacy of Biofeedback Therapy in the Treatment of Dyssynergic Defecation in Community-Dwelling Elderly Women.

Science.gov (United States)

Simón, Miguel A; Bueno, Ana M

The aim of this study was to evaluate the efficacy of biofeedback therapy in the treatment of dyssynergic defecation in chronically constipated community-dwelling elderly women. After an initial assessment phase carried out during 1 month, 20 chronically constipated women with dyssynergic defecation were randomly assigned to either electromyographic biofeedback (EMG-BF) group (n=10) or control group (n=10). Outcome measures used to evaluate the efficacy of treatment were weekly stool frequency, sensation of incomplete evacuation, difficulty evacuation level, mean EMG-activity (μV) of the external anal sphincter during straining to defecate and Anismus index. The results obtained in this randomized controlled trial showed significant differences between the groups in all the dependent variables after 1 month of treatment. Moreover, there was no difference between the groups neither in age nor in the duration of chronic constipation symptoms. At the follow-up, 3 months later, clinical gains were maintained. This study demonstrates that the EMG-BF is an effective behavioral therapy for the treatment of dyssynergic defecation in community-dwelling elderly women.

Capacity Enhancement of Hepatitis C Virus Treatment through Integrated, Community-Based Care

Directory of Open Access Journals (Sweden)

Warren D Hill

2008-01-01

Full Text Available BACKGROUND: An estimated 250,000 Canadians are infected with the hepatitis C virus (HCV. The present study describes a cohort of individuals with HCV referred to community-based, integrated prevention and care projects developed in British Columbia. Treatment outcomes are reported for a subset of individuals undergoing antiviral therapy at four project sites.

Role of outpatient parenteral antibiotic therapy in the treatment of community acquired skin and soft tissue infections in Singapore.

Science.gov (United States)

Chan, Monica; Ooi, Chee Kheong; Wong, Joshua; Zhong, Lihua; Lye, David

2017-07-06

Treatment of community acquired skin and soft tissue infections (SSTIs) is a common indication for outpatient parenteral antibiotic therapy (OPAT) in USA, UK and Australasia, however data from Asia are lacking. OPAT is well established within the Singapore healthcare since 2002, however, systematic use of OPAT for the treatment of SSTIs remains infrequent. In this report, we describe the treatment and outcome of patients with SSTIs referred directly from Emergency Department (ED) to OPAT for continuation of intravenous (IV) antibiotics in Singapore, thus avoiding potential hospital admission. This is a single center university hospital retrospective study of patients with SSTIs presenting to ED who were assessed to require IV antibiotics and accepted to the OPAT clinic for continuation of IV treatment. Exclusion criteria were: haemodynamic instability, uncontrolled or serious underlying co-morbidities, necessity for inpatient surgical drainage, facial cellulitis and cephalosporin allergy. Patients returned daily to the hospital’s OPAT clinic for administration of IV antibiotics and review, then switched to oral antibiotics on improvement. From 7 February 2012 to 31 July 2015, 120 patients with SSTIs were treated in OPAT. Median age was 56 years and 63% were male. Lower limbs were affected in 91%. Diabetes was present in 20%. Sixty-seven (56%) had been treated with oral antibiotics for a median duration of 3 days prior to OPAT treatment. Common symptoms were erythema (100%), swelling (96%), pain (88%) and fever (55%). Antibiotics administered were IV cefazolin with oral probenecid (71%) or IV ceftriaxone (29%) for median 3 days then oral cloxacillin (85%) for median 7 days. Clinical improvement occurred in 90%. Twelve patients (10%) were hospitalized for worsening cellulitis, with 4 patients requiring surgical drainage of abscess. Microbiological cultures from 2 patients with drained abscess grew methicillin sensitive Staphylococcus aureus (MSSA) and Klebsiella

Future Directions in Etiologic, Prevention, and Treatment Research for Eating Disorders

Science.gov (United States)

Stice, Eric; South, Kelsey; Shaw, Heather

2012-01-01

Significant advances have occurred regarding the understanding of etiologic processes that give rise to eating disorders and the design and evaluation of efficacious prevention programs and treatment interventions. Herein we offer suggestions regarding potentially fruitful directions for future research in these areas. We suggest it would be…

Bacterial community compositions of coking wastewater treatment plants in steel industry revealed by Illumina high-throughput sequencing.

Science.gov (United States)

Ma, Qiao; Qu, Yuanyuan; Shen, Wenli; Zhang, Zhaojing; Wang, Jingwei; Liu, Ziyan; Li, Duanxing; Li, Huijie; Zhou, Jiti

2015-03-01

In this study, Illumina high-throughput sequencing was used to reveal the community structures of nine coking wastewater treatment plants (CWWTPs) in China for the first time. The sludge systems exhibited a similar community composition at each taxonomic level. Compared to previous studies, some of the core genera in municipal wastewater treatment plants such as Zoogloea, Prosthecobacter and Gp6 were detected as minor species. Thiobacillus (20.83%), Comamonas (6.58%), Thauera (4.02%), Azoarcus (7.78%) and Rhodoplanes (1.42%) were the dominant genera shared by at least six CWWTPs. The percentages of autotrophic ammonia-oxidizing bacteria and nitrite-oxidizing bacteria were unexpectedly low, which were verified by both real-time PCR and fluorescence in situ hybridization analyses. Hierarchical clustering and canonical correspondence analysis indicated that operation mode, flow rate and temperature might be the key factors in community formation. This study provides new insights into our understanding of microbial community compositions and structures of CWWTPs. Copyright © 2014 Elsevier Ltd. All rights reserved.

Health system tests CRM data base. Community Health Network uses direct mail to boost physicians.

Science.gov (United States)

Botvin, Judith D

2003-01-01

A six-month pilot patient retention project for Community Health Network (CHN), Indianapolis, ran from July 2002 to January 2003. It was a direct mail campaign on behalf of some members of the group practices owned by CHN, designed to test the use of the system's CRM database. Patients of the physicians received personal, dynamically-generated cards reminding them to schedule appointments and tests. Each mailing cost $1.76, including production and mailing.

Barriers to community-directed fire restoration

Science.gov (United States)

R. Bruce Hull; Bruce E. Goldstein

2006-01-01

Wild fire disasters create novel situations and challenges for natural resource managers, including working with emergent community groups that have a great deal of motivation for change, little familiarity with agency protocol, and strong preferences for the goals and methods of forest fire restoration, some of which may run counter to agency norms. After a fire,...

A Decentralized Group Treatment Program.

Science.gov (United States)

Conrow, Douglas C.

Old style and new style mental hospitals are criticized for not dealing directly with a person's inability to live within his community and relate effectively with significant people. The comprehensive mental health programs, which arose in reaction to the deficits of previous facilities and treatment, are viewed as frequently following a similar,…

Dental health and treatment needs among children in a tribal community.

Science.gov (United States)

Viragi, Prashant S; Dwijendra, K S; Kathariya, Mitesh D; Chopra, Kirti; Dadpe, Mahesh V; Madhukar, H S

2013-07-01

To assess the dental health status and treatment needs among children of 'Pardhi' tribal community. A total of 185 children were examined over a period of 2 months using WHO proforma. The statistical software namely SPSS version 15.0 and data was analyzed using Student's t-test and ANOVA test at p filling, i.e. 29.40%, followed by pulp care and restoration (19.30%), two or more surface fillings (15.60%) and extraction (11.70%). The study subjects were characterized by a lack of dental care services, high prevalence of dental caries and treatment needs. Therefore, implementation of a basic oral health care program for this tribal population is a high priority.

Assertive Community Treatment for alcohol dependence (ACTAD: study protocol for a randomised controlled trial

Directory of Open Access Journals (Sweden)

Gilburt Helen

2012-02-01

Full Text Available Abstract Background Alcohol dependence is a significant and costly problem in the UK yet only 6% of people a year receive treatment. Current service provision based on the treatment of acute episodes of illness and emphasising personal choice and motivation results in a small proportion of these patients engaging with alcohol treatment. There is a need for interventions targeted at the population of alcohol dependent patients who are hard to engage in conventional treatment. Assertive Community Treatment (ACT, a model of care based on assertive outreach, has been used for treating patients with severe mental illnesses and presents a promising avenue for engaging patients with primary alcohol dependence. So far there has been little research on this. Methods/Design In this single blind exploratory randomised controlled trial, a total of 90 alcohol dependent participants will be recruited from community addiction services. After completing a baseline assessment, they will be assigned to one of two conditions: (1 ACT plus care as usual, or (2 care as usual. Those allocated to the ACT plus care as usual will receive the same treatment that is routinely provided by services, plus a trained key worker who will provide ACT. ACT comprises intensive and assertive contact at least once a week, over 50% of contacts in the participant's home or local community, and comprehensive case management across social and health care, for a period of one year. All participants will be followed up at 6 months and 12 months to assess outcome post randomisation. The primary outcome measures will be alcohol consumption: mean drinks per drinking day and percentage of days abstinent measured by the Time Line Follow Back interview. Secondary outcome measures will include severity of alcohol dependence, alcohol related problems, motivation to change, social network involvement, quality of life, therapeutic relationship and service use. Other outcome variables are treatment

The objectives of the directive on radiation protection for patients

International Nuclear Information System (INIS)

Courades, J.M.

1992-01-01

Improvement of the quality of medical uses of radiation and avoiding unnecessary exposure are the main objectives of the 1984 Directive laying down basic measures for the radiation protection of persons undergoing medical examination or treatment. This paper explains how these goals have been achieved through the implementation of the various provisions of the Community act since its adoption

Impact of community-based support services on antiretroviral treatment programme delivery and outcomes in resource-limited countries: a synthetic review

Directory of Open Access Journals (Sweden)

Wouters Edwin

2012-07-01

Full Text Available Abstract Background Task-shifting to lay community health providers is increasingly suggested as a potential strategy to overcome the barriers to sustainable antiretroviral treatment (ART scale-up in high-HIV-prevalence, resource-limited settings. The dearth of systematic scientific evidence on the contributory role and function of these forms of community mobilisation has rendered a formal evaluation of the published results of existing community support programmes a research priority. Methods We reviewed the relevant published work for the period from November 2003 to December 2011 in accordance with the guidelines for a synthetic review. ISI Web of Knowledge, Science Direct, BioMed Central, OVID Medline, PubMed, Social Services Abstracts, and Sociological Abstracts and a number of relevant websites were searched. Results The reviewed literature reported an unambiguous positive impact of community support on a wide range of aspects, including access, coverage, adherence, virological and immunological outcomes, patient retention and survival. Looking at the mechanisms through which community support can impact ART programmes, the review indicates that community support initiatives are a promising strategy to address five often cited challenges to ART scale-up, namely (1 the lack of integration of ART services into the general health system; (2 the growing need for comprehensive care, (3 patient empowerment, (4 and defaulter tracing; and (5 the crippling shortage in human resources for health. The literature indicates that by linking HIV/AIDS-care to other primary health care programmes, by providing psychosocial care in addition to the technical-medical care from nurses and doctors, by empowering patients towards self-management and by tracing defaulters, well-organised community support initiatives are a vital part of any sustainable public-sector ART programme. Conclusions The review demonstrates that community support initiatives are a

Predicting delay to treatment of urinary incontinence among urban community-dwelling women in China

Directory of Open Access Journals (Sweden)

Chen Wu

2015-03-01

Conclusion: Women who were older, had lower subjective UI severity, and who reported only stress or urgency UI tended to delay treatment longer; such patients should be targeted for health education and intervention regarding UI in urban communities.

Notification: Hotline Complaint – Drinking Water Treatment Plant at the Fort Belknap Indian Community

Science.gov (United States)

Project #OA-FY13-0076, November 13, 2012. On March 22, 2012, the Office of Inspector General (OIG) received a hotline complaint on the construction of the Drinking Water Treatment Plant (DWTP) at the Fort Belknap Indian Community.

Community periodontal treatment needs in South Korea.

Science.gov (United States)

Lee, M-Y; Chang, S-J; Kim, C-B; Chung, W-G; Choi, E-M; Kim, N-H

2015-11-01

This study aimed to assess the relationship between socio-economic factors and community periodontal treatment needs in Korea. Data were obtained from the year 2009 Korean National Health and Nutrition Examination Survey. Our analysis included 7510 survey participants over the age of 19 years. To assess the relationship between socio-economic factors and the need for periodontal scaling, we performed multivariate logistic regression analyses for data with a complex sampling structure. PASW statistics 19.0 (SPSS Inc., Chicago, IL, USA) was used to perform the statistical analyses, and the results were expressed as odds ratios (OR) with corresponding 95% confidence intervals (CIs). A very high percentage of Korean adults required periodontal scaling (71.5%). After adjusting for sex, age, and socio-economic factors, the need for periodontal scaling was associated with low levels of education (OR: 1.41, 95% CI: 1.03-1.93), low incomes (OR: 1.27, 95% CI: 1.01-1.60), employment as a service and sales worker (OR: 1.39, 95% CI: 1.10-1.77), and employment as a manual worker (OR: 1.31, 95% CI: 1.02-1.69). In South Korea, the need for periodontal scaling was associated with socio-economic factors, such as low levels of education, low incomes, employment as a service and sales worker and employment as a manual worker. Consequently, clinical and community dental hygienists should consider adults with these risk factors as belonging to high-priority subgroups to whom they should respond first. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Costs and outcome of assertive community treatment (ACT) in a rural area in Denmark

DEFF Research Database (Denmark)

Hastrup, Lene Halling; Aagaard, Jørgen

2015-01-01

Purpose: Health economic evidence of assertive community treatment (ACT) in Denmark is limited. The aim of the study was to assess the costs and outcome of ACT among 174 patients with severe and persistent mental illness in a rural area of Denmark. Methods: The study was based on a quasi-experime......Purpose: Health economic evidence of assertive community treatment (ACT) in Denmark is limited. The aim of the study was to assess the costs and outcome of ACT among 174 patients with severe and persistent mental illness in a rural area of Denmark. Methods: The study was based on a quasi...... only. Results: Seventy eight percent of the patients receiving ACT were in contact with psychiatric services at the 4-year follow-up, while 69% of the patients in the control group had contact with psychiatric services (P

Online, directed journaling in community health advanced practice nursing clinical education.

Science.gov (United States)

Daroszewski, Ellen Beth; Kinser, Anita G; Lloyd, Susan L

2004-04-01

The sharing of experiences in advanced practice nursing clinical courses allows for application of core principals to different facets of practice, with the potential to promote discussions beyond the course objectives, create opportunities for mentoring, foster critical thinking, and facilitate change and socialization into advanced practice. A pilot test of online, directed journaling, an innovative sharing and reflection strategy, was incorporated in a two-quarter community health advanced practice nursing clinical course in an attempt to enhance clinical learning. Six female graduate nursing students completed the journaling. A 10-item evaluation measure demonstrated that the online journaling strategy was highly effective and valuable for the students. An assessment of the journaling entries found multiple examples of discussion, mentoring, critical thinking, and socialization. Innovative online strategies should become the standard for sharing in advanced practice nursing education.

Direct-to-consumer marketing of psychological treatments for anxiety disorders.

Science.gov (United States)

Gallo, Kaitlin P; Comer, Jonathan S; Barlow, David H

2013-12-01

Progress disseminating and implementing evidence-based psychological treatments (EBPTs) for the anxiety disorders has been gradual. To date, the dominant approach for promoting the uptake of EBPTs in clinical settings has been to target the education and training of mental health providers, with many consumers remaining unaware of the potential benefits of EBPTs for anxiety disorders. Direct-to-consumer (DTC) marketing may be a promising vehicle for increasing EBPT utilization rates in the treatment of anxiety disorders. This paper provides an overview of the rationale and important considerations for applying DTC efforts to promote evidence-based care in the treatment of anxiety disorders, and reviews current DTC efforts in this area, including resources on the Internet and other media and in-person events. We conclude with recommendations for future efforts in the DTC marketing of EBPTs for the anxiety disorders, including the need for increased funding and grassroots efforts to inform consumers about anxiety disorders and their most effective treatments. Copyright © 2013 Elsevier Ltd. All rights reserved.

Penicillin treatment for patients with Community-Acquired Pneumonia in Denmark

DEFF Research Database (Denmark)

Egelund, Gertrud Baunbæk; Jensen, Andreas Vestergaard; Andersen, Stine Bang

2017-01-01

BACKGROUND: Community-acquired pneumonia (CAP) is a severe infection, with high mortality. Antibiotic strategies for CAP differ across Europe. The objective of the study was to describe the epidemiology of CAP in Denmark and evaluate the prognosis of patients empirically treated with penicillin...... penicillin-G/V using logistic regression analysis. RESULTS: We included 1320 patients. The incidence of hospitalized CAP was 3.1/1000 inhabitants. Median age was 71 years (IQR; 58-81) and in-hospital mortality was 8%. Median duration of antibiotic treatment was 10 days (IQR; 8-12). In total 45% were treated...... with penicillin-G/V as empiric monotherapy and they did not have a higher mortality compared to patients treated with broader-spectrum antibiotics (OR 0.92, CI 95% 0.55-1.53). CONCLUSION: The duration of treatment exceeded recommendations in European guidelines. Empiric monotherapy with penicillin...

Microbes in biological processes for municipal landfill leachate treatment: Community, function and interaction

DEFF Research Database (Denmark)

Zhang, Duoying; Vahala, Riku; Wang, Yu

2016-01-01

Landfill leachate (LFL) contains high strength of ammonium and complex organic substances including biodegradable volatile fatty acids (VFAs), refractory aquatic humic substances (AHS) and micro-scale xenobiotic organic chemicals (XOCs), which promotes the diverse microbial community in LFL...... treatment bioreactors. These microbes cooperate to remove nitrogen, biodegrade organic matters, eliminate the toxicity of XOCs and produce energy. In these diverse microbes, some show dominant in the bioreactor and are prevalent in many kinds of LFL treatment bio-processes, such as Brocadia from the phylum...

Community recognition and beliefs about anorexia nervosa and its treatment.

Science.gov (United States)

Darby, Anita M; Hay, Phillipa J; Mond, Jonathan M; Quirk, Frances

2012-01-01

Mental Health Literacy (MHL), namely recognition, and beliefs about treatment concerning Anorexia Nervosa (AN) were examined in a community sample of male and female (n = 983) aged 15-94 years. A vignette describing a women suffering from the symptoms of AN was presented, followed by a respondent-based structured interview concerning recognition of the problem and treatment beliefs. The majority of participants could identify the problem as that of an eating disorder, although only 16.1% could specifically identify it as AN. Many also believed the problem was primarily one of low self-esteem (32.5%). General practitioners and psychiatrists or psychologists were considered the most helpful treatment providers, while obtaining information about the problem and available services, followed by family therapy, were considered the most helpful treatments. Less than one-third of participants believed complete recovery was possible. Better AN MHL was found in younger, higher educated, and metropolitan domiciled females. This study offers encouraging results in regard to AN MHL. In particular, there was moderate regard for the use of mental health specialists in the treatment of the disorder. However, there appears to be a misconception that AN is largely the manifestation of low self-esteem and confusion concerning the distinction between AN and bulimia nervosa. AN MHL was poorer in males and those with higher social and health disadvantage. Copyright © 2010 Wiley Periodicals, Inc.

Corporate Philanthropy Toward Community Health Improvement in Manufacturing Communities.

Science.gov (United States)

McHugh, Megan; Farley, Diane; Maechling, Claude R; Dunlop, Dorothy D; French, Dustin D; Holl, Jane L

2018-06-01

Virtually all large employers engage in corporate philanthropy, but little is known about the extent to which it is directed toward improving community health. We conducted in-depth interviews with leaders of corporate philanthropy from 13 of the largest manufacturing companies in the US to understand how giving decisions were made, the extent to which funding was directed towards improving community health, and whether companies coordinate with local public health agencies. We found that corporate giving was sizable and directed towards communities in which the manufacturers have a large presence. Giving was aligned with the social determinants of health (i.e., aimed at improving economic stability, the neighborhood and physical environment, education, food security and nutrition, the community and social context, and the health care system). However, improving public health was not often cited as a goal of corporate giving, and coordination with public health agencies was limited. Our results suggest that there may be opportunities for public health agencies to help guide corporate philanthropy, particularly by sharing community-level data and offering their measurement and evaluation expertise.

Polyoxadiazole hollow fibers for produced water treatment by direct contact membrane distillation

KAUST Repository

Xu, Jingli; Srivatsa Bettahalli, N.M.; Chisca, Stefan; Khalid, Mohammed Khalil; Ghaffour, NorEddine; Vilagines, Ré gis; Nunes, Suzana Pereira

2018-01-01

Treatment of produced water in the petroleum industry has been a challenge worldwide. In this study, we evaluated the use of direct contact membrane distillation (DCMD) for this purpose, removing oil and dissolved elements and supplying clean water

Modified Therapeutic Community Treatment for Offenders with Co-Occurring Disorders: Mental Health Outcomes

Science.gov (United States)

Sullivan, Christopher J.; Sacks, Stanley; McKendrick, Karen; Banks, Steven; Sacks, Joann Y.; Stommel, Joseph

2007-01-01

This paper examines outcomes 12 months post-prison release for offenders with co-occurring disorders (n = 185) randomly assigned to either a mental health control treatment (C) or a modified therapeutic community (E). Significant between-group differences were not found for mental health measures, although improvements were observed for each…

Social network fragmentation and community health.

Science.gov (United States)

Chami, Goylette F; Ahnert, Sebastian E; Kabatereine, Narcis B; Tukahebwa, Edridah M

2017-09-05

Community health interventions often seek to intentionally destroy paths between individuals to prevent the spread of infectious diseases. Immunizing individuals through direct vaccination or the provision of health education prevents pathogen transmission and the propagation of misinformation concerning medical treatments. However, it remains an open question whether network-based strategies should be used in place of conventional field approaches to target individuals for medical treatment in low-income countries. We collected complete friendship and health advice networks in 17 rural villages of Mayuge District, Uganda. Here we show that acquaintance algorithms, i.e., selecting neighbors of randomly selected nodes, were systematically more efficient in fragmenting all networks than targeting well-established community roles, i.e., health workers, village government members, and schoolteachers. Additionally, community roles were not good proxy indicators of physical proximity to other households or connections to many sick people. We also show that acquaintance algorithms were effective in offsetting potential noncompliance with deworming treatments for 16,357 individuals during mass drug administration (MDA). Health advice networks were destroyed more easily than friendship networks. Only an average of 32% of nodes were removed from health advice networks to reduce the percentage of nodes at risk for refusing treatment in MDA to below 25%. Treatment compliance of at least 75% is needed in MDA to control human morbidity attributable to parasitic worms and progress toward elimination. Our findings point toward the potential use of network-based approaches as an alternative to role-based strategies for targeting individuals in rural health interventions.

Application of Ion Torrent Sequencing to the Assessment of the Effect of Alkali Ballast Water Treatment on Microbial Community Diversity

Science.gov (United States)

Fujimoto, Masanori; Moyerbrailean, Gregory A.; Noman, Sifat; Gizicki, Jason P.; Ram, Michal L.; Green, Phyllis A.; Ram, Jeffrey L.

2014-01-01

The impact of NaOH as a ballast water treatment (BWT) on microbial community diversity was assessed using the 16S rRNA gene based Ion Torrent sequencing with its new 400 base chemistry. Ballast water samples from a Great Lakes ship were collected from the intake and discharge of both control and NaOH (pH 12) treated tanks and were analyzed in duplicates. One set of duplicates was treated with the membrane-impermeable DNA cross-linking reagent propidium mono-azide (PMA) prior to PCR amplification to differentiate between live and dead microorganisms. Ion Torrent sequencing generated nearly 580,000 reads for 31 bar-coded samples and revealed alterations of the microbial community structure in ballast water that had been treated with NaOH. Rarefaction analysis of the Ion Torrent sequencing data showed that BWT using NaOH significantly decreased microbial community diversity relative to control discharge (pbased principal coordinate analysis (PCoA) plots and UPGMA tree analysis revealed that NaOH-treated ballast water microbial communities differed from both intake communities and control discharge communities. After NaOH treatment, bacteria from the genus Alishewanella became dominant in the NaOH-treated samples, accounting for alkali ballast water treatment in reducing ballast water microbial diversity and demonstrated the application of new Ion Torrent sequencing techniques to microbial community studies. PMID:25222021

Home Water Treatment Habits and Effectiveness in a Rural Arizona Community.

