Little SAC River Watershed: Bacterial Source Tracking Analysis

Agricultural and Food Policy, Environmental Economics and Policy,

Little SAC River Watershed: Bacterial Source Tracking Analysis

Data collected from November 2003 to October 2004 at two sites on the Little Sac River show that the whole body contact water quality criteria was not met during this period. The year was divided in four periods: winter, spring, summer, and fall. Averages and geometric means were above the 200 colonies/100 ml for any of the winter, summer, and fall periods at both sites.This material is based upon work supported by the Environmental Protection Agency, region VII through a grant entitled “DNA Source Tracking of Fecal E. Coli in the Little Sac River, Missouri,” (grant X7-98740401-0). Any opinions, findings, conclusions or recommendations expressed in this publication are those of the authors and do not necessarily reflect the view of the U.S. Environmental Protection Agency

Living it : children, young people, justice

Our main aim in editing this issue has been to create a space for those who had contact with the justice system as young people to share their experiences and reflections.This issue represents an attempt to shift power and control a bit from the professionals who usually edit these types of things, to people who have lived it

Commissioning of self-management support for people with long-term conditions: an exploration of commissioning aspirations and processes

Objectives: To explore how self-management support (SMS) is considered and conceptualised by Clinical Commissioning Groups (CCGs) and whether this is reflected in strategic planning and commissioning. SMS is an essential element of long-term condition (LTC) management and CCGs are responsible for commissioning services that are coordinated, integrated and link into patient's everyday lives. This focus provides a good test and exemplar for how commissioners communicate with their local population to find out what they need.Design: A multisite, quasi-ethnographic exploration of 9 CCGs.Setting: National Health Service (NHS) CCGs in southern England, representing varied socioeconomic status, practice sizes and rural and urban areas.Data collection/analysis: Content analysis of CCG forward plans for mention of SMS. Semistructured interviews with commissioners (n=10) explored understanding of SMS and analysed thematically. The practice of commissioning explored through the observations of Service User Researchers (n=5) attending Governing Body meetings (n=10, 30?hours).Results: Observations illuminate the relative absence of SMS and gateways to active engagement with patient and public voices. Content analysis of plans point to tensions between local aspirations and those identified by NHS England for empowering patients by enhancing SMS services (‘person-centred’, whole systems). Interview data highlight disparities in the process of translating the forward plans into practice. Commissioners reference SMS as a priority yet details of local initiatives are notably absent with austerity (cost-containment) and nationally measured biomedical outcomes taking precedence.Conclusions: Commissioners conceptualise locally sensitive SMS as a means to improve health and reduce service use, but structural and financial constraints result in prioritisation of nationally driven outcome measures and payments relating to biomedical targets. Ultimately, there is little evidence of local needs driving SMS in CCGs. CCGs need to focus more on early strategic planning of lay involvement to provide an avenue for genuine engagement, so that support can be provided for communities and individuals in a way people will engage with.<br/

Upper White River Watershed Integrated Economic and Environmental Management Project

This report outlines enhanced existing local cooperative water quality efforts, sumarizes economic and physical data, and discusses how that information was used to develop analytical models.This project was partially funded by the US EPA Region 7, through the Missouri Department of Natural Resources (subgrant #G05-NPS-09), under Section 319 of the Clean Water Act

Fostering citizenship in marginalised children through participation in Community of Philosophical Inquiry

Given the key drivers around citizenship education, children’s rights, voice, and participation it is essential that all children are supported to engage in the society in which they live. This article explores how Community of Philosophical Inquiry (CoPI) might offer that support to children who are potentially marginalised due to their specific needs. The article presents three case studies of children at risk of being marginalised in school settings who participated in CoPI over a period of ten weeks. CoPI has features that may be conducive to the achievement of broad goals associated with children’s voice and citizenship education. The article explores the ways in which these particular children engaged with CoPI and the impact of participation on their behaviour. The analysis of the accounts of their teachers supports the hypothesis that potentially marginalised children appear to benefit from the structure that is inherent in this form of practical philosophy

Impact of dual antiplatelet therapy on thrombus architecture in patients with acute myocardial infarction

