Creating a Sustainability Scorecard as a predictive tool for measuring the complex social, economic and environmental impacts of industries, a case study: assessing the viability and sustainability of the dairy industry.

Sustainability is a key driver for decisions in the management and future development of industries. The World Commission on Environment and Development (WCED, 1987) outlined imperatives which need to be met for environmental, economic and social sustainability. Development of strategies for measuring and improving sustainability in and across these domains, however, has been hindered by intense debate between advocates for one approach fearing that efforts by those who advocate for another could have unintended adverse impacts. Studies attempting to compare the sustainability performance of countries and industries have also found ratings of performance quite variable depending on the sustainability indices used. Quantifying and comparing the sustainability of industries across the triple bottom line of economy, environment and social impact continues to be problematic. Using the Australian dairy industry as a case study, a Sustainability Scorecard, developed as a Bayesian network model, is proposed as an adaptable tool to enable informed assessment, dialogue and negotiation of strategies at a global level as well as being suitable for developing local solutions.

Service providers' perceptions of active ageing among older adults with lifelong intellectual disabilities.

BACKGROUND: Considerable attention is currently being directed towards both active ageing and the revising of standards for disability services within Australia and internationally. Yet, to date, no consideration appears to have been given to ways to promote active ageing among older adults with intellectual disabilities (IDs). METHODS: Semi-structured interviews were conducted with 16 Australian professional direct-care support staff (service providers) about their perceptions of ageing among older adults with lifelong IDs and what active ageing might entail for an individual from this population who is currently under their care, in both the present and future. Data were analysed against the six core World Health Organization active ageing outcomes for people with IDs. RESULTS: Service providers appeared to be strongly focused on encouraging active ageing among their clients. However, their perceptions of the individual characteristics, circumstances and experiences of older adults with IDs for whom they care suggest that active ageing principles need to be applied to this group in a way that considers both their individual and diverse needs, particularly with respect to them transitioning from day services, employment or voluntary work to reduced activity, and finally to aged care facilities. The appropriateness of this group being placed in nursing homes in old age was also questioned. CONCLUSION: Direct-care staff of older adults with IDs have a vital role to play in encouraging and facilitating active ageing, as well as informing strategies that need to be implemented to ensure appropriate care for this diverse group as they proceed to old age.

Impact of disability on families: grandparents' perspectives.

BACKGROUND: Caring for a child with a disability can be a unique and challenging experience, with families often relying on informal networks for support. Often, grandparents are key support resources, yet little is known about their roles and experiences. Reporting on data collected in a larger Australian study, this article explores grandparents' experiences of caring for a child with a disability and the impact on their family relationships and quality of life. METHOD: A qualitative purposive sampling design was utilised; semi-structured interviews were conducted with 22 grandparents (17 women, 5 men) of children with a disability. Grandparents ranged in age from 55 to 75 years old and lived within a 90-min drive of Brisbane, Australia. Interviews were transcribed and responses analysed using a thematic approach, identifying categories, themes and patterns. FINDINGS: Four key themes characterised grandparents' views about their role in the family: holding own emotions (decision to be positive), self-sacrifice (decision to put family needs first), maintaining family relationships (being the 'go-between') and quality of life for family in the future (concerns about the future). CONCLUSIONS: Grandparents are central to family functioning and quality of life, but this contribution comes with a significant cost to their own personal well-being. Implications for policy, practice and research are discussed, particularly grandparents' fear that their family could not cope without their support.

Life in a retirement village: implications for contact with community and village friends.

BACKGROUND: Friends provide acceptance, companionship, emotional support, and are important to mental health. One reason that older adults give for seeking alternative accommodations is to reduce their loneliness and isolation. OBJECTIVE: The purpose of this study was to investigate whether older adults living in a retirement village have varying amounts of contact with friends who live within the retirement village or in the wider community. METHODS: Three hundred and twenty-three independently living residents of 25 retirement village sites were interviewed. Participants were asked a range of open and closed questions about the amount and kind of contact they had with co-resident friends and community-based friends. RESULTS: Residents engaged in several weekly visits with village friends and maintained regular contact with community friends through telephone calls. Few residents engaged in community outings or participated in village activities with either village or community friends. CONCLUSION: The nature of living in close proximity with other people, influences the amount of informal contact they have with friends. For those older individuals who seek alternative accommodation due to isolation or loneliness, re-location to congregate-style accommodation may increase their social contacts and have a positive impact on their well-being.

Prescription medication costs: a study of physician familiarity.