Science.gov (United States)

Lothrop, Nathan; Wilkinson, Sarah T; Verhougstraete, Marc; Sugeng, Anastasia; Loh, Miranda M; Klimecki, Walter; Beamer, Paloma I

Drinking water quality in the United States (US) is among the safest in the world. However, many residents, often in rural areas, rely on unregulated private wells or small municipal utilities for water needs. These utilities may violate the Safe Drinking Water Act contaminant guidelines, often because they lack the required financial resources. Residents may use alternative water sources or install a home water treatment system. Despite increased home water treatment adoption, few studies have examined their use and effectiveness in the US. Our study addresses this knowledge gap by examining home water treatment in a rural Arizona community. Water samples were analyzed for metal(loid)s, and home treatment and demographic data were recorded in 31 homes. Approximately 42% of homes treated their water. Independent of source water quality, residents with higher income (OR = 1.25; 95%CI (1.00 - 1.64)) and education levels (OR = 1.49; 95%CI (1.12 - 2.12)) were more likely to treat their water. Some contaminant concentrations were effectively reduced with treatment, while some were not. We conclude that increased educational outreach on contaminant testing and treatment, especially to rural areas with endemic water contamination, would result in a greater public health impact while reducing rural health disparities.

Jail-to-community treatment continuum for adults with co-occurring substance use and mental disorders: study protocol for a pilot randomized controlled trial.

Science.gov (United States)

Van Dorn, Richard A; Desmarais, Sarah L; Rade, Candalyn B; Burris, Elizabeth N; Cuddeback, Gary S; Johnson, Kiersten L; Tueller, Stephen J; Comfort, Megan L; Mueser, Kim T

2017-08-04

Adults with co-occurring mental and substance use disorders (CODs) are overrepresented in jails. In-custody barriers to treatment, including a lack of evidence-based treatment options and the often short periods of incarceration, and limited communication between jails and community-based treatment agencies that can hinder immediate enrollment into community care once released have contributed to a cycle of limited treatment engagement, unaddressed criminogenic risks, and (re)arrest among this vulnerable and high-risk population. This paper describes a study that will develop research and communication protocols and adapt two evidence-based treatments, dual-diagnosis motivational interviewing (DDMI) and integrated group therapy (IGT), for delivery to adults with CODs across a jail-to-community treatment continuum. Adaptations to DDMI and IGT were guided by the Risk-Need-Responsivity model and the National Institute of Corrections' implementation competencies; the development of the implementation framework and communication protocols were guided by the Evidence-Based Interagency Implementation Model for community corrections and the Inter-organizational Relationship model, respectively. Implementation and evaluation of the protocols and adapted interventions will occur via an open trial and a pilot randomized trial. The clinical intervention consists of two in-jail DDMI sessions and 12 in-community IGT sessions. Twelve adults with CODs and four clinicians will participate in the open trial to evaluate the acceptability and feasibility of, and fidelity to, the interventions and research and communication protocols. The pilot controlled trial will be conducted with 60 inmates who will be randomized to either DDMI-IGT or treatment as usual. A baseline assessment will be conducted in jail, and four community-based assessments will be conducted during a 6-month follow-up period. Implementation, clinical, public health, and treatment preference outcomes will be evaluated

Changes in Personality Disorder Traits Following 2 Years of Treatment in a Secure Therapeutic Community Milieu

Science.gov (United States)

Morrissey, Catrin; Taylor, Jon

2014-01-01

Therapeutic community treatment models have not previously been applied to forensic patients with mild intellectual disabilities (IDs) with a comorbid diagnosis of personality disorder. Thirteen patients with mild IDs were allocated to a unit within a high secure psychiatric service operating a model of treatment based on the principles and…

Direct visual internal urethrotomy: Is it a durable treatment option?

OpenAIRE

Pal, Dilip Kumar; Kumar, Sanjay; Ghosh, Bastab

2017-01-01

Objective: To evaluate the long-term success rate of direct vision internal urethrotomy as a treatment for anterior urethral strictures. Materials and Methods: We retrospectively analyzed the results for patients who underwent internal urethrotomy from January 2009 to January 2014 for anterior urethral strictures. Patients were followed till January 2016. Patients with complicated urethral strictures with a history of previous urethroplasty, hypospadias repair, or previous radiation were e...

A prison mental health in-reach model informed by assertive community treatment principles: evaluation of its impact on planning during the pre-release period, community mental health service engagement and reoffending.

Science.gov (United States)

McKenna, Brian; Skipworth, Jeremy; Tapsell, Rees; Madell, Dominic; Pillai, Krishna; Simpson, Alexander; Cavney, James; Rouse, Paul

2015-12-01

It is well recognised that prisoners with serious mental illness (SMI) are at high risk of poor outcomes on return to the community. Early engagement with mental health services and other community agencies could provide the substrate for reducing risk. To evaluate the impact of implementing an assertive community treatment informed prison in-reach model of care (PMOC) on post-release engagement with community mental health services and on reoffending rates. One hundred and eighty prisoners with SMI released from four prisons in the year before implementation of the PMOC were compared with 170 such prisoners released the year after its implementation. The assertive prison model of care was associated with more pre-release contacts with community mental health services and contacts with some social care agencies in some prisons. There were significantly more post-release community mental health service engagements after implementation of this model (Z = -2.388, p = 0.02). There was a trend towards reduction in reoffending rates after release from some of the prisons (Z =1.82, p = 0.07). Assertive community treatment applied to prisoners with mental health problems was superior to 'treatment as usual', but more work is needed to ensure that agencies will engage prisoners in pre-release care. The fact that the model showed some benefits in the absence of any increase in resources suggests that it may be the model per se that is effective. Copyright © 2014 John Wiley & Sons, Ltd.

The objectives of the Directive on radiation protection for patients

International Nuclear Information System (INIS)

Courades, J.M.

1992-01-01

Improvement of the quality of medical uses of radiation and avoiding unnecessary exposure are the main objectives of the 1984 Directive laying down basic measures for the radiation protection of persons undergoing medical examination or treatment. This paper explains how these goals have been achieved through the implementation of the various provisions of the Community act since its adoption. (author)

Leadership and Licensure for Drug Treatment and the Implementation of Co-Occurring Disorder Treatment in Community Mental Health Centers.

Science.gov (United States)

Guerrero, Erick G; Padwa, Howard; Lengnick-Hall, Rebecca; Kong, Yinfei; Perrigo, Judith L

2015-07-01

Using a random sample of 48 outpatient mental health programs in low-income and racial and ethnic minority communities, this study examined directorial leadership, drug treatment licensure, and implementation of evidence-based protocols and practices to address co-occurring mental health and substance abuse disorders (COD). Understanding of findings was enhanced with focus groups at six clinics. Most programs (81 %) offered COD treatment. Directorial leadership was positively associated with COD treatment (β = 0.253, p = 0.047, 95 % CI 0.003, 0.502) and COD supervision and training (β = 0.358, p = 0.002, 95 % CI 0.142, 0.575). Licensure was negatively associated with COD treatment (β = -0.235, p = 0.041, 95 % CI -0.460, -0.010) and COD supervision and training (β = -0.195, p = 0.049, 95 % CI -0.389, -0.001). Although lack of financial integration may limit the effect of licensing on COD treatment implementation, the response of leaders to regulation, funding, and human resources issues may encourage COD treatment practices. Implications for leadership interventions and policy are discussed in the context of health care reform.

On the treatment of exchange effects in direct reactions

International Nuclear Information System (INIS)

Bencze, Gy.

1984-11-01

In the theoretical description of direct nuclear reactions the dynamic effects are combined with 'kinematical' effects due to the quantum mechanical exchange interaction caused by the Pauli principle governing the mechanics of identical particles. In the present paper it is shown that in the frame of general algebraic theory of identical particle scattering the effects of the permutational symmetry of nucleons can be separated on an exact way from the treatment of reaction dynamics. Dynamical approximations may be used only after the separation of permutational effects. (D.Gy.)

Effects of iron and calcium carbonate on contaminant removal efficiencies and microbial communities in integrated wastewater treatment systems.

Science.gov (United States)

Zhao, Zhimiao; Song, Xinshan; Zhang, Yinjiang; Zhao, Yufeng; Wang, Bodi; Wang, Yuhui

2017-12-01

In the paper, we explored the influences of different dosages of iron and calcium carbonate on contaminant removal efficiencies and microbial communities in algal ponds combined with constructed wetlands. After 1-year operation of treatment systems, based on the high-throughput pyrosequencing analysis of microbial communities, the optimal operating conditions were obtained as follows: the ACW10 system with Fe 3+ (5.6 mg L -1 ), iron powder (2.8 mg L -1 ), and CaCO 3 powder (0.2 mg L -1 ) in influent as the adjusting agents, initial phosphorus source (PO 4 3- ) in influent, the ratio of nitrogen to phosphorus (N/P) of 30 in influent, and hydraulic retention time (HRT) of 1 day. Total nitrogen (TN) removal efficiency and total phosphorus (TP) removal efficiency were improved significantly. The hydrolysis of CaCO 3 promoted the physicochemical precipitation in contaminant removal. Meanwhile, Fe 3+ and iron powder produced Fe 2+ , which improved contaminant removal. Iron ion improved the diversity, distribution, and metabolic functions of microbial communities in integrated treatment systems. In the treatment ACW10, the dominant phylum in the microbial community was PLANCTOMYCETES, which positively promoted nitrogen removal. After 5 consecutive treatments in ACW10, contaminant removal efficiencies for TN and TP respectively reached 80.6% and 57.3% and total iron concentration in effluent was 0.042 mg L -1 . Copyright © 2017 Elsevier Ltd. All rights reserved.

Relationship of Evidence-Based Practice and Treatments: A Survey of Community Mental Health Providers

Science.gov (United States)

DiMeo, Michelle A.; Moore, G. Kurt; Lichtenstein, Carolyn

2012-01-01

Evidence-based treatments (EBTs) are "interventions" that have been proven effective through rigorous research methodologies. Evidence-based practice (EBP), however, refers to a "decision-making process" that integrates the best available research, clinician expertise, and client characteristics. This study examined community mental health service…

Ibuprofen removal in horizontal subsurface flow constructed wetlands: treatment performance and fungal community dynamics.

Science.gov (United States)

Zhang, Dongqing; Luo, Jinxue; Lee, Zarraz May Ping; Gersberg, Richard M; Liu, Yu; Tan, Soon Keat; Ng, Wun Jern

2016-01-01

The treatment performance of ibuprofen (IBP)-enriched wastewater by horizontal subsurface flow constructed wetlands planted with cattail (Typha angustifolia) and unplanted control mesocosms was investigated. Removal efficiencies of IBP were significantly (p fungal community in these wetland systems. The overall diversity of the fungal community was reduced under the IBP exposure. Taxonomic analysis revealed that 62.2% of the fungal sequences were affiliated with Basidiomycota, followed by Ascomycota (37.4%) at the phylum level. Uncultured fungus (48.2%), Chaetomium sp. (14.2%), Aspergillus sp. (12.4%), Trichoderma sp. (5.7%), Cladosporium sp. (5.4%), and Emericellopsis sp. (5.2%) were identified as dominant genera. At the genus level, a distinct profile of the fungal community in the IBP-enriched mesocosms was observed as compared to the control beds, and as well specific fungal genera were enhanced in the planted beds, regardless of IBP enrichment. However, despite these differences, the composition of the fungal community (as measured by Bray-Curtis similarity) was mostly unaffected by the significant IBP enrichment. On the other hand, a consistent similarity pattern of fungal community structure in the planted mesocosms suggests that the presence of higher macrophytes in the wetland systems may well help shape the fungal community structure.

Supportive-Expressive Dynamic Psychotherapy in the Community Mental Health System: A Pilot Effectiveness Trial for the Treatment of Depression

Science.gov (United States)

Connolly Gibbons, Mary Beth; Thompson, Sarah M.; Scott, Kelli; Schauble, Lindsay A.; Mooney, Tessa; Thompson, Donald; Green, Patricia; MacArthur, Mary Jo; Crits-Christoph, Paul

2013-01-01

The goal of the current article is to present the results of a randomized pilot investigation of a brief dynamic psychotherapy compared with treatment-as-usual (TAU) in the treatment of moderate-to-severe depression in the community mental health system. Forty patients seeking services for moderate-to-severe depression in the community mental health system were randomized to 12 weeks of psychotherapy, with either a community therapist trained in brief dynamic psychotherapy or a TAU therapist. Results indicated that blind judges could discriminate the dynamic sessions from the TAU sessions on adherence to dynamic interventions. The results indicate moderate-to-large effect sizes in favor of the dynamic psychotherapy over the TAU therapy in the treatment of depression. The Behavior and Symptom Identification Scale-24 showed that 50% of patients treated with dynamic therapy moved into a normative range compared with only 29% of patients treated with TAU. PMID:22962971

The directive establishing a community framework for the nuclear safety of nuclear installations: the European Union approach to nuclear safety

International Nuclear Information System (INIS)

Garribba, M.; Chirtes, A.; Nauduzaite, M.

2009-01-01

This article aims at explaining the evolution leading to the adoption of the recent Council Directive 2009/71/EURATOM establishing a Community framework for the nuclear safety of nuclear installations adopted with the consent of all 27 members states following the overwhelming support of the European Parliament, that creates for the first time, a binding legal framework that brings legal certainty to European Union citizens and reinforces the role and independence of national regulators. The paper is divided into three sections. The first section addresses the competence of the European Atomic energy Community to legislate in the area of nuclear safety. It focuses on the 2002 landmark ruling of the European Court of justice that confirmed this competence by recognizing the intrinsic link between radiation protection and nuclear safety. The second part describes the history of the Nuclear safety directive from the initial 2003 European Commission proposal to today 's text in force. The third part is dedicated to a description of the content of the Directive and its implications on the further development of nuclear safety in the European Union. (N.C.)

Initiation and adherence to TB treatment in a Pakistani community influenced more by perceptions than by knowledge of tuberculosis

Directory of Open Access Journals (Sweden)

Mubashir Zafar

2013-01-01

Full Text Available Background: The tuberculosis (TB literature is written almost entirely from a biomedical perspective, while recent studies show that it is imperative to understand lay perception to determine why people seek treatment and may stop taking treatment. Aims: To investigate knowledge about TB, perceptions of (access to TB treatment, and adherence to treatment among a Pakistani population. Setting and Design: Descriptive cross-sectional study. Materials and Methods: A total of 175 participants were selected nonrandomly, 100 were TB patient and 75 were non-TB patient in proportion to the total number of participants in each ward of hospital. Statistical Analysis: Analysis of attitudes and perceptions toward TB, adherence to TB treatment, health seeking behavior, and TB treatment types done by frequency counts and percentages. Regression analysis and logistic regression analysis were performed to test whether differences in age, gender, and education level led to different knowledge scores and different attitudes and preferences toward TB, adherence to TB treatment, health seeking behavior, and TB treatment types. All statistical analyses were performed using Statistical Package for Social Sciences (SPSS 16.0. Result: TB knowledge can be considered fairly well among this community. Respondents′ perceptions suggest that stigma may influence TB patients′ decision in health seeking behavior and adherence to TB treatment. A full 95% of those interviewed believe people with TB tend to hide their TB status out of fear of what others may say. Conclusion: Most of the subjects were unaware of TB that seems to be due to their illiteracy and those who knew had got the knowledge from media, but the majority of the patients who were on directly observed treatment, short-course (DOTS were found to be satisfied.

NO_x reduction by ozone injection and direct plasma treatment

DEFF Research Database (Denmark)

Stamate, Eugen; Salewski, Mirko

2012-01-01

NOx reduction by ozone injection and direct plasma treatment is investigated for different process parameters in a 6 m long serpentine reactor. Several aspects including the role of mixing scheme, water vapours, steep temperature gradient and time dependet NOx levels are taken into consideration...

Effect of polybrominated diphenyl ether (PBDE) treatment on the composition and function of the bacterial community in the sponge Haliclona cymaeformis.

KAUST Repository

Tian, Ren-Mao

2014-01-01

Marine sponges play important roles in benthic environments and are sensitive to environmental stresses. Polybrominated diphenyl ethers (PBDEs) have been widely used as flame retardants since the 1970s and are cytotoxic and genotoxic to organisms. In the present study, we studied the short-period effect of PBDE-47 (2,2\\',4,4\\'-tetrabromodiphenyl ether) treatment on the community structure and functional gene composition of the bacterial community inhabiting the marine sponge Haliclona cymaeformis. Our results showed that the bacterial community shifted from an autotrophic bacteria-dominated community to a heterotrophic bacteria-dominated community in response to PBDE-47 in a time- and concentration-dependent manner. A potentially symbiotic sulfur-oxidizing bacterium (SOB) was dominant (>80% in abundance) in the untreated sponge. However, exposure to a high concentration (1 μg/L) of PBDE-47 caused a substantial decrease in the potential symbiont and an enrichment of heterotrophic bacteria like Clostridium. A metagenomic analysis showed a selective effect of the high concentration treatment on the functional gene composition of the enriched heterotrophic bacteria, revealing an enrichment for the functions responsible for DNA repair, multidrug efflux pumping, and bacterial chemotaxis and motility. This study demonstrated that PBDE-47 induced a shift in the composition of the community and functional genes in the sponge-associated bacterial community, revealing the selective effect of PBDE-47 treatment on the functions of the bacterial community in the microenvironment of the sponge.

A Two-Year Multidisciplinary Training Program for the Frontline Workforce in Community Treatment of Severe Mental Illness.

Science.gov (United States)

Ruud, Torleif; Flage, Karin Blix; Kolbjørnsrud, Ole-Bjørn; Haugen, Gunnar Brox; Sørlie, Tore

2016-01-01

Since 1999, a national two-year multidisciplinary onsite training program has been in operation in Norway. The program trains frontline workforce personnel who provide community treatment to people with severe mental illness. A national network of mental health workers, consumers, caregivers, and others providing or supporting psychosocial treatment and rehabilitation for people with severe mental illness has organized local onsite part-time training programs in collaboration with community mental health centers (CMHCs), municipalities, and primary care providers. CMHC and primary care staff are trained together to increase collaboration. Nationwide dissemination has continued, with new local programs established every year. Evaluations have shown that the program is successful.

[Intrinsic motivation: a new direction of understanding and treatment of schizophrenia?].

Science.gov (United States)

Wertman, Maayan; Grunhaus, Leon; Israeli, David

2013-09-01

While diagnosing schizophrenia, clinicians focus on feeling the quality and nature of the internal motivation of patients. This motivational quality was theoretically conceptualized by Self Determination Theory (SDT). In this article we will review some of the basics of this theory, which focuses on motivational variables assessing behavior on an internal-external axis. Then, we will review prominent findings in the topic of using SDT concepts for the treatment of schizophrenia. The next stage will include a discussion as to the relationship between intrinsic and extrinsic motivators as well as possible neuroanatomy of these behavioral variables. Finally, directions for research will be offered in the field of schizophrenia diagnosis and treatment.

Field-scale electrolysis/ceramic membrane system for the treatment of sewage from decentralized small communities.

Science.gov (United States)

Son, Dong-Jin; Kim, Woo-Yeol; Yun, Chan-Young; Kim, Dae-Gun; Chang, Duk; Sunwoo, Young; Hong, Ki-Ho

2017-07-05

The electrolysis process adopting copper electrodes and ceramic membrane with pore sizes of 0.1-0.2 μm were consisted to a system for the treatment of sewage from decentralized small communities. The system was operated under an HRT of 0.1 hour, voltage of 24 V, and TMP of 0.05 MPa. The system showed average removals of organics, nitrogen, phosphorus, and solids of up to 80%, 52%, 92%, and 100%, respectively. Removal of organics and nitrogen dramatically increased in proportion to increment of influent loading. Phosphorus and solids were remarkably eliminated by both electro-coagulation and membrane filtration. The residual particulate constituents could also be removed successfully through membrane process. A system composed of electrolysis process with ceramic membrane would be a compact, reliable, and flexible option for the treatment of sewage from decentralized small communities.

Hospital policies on life-sustaining treatments and advance directives in Canada.

OpenAIRE

Rasooly, I; Lavery, J V; Urowitz, S; Choudhry, S; Seeman, N; Meslin, E M; Lowy, F H; Singer, P A

1994-01-01

OBJECTIVE: To determine the prevalence and content of hospital policies on life-sustaining treatments (cardiopulmonary resuscitation [CPR], mechanical ventilation, dialysis, artificial nutrition and hydration, and antibiotic therapy for life-threatening infections) and advance directives in Canada. DESIGN: Cross-sectional mailed survey. SETTING: Canada. PARTICIPANTS: Chief executive officers or their designates at public general hospitals. MAIN OUTCOME MEASURES: Information regarding the exis...

Directed funding to address under-provision of treatment for substance use disorders: a quantitative study.

Science.gov (United States)

Frakt, Austin B; Trafton, Jodie; Wallace, Amy; Neuman, Matthew; Pizer, Steven

2013-07-18

Substance use disorders (SUDs) are a substantial problem in the United States (U.S.), affecting far more people than receive treatment. This is true broadly and within the U.S. military veteran population, which is our focus. To increase funding for treatment, the Veterans Health Administration (VA) has implemented several initiatives over the past decade to direct funds toward SUD treatment, supplementing the unrestricted funds VA medical centers receive. We study the 'flypaper effect' or the extent to which these directed funds have actually increased SUD treatment spending. The study sample included all VA facilities and used observational data spanning years 2002 to 2010. Data were analyzed with a fixed effects, ordinary least squares specification with monetized workload as the dependent variable and funding dedicated to SUD specialty clinics the key dependent variable, controlling for unrestricted funding. We observed different effects of dedicated SUD specialty clinic funding over the period 2002 to 2008 versus 2009 to 2010. In the earlier period, there is no evidence of a significant portion of the dedicated funding sticking to its target. In the later period, a substantial proportion--38% in 2009 and 61% in 2010--of funding dedicated to SUD specialty clinics did translate into increased medical center spending for SUD treatment. In comparison, only five cents of every dollar of unrestricted funding is spent on SUD treatment. Relative to unrestricted funding, dedicated funding for SUD treatment was much more effective in increasing workload, but only in years 2009 and 2010. The differences in those years relative to prior ones may be due to the observed management focus on SUD and SUD-related treatment in the later years. If true, this suggests that in a centrally directed healthcare organization such as the VA, funding dedicated to a service is a necessary, but not sufficient condition for increasing resources expended for that service.

Effect of streptomycin treatment on bacterial community structure in the apple phyllosphere.

Directory of Open Access Journals (Sweden)

Erika Yashiro

Full Text Available We studied the effect of many years of streptomycin use in apple orchards on the proportion of phyllosphere bacteria resistant to streptomycin and bacterial community structure. Leaf samples were collected during early July through early September from four orchards that had been sprayed with streptomycin during spring of most years for at least 10 years and four orchards that had not been sprayed. The percentage of cultured phyllosphere bacteria resistant to streptomycin at non-sprayed orchards (mean of 65% was greater than at sprayed orchards (mean of 50% (P = 0.0271. For each orchard, a 16S rRNA gene clone library was constructed from leaf samples. Proteobacteria dominated the bacterial communities at all orchards, accounting for 71 of 104 OTUs (determined at 97% sequence similarity and 93% of all sequences. The genera Massilia, Methylobacterium, Pantoea, Pseudomonas, and Sphingomonas were shared across all sites. Shannon and Simpson's diversity indices and Pielou's evenness index were similar among orchards regardless of streptomycin use. Analysis of Similarity (ANOSIM indicated that long-term streptomycin treatment did not account for the observed variability in community structure among orchards (R = -0.104, P = 0.655. Other variables, including time of summer, temperature and time at sampling, and relative distance of the orchards from each other, also had no significant effect on bacterial community structure. We conclude that factors other than streptomycin exposure drive both the proportion of streptomycin-resistant bacteria and phylogenetic makeup of bacterial communities in the apple phyllosphere in middle to late summer.