Mit dem raschen Aufsteigen der Koronaren Herzerkrankung zur Hauptursache für Mortalität und Morbidität weltweit ist ein tiefgreifendes Verstehen und kontinuierliche Verbesserung der Therapiestrategien der zugrundliegenden Ursachen zur Voraussetzung und Aufgabe für Forscher und Kliniker auf der ganzen Welt geworden. Die aktuelle Standardbehandlung für Patienten vor oder nach PCI ist eine duale antiaggregatorische Therapie mit ASS und einem Thrombozytenaggregationshemmer entweder aus der Thienopyridin-Gruppe (Clopidogrel, Prasugrel, Ticlopidin) oder mit einem nicht-Thienopyridin Derivat wie Ticagrelor oder Cangrelor. In dieser Studie wurde der Fokus auf die zwei Hauptrepräsentanten der Thienopyridin-Gruppe, Clopidogrel und Prasugrel gelegt. Basierend auf der Hypothese dass Prasugrel im Vergleich zu Clopidogrel nicht nur die Größe intrakoronarer Thromben reduziert, sondern auch ihre Komposition und somit die Thrombusarchitektur beeinflusst, war das Ziel dieser Studie diese Charakteristiken von intrakoronaren Thromben in einer Kohorte von STEMI-Patienten zu analysieren und zu vergleichen. Für die Studie wurden insgesamt 102 Patienten, die sich einer PCI und Thrombektomie unterzogen, rekrutiert. 51 Patienten dieser Kohorte erhielten ein Clopidogrel-, die andere Hälfte ein Prasugrel- Loading. Die Loading-Dosis war ASS 500 mg + Clopidogrel 600 mg oder ASS 500 mg + Prasugrel 60 mg entsprechend Standardklinikroutine. Die aspirierten Thromben dieser zwei Gruppen wurden im Anschluss mittels Immunhistologie weiter untersucht. Um einen differenzierten Überblick über die Thrombenkomposition zu erhalten, wurden die histologischen Schnitte neben der Standard HE-Färbung mit einer Auswahl an molekularen Biomarkern (CD14, CD42b, CD68, CD105, MIF, Grem1, TGFß) gefärbt. Die Ergebnisse wurden dann zwischen den zwei Gruppen verglichen und in Relation zu den klinischen Befunden und Patienten-Charakteristika gesetzt. Der größte signifikante Unterschied zwischen den zwei Gruppen zeigte sich hinsichtlich des Fibringehalts. Die intrakoronaren Thromben der Patienten, die mit Clopidogrel behandelt worden waren, zeigten häufiger einen Fibrinanteil von über 50% der ausgewerteten Region im Vergleich zur Prasugrel Gruppe. Angesichts der klinischen Parameter, Risikofaktoren und weiteren Patientenmerkmale zeigten sich keine wesentlichen Unterschiede zwischen den zwei Gruppen, sodass diese Parameter als potenzielle Einflussfaktoren ausgeschlossen werden können. Wir konnten auch einen Trend zu einer erhöhten CD14 Prävalenz in der Clopidogrel Gruppe aufweisen. Wenn auch nicht signifikant erhöht, so spricht dieser Trend doch für eine gesteigerte inflammatorische Reaktion mit erhöhter Beteiligung von Monozyten und Makrophagen in der Clopidogrel-Gruppe. Die übrigen Biomarker zeigten keine signifikanten Unterschiede zwischen den zwei Behandlungsarmen in Bezug auf ihre Expression. Somit konnten wir zeigen, dass ein Kausalzusammenhang zwischen Prasugrel-Loading und geringerem Fibringehalt in intrakoronaren Thromben von STEMI-Patienten besteht und dass die Art der antithrombozytären Behandlung mit Prasugrel oder Clopidogrel einen direkten Einfluss auf die Thrombusarchitektur hat

Post-mortem culture of Balamuthia mandrillaris from the brain and cerebrospinal fluid of a case of granulomatous amoebic meningoencephalitis, using human brain microvascular endothelial cells.

The first isolation in the UK of Balamuthia mandrillaris amoebae from a fatal case of granulomatous amoebic meningoencephalitis is reported. Using primary cultures of human brain microvascular endothelial cells (HBMECs), amoebae were isolated from the brain and cerebrospinal fluid (CSF). The cultures showed a cytopathic effect at 20-28 days, but morphologically identifiable B. mandrillaris amoebae were seen in cleared plaques in subcultures at 45 days. The identification of the organism was later confirmed using PCR on Chelex-treated extracts. Serum taken while the patient was still alive reacted strongly with slide antigen prepared from cultures of the post-mortem isolate, and also with those from a baboon B. mandrillaris strain at 1:10,000 in indirect immunofluorescence, but with Acanthamoeba castellanii (Neff) at 1:160, supporting B. mandrillaris to be the causative agent. If the presence of amoebae in the post-mortem CSF reflects the condition in life, PCR studies on CSF and on biopsies of cutaneous lesions may also be a valuable tool. The role of HBMECs in understanding the interactions of B. mandrillaris with the blood-brain barrier is discussed

Accuracy of Immunofluorescence in the Diagnosis of Primary Ciliary Dyskinesia

RATIONALE The standard approach to diagnosis of primary ciliary dyskinesia (PCD) in the UK consists of assessing ciliary function by high-speed-microscopy and ultrastructure by election microscopy, but equipment and expertise is not widely available internationally. The identification of bi-allelic disease causing mutations is also diagnostic, but many disease causing genes are unknown, and testing is not widely available outside the USA. Fluorescent antibodies to ciliary proteins are used to validate research genetic studies, but diagnostic utility in this disease has not been systematically evaluated. OBJECTIVES: Determine utility of a panel of six fluorescent labelled antibodies as a diagnostic tool for PCD. METHODS: Immunofluorescent labelling of nasal brushings from a discovery cohort of 35 patients diagnosed with PCD by ciliary ultrastructure, and a diagnostic accuracy cohort of 386 patients referred with symptoms suggestive of disease. The results were compared to diagnostic outcome. MEASUREMENTS AND MAIN RESULTS: Immunofluorescence correctly identified mislocalised or absent staining in 100% of the discovery cohort. In the diagnostic cohort immunofluorescence successfully identified 22 of 25 patients with PCD and normal staining in all 252 in whom PCD was considered highly unlikely. Immunofluorescence additionally provided a result in 55% (39) of cases which were previously inconclusive. Immunofluorescence results were available within 14 days, costing $187 per sample compared to electron microscopy (27 days, cost$1452). CONCLUSIONS: Immunofluorescence is a highly specific diagnostic test for PCD, and improves the speed and availability of diagnostic testing, however, sensitivity is limited and immunofluorescence is not suitable as a stand-alone test

Adequate Access to Contraception and Sexual and Reproductive Health (SRH) Information Post-Abortion: A Case Study from Nepal

This qualitative, exploratory study examined the post-abortion experiences of Nepali women, and access and uptake of safe abortion services; unsafe abortion; post-abortion contraception; and sexual and reproductive health information. Analysis revealed themes relating to women’s abortion seeking decision-making processes and barriers to high quality safe abortion services and family planning counselling. Findings emphasised the interconnectivity of sexual and reproductive health and rights; gender discrimination, reproductive coercion; education; poverty; geographical isolation; spousal separation; and women’s empowerment