Application of ion torrent sequencing to the assessment of the effect of alkali ballast water treatment on microbial community diversity.

Science.gov (United States)

Fujimoto, Masanori; Moyerbrailean, Gregory A; Noman, Sifat; Gizicki, Jason P; Ram, Michal L; Green, Phyllis A; Ram, Jeffrey L

2014-01-01

The impact of NaOH as a ballast water treatment (BWT) on microbial community diversity was assessed using the 16S rRNA gene based Ion Torrent sequencing with its new 400 base chemistry. Ballast water samples from a Great Lakes ship were collected from the intake and discharge of both control and NaOH (pH 12) treated tanks and were analyzed in duplicates. One set of duplicates was treated with the membrane-impermeable DNA cross-linking reagent propidium mono-azide (PMA) prior to PCR amplification to differentiate between live and dead microorganisms. Ion Torrent sequencing generated nearly 580,000 reads for 31 bar-coded samples and revealed alterations of the microbial community structure in ballast water that had been treated with NaOH. Rarefaction analysis of the Ion Torrent sequencing data showed that BWT using NaOH significantly decreased microbial community diversity relative to control discharge (pPCoA) plots and UPGMA tree analysis revealed that NaOH-treated ballast water microbial communities differed from both intake communities and control discharge communities. After NaOH treatment, bacteria from the genus Alishewanella became dominant in the NaOH-treated samples, accounting for microbial community structure between PMA-processed and non-PMA samples occurred in intake water samples, which exhibited a significantly higher amount of PMA-sensitive cyanobacteria/chloroplast 16S rRNA than their corresponding non-PMA total DNA samples. The community assembly obtained using Ion Torrent sequencing was comparable to that obtained from a subset of samples that were also subjected to 454 pyrosequencing. This study showed the efficacy of alkali ballast water treatment in reducing ballast water microbial diversity and demonstrated the application of new Ion Torrent sequencing techniques to microbial community studies.

Microbial community functional structures in wastewater treatment plants as characterized by GeoChip.

Science.gov (United States)

Wang, Xiaohui; Xia, Yu; Wen, Xianghua; Yang, Yunfeng; Zhou, Jizhong

2014-01-01

Biological WWTPs must be functionally stable to continuously and steadily remove contaminants which rely upon the activity of complex microbial communities. However, knowledge is still lacking in regard to microbial community functional structures and their linkages to environmental variables. To investigate microbial community functional structures of activated sludge in wastewater treatment plants (WWTPs) and to understand the effects of environmental factors on their structure. 12 activated sludge samples were collected from four WWTPs in Beijing. A comprehensive functional gene array named GeoChip 4.2 was used to determine the microbial functional genes involved in a variety of biogeochemical processes such as carbon, nitrogen, phosphorous and sulfur cycles, metal resistance, antibiotic resistance and organic contaminant degradation. High similarities of the microbial community functional structures were found among activated sludge samples from the four WWTPs, as shown by both diversity indices and the overlapped genes. For individual gene category, such as egl, amyA, lip, nirS, nirK, nosZ, ureC, ppx, ppk, aprA, dsrA, sox and benAB, there were a number of microorganisms shared by all 12 samples. Canonical correspondence analysis (CCA) showed that the microbial functional patterns were highly correlated with water temperature, dissolved oxygen (DO), ammonia concentrations and loading rate of chemical oxygen demand (COD). Based on the variance partitioning analyses (VPA), a total of 53% of microbial community variation from GeoChip data can be explained by wastewater characteristics (25%) and operational parameters (23%), respectively. This study provided an overall picture of microbial community functional structures of activated sludge in WWTPs and discerned the linkages between microbial communities and environmental variables in WWTPs.

Microbial community functional structures in wastewater treatment plants as characterized by GeoChip.

Directory of Open Access Journals (Sweden)

Xiaohui Wang

Full Text Available BACKGROUND: Biological WWTPs must be functionally stable to continuously and steadily remove contaminants which rely upon the activity of complex microbial communities. However, knowledge is still lacking in regard to microbial community functional structures and their linkages to environmental variables. AIMS: To investigate microbial community functional structures of activated sludge in wastewater treatment plants (WWTPs and to understand the effects of environmental factors on their structure. METHODS: 12 activated sludge samples were collected from four WWTPs in Beijing. A comprehensive functional gene array named GeoChip 4.2 was used to determine the microbial functional genes involved in a variety of biogeochemical processes such as carbon, nitrogen, phosphorous and sulfur cycles, metal resistance, antibiotic resistance and organic contaminant degradation. RESULTS: High similarities of the microbial community functional structures were found among activated sludge samples from the four WWTPs, as shown by both diversity indices and the overlapped genes. For individual gene category, such as egl, amyA, lip, nirS, nirK, nosZ, ureC, ppx, ppk, aprA, dsrA, sox and benAB, there were a number of microorganisms shared by all 12 samples. Canonical correspondence analysis (CCA showed that the microbial functional patterns were highly correlated with water temperature, dissolved oxygen (DO, ammonia concentrations and loading rate of chemical oxygen demand (COD. Based on the variance partitioning analyses (VPA, a total of 53% of microbial community variation from GeoChip data can be explained by wastewater characteristics (25% and operational parameters (23%, respectively. CONCLUSIONS: This study provided an overall picture of microbial community functional structures of activated sludge in WWTPs and discerned the linkages between microbial communities and environmental variables in WWTPs.

Timing is everything: priority effects alter community invasibility after disturbance.

Science.gov (United States)

Symons, Celia C; Arnott, Shelley E

2014-02-01

Theory suggests that communities should be more open to the establishment of regional species following disturbance because disturbance may make more resources available to dispersers. However, after an initial period of high invasibility, growth of the resident community may lead to the monopolization of local resources and decreased probability of successful colonist establishment. During press disturbances (i.e., directional environmental change), it remains unclear what effect regional dispersal will have on local community structure if the establishment of later arriving species is affected by early arriving species (i.e., if priority effects are important). To determine the relationship between time-since-disturbance and invasibility, we conducted a fully factorial field mesocosm experiment that exposed tundra zooplankton communities to two emerging stressors - nutrient and salt addition, and manipulated the arrival timing of regional dispersers. Our results demonstrate that invasibility decreases with increasing time-since-disturbance as abundance (nutrient treatments) or species richness (salt treatments) increases in the resident community. Results suggest that the relative timing of dispersal and environmental change will modify the importance of priority effects in determining species composition after a press disturbance.

Reasons for Schizophrenia Patients Remaining out of Treatment: Results from a Prospective Study in a Rural South Indian Community.

Science.gov (United States)

Kumar, Channaveerachari Naveen; Thirthalli, Jagadisha; Suresha, Kudumallige Krishnappa; Venkatesh, Basappa K; Kishorekumar, Kengeri V; Arunachala, Udupi; Gangadhar, Bangalore N

2016-01-01

A few studies have examined the factors associated with schizophrenia patients remaining untreated in India. We identified 184 schizophrenia patients in a rural community, offered the treatment with antipsychotics and followed them up in their Primary Health Centers for 1-year. Twenty-nine (15.8%) patients remained untreated at both the baseline and 1-year follow-up despite our best attempts to keep them under the treatment umbrella. They were interviewed in detail regarding the reasons for remaining untreated. This group was compared with another group of patients (n = 69) who had stopped the treatment at baseline but were successfully brought under the treatment umbrella throughout the 1-year follow-up period. The reasons for remaining untreated were (n; %): (a) Unsatisfactory improvement with previous treatment attempts (19; 65.5%), (b) poor bond between the patients and the families (6; 20.7%), (c) active symptoms not allowing any treatment efforts from the family members (6; 20.7%), (d) magico-religious beliefs about the illness and its treatment (4; 13.8%), (e) poor social support (3; 10.3%), (f) adverse effects of the medications (2; 6.9%), and (g) perception of recovery and cure (1; 3.4%). For many patients, a constellation of these reasons was responsible for them remaining untreated. In contrast, the common reasons for those who restarted medications to have stopped the treatment at some time were the lack of awareness, the need to continue medications (47; 68.1%), and the financial constraints (28; 40.6%). The predominant reason for schizophrenia patients not remaining on the treatment in this rural community was the families' lack of faith in antipsychotic treatment. Provision of comprehensive treatment package including medical, psychosocial and rehabilitative services, and sensitizing the community about benefits of the treatment may help in ensuring that all patients with psychosis receive the best care.

A new service model for the treatment of severe anorexia nervosa in the community: the Anorexia Nervosa Intensive Treatment Team

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Munro, Calum; Thomson, Victoria; Corr, Jean; Randell, Louise; Davies, Jennie E.; Gittoes, Claire; Honeyman, Vicky; Freeman, Chris P.

2014-01-01

Aims and method A community intensive treatment service for severe anorexia nervosa is described. The service is multidisciplinary but driven by a focus on psychological formulation. Psychological and dietetic interventions are grounded in a process of active risk management. Evaluations of safety, cost and acceptability of the service are described. Results Patients are highly satisfied with their care. A relatively low mortality rate for such a high-risk population was observed. In-patient bed use and costs were substantially reduced. Clinical implications There is a case for greater use of intensive community care for patients with severe anorexia nervosa, as it can be acceptable to patients, relatively safe and cost less than admission. PMID:25285220

Perceived Need for Treatment and Engagement in Mental Health Services Among Community-Referred Racial/Ethnic Minority Adolescents.

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Fisher, Jacqueline Horan; Lichvar, Emily; Hogue, Aaron; Dauber, Sarah

2018-03-10

This study examines clinical and family predictors of perceived need for treatment and engagement in mental health treatment services among community-referred racial/ethnic minority adolescents and their primary caregivers. Findings indicated that the majority of families perceived a need for treatment, but that perceived need was not associated with treatment engagement. Family factors (i.e., low cohesion and high conflict within the family) predicted perceived need for treatment among adolescents, whereas clinical factors (i.e., adolescent internalizing and externalizing symptomatology) predicted caregiver perceived need for adolescent treatment. Neither clinical nor family factors predicted treatment engagement.

Cash and counseling: a promising option for consumer direction of home- and community-based services and supports.

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Mahoney, Kevin J; Simon-Rusinowitz, Lori; Simone, Kristin; Zgoda, Karen

2006-01-01

The Cash and Counseling Demonstration began as a 3-state social experiment to test the claims of members of the disability community that, if they had more control over their services, their lives would improve and costs would be no higher. The 2004 expansion to 12 states brings us closer to the tipping point when this option will be broadly available. The original demonstration was a controlled experiment with randomized assignment, supplemented by an ethnographic study and a process evaluation. Consumers managing flexible, individualized budgets were much more satisfied, had fewer unmet needs, and had comparable health outcomes. Access to service and supports was greatly improved. Consumer direction is increasingly accepted as a desirable option in home and community services.

Predation risk determines breeding territory choice in a Mediterranean cavity-nesting bird community.

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Parejo, Deseada; Avilés, Jesús M

2011-01-01

Non-direct effects of predation can be an important component of the total effect of predation, modulating animal population and community dynamics. The isolated effects of predation risk on the spatial organisation of the breeding bird community, however, remains poorly studied. We investigated whether an experimentally increased predation risk prior to reproduction affected breeding territory selection and subsequent reproductive strategies in three Mediterranean cavity-nesting birds, i.e., the little owl Athene noctua, European roller Coracias garrulus and scops owl Otus scops. We found that territories used the previous year were more likely to be re-occupied when they belonged to the safe treatment rather than to the risky treatment. The first choice of breeders of all three species was for safe territories over risky ones. When all breeding attempts in the season (i.e., final occupation) were considered, breeders also preferred safe to risky sites. In addition, little owls laid larger eggs in risky territories than in safe territories. Our study provides experimental evidence of a rapid preventive response of the three most abundant species in a cavity-nesting bird community to a short-term manipulation of predation risk. This response highlights the key role of the non-direct effects of predation in modulating avian community organisation.

[Probiotics as an items of increasing the effectiveness of treatment of community-acquired pneumonia in adolescents].

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Gonchar, N V; Kassner, L N; Korenev, P B; Il'kovich, Iu M; Mogilina, S V; Petrov, L N

2011-01-01

The aim of the work was to evaluate the efficiency of microbial probiotics Vitaflor and metabolic probiotic Aktoflor-C in complex treatment of community-acquired pneumonia in adolescents in a hospital. The observation involved 38 children aged 11 to 18 years with radiologically verified community-acquired pneumonia, including 23 boys and 15 girls. Patients were divided in 3 groups. Patients in group 1 (n = 13) simultaneously with the antibiotic therapy received per os Vitaflor probiotic containing symbiotic strains of Lactobacillus acidophilus; patients in group 2 (n = 10) along with antibiotic therapy received per os metabolic probiotic Aktoflor-C, containing low molecular weight exometabolites bacteria; patient of the comparison group (n = 15) received antibiotic therapy only. The effectiveness of the used treatment schemes was assessed on the dynamics of the gut state microbiot acoarding to an extended bacteriological examination of faecal flora, level of saliva IgA secretory (before and after treatment), the dynamics of SF-36 quality of life 1 month after discharge from hospital. Was conducted a study of economic efficiency of different modes of therapy. Results showed that adolescents with community-acquired pneumonia during standard antibiotic therapy indicated development of dysbiotic bowel disturbances in the form of reliable oppression of the bifidobacteria and laktoflora. Dysbiosis of the microbial associations are not conducive to proper implementation of immune and nutritional functions of the intestine that shows the imperfection of rehabilitation of patients with pneumonia according to the evaluation of SF-36 quality of life. Pharmacoeconomic analysis revealed the benefits of probiotic metabolic type "Aktoflor" used in addition to standard therapy of community-acquired pneumonia in adolescents.

Risky decision-making predicts short-term outcome of community but not residential treatment for opiate addiction. Implications for case management.

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Passetti, F; Clark, L; Davis, P; Mehta, M A; White, S; Checinski, K; King, M; Abou-Saleh, M

2011-10-01

Opiate addiction is associated with decision-making deficits and we previously showed that the extent of these impairments predicts aspects of treatment outcome. Here we aimed to establish whether measures of decision-making performance might be used to inform placement matching. Two groups of opiate dependent individuals, one receiving treatment in a community setting (n=48) and one in a residential setting (n=32) were administered computerised tests of decision-making, impulsivity and planning shortly after the beginning of treatment, to be followed up three months into each programme. In the community sample, performance on the decision-making tasks at initial assessment predicted abstinence from illicit drugs at follow-up. In contrast, in the residential sample there was no relationship between decision-making and clinical outcome. Intact decision-making processes appear to be necessary for upholding a resolve to avoid taking drugs in a community setting, but the importance of these mechanisms may be attenuated in a residential treatment setting. The results support the placement matching hypothesis, suggesting that individuals with more prominent decision-making deficits may particularly benefit from treatment in a residential setting and from the inclusion of aspects of cognitive rehabilitation in their treatment programme. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Changes in the Structure of the Microbial Community Associated with Nannochloropsis salina following Treatments with Antibiotics and Bioactive Compounds

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Geng, Haifeng; Tran-Gyamfi, Mary B.; Lane, Todd W.; Sale, Kenneth L.; Yu, Eizadora T.

2016-01-01

Open microalgae cultures host a myriad of bacteria, creating a complex system of interacting species that influence algal growth and health. Many algal microbiota studies have been conducted to determine the relative importance of bacterial taxa to algal culture health and physiological states, but these studies have not characterized the interspecies relationships in the microbial communities. We subjected Nanochroloropsis salina cultures to multiple chemical treatments (antibiotics and quorum sensing compounds) and obtained dense time-series data on changes to the microbial community using 16S gene amplicon metagenomic sequencing (21,029,577 reads for 23 samples) to measure microbial taxa-taxa abundance correlations. Short-term treatment with antibiotics resulted in substantially larger shifts in the microbiota structure compared to changes observed following treatment with signaling compounds and glucose. We also calculated operational taxonomic unit (OTU) associations and generated OTU correlation networks to provide an overview of possible bacterial OTU interactions. This analysis identified five major cohesive modules of microbiota with similar co-abundance profiles across different chemical treatments. The Eigengenes of OTU modules were examined for correlation with different external treatment factors. This correlation-based analysis revealed that culture age (time) and treatment types have primary effects on forming network modules and shaping the community structure. Additional network analysis detected Alteromonadeles and Alphaproteobacteria as having the highest centrality, suggesting these species are “keystone” OTUs in the microbial community. Furthermore, we illustrated that the chemical tropodithietic acid, which is secreted by several species in the Alphaproteobacteria taxon, is able to drastically change the structure of the microbiota within 3 h. Taken together, these results provide valuable insights into the structure of the microbiota

Treatment delay among pulmonary tuberculosis patients in pastoralist communities in Bale Zone, Southeast Ethiopia

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Hussen Awol

2012-06-01

Full Text Available Abstract Background Tuberculosis (TB is a major public health problem in Africa with Ethiopia being the most affected. Treatment delay is an important indicator of access to TB diagnosis and treatment. However, little is known about factors associated with treatment delay of pulmonary TB among pastoralists. Health facility based cross sectional study was conducted on 129 pulmonary TB patients in pastoralist community. The study was conducted in three health centers and a hospital. Time between onset of TB symptoms and first visit to a professional health care provider (patient delay, and the time between first visits to the professional health care provider to the date of diagnosis (provider's delay were analyzed using SPSS 16.0 statistical software. Findings A total of 129 new smear positive pulmonary TB patients participated in the study. The median total delay was 97 days. The median patient and health provider delays were 63 and 34 days, respectively. Ninety six percent of the patients were delayed for more than the twenty one days cutoff point. Patient delay was positively associated with first visit to traditional healer/private clinic/drug shop, rural residence, being illiterate, living in more than 10 kilometers from health facility; severity of illness at first presentation to health facility. Provider delay was positively associated with rural residence, being illiterate, patient with good functional status, patients in contact with more than two health providers, and place of first visit being traditional healer/private clinic/drug shop. Conclusions This study showed that majority of smear positive patients delayed either for diagnosis or treatment, thus continue to serve as reservoirs of infection. This indicates that there is a need for intervention to decrease patient and provider delays. Effort to reduce delays in pastoralist communities should focus on improving access to services in rural communities, engaging traditional and

Elevational characteristics of the archaeal community in full-scale activated sludge wastewater treatment plants at a 3,660-meter elevational scale.

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Niu, Lihua; Zhang, Xue; Li, Yi; Wang, Peifang; Zhang, Wenlong; Wang, Chao; Wang, Qing

2017-07-01

Due to the important roles of archaea in wastewater treatment processes, archaeal communities have been studied extensively in various anaerobic reactors, but the knowledge of archaeal communities in full-scale activated sludge wastewater treatment plants (WWTPs) remains quite poor. In this study, 454-pyrosequencing was for the first time employed to investigate archaeal communities from 20 full-scale activated sludge WWTPs distributed at a 3,660-meter elevational scale in China. Results showed that archaeal communities from WWTPs were dominated by Methanosarcinales (84.6%). A core archaeal population (94.5%) composed of Methanosaeta, Methanosarcina, Methanogenium and Methanobrevibacter was shared among WWTPs. The elevational pattern of archaeal communities was observed in WWTPs, with an elevational threshold associated with archaeal community richness and structures at approximately 1,500 meters above sea level (masl). A declining trend in community richness with increasing elevation was observed at higher elevations, whereas no trend was presented at lower elevations. Spearman correlation analysis indicated that the archaeal community richness at higher elevations was associated with more environmental variables than that at lower elevations. Redundancy analysis indicated that wastewater variables were the dominant contributors to the variation of community structures at higher elevations, followed by operational variables and elevation.

A Comparison of Systematic Desensitization and Directed Masturbation in the Treatment of Primary Orgasmic Dysfunction in Females

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Andersen, Barbara L.

2009-01-01

Thirty subjects seeking treatment for primary inorgasmia accompanied by sexual anxiety or aversion were assigned to one of three groups: systematic desensitization (SD), directed masturbation (DM), or waiting list control (WL). Following treatment, subjects were retested, and the WL group then received directed masturbation treatment. A third testing constituted a follow-up for the SD and DM groups and a posttreatment testing for the WL. Both treatments were equally effective in improving subjects’ sexual self-acceptance and increasing sexual pleasure. Changes in anxiety were negligible; however, sexual arousal and orgasm for DM and WL subjects increased. The gains of the WL group not only replicated the findings of the DM group but also were of greater magnitude. PMID:6114968

From where are tuberculosis patients accessing treatment in India? Results from a cross-sectional community based survey of 30 districts.

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Srinath Satyanarayana

Full Text Available BACKGROUND: Tuberculosis (TB notification in India by the Revised National TB Control Programme (RNTCP provides information on TB patients registered for treatment from the programme. There is limited information about the proportion of patients treated for TB outside RNTCP and where these patients access their treatment. OBJECTIVES: To estimate the proportion of patients accessing TB treatment outside the RNTCP and to identify their basic demographic characteristics. METHODS: A cross sectional community-based survey in 30 districts. Patients were identified through a door-to-door survey and interviewed using a semi-structured questionnaire. RESULTS: Of the estimated 75,000 households enumerated, 73,249 households (97.6% were visited. Of the 371,174 household members, 761 TB patients were identified (∼205 cases per 100,000 populations. Data were collected from 609 (80% TB patients of which 331 [54% (95% CI: 42-66%] were determined to be taking treatment 'under DOTS/RNTCP'. The remaining 278 [46% (95% CI: 34-57%] were on treatment from 'outside DOTS/RNTCP' sources and hence were unlikely to be part of the TB notification system. Patients who were accessing treatment from 'outside DOTS/RNTCP' were more likely to be patients from rural areas [adjusted Odds Ratio (aOR 2.5, 95% CI (1.2-5.3] and whose TB was diagnosed in a non-government health facility (aOR 14.0, 95% CI 7.9-24.9. CONCLUSIONS: This community-based survey found that nearly half of self-reported TB patients were missed by TB notification system in these districts. The study highlights the need for 1 Reviewing and revising the scope of the TB notification system, 2 Strengthening and monitoring health care delivery systems with periodic assessment of the reach and utilisation of the RNTCP services especially among rural communities, 3 Advocacy, communication and social mobilisation activities focused at rural communities with low household incomes and 4 Inclusive involvement of all

Direct visual internal urethrotomy: Is it a durable treatment option?

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Pal, Dilip Kumar; Kumar, Sanjay; Ghosh, Bastab

2017-01-01

To evaluate the long-term success rate of direct vision internal urethrotomy as a treatment for anterior urethral strictures. We retrospectively analyzed the results for patients who underwent internal urethrotomy from January 2009 to January 2014 for anterior urethral strictures. Patients were followed till January 2016. Patients with complicated urethral strictures with a history of previous urethroplasty, hypospadias repair, or previous radiation were excluded from the study, as anticipated low success rate of direct visual internal urethrotomy (DVIU) in these patients. The Kaplan-Meier method was used to analyze stricture-free probability after the first, second, and third urethrotomy. A total of 186 patients were included in this study. Stricture-free rates after first, second, and third urethrotomy were 29.66%, 22.64%, and 13.33%, respectively. Although DVIU may be a management option for anterior urethral stricture disease, it seems that long-term results are disappointing.

Short-Term Cognitive-Behavioural Group Treatment for Hoarding Disorder: A Naturalistic Treatment Outcome Study.

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Moulding, Richard; Nedeljkovic, Maja; Kyrios, Michael; Osborne, Debra; Mogan, Christopher

2017-01-01

The study aim was to test whether a 12-week publically rebated group programme, based upon Steketee and Frost's Cognitive Behavioural Therapy-based hoarding treatment, would be efficacious in a community-based setting. Over a 3-year period, 77 participants with clinically significant hoarding were recruited into 12 group programmes. All completed treatment; however, as this was a community-based naturalistic study, only 41 completed the post-treatment assessment. Treatment included psychoeducation about hoarding, skills training for organization and decision making, direct in-session exposure to sorting and discarding, and cognitive and behavioural techniques to support out-of-session sorting and discarding, and nonacquiring. Self-report measures used to assess treatment effect were the Savings Inventory-Revised (SI-R), Savings Cognition Inventory, and the Depression, Anxiety and Stress Scales. Pre-post analyses indicated that after 12 weeks of treatment, hoarding symptoms as measured on the SI-R had reduced significantly, with large effect sizes reported in total and across all subscales. Moderate effect sizes were also reported for hoarding-related beliefs (emotional attachment and responsibility) and depressive symptoms. Of the 41 participants who completed post-treatment questionnaires, 14 (34%) were conservatively calculated to have clinically significant change, which is considerable given the brevity of the programme judged against the typical length of the disorder. The main limitation of the study was the moderate assessment completion rate, given its naturalistic setting. This study demonstrated that a 12-week group treatment for hoarding disorders was effective in reducing hoarding and depressive symptoms in an Australian clinical cohort and provides evidence for use of this treatment approach in a community setting. Copyright © 2016 John Wiley & Sons, Ltd. A 12-week group programme delivered in a community setting was effective for helping with

Community resources support adherence to treatment for childhood cancer in El Salvador.

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Rossell, Nuria; Salaverria, Carmen; Hernandez, Angelica; Alabi, Soad; Vasquez, Roberto; Bonilla, Miguel; Lam, Catherine G; Ribeiro, Raul; Reis, Ria

2018-01-01

In order to reduce nonadherence and treatment abandonment of children with cancer in El Salvador, institutions located nearby the patients' homes were involved to provide support. Methodological approach: Health clinics and municipality offices in the patients' communities were asked to assist families who were not promptly located after missing hospital appointments, or those whose financial limitations were likely to impede continuation of treatment. Data was collected about the number of contacted institutions, the nature of help provided, staff's time investments, and parents' perceptions about the intervention. Local institutions (133 from 206 contacts) conducted home visits (83), and/or provided parents with money (55) or transportation (60). Parents found this support essential for continuing the treatment but they also encountered challenges regarding local institutions' inconsistencies. Nonadherence and abandonment decreased. Economic burden was reduced on both the families and the hospital. Involvement of external institutions might become regular practice to support families of children with cancer.

Coolmine Therapeutic Community, Dublin: a 40-year history of Ireland's first voluntary drug treatment service.

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Butler, Shane

2016-02-01

To document the evolution over 40 years (from 1973 to 2013) of Coolmine Therapeutic Community (Ireland's first voluntary drug treatment service) against a background of broader drug policy developments in the Republic of Ireland and elsewhere during this period. Data were gathered by means of archival research within Coolmine, complemented by semi-structured interviews with former clients, current and former Coolmine management and staff, and representatives of outsider stakeholder interests. Coolmines's history has three phases: (1) an early and uncontentious phase, in which external authorities provided financial support for Coolmine without questioning its work practices or outcomes; (2) a middle, controversial phase, in which Coolmine struggled for survival in an external policy environment now dominated by harm reduction strategies; and (3) a final phase in which, through the use of conventional corporate governance, Coolmine management sought to repair its damaged reputation by introducing evidence-based clinical practices. Coolmine Therapeutic Community was established when drug treatment services in Ireland were in their infancy, and its changing fortunes over subsequent decades reflected changing perceptions of what constitutes appropriate addiction treatment-and in particular the role to be played by former addicts within addiction treatment systems-as well as changing perceptions of funding relationships between statutory authorities and voluntary providers of health and social services. © 2015 Society for the Study of Addiction.

Good Governance and Foreign Direct Investment : A Legal Contribution to a Balanced Economic Development in the East African Community (EAC)

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Mbembe, Binda

2015-01-01

One of the objectives of the East African Community (EAC) is the promotion of a balanced economic development between its Partner States: Burundi, Kenya, Rwanda, Tanzania, and Uganda. And one of the ways to reach this economic development is the attraction of investment, especially Foreign Direct

Application of ion torrent sequencing to the assessment of the effect of alkali ballast water treatment on microbial community diversity.

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Masanori Fujimoto

Full Text Available The impact of NaOH as a ballast water treatment (BWT on microbial community diversity was assessed using the 16S rRNA gene based Ion Torrent sequencing with its new 400 base chemistry. Ballast water samples from a Great Lakes ship were collected from the intake and discharge of both control and NaOH (pH 12 treated tanks and were analyzed in duplicates. One set of duplicates was treated with the membrane-impermeable DNA cross-linking reagent propidium mono-azide (PMA prior to PCR amplification to differentiate between live and dead microorganisms. Ion Torrent sequencing generated nearly 580,000 reads for 31 bar-coded samples and revealed alterations of the microbial community structure in ballast water that had been treated with NaOH. Rarefaction analysis of the Ion Torrent sequencing data showed that BWT using NaOH significantly decreased microbial community diversity relative to control discharge (p<0.001. UniFrac distance based principal coordinate analysis (PCoA plots and UPGMA tree analysis revealed that NaOH-treated ballast water microbial communities differed from both intake communities and control discharge communities. After NaOH treatment, bacteria from the genus Alishewanella became dominant in the NaOH-treated samples, accounting for <0.5% of the total reads in intake samples but more than 50% of the reads in the treated discharge samples. The only apparent difference in microbial community structure between PMA-processed and non-PMA samples occurred in intake water samples, which exhibited a significantly higher amount of PMA-sensitive cyanobacteria/chloroplast 16S rRNA than their corresponding non-PMA total DNA samples. The community assembly obtained using Ion Torrent sequencing was comparable to that obtained from a subset of samples that were also subjected to 454 pyrosequencing. This study showed the efficacy of alkali ballast water treatment in reducing ballast water microbial diversity and demonstrated the application of new

A qualitative study on health workers' and community members' perceived sources, role of information and communication on malaria treatment, prevention and control in southeast Nigeria.

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Umeano-Enemuoh, Jane C; Uzochukwu, Benjamim; Ezumah, Nkoli; Mangham-Jefferies, Lindsay; Wiseman, Virginia; Onwujekwe, Obinna

2015-10-22

It has been widely acknowledged that well-planned and executed communication programmes can contribute to achieving malaria prevention and treatment goals. This however requires a good understanding of current sources and roles of information used by both health workers and communities. The study aimed at determining health workers' and community members' sources, value and use of information on malaria prevention and treatment in Nigeria. Qualitative data was collected from six selected communities (three urban and three rural) in Enugu state, southeast Nigeria. A total of 18 Focus Group Discussions (FGDs) with 179 community members and 26 in-depth interviews (IDIs) with health workers in public and private health facilities were used to collect data on where people receive treatment for malaria and access information on malaria. The FGDS and IDIs also provided data on the values, uses and effects of information and communication on malaria treatment seeking and provision of services. The findings revealed that the major sources of information on malaria for health workers and community members were advertisements in the mass media, workshops and seminars organized by donor agencies, facility supervision, posters, other health workers, television and radio adverts. Community involvement in the design and delivery of information on malaria control was seen as a strong strategy for improving both consumer and provider knowledge. Information from the different sources catalyzed appropriate provision and consumption of malaria treatment amongst health workers and community members. Health workers and consumers receive information on malaria prevention and treatment from multiple sources of communication and information, which they find useful. Harnessing these information sources to encourage consistent and accurate messages around malaria prevention and treatment is a necessary first step in the design and implementation of malaria communication and behaviour change

Development of a Medication Monitoring System for an Integrated Multidisciplinary Program of Assertive Community Treatment (IMPACT Team

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Nicole B. Washington, DO, Assistant Professor

2012-01-01

Full Text Available Purpose: The primary goal was to improve medication management oversight for a severely mentally ill (SMI community-based population by developing a medication monitoring system based on current guidelines to optimize pharmacotherapy and minimize potential medication-related adverse effects. The secondary goal was improvement in coordination of care between healthcare providers. Methods: Guidelines for medication used for psychiatric indications were reviewed. A database of medication for psychiatric indications with monitoring recommendation was developed. Results: Medication regimens for 68 members of the Integrated Multidisciplinary Program of Assertive Community Treatment (IMPACT program qualified for review. Fourteen medications, carbamazepine, chlorpromazine, clozapine, fluphenazine and fluphenazine long-acting injections (LAI, haloperidol and haloperidol LAI, lithium, lurasidone, olanzapine, paliperidone and paliperidone LAI, perphenazine, quetiapine, risperidone and risperidone LAI, valproic acid/divalproex, and ziprasidone, were identified. In total, 111 medications are used on a monthly basis. Each member receives more than one medication qualifying for review. Additional monitoring parameters that were evaluated included changes in laboratory orders for members with insulin-dependent diabetes. Annual lipid panels were changed to every 6 months, if applicable. Conclusions and Future Directions: This medication monitoring program was developed to help ensure IMPACT members receive the most effective care and minimize potential medication-related adverse effects. The secondary goal was to improve coordination of care. Medication monitoring will be added as a continuous quality assurance measure. Lab results will be reviewed at least monthly. The medication monitoring program will be evaluated annually.

Direct and indirect effects of caregiver social support on adolescent psychological outcomes in two South African AIDS-affected communities

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Casale, Marisa; Cluver, Lucie; Crankshaw, Tamaryn; Kuo, Caroline; Lachman, Jamie M.; Wild, Lauren G.

2015-01-01

Caregiver social support has been shown to be protective for caregiver mental health, parenting and child psychosocial outcomes. This is the first known analysis to quantitatively investigate the relationship between caregiver social support and adolescent psychosocial outcomes in HIV-endemic, resource-scarce Southern African communities. A cross-sectional household survey was conducted over 2009-2010 with 2477 South African adolescents aged 10-17 and their adult caregivers (18 years or older) in one urban and one rural community in South Africa’s KwaZulu-Natal province. Adolescent adjustment was assessed using adult caregiver reports of the Strengths and Difficulties questionnaire (SDQ), which measures peer problems, hyperactivity, conduct problems, emotional symptoms and child prosocial behavior. Hierarchical linear regressions and multiple mediation analyses, using bootstrapping procedures, were conducted to assess for: a) direct effects of more caregiver social support on better adolescent psychosocial wellbeing; and b) indirect effects mediated by better parenting and caregiver mental health. Direct associations (psocial support components within parenting interventions but also point to scope for positive intervention on adolescent psychosocial wellbeing through the broader family social network. PMID:25623784

Influence of long-term repeated prescribed burning on mycelial communities of ectomycorrhizal fungi.

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Bastias, Brigitte A; Xu, Zhihong; Cairney, John W G

2006-01-01

To demonstrate the efficacy of direct DNA extraction from hyphal ingrowth bags for community profiling of ectomycorrhizal (ECM) mycelia in soil, we applied the method to investigate the influence of long-term repeated prescribed burning on an ECM fungal community. DNA was extracted from hyphal ingrowth bags buried in forest plots that received different prescribed burning treatments for 30 yr, and denaturing gradient gel electrophoresis (DGGE) profiles of partial fungal rDNA internal transcribed spacer (ITS) regions were compared. Restriction fragment length polymorphism (RFLP) and sequence analyses were also used to compare clone assemblages between the treatments. The majority of sequences derived from the ingrowth bags were apparently those of ECM fungi. DGGE profiles for biennially burned plots were significantly different from those of quadrennially burned and unburned control plots. Analysis of clone assemblages indicated that this reflected altered ECM fungal community composition. The results indicate that hyphal ingrowth bags represent a useful method for investigation of ECM mycelial communities, and that frequent long-term prescribed burning can influence below-ground ECM fungal communities.

Towards holistic dual diagnosis care: physical health screening in a Victorian community-based alcohol and drug treatment service.

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Jackson, Lara; Felstead, Boyce; Bhowmik, Jahar; Avery, Rachel; Nelson-Hearity, Rhonda

2016-01-01

The poorer health outcomes experienced by people with mental illness have led to new directions in policy for routine physical health screening of service users. By contrast, little attention has been paid to the physical health needs of consumers of alcohol and other drug (AOD) services, despite a similar disparity in physical health outcomes compared with the general population. The majority of people with problematic AOD use have comorbid mental illness, known as a dual diagnosis, likely to exacerbate their vulnerability to poor physical health. With the potential for physical health screening to improve health outcomes for AOD clients, a need exists for systematic identification and management of common health conditions. Within the current health service system, those with a dual diagnosis are more likely to have their physical health surveyed and responded to if they present for treatment in the mental health system. In this study, a physical health screening tool was administered to clients attending a community-based AOD service. The tool was administered by a counsellor during the initial phase of treatment, and referrals to health professionals were made as appropriate. Findings are discussed in terms of prevalence, types of problems identified and subsequent rates of referral. The results corroborate the known link between mental and physical ill health, and contribute to developing evidence that AOD clients present with equally concerning physical ill health to that of mental health clients and should equally be screened for such when presenting for AOD treatment.

Schistosomiasis and soil-transmitted helminth control in Niger: cost effectiveness of school based and community distributed mass drug administration [corrected].

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Jacqueline Leslie

2011-10-01

Full Text Available BACKGROUND: In 2004 Niger established a large scale schistosomiasis and soil-transmitted helminths control programme targeting children aged 5-14 years and adults. In two years 4.3 million treatments were delivered in 40 districts using school based and community distribution. METHOD AND FINDINGS: Four districts were surveyed in 2006 to estimate the economic cost per district, per treatment and per schistosomiasis infection averted. The study compares the costs of treatment at start up and in a subsequent year, identifies the allocation of costs by activity, input and organisation, and assesses the cost of treatment. The cost of delivery provided by teachers is compared to cost of delivery by community distributers (CDD. The total economic cost of the programme including programmatic, national and local government costs and international support in four study districts, over two years, was US$ 456,718; an economic cost/treatment of $0.58. The full economic delivery cost of school based treatment in 2005/06 was $0.76, and for community distribution was $0.46. Including only the programme costs the figures are $0.47 and $0.41 respectively. Differences at sub-district are more marked. This is partly explained by the fact that a CDD treats 5.8 people for every one treated in school. The range in cost effectiveness for both direct and direct and indirect treatments is quantified and the need to develop and refine such estimates is emphasised. CONCLUSIONS: The relative cost effectiveness of school and community delivery differs by country according to the composition of the population treated, the numbers targeted and treated at school and in the community, the cost and frequency of training teachers and CDDs. Options analysis of technical and implementation alternatives including a financial analysis should form part of the programme design process.

Change in the direct cost of treatment for children and adolescents with hyperkinetic disorder in Germany over a period of four years

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Rothenberger Aribert

2009-01-01

Full Text Available Abstract Background In many developed countries, the treatment of hyperkinetic disorder (or ADHD consumes a considerable amount of resources. The primary aim of this study was to determine change in the direct cost of treatment for children and adolescents with hyperkinetic disorder in Germany over time, and compare the cost with the cost of treatment for two physical disorders: epilepsy and asthma. Methods The German Federal Statistical Office provided data on the direct cost of treating hyperkinetic disorder, epilepsy and asthma in Germany for 2002, 2004, and 2006. The direct costs of treatment incurred by hyperkinetic disorder in these years were compared with those incurred by epilepsy and asthma. Results The total direct cost of treatment for the hyperkinetic disorder was € 177 million in 2002, € 234 million in 2004, and € 341 million in 2006. The largest proportion of the cost was incurred by the age group Conclusion The direct cost of treatment for hyperkinetic disorder in the age group

Index of Effort: An Analytical Model for Evaluating and Re-Directing Student Recruitment Activities for a Local Community College.

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Landini, Albert J.

This index of effort is proposed as a means by which those in charge of student recruitment activities at community colleges can be sure that their efforts are being directed toward all of the appropriate population. The index is an analytical model based on the concept of socio-economic profiles, using small area 1970 census data, and is the…

A comparative analysis of pressure sore treatment modalities in community settings

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N. Small

2002-09-01

Full Text Available The management of pressure sores in community settings, poses a clinical problem which challenges the patient’s tolerance and the clinician’s diligence and ingenuity. Pressure sores can be painful, lead to infection and are associated with considerable morbidity and increased mortality (Patterson & Bennett, 1995:919; Bale, Banks, Hagelstein & Harding, 1998:65. Treatment costs of these wounds are high in terms of resources (Colin 1995:65; Wood, Griffiths & Stoner, 1997:256. However, since there are untold cost in terms of pain and suffering to the patient, it is impossible to calculate the true cost of pressure sores (Dealey, 1994:87.

Effect of heterogeneous Fenton-like pre-treatment on anaerobic granular sludge performance and microbial community for the treatment of traditional Chinese medicine wastewater

Energy Technology Data Exchange (ETDEWEB)

Su, Chengyuan, E-mail: suchengyuan2008@126.com [School of Environment and Resources, Guangxi Normal University, 15 Yucai Road, Guilin 541004 (China); School of Municipal and Environmental Engineering, Harbin Institute of Technology, 73 Huanghe Road, Harbin 150090 (China); Li, Weiguang [School of Municipal and Environmental Engineering, Harbin Institute of Technology, 73 Huanghe Road, Harbin 150090 (China); Lu, Yuxiang; Chen, Menglin; Huang, Zhi [School of Environment and Resources, Guangxi Normal University, 15 Yucai Road, Guilin 541004 (China)

2016-08-15

Highlights: • Rhein has metabolic or physiological toxicity on methanogens in anaerobic granular sludge. • TCM wastewater containing rhein can be successfully treated by the combined treatment. • The productions of the EPS of granular sludge increased after pre-treatment. • Methanoregula, Methanobacterium, Methanosphaerula were predominant in the DC reactor after pre-treatment. - Abstract: The effect of a heterogeneous Fenton-like pre-treatment on the anaerobic processes, characteristics and microbial community of sludge was investigated for traditional Chinese medicine (TCM) wastewater containing rhein. When the concentrations of rhein were 50 mg/L and 100 mg/L, the toxic effect was physiological toxicity for anaerobic granular sludge. Using a single double circle (DC) reactor for the treatment of TCM wastewater containing rhein at concentrations of 15–20 mg/L, the chemical oxygen demand (COD) removal rate was 69%, and coenzyme F{sub 420} was nearly undetectable in the 3D-excitation-emission matrix (EEM) spectra of soluble microbial products (SMP). The abundances of Methanoregula, Methanobacterium, Methanosphaerula were only 5.57%, 2.39% and 1.08% in the DC reactor, respectively. TCM wastewater containing rhein could be successfully treated by the combination of the heterogeneous Fenton-like pre-treatment and the DC reactor processes, and the COD removal rate reached 95%. Meanwhile, the abundances of Methanoregula, Methanobacterium, Methanosphaerula increased to 22.5%, 18.5%, and 13.87%, respectively. For the bacterial community, the abundance of Acidobacteria-Gp6 decreased from 6.99% to 1.07%, while the abundances of Acidobacteria-Gp1 and Acidobacteria-Gp2 increased from 1.61% to 6.55% and from 1.28% to 5.87%, respectively.

The red road to wellness: cultural reclamation in a Native First Nations community treatment center.

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Gone, Joseph P

2011-03-01

This article explores how Native American cultural practices were incorporated into the therapeutic activities of a community-controlled substance abuse treatment center on a "First Nations" reserve in the Canadian north. Analysis of open-ended interviews with nineteen staff and clients-as contextualized by participant observation, program records, and existing ethnographic resources-yielded insights concerning local therapeutic practice with outpatients and other community members. Specifically, program staff adopted and promoted a diverse array of both western and Aboriginal approaches that were formally integrated with reference to the Aboriginal symbol of the medicine wheel. Although incorporations of indigenous culture marked Lodge programs as distinctively Aboriginal in character, the subtle but profound influence of western "therapy culture" was centrally evident in healing activities as well. Nuanced explication of these activities illustrated four contributions of cultural analysis for community psychology.

Metagenomic analysis of bacterial community composition and antibiotic resistance genes in a wastewater treatment plant and its receiving surface water.

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Tang, Junying; Bu, Yuanqing; Zhang, Xu-Xiang; Huang, Kailong; He, Xiwei; Ye, Lin; Shan, Zhengjun; Ren, Hongqiang

2016-10-01

The presence of pathogenic bacteria and the dissemination of antibiotic resistance genes (ARGs) may pose big risks to the rivers that receive the effluent from municipal wastewater treatment plants (WWTPs). In this study, we investigated the changes of bacterial community and ARGs along treatment processes of one WWTP, and examined the effects of the effluent discharge on the bacterial community and ARGs in the receiving river. Pyrosequencing was applied to reveal bacterial community composition including potential bacterial pathogen, and Illumina high-throughput sequencing was used for profiling ARGs. The results showed that the WWTP had good removal efficiency on potential pathogenic bacteria (especially Arcobacter butzleri) and ARGs. Moreover, the bacterial communities of downstream and upstream of the river showed no significant difference. However, the increase in the abundance of potential pathogens and ARGs at effluent outfall was observed, indicating that WWTP effluent might contribute to the dissemination of potential pathogenic bacteria and ARGs in the receiving river. Copyright © 2016 Elsevier Inc. All rights reserved.

Factor Analysis of Therapist-Identified Treatment Targets in Community-Based Children's Mental Health.

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Love, Allison R; Okado, Izumi; Orimoto, Trina E; Mueller, Charles W

2018-01-01

The present study used exploratory and confirmatory factor analyses to identify underlying latent factors affecting variation in community therapists' endorsement of treatment targets. As part of a statewide practice management program, therapist completed monthly reports of treatment targets (up to 10 per month) for a sample of youth (n = 790) receiving intensive in-home therapy. Nearly 75 % of youth were diagnosed with multiple co-occurring disorders. Five factors emerged: Disinhibition, Societal Rules Evasion, Social Engagement Deficits, Emotional Distress, and Management of Biodevelopmental Outcomes. Using logistic regression, primary diagnosis predicted therapist selection of Disinhibition and Emotional Distress targets. Client age predicted endorsement of Societal Rules Evasion targets. Practice-to-research implications are discussed.

Effect of polybrominated diphenyl ether (PBDE) treatment on the composition and function of the bacterial community in the sponge Haliclona cymaeformis.

KAUST Repository

Tian, Ren-Mao; Lee, On On; Wang, Yong; Cai, Lin; Bougouffa, Salim; Chiu, Jill Man Ying; Wu, Rudolf Shiu Sun; Qian, Pei-Yuan

2014-01-01

. In the present study, we studied the short-period effect of PBDE-47 (2,2',4,4'-tetrabromodiphenyl ether) treatment on the community structure and functional gene composition of the bacterial community inhabiting the marine sponge Haliclona cymaeformis. Our

Marketing the Program. New Directions for Community Colleges, Number 36.

Science.gov (United States)

Keim, William A., Ed.; Keim, Marybelle C., Ed.

1981-01-01

This collection of essays examines the role of marketing in the recruitment and retention of community college students. First, Philip Kotler and Leslie A. Goldgehn define the marketing process and assess its potential benefits. Richard C. Richardson, Jr., and Donald S. Doucette question the effectiveness of marketing in the community college.…

Moving alcohol prevention research forward-Part II: new directions grounded in community-based system dynamics modeling.

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Apostolopoulos, Yorghos; Lemke, Michael K; Barry, Adam E; Lich, Kristen Hassmiller

2018-02-01

Given the complexity of factors contributing to alcohol misuse, appropriate epistemologies and methodologies are needed to understand and intervene meaningfully. We aimed to (1) provide an overview of computational modeling methodologies, with an emphasis on system dynamics modeling; (2) explain how community-based system dynamics modeling can forge new directions in alcohol prevention research; and (3) present a primer on how to build alcohol misuse simulation models using system dynamics modeling, with an emphasis on stakeholder involvement, data sources and model validation. Throughout, we use alcohol misuse among college students in the United States as a heuristic example for demonstrating these methodologies. System dynamics modeling employs a top-down aggregate approach to understanding dynamically complex problems. Its three foundational properties-stocks, flows and feedbacks-capture non-linearity, time-delayed effects and other system characteristics. As a methodological choice, system dynamics modeling is amenable to participatory approaches; in particular, community-based system dynamics modeling has been used to build impactful models for addressing dynamically complex problems. The process of community-based system dynamics modeling consists of numerous stages: (1) creating model boundary charts, behavior-over-time-graphs and preliminary system dynamics models using group model-building techniques; (2) model formulation; (3) model calibration; (4) model testing and validation; and (5) model simulation using learning-laboratory techniques. Community-based system dynamics modeling can provide powerful tools for policy and intervention decisions that can result ultimately in sustainable changes in research and action in alcohol misuse prevention. © 2017 Society for the Study of Addiction.

Comparative Effects of Biomass Pre-Treatments for Direct and Indirect Transesterification to Enhance Microalgal Lipid Recovery

International Nuclear Information System (INIS)

Ghasemi Naghdi, Forough; Thomas-Hall, Skye R.; Durairatnam, Reuben; Pratt, Steven; Schenk, Peer M.

2014-01-01

Microalgal lipid recovery for biodiesel production is currently considered suboptimal, but pre-treatment of algal biomass, the use of solvent mixtures and the positioning of transesterification can lead to increased yields. Here, the effect of various reportedly successful pre-treatments and solvent mixtures were directly compared to each other and combined with direct and indirect transesterification methods using the oleaginous microalga Tetraselmis sp. M8. Microwave and thermal pre-treatments were applied and the total lipid and fatty acid methyl ester (FAME) recoveries were investigated. The application of pre-treatments increased FAME recovery through indirect transesterification when a Soxhlet system was used but they had no significant effect for direct transesterification. Gravimetric analyses of total lipids revealed that lipid recovery was highest when utilizing the chloroform-based Bligh and Dyer extraction method; however, FAME yield was the highest when applying a Soxhlet system utilizing a solvent mixture of hexane–ethanol (3:1). Total lipid recovery did not necessarily correlate with the recovery of FAMEs. The highest FAME recovery was achieved from thermal or microwave pre-treated biomass followed by indirect transesterification through Soxhlet extraction. FAME recovery could be more than doubled (increase of up to 171%) under these conditions. We conclude that a simple thermal pre-treatment (80°C for 10 min) in combination with solvent mixture extraction through indirect transesterification may present a cost-effective and scalable option for large-scale lipid extraction from microalgae.

Comparative effects of biomass pre-treatments for direct and indirect transesterification to enhance microalgal lipid recovery

Directory of Open Access Journals (Sweden)

Forough eGhasemi Naghdi

2014-12-01

Full Text Available Microalgal lipid recovery for biodiesel production is currently considered suboptimal, but pre-treatment of algal biomass, the use of solvent mixtures and the positioning of transesterification can lead to increased yields. Here, the effect of various reportedly successful pre-treatments and solvent mixtures were directly compared to each other and combined with direct and indirect transesterification methods using the oleaginous microalga Tetraselmis sp. M8. Microwave and thermal pre-treatments were applied and the total lipid and fatty acid methyl ester (FAME recoveries were investigated. The application of pre-treatments increased FAME recovery through indirect transesterification when a Soxhlet system was used but they had no significant effect for direct transesterification. Gravimetric analyses of total lipids revealed that lipid recovery was highest when utilizing the chloroform-based Bligh and Dyer extraction method; however FAME yield was the highest when applying a Soxhlet system utilizing a solvent mixture of hexane-ethanol (3:1. Total lipid recovery did not necessarily correlate with the recovery of FAMEs. The highest FAME recovery was achieved from thermal or microwave pre-treated biomass followed by indirect transesterification through Soxhlet extraction. FAME recovery could be more than doubled (increase of up to 171% under these conditions. We conclude that a simple thermal pre-treatment (80°C for 10 min in combination with solvent mixture extraction through indirect transesterification may present a cost-effective and scalable option for large-scale lipid extraction from microalgae.

Comparative Effects of Biomass Pre-Treatments for Direct and Indirect Transesterification to Enhance Microalgal Lipid Recovery

Energy Technology Data Exchange (ETDEWEB)

Ghasemi Naghdi, Forough; Thomas-Hall, Skye R.; Durairatnam, Reuben [Algae Biotechnology Laboratory, School of Agriculture and Food Sciences, The University of Queensland, Brisbane, QLD (Australia); Pratt, Steven [School of Chemical Engineering, The University of Queensland, Brisbane, QLD (Australia); Schenk, Peer M., E-mail: p.schenk@uq.edu.au [Algae Biotechnology Laboratory, School of Agriculture and Food Sciences, The University of Queensland, Brisbane, QLD (Australia)

2014-12-04

Microalgal lipid recovery for biodiesel production is currently considered suboptimal, but pre-treatment of algal biomass, the use of solvent mixtures and the positioning of transesterification can lead to increased yields. Here, the effect of various reportedly successful pre-treatments and solvent mixtures were directly compared to each other and combined with direct and indirect transesterification methods using the oleaginous microalga Tetraselmis sp. M8. Microwave and thermal pre-treatments were applied and the total lipid and fatty acid methyl ester (FAME) recoveries were investigated. The application of pre-treatments increased FAME recovery through indirect transesterification when a Soxhlet system was used but they had no significant effect for direct transesterification. Gravimetric analyses of total lipids revealed that lipid recovery was highest when utilizing the chloroform-based Bligh and Dyer extraction method; however, FAME yield was the highest when applying a Soxhlet system utilizing a solvent mixture of hexane–ethanol (3:1). Total lipid recovery did not necessarily correlate with the recovery of FAMEs. The highest FAME recovery was achieved from thermal or microwave pre-treated biomass followed by indirect transesterification through Soxhlet extraction. FAME recovery could be more than doubled (increase of up to 171%) under these conditions. We conclude that a simple thermal pre-treatment (80°C for 10 min) in combination with solvent mixture extraction through indirect transesterification may present a cost-effective and scalable option for large-scale lipid extraction from microalgae.

Direct and indirect controls on organic matter decomposition in four coastal wetland communities along a landscape salinity gradient

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Stagg, Camille L.; Baustian, Melissa M.; Perry, Carey L.; Carruthers, Tim J.B.; Hall, Courtney T.

2018-01-01

Coastal wetlands store more carbon than most ecosystems globally. As sea level rises, changes in flooding and salinity will potentially impact ecological functions, such as organic matter decomposition, that influence carbon storage. However, little is known about the mechanisms that control organic matter loss in coastal wetlands at the landscape scale. As sea level rises, how will the shift from fresh to salt-tolerant plant communities impact organic matter decomposition? Do long-term, plant-mediated, effects of sea-level rise differ from direct effects of elevated salinity and flooding?We identified internal and external factors that regulated indirect and direct pathways of sea-level rise impacts, respectively, along a landscape-scale salinity gradient that incorporated changes in wetland type (fresh, oligohaline, mesohaline and polyhaline marshes). We found that indirect and direct impacts of sea-level rise had opposing effects on organic matter decomposition.Salinity had an indirect effect on litter decomposition that was mediated through litter quality. Despite significant variation in environmental conditions along the landscape gradient, the best predictors of above- and below-ground litter decomposition were internal drivers, initial litter nitrogen content and initial litter lignin content respectively. Litter decay constants were greatest in the oligohaline marsh and declined with increasing salinity, and the fraction of litter remaining (asymptote) was greatest in the mesohaline marsh. In contrast, direct effects of salinity and flooding were positive. External drivers, salinity and flooding, stimulated cellulytic activity, which was highest in the polyhaline marsh.Synthesis. Our results indicate that as sea level rises, initial direct effects of salinity will stimulate decay of labile carbon, but over time as plant communities shift from fresh to polyhaline marsh, litter decay will decline, yielding greater potential for long-term carbon storage

Impact of urban waste water treatment on sludge utilization and disposal with special emphasis on thermal treatment

International Nuclear Information System (INIS)

Gammeltoft, P.

1993-01-01

The acceptance of the European Communities Directive 9/271/CEE concerning urban waste water treatment by all the EC Member States will result in a sewage sludge production increase of 2 to 3 times the actual amounts (for the year 2000 the forecast is about 30 million tonnes per year). All the traditional sewage sludge treatment methods (agricultural, disposal, compost, thermal treatment) entail costs which are always increasing because of the stricter requirements; in addition EC policy is oriented towards the reduction of the quantity of sludge production. In some situations, drying and subseque incineration may thus be the only practicable method of disposal, particularly, in very large urban agglomerations

Cost-effectiveness analysis of the national implementation of integrated community case management and community-based health planning and services in Ghana for the treatment of malaria, diarrhoea and pneumonia.

Science.gov (United States)

Escribano Ferrer, Blanca; Hansen, Kristian Schultz; Gyapong, Margaret; Bruce, Jane; Narh Bana, Solomon A; Narh, Clement T; Allotey, Naa-Korkor; Glover, Roland; Azantilow, Naa-Charity; Bart-Plange, Constance; Sagoe-Moses, Isabella; Webster, Jayne

2017-07-05

Ghana has developed two main community-based strategies that aim to increase access to quality treatment for malaria, diarrhoea and suspected pneumonia: the integrated community case management (iCCM) and the community-based health planning and services (CHPS). The aim of the study was to assess the cost-effectiveness of these strategies under programme conditions. A cost-effectiveness analysis was conducted. Appropriate diagnosis and treatment given was the effectiveness measure used. Appropriate diagnosis and treatment data was obtained from a household survey conducted 2 and 8 years after implementation of iCCM in the Volta and Northern Regions of Ghana, respectively. The study population was carers of children under-5 years who had fever, diarrhoea and/or cough in the last 2 weeks prior to the interview. Costs data was obtained mainly from the National Malaria Control Programme (NMCP), the Ministry of Health, CHPS compounds and from a household survey. Appropriate diagnosis and treatment of malaria, diarrhoea and suspected pneumonia was more cost-effective under the iCCM than under CHPS in the Volta Region, even after adjusting for different discount rates, facility costs and iCCM and CHPS utilization, but not when iCCM appropriate treatment was reduced by 50%. Due to low numbers of carers visiting a CBA in the Northern Region it was not possible to conduct a cost-effectiveness analysis in this region. However, the cost analysis showed that iCCM in the Northern Region had higher cost per malaria, diarrhoea and suspected pneumonia case diagnosed and treated when compared to the Volta Region and to the CHPS strategy in the Northern Region. Integrated community case management was more cost-effective than CHPS for the treatment of malaria, diarrhoea and suspected pneumonia when utilized by carers of children under-5 years in the Volta Region. A revision of the iCCM strategy in the Northern Region is needed to improve its cost-effectiveness. Long-term financing

Microbial communities in riparian soils of a settling pond for mine drainage treatment.

Science.gov (United States)

Fan, Miaochun; Lin, Yanbing; Huo, Haibo; Liu, Yang; Zhao, Liang; Wang, Entao; Chen, Weimin; Wei, Gehong

2016-06-01

Mine drainage leads to serious contamination of soil. To assess the effects of mine drainage on microbial communities in riparian soils, we used an Illumina MiSeq platform to explore the soil microbial composition and diversity along a settling pond used for mine drainage treatment. Non-metric multidimensional scaling analysis showed that the microbial communities differed significantly among the four sampling zones (influent, upstream, downstream and effluent), but not seasonally. Constrained analysis of principal coordinates indicated heavy metals (zinc, lead and copper), total sulphur, pH and available potassium significantly influenced the microbial community compositions. Heavy metals were the key determinants separating the influent zone from the other three zones. Lower diversity indices were observed in the influent zone. However, more potential indicator species, related to sulphur and organic matter metabolism were found there, such as the sulphur-oxidizing genera Acidiferrobacter, Thermithiobacillus, Limnobacter, Thioprofundum and Thiovirga, and the sulphur-reducing genera Desulfotomaculum and Desulfobulbus; the organic matter degrading genera, Porphyrobacter and Paucimonas, were also identified. The results indicated that more microorganisms related to sulphur- and carbon-cycles may exist in soils heavily contaminated by mine drainage. Copyright © 2016 Elsevier Ltd. All rights reserved.

Transcranial direct-current stimulation as treatment in epilepsy.

Science.gov (United States)

Gschwind, Markus; Seeck, Margitta

2016-12-01

Neuromodulation (NM) is a complementary therapy for patients with drug-resistant epilepsy. Vagal nerve stimulation and deep brain stimulation of the anterior thalamus are established techniques and have shown their efficacy in lowering seizure frequency, but they are invasive and rarely render patients seizure-free. Non-invasive NM techniques are therefore increasingly investigated in a clinical context. Areas covered: Current knowledge about transcranial direct-current stimulation (tDCS) and other non-invasive NM in patients with epilepsy, based on the available animal and clinical studies from PubMed search. Expert commentary: tDCS modulates neuronal membrane potentials, and consequently alters cortical excitability. Cathodal stimulation leads to cortical inhibition, which is of particular importance in epilepsy treatment. The antiepileptic efficacy is promising but still lacks systematic studies. The beneficial effect, seen in ~20%, outlasts the duration of stimulation, indicating neuronal plasticity and is therefore of great interest to obtain long-term effects.

Association between community pharmacy loyalty and persistence and implementation of antipsychotic treatment among individuals with schizophrenia.

Science.gov (United States)

Zongo, Frank E; Moisan, Jocelyne; Grégoire, Jean-Pierre; Lesage, Alain; Dossa, Anara Richi; Lauzier, Sophie

2018-01-01

Non-adherence is a major obstacle to optimal treatment of schizophrenia. Community pharmacists are in a key position to detect non-adherence and put in place interventions. Their role is likely to be more efficient when individuals are loyal to a single pharmacy. To assess the association between the level of community pharmacy loyalty and persistence with and implementation of antipsychotic drug treatment among individuals with schizophrenia. A cohort study using databases from the Quebec health insurance board (Canada) was conducted among new antipsychotic users insured by Quebec's public drug plan. Level of community pharmacy loyalty was assessed as the number of pharmacies visited in the year after antipsychotics initiation. Persistence was defined as having an antipsychotic supply in the user's possession on the 730 th day after its initiation and implementation as having antipsychotics in the user's possession for ≥80% of the days in the second year after antipsychotics initiation (among persistent only). Generalized linear models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (95%CI). 6,251 individuals were included in the cohort and 54.1% had their drug prescriptions filled in >1 pharmacy. When compared to those who had their prescriptions filled in a single pharmacy, those who had their prescriptions filled in ≥4 different pharmacies were 22% more likely to be non-persistent (aPR = 1.22; 95%CI = 1.10-1.37) and 49% more likely to have an antipsychotic for loyalty in the context of severe mental illness indicates that this healthcare organisation factor might be associated with antipsychotics persistence and implementation. Identification of individuals with low community pharmacy loyalty and initiatives to optimize community pharmacy loyalty could contribute to enhanced persistence and implementation. Copyright © 2016 Elsevier Inc. All rights reserved.

[A new challenge in clinical practice: resistance to directly acting antivirals in hepatitis C treatment].

Science.gov (United States)

Chen, Z W; Hu, P; Ren, H

2016-03-20

Directly acting antivirals (DAAs) is a major treatment of hepatitis C virus (HCV) overseas. But DAAs resistance is getting more and more clinicians' attention. DAAs have not been approved in China to date, even though some of them are in clinical trials. However, a good knowledge of DAAs resistance is important on optimizing HCV treatment regimens, increasing sustained virological response (SVR) and decreasing treatment failure in clinical. In this review, DAAs resistance mechanism and virologic barrier to resistance, the prevalence of pre-existing DAAs resistance-associated variants (RAVs), the impact of RAVs on treatment outcome, the options of treatment regimens after resistance and drug resistance testing are discussed, hoping to provide some help for DAAs' standardized treatment in China in the future.

Treatment of Individuals with Borderline Personality Disorder Using Dialectical Behavior Therapy in a Community Mental Health Setting: Clinical Application and a Preliminary Investigation

Science.gov (United States)

Ben-Porath, Denise D.; Peterson, Gregory A.; Smee, Jacqueline

2004-01-01

This article describes an effort to implement and examine dialectical behavior therapy's (DBT) effectiveness in a community mental health setting. Modifications made to address unique aspects of community mental health settings are described. Barriers encountered in implementation of DBT treatment in community mental health settings, such as staff…

Development of an adjoint sensitivity field-based treatment-planning technique for the use of newly designed directional LDR sources in brachytherapy.

Science.gov (United States)

Chaswal, V; Thomadsen, B R; Henderson, D L

2012-02-21

The development and application of an automated 3D greedy heuristic (GH) optimization algorithm utilizing the adjoint sensitivity fields for treatment planning to assess the advantage of directional interstitial prostate brachytherapy is presented. Directional and isotropic dose kernels generated using Monte Carlo simulations based on Best Industries model 2301 I-125 source are utilized for treatment planning. The newly developed GH algorithm is employed for optimization of the treatment plans for seven interstitial prostate brachytherapy cases using mixed sources (directional brachytherapy) and using only isotropic sources (conventional brachytherapy). All treatment plans resulted in V100 > 98% and D90 > 45 Gy for the target prostate region. For the urethra region, the D10(Ur), D90(Ur) and V150(Ur) and for the rectum region the V100cc, D2cc, D90(Re) and V90(Re) all are reduced significantly when mixed sources brachytherapy is used employing directional sources. The simulations demonstrated that the use of directional sources in the low dose-rate (LDR) brachytherapy of the prostate clearly benefits in sparing the urethra and the rectum sensitive structures from overdose. The time taken for a conventional treatment plan is less than three seconds, while the time taken for a mixed source treatment plan is less than nine seconds, as tested on an Intel Core2 Duo 2.2 GHz processor with 1GB RAM. The new 3D GH algorithm is successful in generating a feasible LDR brachytherapy treatment planning solution with an extra degree of freedom, i.e. directionality in very little time.

Development of an adjoint sensitivity field-based treatment-planning technique for the use of newly designed directional LDR sources in brachytherapy

Science.gov (United States)

Chaswal, V.; Thomadsen, B. R.; Henderson, D. L.

2012-02-01

The development and application of an automated 3D greedy heuristic (GH) optimization algorithm utilizing the adjoint sensitivity fields for treatment planning to assess the advantage of directional interstitial prostate brachytherapy is presented. Directional and isotropic dose kernels generated using Monte Carlo simulations based on Best Industries model 2301 I-125 source are utilized for treatment planning. The newly developed GH algorithm is employed for optimization of the treatment plans for seven interstitial prostate brachytherapy cases using mixed sources (directional brachytherapy) and using only isotropic sources (conventional brachytherapy). All treatment plans resulted in V100 > 98% and D90 > 45 Gy for the target prostate region. For the urethra region, the D10Ur, D90Ur and V150Ur and for the rectum region the V100cc, D2cc, D90Re and V90Re all are reduced significantly when mixed sources brachytherapy is used employing directional sources. The simulations demonstrated that the use of directional sources in the low dose-rate (LDR) brachytherapy of the prostate clearly benefits in sparing the urethra and the rectum sensitive structures from overdose. The time taken for a conventional treatment plan is less than three seconds, while the time taken for a mixed source treatment plan is less than nine seconds, as tested on an Intel Core2 Duo 2.2 GHz processor with 1GB RAM. The new 3D GH algorithm is successful in generating a feasible LDR brachytherapy treatment planning solution with an extra degree of freedom, i.e. directionality in very little time.

Microbial Community Composition of Polyhydroxyalkanoate-Accumulating Organisms in Full-Scale Wastewater Treatment Plants Operated in Fully Aerobic Mode

Science.gov (United States)

Oshiki, Mamoru; Onuki, Motoharu; Satoh, Hiroyasu; Mino, Takashi

2013-01-01

The removal of biodegradable organic matter is one of the most important objectives in biological wastewater treatments. Polyhydroxyalkanoate (PHA)-accumulating organisms (PHAAOs) significantly contribute to the removal of biodegradable organic matter; however, their microbial community composition is mostly unknown. In the present study, the microbial community composition of PHAAOs was investigated at 8 full-scale wastewater treatment plants (WWTPs), operated in fully aerobic mode, by fluorescence in situ hybridization (FISH) analysis and post-FISH Nile blue A (NBA) staining techniques. Our results demonstrated that 1) PHAAOs were in the range of 11–18% in the total number of cells, and 2) the microbial community composition of PHAAOs was similar at the bacterial domain/phylum/class/order level among the 8 full-scale WWTPs, and dominant PHAAOs were members of the class Alphaproteobacteria and Betaproteobacteria. The microbial community composition of α- and β-proteobacterial PHAAOs was examined by 16S rRNA gene clone library analysis and further by applying a set of newly designed oligonucleotide probes targeting 16S rRNA gene sequences of α- or β-proteobacterial PHAAOs. The results demonstrated that the microbial community composition of PHAAOs differed in the class Alphaproteobacteria and Betaproteobacteria, which possibly resulted in a different PHA accumulation capacity among the WWTPs (8.5–38.2 mg-C g-VSS−1 h−1). The present study extended the knowledge of the microbial diversity of PHAAOs in full-scale WWTPs operated in fully aerobic mode. PMID:23257912

Integrating the child into home and community following the completion of cancer treatment.

Science.gov (United States)

Labay, Larissa E; Mayans, Sherri; Harris, Michael B

2004-01-01

The present article examines the period of time immediately following the completion of treatment for childhood cancer. The unique concerns experienced by families at this stage of the cancer treatment are examined, and the specific challenges that children face as they renegotiate roles and relationships that are necessary for successful reintegration into family, school, and community settings are discussed. Obstacles to successful reintegration that are frequently encountered by patients and families are reviewed, as well as variables that may promote optimal adjustment during this transitional period. The need for continued research in this area is highlighted, and specific research questions are identified. An emphasis is placed on applying a socioecological framework to research and clinical work with pediatric oncology patients at this stage of the cancer experience.

Direct-to-consumer marketing of psychological treatments: A randomized controlled trial.

Science.gov (United States)

Gallo, Kaitlin P; Comer, Jonathan S; Barlow, David H; Clarke, Roberta N; Antony, Martin M

2015-10-01

Although direct-to-consumer (DTC) marketing of pharmacologic interventions is effective and common, similar approaches have yet to be evaluated in the promotion of psychological treatments (PTs). This is the first randomized controlled trial evaluating the potential of DTC marketing of PTs. Participants (N = 344; 75.0% female, mean age = 18.6 years, 48.5% non-Hispanic White) were randomly assigned to consume one of four extended commercial campaigns embedded within unrelated programming across 3 weeks. The four campaign conditions were a PT campaign, a PT informing about medication side effects campaign, a medication campaign, and a neutral campaign. Attitudes about and intention to seek psychological treatment were assessed prior to campaign exposure (T1), 1 week following the final week of campaign exposure (T2), and at a 3-month follow-up evaluation (T3). The percentage of participants who newly intended psychological treatment at T2 or T3 differed by condition, with those assigned to the PT campaign slightly more likely to have intended to receive psychological treatment at T2 or T3 than those in other conditions. Baseline reports of emotional symptoms moderated the effect of condition on attitudes toward PT and perceived likelihood of seeking treatment in the future. Findings support the preliminary utility of DTC marketing of psychological treatments. Increasing consumer knowledge of PTs may be a worthwhile complement to current dissemination and implementation efforts aimed at promoting the uptake of PTs in mental health care. (c) 2015 APA, all rights reserved).

A novel approach for harnessing biofilm communities in moving bed biofilm reactors for industrial wastewater treatment

Directory of Open Access Journals (Sweden)

Joe A. Lemire

2015-10-01

Full Text Available Moving bed biofilm reactors (MBBRs are an effective biotechnology for treating industrial wastewater. Biomass retention on moving bed biofilm reactor (MBBR carriers (biofilm support materials, allows for the ease-of-operation and high treatment capacity of MBBR systems. Optimization of MBBR systems has largely focused on aspects of carrier design, while little attention has been paid to enhancing strategies for harnessing microbial biomass. Previously, our research group demonstrated that mixed-species biofilms can be harvested from an industrial wastewater inoculum [oil sands process water (OSPW] using the Calgary Biofilm Device (CBD. Moreover, the resultant biofilm communities had the capacity to degrade organic toxins (naphthenic acids—NAs that are found in OSPW. Therefore, we hypothesized that harnessing microbial communities from industrial wastewater, as biofilms, on MBBR carriers may be an effective method to bioremediate industrial wastewater.Here, we detail our methodology adapting the workflow employed for using the CBD, to generate inoculant carriers to seed an MBBR.In this study, OSPW-derived biofilm communities were successfully grown, and their efficacy evaluated, on commercially available MBBR carriers affixed within a modified CBD system. The resultant biofilms demonstrated the capacity to transfer biomass to recipient carriers within a scaled MBBR. Moreover, MBBR systems inoculated in this manner were fully active 2 days post-inoculation, and readily degraded a select population of NAs. Together, these findings suggest that harnessing microbial communities on carriers affixed within a modified CBD system may represent a facile and rapid method for obtaining functional inoculants for use in wastewater MBBR treatment systems.

Evaluation of the process performance of a down-flow hanging sponge reactor for direct treatment of domestic wastewater in Bangkok, Thailand.

Science.gov (United States)

Miyaoka, Yuma; Yoochatchaval, Wilasinee; Sumino, Haruhiko; Banjongproo, Pathan; Yamaguchi, Takashi; Onodera, Takashi; Okadera, Tomohiro; Syutsubo, Kazuaki

2017-08-24

This study assesses the performance of an aerobic trickling filter, down-flow hanging sponge (DHS) reactor, as a decentralized domestic wastewater treatment technology. Also, the characteristic eukaryotic community structure in DHS reactor was investigated. Long-term operation of a DHS reactor for direct treatment of domestic wastewater (COD = 150-170 mg/L and BOD = 60-90 mg/L) was performed under the average ambient temperature ranged from 28°C to 31°C in Bangkok, Thailand. Throughout the evaluation period of 550 days, the DHS reactor at a hydraulic retention time of 3 h showed better performance than the existing oxidation ditch process in the removal of organic carbon (COD removal rate = 80-83% and BOD removal rate = 91%), nitrogen compounds (total nitrogen removal rate = 45-51% and NH 4 + -N removal rate = 95-98%), and low excess sludge production (0.04 gTS/gCOD removed). The clone library based on the 18S ribosomal ribonucleic acid gene sequence revealed that phylogenetic diversity of 18S rRNA gene in the DHS reactor was higher than that of the present oxidation ditch process. Furthermore, the DHS reactor also demonstrated sufficient COD and NH 4 + -N removal efficiency under flow rate fluctuation conditions that simulates a small-scale treatment facility. The results show that a DHS reactor could be applied as a decentralized domestic wastewater treatment technology in tropical regions such as Bangkok, Thailand.

Community Alternatives for Love and Limits (CALL: A community-based family strengthening multi-family intervention program to respond to adolescents at risk

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David Wilkerson

2005-12-01

Full Text Available Family strengthening has become a source of growing interest, research, and program design in the fields of prevention and treatment for problems of youth delinquency, school failure, alcohol, tobacco and other drug abuse (ATOD. Despite many studies that illustrate the positive outcomes of family strengthening programs and family-focused interventions, their use in communities has not advanced commensurate with their promise. This article offers a rationale for why programming efforts should continue to be directed towards family strengthening efforts as opposed to youth-focused only interventions. In addition, a community-based, family-strengthening alternative is described that addresses issues of youth delinquency while reducing barriers associated with availability, accessibility, and cost.

STUDY ON WASTE WATER TREATMENT PLANTS

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Mariana DUMITRU

2015-04-01

Full Text Available Biogas is more and more used as an alternative source of energy, considering the fact that it is obtained from waste materials and it can be easily used in cities and rural communities for many uses, between which, as a fuel for households. Biogas has many energy utilisations, depending on the nature of the biogas source and the local demand. Generally, biogas can be used for heat production by direct combustion, electricity production by fuel cells or micro-turbines, Combined Hest and Power generation or as vehicle fuel. In this paper we search for another uses of biogas and Anaerobe Digestion substrate, such as: waste water treatment plants and agricultural wastewater treatment, which are very important in urban and rural communities, solid waste treatment plants, industrial biogas plants, landfill gas recovery plants. These uses of biogas are very important, because the gas emissions and leaching to ground water from landfill sites are serious threats for the environment, which increase more and more bigger during the constant growth of some human communities. That is why, in the developed European countries, the sewage sludge is treated by anaerobe digestion, depending on national laws. In Romania, in the last years more efforts were destined to use anaerobe digestion for treating waste waters and management of waste in general. This paper can be placed in this trend of searching new ways of using with maximum efficiency the waste resulted in big communities.

Community-Based Promotional Campaign to Improve Uptake of Intermittent Preventive Antimalarial Treatment in Pregnancy in Burkina Faso

NARCIS (Netherlands)

Gies, Sabine; Coulibaly, Sheick O.; Ky, Clotilde; Ouattara, Florence T.; Brabin, Bernard J.; d'Alessandro, Umberto

2009-01-01

Malaria preventive strategies in pregnancy were assessed in a health center randomized trial comparing intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) with and without community based promotional activities in rural Burkina Faso. The study involved 2,240 secundigravidae

Directly e-mailing authors of newly published papers encourages community curation

Science.gov (United States)

Bunt, Stephanie M.; Grumbling, Gary B.; Field, Helen I.; Marygold, Steven J.; Brown, Nicholas H.; Millburn, Gillian H.

2012-01-01

Much of the data within Model Organism Databases (MODs) comes from manual curation of the primary research literature. Given limited funding and an increasing density of published material, a significant challenge facing all MODs is how to efficiently and effectively prioritize the most relevant research papers for detailed curation. Here, we report recent improvements to the triaging process used by FlyBase. We describe an automated method to directly e-mail corresponding authors of new papers, requesting that they list the genes studied and indicate (‘flag’) the types of data described in the paper using an online tool. Based on the author-assigned flags, papers are then prioritized for detailed curation and channelled to appropriate curator teams for full data extraction. The overall response rate has been 44% and the flagging of data types by authors is sufficiently accurate for effective prioritization of papers. In summary, we have established a sustainable community curation program, with the result that FlyBase curators now spend less time triaging and can devote more effort to the specialized task of detailed data extraction. Database URL: http://flybase.org/ PMID:22554788

Multistage A-O Activated Sludge Process for Paraformaldehyde Wastewater Treatment and Microbial Community Structure Analysis

Directory of Open Access Journals (Sweden)

Danyang Zheng

2016-01-01

Full Text Available In recent years, the effect of formaldehyde on microorganisms and body had become a global public health issue. The multistage combination of anaerobic and aerobic process was adopted to treat paraformaldehyde wastewater. Microbial community structure in different reaction stages was analyzed through high-throughput sequencing. Results showed that multistage A-O activated sludge process positively influenced polyformaldehyde wastewater. The removal rates of formaldehyde were basically stable at more than 99% and those of COD were about 89%. Analysis of the microbial diversity index indicated that the microbial diversity of the reactor was high, and the treatment effect was good. Moreover, microbial community had certain similarity in the same system. Microbial communities in different units also showed typical representative characteristics affected by working conditions and influent concentrations. Proteobacteria, Firmicutes, and Bacteroidetes were the dominant fungal genera in the phylum level of community composition. As to family and genus levels, Peptostreptococcaceae was distributed at various stages and the dominant in this system. This bacterium also played an important role in organic matter removal, particularly decomposition of the acidified middle metabolites. In addition, Rhodobacteraceae and Rhodocyclaceae were the formaldehyde-degrading bacteria found in the reactor.

Predictors for compliance with community directed ivermectin ...

African Journals Online (AJOL)

In addition the FGDs elicited information regarding social influence towards ivermectin treatment and who the source of social influences are. Perceived barriers and supports towards ivermectin treatment were also explored. The key informant interviews mainly elicited the problems they face in ivermectin distribution and ...

Pesticides from wastewater treatment plant effluents affect invertebrate communities.

Science.gov (United States)

Münze, Ronald; Hannemann, Christin; Orlinskiy, Polina; Gunold, Roman; Paschke, Albrecht; Foit, Kaarina; Becker, Jeremias; Kaske, Oliver; Paulsson, Elin; Peterson, Märit; Jernstedt, Henrik; Kreuger, Jenny; Schüürmann, Gerrit; Liess, Matthias

2017-12-01

We quantified pesticide contamination and its ecological impact up- and downstream of seven wastewater treatment plants (WWTPs) in rural and suburban areas of central Germany. During two sampling campaigns, time-weighted average pesticide concentrations (c TWA ) were obtained using Chemcatcher® passive samplers; pesticide peak concentrations were quantified with event-driven samplers. At downstream sites, receiving waters were additionally grab sampled for five selected pharmaceuticals. Ecological effects on macroinvertebrate structure and ecosystem function were assessed using the biological indicator system SPEAR pesticides (SPEcies At Risk) and leaf litter breakdown rates, respectively. WWTP effluents substantially increased insecticide and fungicide concentrations in receiving waters; in many cases, treated wastewater was the exclusive source for the neonicotinoid insecticides acetamiprid and imidacloprid in the investigated streams. During the ten weeks of the investigation, five out of the seven WWTPs increased in-stream pesticide toxicity by a factor of three. As a consequence, at downstream sites, SPEAR values and leaf litter degradation rates were reduced by 40% and 53%, respectively. The reduced leaf litter breakdown was related to changes in the macroinvertebrate communities described by SPEAR pesticides and not to altered microbial activity. Neonicotinoids showed the highest ecological relevance for the composition of invertebrate communities, occasionally exceeding the Regulatory Acceptable Concentrations (RACs). In general, considerable ecological effects of insecticides were observed above and below regulatory thresholds. Fungicides, herbicides and pharmaceuticals contributed only marginally to acute toxicity. We conclude that pesticide retention of WWTPs needs to be improved. Copyright © 2017 Elsevier B.V. All rights reserved.

TB treatment initiation and adherence in a South African community influenced more by perceptions than by knowledge of tuberculosis

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Møller Valerie

2010-02-01

Full Text Available Abstract Background Tuberculosis (TB is a global health concern. Inadequate case finding and case holding has been cited as major barrier to the control of TB. The TB literature is written almost entirely from a biomedical perspective, while recent studies show that it is imperative to understand lay perception to determine why people seek treatment and may stop taking treatment. The Eastern Cape is known as a province with high TB incidence, prevalence and with one of the worst cure rates of South Africa. Its inhabitants can be considered lay experts when it comes to TB. Therefore, we investigated knowledge, perceptions of (access to TB treatment and adherence to treatment among an Eastern Cape population. Methods An area-stratified sampling design was applied. A total of 1020 households were selected randomly in proportion to the total number of households in each neighbourhood. Results TB knowledge can be considered fairly good among this community. Respondents' perceptions suggest that stigma may influence TB patients' decision in health seeking behavior and adherence to TB treatment. A full 95% of those interviewed believe people with TB tend to hide their TB status out of fear of what others may say. Regression analyses revealed that in this population young and old, men and women and the lower and higher educated share the same attitudes and perceptions. Our findings are therefore likely to reflect the actual situation of TB patients in this population. Conclusions The lay experts' perceptions suggests that stigma appears to effect case holding and case finding. Future interventions should be directed at improving attitudes and perceptions to potentially reduce stigma. This requires a patient-centered approach to empower TB patients and active involvement in the development and implementation of stigma reduction programs.

Urological Emergency Admissions to a Community Hospital: A Review

Science.gov (United States)

Atkins, Sam O.

1983-01-01

A one-year study was conducted on the impact of emergency admissions to the 125-bed Southwest Community Hospital in Atlanta, Georgia. During the study in 1979, 70 urological emergency room admissions were made, of which 44 (62.8 percent) were males and 26 (37.2 percent) were females. In comparison, 93 admissions were made directly from the private office. The study considered the timeliness of diagnosis and treatment, surgical procedures performed, impact on urological emergency room nursing and medical personnel, physician response to notification, cost containment, and implied legal ramifications and organization structure. Thus, an immediate close scrutiny of urological emergency admission at the nonuniversity affiliated Southwest Community Hospital was permitted. PMID:6876189

Legacy effects of no-analogue disturbances alter plant community diversity and composition in semi-arid sagebrush steppe

Science.gov (United States)

Ripplinger, Julie; Franklin, Janet; Edwards, Thomas C.

2015-01-01

Questions(i) What role does the type of managed disturbance play in structuring sagebrush steppe plant communities? (ii) How does the composition of post-disturbance plant communities change with time since disturbance? (iii) Does plant community diversity change over time following managed disturbance?LocationField study within the sagebrush steppe ecosystem. Rich County, Utah, USA.MethodsWe developed a chronosequence spanning up to 50 yrs post-treatment to study sagebrush steppe vegetation dynamics. Direct ordination was used to examine plant community composition by managed disturbance type and time since disturbance, and factorial analysis of covariance was used to examine diversity dynamics following disturbance. Indicator species values were calculated in order to identify characteristic species for each disturbance type.ResultsPlant communities experienced a shift toward distinct community composition for each of the three managed disturbance types, and gave no indication of returning to untreated community composition or diversity. Small post-disturbance increases in the number of non-native grass species were observed in the treatments relative to reference, with native forb species making the largest contribution to altered composition. On fire- and chemically-treated sites the proportional native forb species richness increased over time since disturbance, while the proportional contribution of non-native forbs to total species richness decreased. For all three treatment types, native grasses contributed less on average to total richness than on reference sites, while non-native grasses made up a higher proportion of total richness.ConclusionsCommon shrubland management techniques have legacy effects on the composition and diversity of sagebrush steppe plant communities, and no-analogue disturbances, such as chemical or mechanical treatments, have more pronounced legacy effects than treatments similar to natural disturbance regimes (fire). This study

Effectiveness of the Community Treatment Order in streamlining psychiatric services.

Science.gov (United States)

Awara, Mahmoud A; Jaffar, Khalid; Roberts, Pauline

2013-04-01

The implementation of the Community Treatment Order (CTO) has created controversy surrounding its beneficence. The study aims at examining the effectiveness of the CTO in reducing the rate and duration of revolving door admissions for patients who were made subject to this Order. All patients who were made subject to CTO between November 2008 and August 2009 in South Essex were involved in the study where patients acted as their own control through comparing their pre-CTO, during CTO and post-CTO's admission rate and duration. There was a significant reduction in the rate and duration of admissions in the period during and post-CTO state. The CTO proved to be effective in reducing revolving door admissions and it has a beneficial carryover effect in the post-CTO state.

Markets and institutions: relations agents/regulators. The new power of Spanish Autonomous Communities

International Nuclear Information System (INIS)

Guayo Castiella, I. de

2007-01-01

The implementation in Spain of the 2003 European Directive on common rules for the internal market for electricity implies a more precise determination of who are the regulatory authorities, as well as which powers enjoy each of them; in Spain, also, the implementation process, relating to the regulatory authorities issues, including the competence of the Autonomous Communities. The implementation process has taken place soon after new Statutes of a number of Autonomous Communities have been passed, where energy issues, at least apparently, are subject to a new treatment. (Author) 25 refs

Post-treatment follow-up study of abdominal cystic echinococcosis in tibetan communities of northwest Sichuan Province, China.

Directory of Open Access Journals (Sweden)

Tiaoying Li

2011-10-01

Full Text Available Human cystic echinococcosis (CE, caused by the larval stage of Echinococcus granulosus, with the liver as the most frequently affected organ, is known to be highly endemic in Tibetan communities of northwest Sichuan Province. Antiparasitic treatment with albendazole remains the primary choice for the great majority of patients in this resource-poor remote area, though surgery is the most common approach for CE therapy that has the potential to remove cysts and lead to complete cure. The current prospective study aimed to assess the effectiveness of community based use of cyclic albendazole treatment in Tibetan CE cases, and concurrently monitor the changes of serum specific antibody levels during treatment.Ultrasonography was applied for diagnosis and follow-up of CE cases after cyclic albendazole treatment in Tibetan communities of Sichuan Province during 2006 to 2008, and serum specific IgG antibody levels against Echinococcus granulosus recombinant antigen B in ELISA was concurrently monitored in these cases. A total of 196 CE cases were identified by ultrasound, of which 37 (18.9% showed evidence of spontaneous healing/involution of hepatic cyst(s with CE4 or CE5 presentations. Of 49 enrolled CE cases for treatment follow-up, 32.7% (16 were considered to be cured based on B-ultrasound after 6 months to 30 months regular albendazole treatment, 49.0% (24 were improved, 14.3% (7 remained unchanged, and 4.1% (2 became aggravated. In general, patients with CE2 type cysts (daughter cysts present needed a longer treatment course for cure (26.4 months, compared to cases with CE1 (univesicular cysts (20.4 months or CE3 type (detached cyst membrane or partial degeneration of daughter cysts (9 months. In addition, the curative duration was longer in patients with large (>10 cm cysts (22.3 months, compared to cases with medium (5-10 cm cysts (17.3 months or patients with small (<5 cm cysts (6 months. At diagnosis, seven (53.8% of 13 cases with CE1 type

Annual national direct and indirect cost estimates of the prevention and treatment of cervical cancer in Brazil

Science.gov (United States)

Novaes, Hillegonda Maria Dutilh; Itria, Alexander; Silva, Gulnar Azevedo e; Sartori, Ana Marli Christovam; Rama, Cristina Helena; de Soárez, Patrícia Coelho

2015-01-01

OBJECTIVE: To estimate the annual direct and indirect costs of the prevention and treatment of cervical cancer in Brazil. METHODS: This cost description study used a "gross-costing" methodology and adopted the health system and societal perspectives. The estimates were grouped into sets of procedures performed in phases of cervical cancer care: the screening, diagnosis and treatment of precancerous lesions and the treatment of cervical cancer. The costs were estimated for the public and private health systems, using data from national health information systems, population surveys, and literature reviews. The cost estimates are presented in 2006 USD. RESULTS: From the societal perspective, the estimated total costs of the prevention and treatment of cervical cancer amounted to USD $1,321,683,034, which was categorized as follows: procedures (USD $213,199,490), visits (USD $325,509,842), transportation (USD $106,521,537) and productivity losses (USD $676,452,166). Indirect costs represented 51% of the total costs, followed by direct medical costs (visits and procedures) at 41% and direct non-medical costs (transportation) at 8%. The public system represented 46% of the total costs, and the private system represented 54%. CONCLUSION: Our national cost estimates of cervical cancer prevention and treatment, indicating the economic importance of cervical cancer screening and care, will be useful in monitoring the effect of the HPV vaccine introduction and are of interest in research and health care management. PMID:26017797

Transcranial direct current stimulation (tDCS) for treatment of major depression during pregnancy: study protocol for a pilot randomized controlled trial.

Science.gov (United States)

Vigod, Simone; Dennis, Cindy-Lee; Daskalakis, Zafiris; Murphy, Kellie; Ray, Joel; Oberlander, Tim; Somerton, Sarah; Hussain-Shamsy, Neesha; Blumberger, Daniel

2014-09-18

Women with depression in pregnancy are faced with difficult treatment decisions. Untreated, antenatal depression has serious negative implications for mothers and children. While antidepressant drug treatment is likely to improve depressive symptoms, it crosses the placenta and may pose risks to the unborn child. Transcranial direct current stimulation is a focal brain stimulation treatment that improves depressive symptoms within 3 weeks of treatment by inducing changes to brain areas involved in depression, without impacting any other brain areas, and without inducing changes to heart rate, blood pressure or core body temperature. The localized nature of transcranial direct current stimulation makes it an ideal therapeutic approach for treating depression during pregnancy, although it has never previously been evaluated in this population. We describe a pilot randomized controlled trial of transcranial direct current stimulation among women with depression in pregnancy to assess the feasibility of a larger, multicentre efficacy study. Women over 18 years of age and between 14 and 32 weeks gestation can be enrolled in the study provided they meet diagnostic criteria for a major depressive episode of at least moderate severity and have been offered but refused antidepressant medication. Participants are randomized to receive active transcranial direct current stimulation or a sham condition that is administered in 15 30-minute treatments over three weeks. Women sit upright during treatment and receive obstetrical monitoring prior to, during and after each treatment session. Depressive symptoms, treatment acceptability, and pregnancy outcomes are assessed at baseline (prior to randomization), at the end of each treatment week, every four weeks post-treatment until delivery, and at 4 and 12 weeks postpartum. Transcranial direct current stimulation is a novel therapeutic option for treating depression during pregnancy. This protocol allows for assessment of the

Profiling bacterial communities associated with sediment-based aquaculture bioremediation systems under contrasting redox regimes

Science.gov (United States)

Robinson, Georgina; Caldwell, Gary S.; Wade, Matthew J.; Free, Andrew; Jones, Clifford L. W.; Stead, Selina M.

2016-12-01

Deposit-feeding invertebrates are proposed bioremediators in microbial-driven sediment-based aquaculture effluent treatment systems. We elucidate the role of the sediment reduction-oxidation (redox) regime in structuring benthic bacterial communities, having direct implications for bioremediation potential and deposit-feeder nutrition. The sea cucumber Holothuria scabra was cultured on sediments under contrasting redox regimes; fully oxygenated (oxic) and redox stratified (oxic-anoxic). Taxonomically, metabolically and functionally distinct bacterial communities developed between the redox treatments with the oxic treatment supporting the greater diversity; redox regime and dissolved oxygen levels were the main environmental drivers. Oxic sediments were colonised by nitrifying bacteria with the potential to remediate nitrogenous wastes. Percolation of oxygenated water prevented the proliferation of anaerobic sulphate-reducing bacteria, which were prevalent in the oxic-anoxic sediments. At the predictive functional level, bacteria within the oxic treatment were enriched with genes associated with xenobiotics metabolism. Oxic sediments showed the greater bioremediation potential; however, the oxic-anoxic sediments supported a greater sea cucumber biomass. Overall, the results indicate that bacterial communities present in fully oxic sediments may enhance the metabolic capacity and bioremediation potential of deposit-feeder microbial systems. This study highlights the benefits of incorporating deposit-feeding invertebrates into effluent treatment systems, particularly when the sediment is oxygenated.

Avian community responses to juniper woodland structure and thinning treatments on the Colorado Plateau

Science.gov (United States)

Crow, Claire; van Riper, Charles

2011-01-01

Federal land managers are increasingly implementing fuels-reduction treatments throughout the western United States with objectives of ecological restoration and fire hazard reduction in pinyon-juniper (Pinus spp.-Juniperus spp.) woodlands. The pinyon-juniper woodland ecosystem complex is highly variable across the western landscape, as is bird community composition. We investigated relations between breeding birds and vegetation characteristics in modified pinyon-juniper woodlands at three sites (BLM, USFS, NPS) on the Colorado Plateau. During the breeding seasons of 2005 and 2006, we surveyed birds and measured vegetation in 74 study plots. These plots were each 3.1 hectares (ha; 7.6 acres), located across the range of natural variation, with 41 control sites and 33 plots in areas previously thinned by hand-cutting or chaining. We found that relations of avian pinyon-juniper specialists and priority species to vegetation characteristics were generally in agreement with the findings of previous studies and known nesting and feeding habits of those birds. Relatively high density of pinyon pines was important to species richness and abundance in 6 of 14 species. Abundance of all species was related to treatment method, and we found no difference in bird communities at chaining and hand-cut sites.

Community-based clinic volunteering: an evaluation of the direct and indirect effects on the experience of health science college students.

Science.gov (United States)

Bird, Yelena; Islam, Adiba; Moraros, John

2016-01-18

The present study was conducted in a multi service-learning, student managed and operated, community-based clinic. Its aim was to measure the direct and indirect effects of how proximal factors (i.e., 'management', 'support received', 'duration of involvement', and 'average time spent per month') and mediators (i.e., 'training received', 'motivation', and 'commitment') influence distal outcomes (i.e., 'performance', 'satisfaction', and 'overall experience') within a volunteer organization. Participants were recruited through the use of an email list server. An online survey was used containing multi-item measures from validated scales. Data were collected from 170 volunteers from July to August 2013. Data analysis used a structural equation modeling (SEM) framework for the estimation of direct and indirect effects on constructs and variables of interest. Only statistically significant relationships were reported at p direct effects worthy of note. First, the proximal factor of 'management' plays an important role in influencing the mediators of 'motivation' (standardized beta = 0.55) and 'training received' (0.65) by the student volunteers but has a relatively small impact on their 'commitment' (0.39) to the organization. Second, the mediator of 'motivation' proved to have the strongest impact on the distal outcome of volunteer 'performance' and 'satisfaction' levels (0.41 and 0.58 respectively), whereas 'commitment' (0.44) was the key in determining their 'overall experience' with the organization. These results in turn, help contextualize the indirect effects observed in our study. Namely, the proximal factor of 'management' played a distinctive role in influencing the distal outcomes of volunteer 'performance' (0.32) and 'overall experience' (0.66), whereas the organizational 'support received' by the volunteers was key to their 'satisfaction' (0.21). The findings of the present study shed light into the direct and indirect effects of how proximal factors

Effects of the pyrethroid insecticide cypermethrin on a freshwater community studied under field conditions. II. Direct and indirect effects on the species composition

DEFF Research Database (Denmark)

Wendt-Rasch, Lina; Friberg-Jensen, Ursula; Woin, Per

2003-01-01

species were calculated using inverse regression and revealed that copepod nauplii were the most sensitive (NEC=0.01 microg/l) of the crustacean groups examined. The observed alterations of the species composition of the autotrophic communities as well as of the rotifers were most likely caused indirectly...... cypermethrin concentrations, ranging from 0.01 to 6 microg/l. This paper is the second in a series of two and describes the effects on the species composition of the crustacean, rotifer, periphyton and phytoplankton communities. Multivariate ordination technique (redundancy analysis (RDA) combined with Monte...... Carlo permutation tests) showed that exposure to cypermethrin caused significant changes in the species composition of the communities. Changes in the structure of the communities were observed following exposure to a nominal concentration of 0.13 microg cypermethrin per litre above. The direct acute...

G-CSF in solid tumor chemotherapy: a tailored regimen reduces febrile neutropenia, treatment delays and direct costs.

Science.gov (United States)

Tsavaris, Nicolas; Kosmas, Christos; Gouveris, Panagiotis; Vadiak, Maria; Dimitrakopoulos, Antonis; Karadima, Dimitra; Pagouni, Efterpi; Panagiotakopoulos, George; Tzima, Evanthia; Ispoglou, Sevasti; Sakelariou, Dimitris; Koufos, Christos

2004-02-01

Current guidelines do not recommend G-CSF for patients with risk factors for neutropenia. One-hundred patients undergoing chemotherapy were randomized to treatment with G-CSF at 5 Kg/kg for established febrile neutropenia (ANC <1000/microl) (Group A) or G-CSF at 263 Kg/day if ANC was 1500/microl or less on the day of the expected nadir, with the duration of treatment determined by the severity of neutropenia (Group B). The number of doses of G-CSF was similar in the two groups. There were 34 cases of febrile neutropenia in Group A, but none in Group B (p=0.0001). Hospital admission for febrile neutropenia, antibiotic use and delays in chemotherapy were all significantly more common in Group A. Total direct costs were estimated to be 66, 646 for Group A and 47, 119 for Group B. Tailoring treatment does not increase G-CSF use, but significantly reduces febrile neutropenia and treatment delays and lowers direct costs.

Community case management improves use of treatment for ...

African Journals Online (AJOL)

Objective: Evaluate the performance of volunteers in providing Community Case Management (CCM) for diarrhea, fever and pneumonia – in a pre-HEW setting in Liben Woreda, Oromiya Regional State. Methods: Save the Children supported Ministry of Health and communities to deliver child survival interventions from ...

Community awareness about malaria, its treatment and mosquito ...

African Journals Online (AJOL)

Background: Despite the rapid expansion of malaria into highland areas of Ethiopia and the movement of malaria inexperienced people to endemic areas, there is no enough information about how highland communities perceive malaria. Objective: To assess communities' awareness of malaria and its mosquito vector in ...

The effects of psychotherapy treatment on outcome in bulimia nervosa: Examining indirect effects through emotion regulation, self-directed behavior, and self-discrepancy within the mediation model.

Science.gov (United States)

Peterson, Carol B; Berg, Kelly C; Crosby, Ross D; Lavender, Jason M; Accurso, Erin C; Ciao, Anna C; Smith, Tracey L; Klein, Marjorie; Mitchell, James E; Crow, Scott J; Wonderlich, Stephen A

2017-06-01

The purpose of this investigation was to examine the indirect effects of Integrative Cognitive-Affective Therapy (ICAT-BN) and Cognitive-Behavioral Therapy-Enhanced (CBT-E) on bulimia nervosa (BN) treatment outcome through three hypothesized maintenance variables: emotion regulation, self-directed behavior, and self-discrepancy. Eighty adults with BN were randomized to 21 sessions of ICAT-BN or CBT-E. A regression-based bootstrapping approach was used to test the indirect effects of treatment on outcome at end of treatment through emotion regulation and self-directed behavior measured at mid-treatment, as well as the indirect effects of treatment at follow-up through emotion regulation, self-directed behavior, and self-discrepancy measured at end of treatment. No significant differences in outcome between treatment conditions were observed, and no significant direct or indirect effects were found. Examination of the individual paths within the indirect effects models revealed comparable treatment effects. Across treatments, improvements in emotion regulation and self-directed behavior between baseline and mid-treatment predicted improvements in global eating disorder scores but not binge eating and purging frequency at end of treatment. Baseline to end of treatment improvements in emotion regulation and self-directed behavior also predicted improvements in global eating disorder scores at follow-up. Baseline to end of treatment improvements in emotion regulation predicted improvements in binge eating and baseline to end of treatment increases in positive self-directed behavior predicted improvements in purging at follow-up. These findings suggest that emotion regulation and self-directed behavior are important treatment targets and that ICAT-BN and CBT-E are comparable in modifying these psychological processes among individuals with BN. © 2017 Wiley Periodicals, Inc.

Linking above and belowground responses to global change at community and ecosystem scales.

Energy Technology Data Exchange (ETDEWEB)

Antoninka, Anita [Northern Arizona University; Wolf, Julie [Northern Arizona University; Bowker, Matt [Northern Arizona University; Classen, Aimee T [ORNL; JohnsonPhD, Dr Nancy C [Northern Arizona University

2009-01-01

Cryptic belowground organisms are difficult to observe and their responses to global changes are not well understood. Nevertheless, there is reason to believe that interactions among above- and belowground communities may mediate ecosystem responses to global change. We used grassland mesocosms to manipulate the abundance of one important group of soil organisms, arbuscular mycorrhizal (AM) fungi, and to study community and ecosystem responses to CO2 and N enrichment. After two growing seasons, biomass responses of plant communities were recorded, and soil community responses were measured using microscopy, phospholipid fatty acids (PLFA) and community-level physiological profiles (CLPP). Ecosystem responses were examined by measuring net primary production (NPP), evapotranspiration, total soil organic matter (SOM), and extractable mineral N. Structural equation modeling was used to examine the causal relationships among treatments and response variables. We found that while CO2 and N tended to directly impact ecosystem functions (evapotranspiration and NPP, respectively), AM fungi indirectly impacted ecosystem functions by strongly influencing the composition of plant and soil communities. For example, the presence of AM fungi had a strong influence on other root and soil fungi and soil bacteria. We found that the mycotrophic status of the dominant plant species in the mesocosms determined whether the presence of AM fungi increased or decreased NPP. Mycotrophic grasses dominated the mesocosm communities during the first growing season, and thus, the mycorrhizal treatments had the highest NPP. In contrast, non-mycotrophic forbs were dominant during the second growing season and thus, the mycorrhizal treatments had the lowest NPP. The composition of the plant community strongly influenced soil N; and the composition of the soil organisms strongly influenced SOM accumulation in the mesocosms. These results show how linkages between above- and belowground communities

Forensic Assertive Community Treatment in a Continuum of Care for Male Internees in Belgium: Results After 33 Months.

Science.gov (United States)

Marquant, Thomas; Sabbe, Bernard; Van Nuffel, Meike; Verelst, Rudy; Goethals, Kris

2018-01-01

Non-forensic or regular assertive community treatment (ACT) has positive effects on non-forensic outcomes but has poor effects on forensic outcome measures. In this study, we examined non-forensic and forensic outcome measures of a forensic adaptation of ACT (ForACT) within a continuum of care for internees. Data were collected retrospectively from files of 70 participants in the ForACT group who had been released from a forensic hospital. The control group comprised internees who had left prison and entered community-based care (n = 56). The ForACT group demonstrated significantly better outcomes on forensic measures, such as arrests and incarcerations, and had better community tenure. However, this group showed high hospitalization rates. The findings indicate that this type of community-based care can be beneficial for such internees; however, internees continue to experience difficulties reintegrating into society.

Degradation of nicotine in water solutions using a water falling film DBD plasma reactor: direct and indirect treatment

Science.gov (United States)

Krupež, Jelena; Kovačević, Vesna V.; Jović, Milica; Roglić, Goran M.; Natić, Maja M.; Kuraica, Milorad M.; Obradović, Bratislav M.; Dojčinović, Biljana P.

2018-05-01

Nicotine degradation efficiency in water solutions was studied using a water falling film dielectric barrier discharge (DBD) reactor. Two different treatments were applied: direct treatment, the recirculation of the solution through a DBD reactor, and indirect treatment, the bubbling of the gas from the DBD through the porous filter into the solution. In a separate experiment, samples spiked with nicotine in double distilled water (ddH2O) and tap water were studied and compared after both treatments. Furthermore, the effects of the homogeneous catalysts, namely, Fe2+ and H2O2, were tested in the direct treatment. Nicotine degradation efficiency was determined using high-performance liquid chromatography. A degradation efficiency of 90% was achieved after the direct treatment catalyzed with Fe2+. In order to analyze the biodegradability, mineralization level, and toxicity of the obtained solutions, after all degradation procedures the values of the following parameters were determined: total organic carbon, chemical oxygen demand, biochemical oxygen demand, and the Artemia salina toxicity test. The results showed that an increase in biodegradability was obtained, after all treatments. A partial nicotine mineralization was achieved and the mortality of the A. salina organism decreased in the treated samples, all of which indicating the effective removal of nicotine and the creation of less toxic solutions. Nicotine degradation products were identified using ultrahigh-performance liquid chromatography coupled with a linear ion trap Orbitrap hybrid mass spectrometer and a simple mechanism for oxidative degradation of nicotine in non-thermal plasma systems is proposed.

PSYCOSOCIAL FACTORS EVALUATION ON PREVENTION AND TREATMENT OF DIARRHEIC DISEASES IN YAQUI COMMUNITIES

Directory of Open Access Journals (Sweden)

Guadalupe Valenzuela Avendaño y Jesús Francisco Laborín Álvarez

2007-04-01

Full Text Available To analyze knowledge and some psychosocial factors influence on prevention and treatment of diarrheic diseases in Yaqui communities. By a non-probabilistic sampling, 209 mothers were selected from Yaqui families having at least one six years old child or younger, and that they had attended at least one diarrhoea episode within 72 hours previous the interview. A non-experimental, correlational and cross-sectional design was used to analyse data. The knowledge level that mothers show about causes, symptoms and care during the diarrhoea is medium. Data also demonstrate a low to moderate level of correlation among the factors of the reasoned action model. The theory of reasoned action was not 100% suitable for Yaqui communities, because this model was originally proposed for urban areas and studied populations, therefore we recommend combine it quantitative and qualitative techniques with the purpose of collecting more reliable data, as include in the evaluation referring aspects to the culture and idiosyncrasy.

Acer negundo invasion along a successional gradient: early direct facilitation by native pioneers and late indirect facilitation by conspecifics.

Science.gov (United States)

Saccone, Patrick; Pagès, Jean-Philippe; Girel, Jacky; Brun, Jean-Jacques; Michalet, Richard

2010-08-01

*Here, we analysed the role of direct and indirect plant interactions in the invasion process of Acer negundo along a natural successional gradient in the Middle Rhone floodplain (France). We addressed two questions: What are the responses of the invasive Acer seedlings to native communities' effects along the successional gradient? What are the effects of the invasive Acer adult trees on the native communities? *In the three communities (Salix, Acer and Fraxinus stands) we transplanted juveniles of the invasive and juveniles of the natives within the forest and in experimental gaps, and with and without the herb layer. We also quantified changes in understory functional composition, light, nitrogen and moisture among treatments. *Acer seedlings were directly facilitated for survival in the Salix and Acer communities and indirectly facilitated for growth by adult Acer through the reduction of the abundance of highly competitive herbaceous competitors. *We conclude that direct facilitation by the tree canopy of the native pioneer Salix is very likely the main biotic process that induced colonization of the invasive Acer in the floodplain and that indirect facilitation by adult conspecifics contributed to population establishment.

Direct observation of deformation of nafion surfaces induced by methanol treatment by using atomic force microscopy

International Nuclear Information System (INIS)

Umemura, Kazuo; Kuroda, Reiko; Gao Yanfeng; Nagai, Masayuki; Maeda, Yuta

2008-01-01

We successfully characterized the effect of methanol treatment on the nanoscopic structures of a nafion film, which is widely used in direct methanol fuel cells (DMFCs). Atomic force microscopy (AFM) was used to repetitively image a particular region of a nafion sample before and after methanol solutions were dropped onto the nafion film and dried in air. When the surface was treated with 20% methanol for 5 min, many nanopores appeared on the surface. The number of nanopores increased when the sample was treated twice or thrice. By repetitive AFM imaging of a particular region of the same sample, we found that the shapes of the nanopores were deformed by the repeated methanol treatment, although the size of the nanopores had not significantly changed. The creation of the nanopores was affected by the concentration of methanol. Our results directly visualized the effects of methanol treatment on the surface structures of a nafion film at nanoscale levels for the first time

Measuring the CO2 shadow price for wastewater treatment: A directional distance function approach

International Nuclear Information System (INIS)

Molinos-Senante, María; Hanley, Nick; Sala-Garrido, Ramón

2015-01-01

Highlights: • The shadow price of CO 2 informs about the marginal abatement cost of this pollutant. • It is estimated the shadow price of CO 2 for wastewater treatment plants. • The shadow prices depend on the setting of the directional vectors of the distance function. • Sewage sludge treatment technology affects the CO 2 shadow price. - Abstract: The estimation of the value of carbon emissions has become a major research and policy topic since the establishment of the Kyoto Protocol. The shadow price of CO 2 provides information about the marginal abatement cost of this pollutant. It is an essential element in guiding environmental policy issues, since the CO 2 shadow price can be used when fixing carbon tax rates, in environmental cost-benefit analysis and in ascertaining an initial market price for a trading system. The water industry could play an important role in the reduction of greenhouse gas (GHG) emissions. This paper estimates the shadow price of CO 2 for a sample of wastewater treatment plants (WWTPs), using a parametric quadratic directional distance function. Following this, in a sensitivity analysis, the paper evaluates the impact of different settings of directional vectors on the shadow prices. Applying the Mann–Whitney and Kruskal–Wallis non-parametric tests, factors affecting CO 2 prices are investigated. The variation of CO 2 shadow prices across the WWTPs evaluated argues in favour of a market-based approach to CO 2 mitigation as opposed to command-and-control regulation. The paper argues that the estimation of the shadow price of CO 2 for non-power enterprises can provide incentives for reducing GHG emissions

Ecological and evolutionary effects of stickleback on community structure.

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Simone Des Roches

Full Text Available Species' ecology and evolution can have strong effects on communities. Both may change concurrently when species colonize a new ecosystem. We know little, however, about the combined effects of ecological and evolutionary change on community structure. We simultaneously examined the effects of top-predator ecology and evolution on freshwater community parameters using recently evolved generalist and specialist ecotypes of three-spine stickleback (Gasterosteus aculeatus. We used a mesocosm experiment to directly examine the effects of ecological (fish presence and density and evolutionary (phenotypic diversity and specialization factors on community structure at lower trophic levels. We evaluated zooplankton biomass and composition, periphyton and phytoplankton chlorophyll-a concentration, and net primary production among treatments containing different densities and diversities of stickleback. Our results showed that both ecological and evolutionary differences in the top-predator affect different aspects of community structure and composition. Community structure, specifically the abundance of organisms at each trophic level, was affected by stickleback presence and density, whereas composition of zooplankton was influenced by stickleback diversity and specialization. Primary productivity, in terms of chlorophyll-a concentration and net primary production was affected by ecological but not evolutionary factors. Our results stress the importance of concurrently evaluating both changes in density and phenotypic diversity on the structure and composition of communities.

Assessing the efficacy of a modified assertive community-based treatment programme in a developing country

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Botha Ulla A

2010-09-01

Full Text Available Abstract Background A number of recently published randomized controlled trials conducted in developed countries have reported no advantage for assertive interventions over standard care models. One possible explanation could be that so-called "standard care" has become more comprehensive in recent years, incorporating some of the salient aspects of assertive models in its modus operandi. Our study represents the first randomised controlled trial assessing the effect of a modified assertive treatment service on readmission rates and other measures of outcome in a developing country. Methods High frequency service users were randomized into an intervention (n = 34 and a control (n = 26 group. The control group received standard community care and the active group an assertive intervention based on a modified version of the international model of assertive community treatment. Study visits were conducted at baseline and 12 months with demographic and illness information collected at visit 1 and readmission rates documented at study end. Symptomatology and functioning were measured at both visits using the PANSS, CDSS, ESRS, WHO-QOL and SOFAS. Results At 12 month follow-up subjects receiving the assertive intervention had significantly lower total PANSS (p = 0.02 as well as positive (p Conclusions Our results indicate that assertive interventions in a developing setting where standard community mental services are often under resourced can produce significant outcomes. Furthermore, these interventions need not be as expensive and comprehensive as international, first-world models in order to reduce inpatient days, improve psychopathology and overall levels of functioning in patients with severe mental illness.

Relationship of social support and decisional conflict to advance directives attitude in Korean older adults: A community-based cross-sectional study.

Science.gov (United States)

Lee, JuHee; Jung, Dukyoo; Choi, MoonKi

2016-01-01

The aim of this study was to clarify the relationship between social support, decisional conflict, and attitude towards advance directives, and determine whether decisional conflict mediates the relation between social support and advance directives attitude among older adults in South Korea. In total, 209 community-based older adults (mean age, 74.82 years) participated in this cross-sectional study. Demographic characteristics, self-perceived health status, social support, decisional conflict, and advance directives attitude were investigated via a structured questionnaire. Data analysis was carried out using Pearson's correlation and path analyses. The mean score of advance directives attitude was 48.01 (range, 35-61). Decisional conflict and social support were both significantly related to advance directives attitude (P conflict was a mediator between social support and advance directives attitudes. The results confirmed the importance of social support for reducing decisional conflict and encouraging positive attitudes toward advance directives. Future studies are needed to support the development of culturally sensitive educational approaches regarding advance directives for older adults in Korea. © 2015 The Authors. Japan Journal of Nursing Science © 2015 Japan Academy of Nursing Science.

The relationship between social support, treatment interruption and treatment outcome in patients with multidrug-resistant tuberculosis in China: a mixed-methods study.

Science.gov (United States)

Yin, Jia; Wang, Xiaomeng; Zhou, Lin; Wei, Xiaolin

2018-04-24

Multidrug-resistant tuberculosis (MDR-TB) has been a major threat for successful TB control. We examined the relationship between social support and treatment outcomes in MDR-TB patients and evaluated barriers to social support. Retrospective cohort study with MDR-TB patients enrolled in the Global Fund program between 1 January 2009 and 30 June 2014 in Zhejiang, China. We reviewed all MDR-TB patients' diagnoses and treatment outcomes. In-depth interviews were conducted with 10 community health workers and 10 patients. Pathway analysis was employed to examine the association between social support and treatment outcomes, and the mediating effect of medication adherence on their relationship. Of 218 participants, 144 (66%) were successfully treated and 59 (27%) had poor treatment adherence. Directly observed therapy (DOT) had an indirect positive effect on treatment success, mediating through medication adherence (β.=0.541, p=0.008; β =0.538, p<0.001). Financial support had both a direct (β.=0.769, p<0.001) and an indirect positive effect on treatment success, which was mediated by a self-reported social support scale (β.=0.541, p=0.008; β =0.538, p<0.001). The interviews indicated poor performance of DOT. Patients often suffered from substantial stigma, but were not provided with psychological support. DOT and financial support were effective strategies for improving successful treatment outcomes in MDR-TB patients, but they were delivered not considering patients' perspectives. There is an urgent need for consistent and specific psychological support for MDR-TB patients in their communities. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Configuration of biological wastewater treatment line and influent composition as the main factors driving bacterial community structure of activated sludge

OpenAIRE

Jaranowska, Paulina; Cydzik-Kwiatkowska, Agnieszka; Zieli?ska, Magdalena

2013-01-01

The structure of microbial consortia in wastewater treatment facilities is a resultant of environmental conditions created by the operational parameters of the purification process. In the research, activated sludge from nine Polish wastewater treatment plants (WWTPs) was investigated at a molecular level to determine the impact of the complexity of biological treatment line and the influent composition on the species structure and the diversity of bacterial consortia. The community fingerpri...

Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy

DEFF Research Database (Denmark)

Bjørndal, Lars; Reit, Claes; Bruun, Gitte Hoffmann

2010-01-01

Less invasive excavation methods have been suggested for deep caries lesions. We tested the effects of stepwise vs. direct complete excavation, 1 yr after the procedure had been carried out, in 314 adults (from six centres) who had received treatment of a tooth with deep caries. The teeth had car...

Can We Predict Oral Antibiotic Treatment Failure in Children with Fast-Breathing Pneumonia Managed at the Community Level? A Prospective Cohort Study in Malawi.

Directory of Open Access Journals (Sweden)

Carina King

Full Text Available Pneumonia is the leading cause of infectious death amongst children globally, with the highest burden in Africa. Early identification of children at risk of treatment failure in the community and prompt referral could lower mortality. A number of clinical markers have been independently associated with oral antibiotic failure in childhood pneumonia. This study aimed to develop a prognostic model for fast-breathing pneumonia treatment failure in sub-Saharan Africa.We prospectively followed a cohort of children (2-59 months, diagnosed by community health workers with fast-breathing pneumonia using World Health Organisation (WHO integrated community case management guidelines. Cases were followed at days 5 and 14 by study data collectors, who assessed a range of pre-determined clinical features for treatment outcome. We built the prognostic model using eight pre-defined parameters, using multivariable logistic regression, validated through bootstrapping.We assessed 1,542 cases of which 769 were included (32% ineligible; 19% defaulted. The treatment failure rate was 15% at day 5 and relapse was 4% at day 14. Concurrent malaria diagnosis (OR: 1.62; 95% CI: 1.06, 2.47 and moderate malnutrition (OR: 1.88; 95% CI: 1.09, 3.26 were associated with treatment failure. The model demonstrated poor calibration and discrimination (c-statistic: 0.56.This study suggests that it may be difficult to create a pragmatic community-level prognostic child pneumonia tool based solely on clinical markers and pulse oximetry in an HIV and malaria endemic setting. Further work is needed to identify more accurate and reliable referral algorithms that remain feasible for use by community health workers.

European Communities (Foodstuffs treated with ionising radiation) Regulations, 2000. Statutory Instrument S.I. No. 297 of 2000

International Nuclear Information System (INIS)

2000-01-01

These Regulations give effect to Directive 1999/2/EC (the framework Directive) of the European Parliament and of the Council of 22 February 1999 on the approximation of the laws of the Member States concerning foods and food ingredients treated with ionising radiation and Directive 1999/3/EC (the implementing Directive) of the European Parliament and of the Council of 22 February 1999 on the establishment of a Community list of foods and food ingredients treated with ionising radiation. The effect of these Regulations is to lay down the general provisions for the treatment of foodstuffs with ionising radiation. Provisions concerning the approval and control of irradiation facilities and rules on labelling are also included. A positive list of foodstuffs authorised for treatment with ionising radiation and their maximum radiation doses are defined in the implementing Directive. These Regulations should be read together with the two Directives (author)

Effect of heat treatment on the characteristics of tool steel deposited by the directed energy deposition process

Science.gov (United States)

Park, Jun Seok; Lee, Min-Gyu; Cho, Yong-Jae; Sung, Ji Hyun; Jeong, Myeong-Sik; Lee, Sang-Kon; Choi, Yong-Jin; Kim, Da Hye

2016-01-01

The directed energy deposition process has been mainly applied to re-work and the restoration of damaged steel. Differences in material properties between the base and the newly deposited materials are unavoidable, which may affect the mechanical properties and durability of the part. We investigated the effect of heat treatment on the characteristics of tool steel deposited by the DED process. We prepared general tool steel materials of H13 and D2 that were deposited onto heat-treated substrates of H13 and D2, respectively, using a direct metal tooling process. The hardness and microstructure of the deposited steel before and after heat treatment were investigated. The hardness of the deposited H13 steel was higher than that of wrought H13 steel substrate, while that of the deposited D2 was lower than that of wrought D2. The evolution of the microstructures by deposition and heat treatment varied depending on the materials. In particular, the microstructure of the deposited D2 steel after heat treatment consisted of fine carbides in tempered martensite and it is expected that the deposited D2 steel will have isotropic properties and high hardness after heat treatment.

Adaptation and implementation of family-based treatment enhanced with dialectical behavior therapy skills for anorexia nervosa in community-based specialist clinics.

Science.gov (United States)

Accurso, Erin C; Astrachan-Fletcher, Ellen; O'Brien, Setareh; McClanahan, Susan F; Le Grange, Daniel

2018-01-01

Although family-based therapy (FBT) is a well-established treatment for anorexia nervosa, its implementation and effectiveness in clinical settings has been neglected. A group of seven therapists at a community-based eating disorders clinic were trained in skills-enhanced FBT and provided treatment to 11 youth with anorexia nervosa. Family-based skills training, which borrowed heavily from dialectical behavior therapy, was introduced in four additional sessions and then integrated throughout the remainder of FBT. FBT was perceived as appropriate and acceptable by all participants. Therapists reported high treatment fidelity. There was a large improvement in weight and moderate improvement in caregiver-reported eating disorder psychopathology but no clinically significant change by youth report. This study provides preliminary data on the implementation and effectiveness of FBT in the community.

[Prevalence of Clonorchis sinensis infection and effect of albendazole treatment among residents in two communities of Zhongshan City].

Science.gov (United States)

Ying-Yan, Zheng; Ting-Jun, Xie; Man, Wang; Yue-Yi, Fang; Le, Luo

2018-02-22

To understand the prevalence of Clonorchis sinensis infection among residents in two communities of Zhongshan City, and evaluate the effect of albendazole treatment, so as to offer the evidence for formulating the strategy of clonorchiasis prevention and control. The stool specimens were collected from the residents of two comprehensive demonstration areas, and the eggs of C. sinensis were detected by Kato-Katz technique. Those who were tested positive were treated with albendazole (0.4, twice a day for 4 days in adults, and half dosage for children aged 16 years or below). Three weeks after the treatment, the stool specimens were recollected and retested to evaluate the effect. A total of 532 people were investigated and 96 were tested positive, with an infection rate of 18.05%. The infection rate was 28.63% (69/241) in the males and 9.28% (27/291) in the females, and there was a significant difference between them ( χ 2 = 334.99, P sinensis among residents in the two communities of Zhongshan City is high, especially among the males and aged people. The effect of albendazole is good in the treatment of C. sinensis infection. In the future, the general survey and treatment should be strengthened in order to lower the infection rate.

Polyoxadiazole hollow fibers for produced water treatment by direct contact membrane distillation

KAUST Repository

Xu, Jingli

2018-01-08

Treatment of produced water in the petroleum industry has been a challenge worldwide. In this study, we evaluated the use of direct contact membrane distillation (DCMD) for this purpose, removing oil and dissolved elements and supplying clean water from waste. We synthesized fluorinated polyoxadiazole, a highly hydrophobic polymer, to fabricate hollow fiber membranes, which were optimized and tested for simulated produced water and real produced water treatment. The process performance was investigated under different operating parameters, such as feed temperature, feed flow velocity and length of the membrane module for 4 days. The results indicate that by increasing feed temperature and feed flow rate the vapor flux increases. The flux decreased with increasing the length of the module due to the decrease of the driving force along the module. The fouling behavior, which corresponds to flux decline and cleaning efficiency of the membrane, was studied. The performance of the fabricated hollow fiber membranes was demonstrated for the treatment of produced water, complying with the industrial reuse and discharge limits.

Yield of community-based tuberculosis targeted testing and treatment in foreign-born populations in the United States: A systematic review.

Directory of Open Access Journals (Sweden)

Mohsen Malekinejad

Full Text Available To synthesize outputs and outcomes of community-based tuberculosis targeted testing and treatment (TTT programs in foreign-born populations (FBP in the United States (US.We systematically searched five bibliographic databases and other key resources. Two reviewers independently applied eligibility criteria to screen citations and extracted data from included studies. We excluded studies that contained 90%. We used random-effects meta-analytic models to calculate pooled proportions and 95% confidence intervals (CI for community-based TTT cascade steps (e.g., recruited, tested and treated, and used them to create two hypothetical cascades for 100 individuals.Fifteen studies conducted in 10 US states met inclusion criteria. Studies were heterogeneous in recruitment strategies and mostly recruited participants born in Latin America. Of 100 hypothetical participants (predominantly FBP reached by community-based TTT, 40.4 (95% CI 28.6 to 50.1 would have valid test results, 15.7 (95% CI 9.9 to 21.8 would test positive, and 3.6 (95% CI 1.4 to 6.0 would complete LTBI treatment. Likewise, of 100 hypothetical participants (majority FBP reached, 77.9 (95% CI 54.0 to 92.1 would have valid test results, 26.5 (95% CI 18.0 to 33.5 would test positive, and 5.4 (95% CI 2.1 to 9.0 would complete LTBI treatment. Of those with valid test results, pooled proportions of LTBI test positive for predominantly FBP and majority FBP were 38.9% (95% CI 28.6 to 49.8 and 34.3% (95% CI 29.3 to 39.5, respectively.We observed high attrition throughout the care cascade in FBP participating in LTBI community-based TTT studies. Few studies included cascade steps prior to LTBI diagnosis, limiting our review findings. Moreover, Asia-born populations in the US are substantially underrepresented in the FBP community-based TTT literature.

Analysis of the bacterial community changes in soil for septic tank effluent treatment in response to bio-clogging.

Science.gov (United States)

Nie, J Y; Zhu, N W; Zhao, K; Wu, L; Hu, Y H

2011-01-01

Soil columns were set up to survey the bacterial community in the soil for septic tank effluent treatment. When bio-clogging occurred in the soil columns, the effluent from the columns was in poorer quality. To evaluate changes of the soil bacterial community in response to bio-clogging, the bacterial community was characterized by DNA gene sequences from soil samples after polymerase chain reaction coupled with denaturing gradient gel electrophoresis process. Correspondence analysis showed that Proteobacteria related bacteria were the main bacteria within the soil when treating septic tank effluent. However, Betaproteobacteria related bacteria were the dominant microorganisms in the normal soil, whereas Alphaproteobacteria related bacteria were more abundant in the clogged soil. This study provided insight into changes of the soil bacterial community in response to bio-clogging. The results can supply some useful information for the design and management of soil infiltration systems.

Effectiveness of Ebola treatment units and community care centers - Liberia, September 23-October 31, 2014.

Science.gov (United States)

Washington, Michael L; Meltzer, Martin L

2015-01-30

Previous reports have shown that an Ebola outbreak can be slowed, and eventually stopped, by placing Ebola patients into settings where there is reduced risk for onward Ebola transmission, such as Ebola treatment units (ETUs) and community care centers (CCCs) or equivalent community settings that encourage changes in human behaviors to reduce transmission risk, such as making burials safe and reducing contact with Ebola patients. Using cumulative case count data from Liberia up to August 28, 2014, the EbolaResponse model previously estimated that without any additional interventions or further changes in human behavior, there would have been approximately 23,000 reported Ebola cases by October 31, 2014. In actuality, there were 6,525 reported cases by that date. To estimate the effectiveness of ETUs and CCCs or equivalent community settings in preventing greater Ebola transmission, CDC applied the EbolaResponse model to the period September 23-October 31, 2014, in Liberia. The results showed that admitting Ebola patients to ETUs alone prevented an estimated 2,244 Ebola cases. Having patients receive care in CCCs or equivalent community settings with a reduced risk for Ebola transmission prevented an estimated 4,487 cases. Having patients receive care in either ETUs or CCCs or in equivalent community settings, prevented an estimated 9,100 cases, apparently as the result of a synergistic effect in which the impact of the combined interventions was greater than the sum of the two interventions. Caring for patients in ETUs, CCCs, or in equivalent community settings with reduced risk for transmission can be important components of a successful public health response to an Ebola epidemic.

Recommendations for the diagnosis, treatment and prevention of the pneumonia acquired in the community in adults

International Nuclear Information System (INIS)

2003-01-01

The pneumonia acquired in the community in adults, is the acute infection of the pulmonary parenchyma that is developed away from the hospital environment, it is manifested in the first 48 hours from the entrance to the hospital or after seven days of having left. The supplement includes clinical square, epidemiology, etiology classification, diagnostic, treatment and prevention among others

Plant community resistance to invasion by Bromus species: The roles of community attributes, Bromus interactions with plant communities, and Bromus traits [Chapter 10

Science.gov (United States)

Jeanne C. Chambers; Matthew J. Germino; Jayne Belnap; Cynthia S. Brown; Eugene W. Schupp; Samuel B. St. Clair

2016-01-01

The factors that determine plant community resistance to exotic annual Bromus species (Bromus hereafter) are diverse and context specific. They are influenced by the environmental characteristics and attributes of the community, the traits of Bromus species, and the direct and indirect interactions of Bromus with the plant community. Environmental factors, in...

Direct matrix-assisted laser desorption ionization time-of-flight mass spectrometry improves appropriateness of antibiotic treatment of bacteremia.

Directory of Open Access Journals (Sweden)

Anne L M Vlek

Full Text Available Matrix assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS allows the identification of microorganisms directly from positive blood culture broths. Use of the MALDI-TOF MS for rapid identification of microorganisms from blood culture broths can reduce the turnaround time to identification and may lead to earlier appropriate treatment of bacteremia. During February and April 2010, direct MALDI-TOF MS was routinely performed on all positive blood cultures. During December 2009 and March 2010 no direct MALDI-TOF MS was used. Information on antibiotic therapy was collected from the hospital and intensive care units' information systems from all positive blood cultures during the study period. In total, 253 episodes of bacteremia were included of which 89 during the intervention period and 164 during the control period. Direct performance of MALDI-TOF MS on positive blood culture broths reduced the time till species identification by 28.8-h and was associated with an 11.3% increase in the proportion of patients receiving appropriate antibiotic treatment 24 hours after blood culture positivity (64.0% in the control period versus 75.3% in the intervention period (p0.01. Routine implementation of this technique increased the proportion of patients on adequate antimicrobial treatment within 24 hours.

Direct matrix-assisted laser desorption ionization time-of-flight mass spectrometry improves appropriateness of antibiotic treatment of bacteremia.

Science.gov (United States)

Vlek, Anne L M; Bonten, Marc J M; Boel, C H Edwin

2012-01-01

Matrix assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) allows the identification of microorganisms directly from positive blood culture broths. Use of the MALDI-TOF MS for rapid identification of microorganisms from blood culture broths can reduce the turnaround time to identification and may lead to earlier appropriate treatment of bacteremia. During February and April 2010, direct MALDI-TOF MS was routinely performed on all positive blood cultures. During December 2009 and March 2010 no direct MALDI-TOF MS was used. Information on antibiotic therapy was collected from the hospital and intensive care units' information systems from all positive blood cultures during the study period. In total, 253 episodes of bacteremia were included of which 89 during the intervention period and 164 during the control period. Direct performance of MALDI-TOF MS on positive blood culture broths reduced the time till species identification by 28.8-h and was associated with an 11.3% increase in the proportion of patients receiving appropriate antibiotic treatment 24 hours after blood culture positivity (64.0% in the control period versus 75.3% in the intervention period (p0.01)). Routine implementation of this technique increased the proportion of patients on adequate antimicrobial treatment within 24 hours.

Effect of Copper Treatment on the Composition and Function of the Bacterial Community in the Sponge Haliclona cymaeformis

KAUST Repository

Tian, R.-M.; Wang, Y.; Bougouffa, Salim; Gao, Z.-M.; Cai, L.; Zhang, W.-P.; Bajic, Vladimir B.; Qian, P.-Y.

2014-01-01

and poses a threat to marine organisms. Here, we examined the effects of copper treatment on the composition of the sponge-associated bacterial community and the genetic features that facilitate the survival of enriched bacteria under copper stress. The 16S

Changes in the ammonia-oxidizing bacteria community in response to operational parameters during the treatment of anaerobic sludge digester supernatant.

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Cydzik-Kwiatkowska, Agnieszka; Zielińska, Magdalena; Bernat, Katarzyna; Kulikowska, Dorota; Wojnowska-Baryła, Irena

2012-07-01

The understanding of the relationship between ammoniaoxidizing bacteria (AOB) communities in activated sludge and the operational treatment parameters supports the control of the treatment of ammonia-rich wastewater. The modifications of treatment parameters by alteration of the number and length of aerobic and anaerobic stages in the sequencing batch reactor (SBR) working cycle may influence the efficiency of ammonium oxidation and induce changes in the AOB community. Therefore, in the research, the impact of an SBR cycle mode with alternating aeration/ mixing conditions (7 h/1 h vs. 4 h/5.5 h) and volumetric exchange rate (n) on AOB abundance and diversity in activated sludge during the treatment of anaerobic sludge digester supernatant at limited oxygen concentration in the aeration stage (0.7 mg O2/l) was assessed. AOB diversity expressed by the Shannon-Wiener index (H') was determined by the cycle mode. At aeration/mixing stage lengths of 7 h/1 h, H' averaged 2.48 +/- 0.17, while at 4 h/ 5.5 h it was 2.35 +/- 0.16. At the given mode, AOB diversity decreased with increasing n. The cycle mode did not affect AOB abundance; however, a higher AOB abundance in activated sludge was promoted by decreasing the volumetric exchange rate. The sequences clustering with Nitrosospira sp. NpAV revealed the uniqueness of the AOB community and the simultaneously lower ability of adaptation of Nitrosospira sp. to the operational parameters applied in comparison with Nitrosomonas sp.

The current situation of the wastewater treatment in the rural communities in Lugo (Spain); Situacion actual de la depuracion de aguas residuales en los nucleos rurales de la provincia de Lugo

Energy Technology Data Exchange (ETDEWEB)

Cajavarille Martinez, A.; Cancela Barrio, J. J.; Cuesta Garcia, T. S.; Marey Perez, M. F.

2007-07-01

The application of the Water Framework Directive and the Directive 91/271/CEE conditions the objectives of the plans of wastewater management approved in different Autonomous Communities in Spain. In all the lines of performance the treatment of the towns with more than 2,000 e-i has been priorized. It is foreseeable that in one second phase the smallest towns will study. In this case, the collective, individual or decentralized systems will be valued of wastewater management. This paper analyzes the present situation of the wastewater management in the rural scope of the province of Lugo by means of a survey in the 67 city councils. the high-priority lines of performance and the methodology for the selection of the suitable technology are defined from the collected data. (Author) 10 refs.

Abnormal uterine bleeding in women receiving direct oral anticoagulants for the treatment of venous thromboembolism.

Science.gov (United States)

Godin, Richard; Marcoux, Violaine; Tagalakis, Vicky

2017-08-01

Abnormal uterine bleeding (AUB) is a common complication of anticoagulant therapy in premenopausal women affected with acute venous thromboembolism. AUB impacts quality of life, and can lead to premature cessation of anticoagulation. There is increasing data to suggest that the direct oral anticoagulants when used for the treatment of venous thromboembolism differ in their menstrual bleeding profile. This article aims to review the existing literature regarding the association between AUB and the direct oral anticoagulants and make practical recommendations. Copyright © 2017 Elsevier Inc. All rights reserved.

Life cycle assessment of wastewater treatment options for small and decentralized communities.

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Machado, A P; Urbano, L; Brito, A G; Janknecht, P; Salas, J J; Nogueira, R

2007-01-01

Sustainability has strong implications on the practice of engineering. Life cycle assessment (LCA) is an appropriate methodology for assessing the sustainability of a wastewater treatment plant design. The present study used a LCA approach for comparing alternative wastewater treatment processes for small and decentralised rural communities. The assessment was focused on two energy-saving systems (constructed wetland and slow rate infiltration) and a conventional one (activated sludge process). The low environmental impact of the energy-saving wastewater treatment plants was demonstrated, the most relevant being the global warming indicator. Options for reduction of life cycle impacts were assessed including materials used in construction and operational lifetime of the systems. A 10% extension of operation lifetime of constructed wetland and slow rate infiltration systems led to a 1% decrease in CO2 emissions, in both systems. The decrease in the abiotic depletion was 5 and 7%, respectively. Also, replacing steel with HDPE in the activated sludge tank resulted in a 1% reduction in CO2 emission and 1% in the abiotic depletion indicator. In the case of the Imhoff tank a 1% reduction in CO2 emissions and 5% in the abiotic depletion indicator were observed when concrete was replaced by HDPE.

Factors associated with linkage to HIV care and TB treatment at community-based HIV testing services in Cape Town, South Africa.

Science.gov (United States)

Meehan, Sue-Ann; Sloot, Rosa; Draper, Heather R; Naidoo, Pren; Burger, Ronelle; Beyers, Nulda

2018-01-01

Diagnosing HIV and/or TB is not sufficient; linkage to care and treatment is conditional to reduce the burden of disease. This study aimed to determine factors associated with linkage to HIV care and TB treatment at community-based services in Cape Town, South Africa. This retrospective cohort study utilized routinely collected data from clients who utilized stand-alone (fixed site not attached to a health facility) and mobile HIV testing services in eight communities in the City of Cape Town Metropolitan district, between January 2008 and June 2012. Clients were included in the analysis if they were ≥12 years and had a known HIV status. Generalized estimating equations (GEE) logistic regression models were used to assess the association between determinants (sex, age, HIV testing service and co-infection status) and self-reported linkage to HIV care and/or TB treatment. Linkage to HIV care was 3 738/5 929 (63.1%). Linkage to HIV care was associated with the type of HIV testing service. Clients diagnosed with HIV at mobile services had a significantly reduced odds of linking to HIV care (aOR 0.7 (CI 95%: 0.6-0.8), p<0.001. Linkage to TB treatment was 210/275 (76.4%). Linkage to TB treatment was not associated with sex and service type, but was associated with age. Clients in older age groups were less likely to link to TB treatment compared to clients in the age group 12-24 years (all, p-value<0.05). A large proportion of clients diagnosed with HIV at mobile services did not link to care. Almost a quarter of clients diagnosed with TB did not link to treatment. Integrated community-based HIV and TB testing services are efficient in diagnosing HIV and TB, but strategies to improve linkage to care are required to control these epidemics.

Community risk factors for ocular Chlamydia infection in Niger: pre-treatment results from a cluster-randomized trachoma trial.

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Abdou Amza

Full Text Available Trachoma control programs utilize mass azithromycin distributions to treat ocular Chlamydia trachomatis as part of an effort to eliminate this disease world-wide. But it remains unclear what the community-level risk factors are for infection.This cluster-randomized, controlled trial entered 48 randomly selected communities in a 2×2 factorial design evaluating the effect of different treatment frequencies and treatment coverage levels. A pretreatment census and examination established the prevalence of risk factors for clinical trachoma and ocular chlamydia infection including years of education of household head, distance to primary water source, presence of household latrine, and facial cleanliness (ocular discharge, nasal discharge, and presence of facial flies. Univariate and multivariate associations were tested using linear regression and Bayes model averaging.There were a total of 24,536 participants (4,484 children aged 0-5 years in 6,235 households in the study. Before treatment in May to July 2010, the community-level prevalence of active trachoma (TF or TI utilizing the World Health Organization [WHO] grading system was 26.0% (95% CI: 21.9% to 30.0% and the mean community-level prevalence of chlamydia infection by Amplicor PCR was 20.7% (95% CI: 16.5% to 24.9% in children aged 0-5 years. Univariate analysis showed that nasal discharge (0.29, 95% CI: 0.04 to 0.54; P = 0.03, presence of flies on the face (0.40, 95% CI: 0.17 to 0.64; P = 0.001, and years of formal education completed by the head of household (0.07, 95% CI: 0.07 to 0.13; P = 0.03 were independent risk factors for chlamydia infection. In multivariate analysis, facial flies (0.26, 95% CI: 0.02 to 0.49; P = 0.03 and years of formal education completed by the head of household (0.06, 95% CI: 0.008 to 0.11; P = 0.02 were associated risk factors for ocular chlamydial infection.We have found that the presence of facial flies and years of education of the head

Effect of cerium dioxide, titanium dioxide, silver, and gold nanoparticles on the activity of microbial communities intended in wastewater treatment

International Nuclear Information System (INIS)

García, Ana; Delgado, Lucía; Torà, Josep A.; Casals, Eudald; González, Edgar; Puntes, Víctor; Font, Xavier; Carrera, Julián; Sánchez, Antoni

2012-01-01

Highlights: ► Toxicity of TiO 2 , CeO 2 , Ag and Au nanoparticles (NP) has been studied. ► NP were synthesized in the lab and stabilized to prevent agglomeration. ► Toxicity was studied in all the communities used for the wastewater treatment. ► Heterotrophic, nitrifying and anaerobic organisms were studied for nanotoxicology. ► Au and TiO 2 NP were not toxic, but Ag and CeO 2 NP were inhibitory. - Abstract: Growth in production and use of nanoparticles (NPs) will result increased concentrations of these in industrial and urban wastewaters and, consequently, in wastewater-treatment facilities. The effect of this increase on the performance of the wastewater-treatment process has not been studied systematically and including all the microbial communities involved in wastewater treatment. The present work investigates, by using respiration tests and biogas-production analysis, the inhibitory effect of four different commonly used metal oxide (CeO 2 and TiO 2 ) and zero-valent metal (Ag and Au) nanoparticles on the activity of the most important microbial communities present in a modern wastewater-treatment plant. Specifically, the actions of ordinary heterotrophic organisms, ammonia oxidizing bacteria, and thermophilic and mesophilic anaerobic bacteria were tested in the presence and absence of the nanoparticles. In general, CeO 2 nanoparticles caused the greatest inhibition in biogas production (nearly 100%) and a strong inhibitory action of other biomasses; Ag nanoparticles caused an intermediate inhibition in biogas production (within 33–50%) and a slight inhibition in the action of other biomasses, and Au and TiO 2 nanoparticles caused only slight or no inhibition for all tested biomasses.

A win for the patient: Direct patient notification improves treatment rates of active Helicobacter pylori infection.

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Selvaratnam, Sriharan; Yeoh, Joey; Hsiang, John; Patrick, Alasdair B

2014-01-01

Current international guidelines recommend the commencement of effective eradication therapy as soon as active Helicobacter pylori (H. pylori) infection is confirmed. At our institution, all positive Campylobacter-like Organism (CLO) test results were automatically communicated to general practitioners (GPs) via a standardised letter, which also advised the commencement of eradication therapy. Despite this endeavour, a clinical audit conducted in 2011 demonstrated that only 66 per cent of confirmed H. pylori-positive South Auckland patients received eradication treatment and only 83 per cent of these patients received treatment within one month. Improve the timely initiation of H. pylori eradication therapy through direct patient notification. A prospective clinical audit of 109 consecutive outpatients with a positive CLO test identified at gastroscopy. In addition to standard general practitioner notification, patients were also directly notified of their positive CLO test result via a standardised letter, which provided information about H. pylori and its disease associations as well as advising patients to seek consultation with their GP to commence eradication therapy. Dispensing data was examined using Test Safe electronic records to determine the total uptake and timing of treatment compared to data from a preliminary 2011 audit. Ninety-five per cent of H. pylori-positive patients received standard triple therapy; therefore, treatment of active H. pylori infection was significantly higher when patients were directly notified in addition to standard GP notification, when compared to GP notification alone (95 per cent vs 66 per cent, paudit in 2011 (100 per cent vs. 83 per cent, pstrategy that significantly improves the timely initiation of eradication therapy for active H. pylori infection. This has since been integrated into standard practice at our District Health Board (DHB).

International food aid – directions of changes

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Agnieszka Sapa

2012-04-01

Full Text Available Permanently unsolved world food insecurity problem makes the international community search for solutions. One of the used methods is international food aid directed to developing countries. Long term analyses of the food aid flows allow to identify some tendencies that show: increase of emergency food aid and decrease of direct transfer. These tendencies also apply to the two biggest food donors i.e. the USA and the EU. The noticeable directions of changes are based on the international community initiatives, on which the national regulation are formed later.

Engaging parents in evidence-based treatments in schools: Community perspectives from implementing CBITS.

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