BACKGROUND: Studies in the past 25 years have suggested that physicians are not familiar with the costs of common prescription medications. OBJECTIVES: To determine physician familiarity with the cost of common prescription medications and to determine the value physicians place on knowing information regarding the cost of medications. DESIGN: Survey. SETTING: Seven community-based family medicine residency teaching clinics in Iowa. PARTICIPANTS: Two hundred five practicing resident and faculty physicians. INTERVENTIONS: From a series of $10 price intervals (range, $0.01-$80.00), physicians were asked to select the interval containing the cash price of the medication to an uninsured patient for 50 medications commonly prescribed in outpatient family medicine clinics. Physicians were also questioned about the value of medication cost information to their practice. MAIN OUTCOME MEASURES: The percentage of correct responses and the mean pricing scores were calculated for each respondent and for all medications. RESULTS: One hundred seventy-eight physicians responded (86.8%). Only 22.9% of the responses correctly identified the cost of the medication. More than two thirds (68.3%) of the responses underestimated the correct price interval. Branded drugs were underestimated in 89.9% of responses, while generic drugs were overestimated in 90.2% of responses. Overall, 64.4% of physicians believed they did not receive sufficient information in their practices regarding prescription drug costs, and nearly all (93.6%) reported that regular information on prescription medication costs would help them prescribe more cost-effectively. CONCLUSIONS: Physicians are unfamiliar with the costs of medications they commonly prescribe, and they report that regular access to information on prescription medication costs would help them prescribe more cost-effectively. Arch Fam Med. 2000;9:1002-1007

Assessment of patients' perceptions and beliefs regarding herbal therapies.

We evaluated the demographics and beliefs regarding safety and efficacy of herbal therapy among individuals in Iowa and assessed the willingness to discuss the use of these products with health care providers. We distributed 1300 surveys to two random samples: patients attending eight clinics, and residents of the state (mailing). Data were categorized according to herb use and compared between users and nonusers. The response rate was 61% (794 people), with 41.6% of respondents reporting herb use. They were predominately white women and were likely to have had education beyond high school (p<0.05). Their use of prescription drugs was high (p<0.05). Although users rated safety and efficacy of herbs higher than nonusers (p<0.05), both groups believed that health care providers should be aware of use and would provide this information.

Effect of probenecid on phagocytosis and intracellular killing of Staphylococcus aureus and Escherichia coli by human monocytes and granulocytes.

The present study concerns the effects of probenecid on the phagocytosis and intracellular killing of Staphylococcus aureus and Escherichia coli by human monocytes and granulocytes. In both monocytes and granulocytes the inhibitory effect on phagocytosis was very small. Inhibition of intracellular killing of S. aureus by monocytes and granulocytes by probenecid was concentration dependent, being half-maximal at about 2 mM probenecid, and near-maximal at about 5 mM probenecid. The intracellular killing could also be inhibited when probenecid was added when this process was already started. Probenecid also inhibited the intracellular killing of E. coli by granulocytes, but not by monocytes. In the concentration range used, probenecid had no toxic effect on phagocytes or bacteria during the 2 hr of the experiments.

The antibacterial activity of benzylpenicillin against Staphylococcus aureus ingested by granulocytes.

Granulocytes that had ingested pre-opsonized Staphylococcus aureus for 3 min at 37 degrees C and then had been washed twice, were incubated in the presence of benzylpenicillin. The antibiotic showed a concentration-dependent effect on cell-associated S. aureus between 0.005 and 0.1 mg/l benzylpenicillin. The antibacterial effect on cell-associated S. aureus was equal to that on opsonized S. aureus in suspension. Microscopic studies with lysostaphin showed that the number of extracellular bacteria was negligible and that the decrease in the number of cell-associated bacteria reflected the true rate of intracellular killing of S. aureus. Contrary to the generally accepted opinion that benzylpenicillin does not act intracellularly in granulocytes, we were able to show intracellular antibacterial activity of benzylpenicillin against S. aureus under the experimental conditions we used.

The influence of human monocytes on the antibacterial activity of vancomycin and teicoplanin against Staphylococcus aureus.

The influence of human monocytes on the antibacterial activity of vancomycin and teicoplanin against Staphylococcus aureus was investigated. Monocytes, which neither phagocytosed nor killed bacteria because no serum was present in the incubation medium, enhanced the effect of both antibiotics. When phagocytosis and intracellular killing were induced by the use of pre-opsonized S. aureus or the addition of serum during the incubation, the antibacterial effect of vancomycin and teicoplanin was diminished. Both antibiotics showed intracellular activity against S. aureus ingested by monocytes. In the first hour of incubation the rate of killing of ingested S. aureus was greater than that of non-phagocytosed S. aureus.

Influence of human monocytes on the antibacterial activity of kanamycin and gentamicin for Staphylococcus aureus.

The present study was performed to compare the antibacterial activities of kanamycin and gentamicin on Staphylococcus aureus phagocytosed by human monocytes and on nonphagocytosed S. aureus. The method used permitted the measurement of the effect of antibiotics on intracellular bacteria independent of phagocytosis and intracellular killing by the monocytes. A morphological assay with lysostaphin established the intracellular localization of about 70% of the cell-associated S. aureus in the monocyte-bacterium suspension. After 1 h of incubation, the antibacterial activity of both aminoglycosides was greater against intracellular than against nonphagocytosed S. aureus, but after 3 h, the reverse was true. The maximal effect on phagocytosed S. aureus, i.e., killing of about 98% of the bacteria, was reached in the first hour of incubation at kanamycin and gentamicin concentrations of 5 and 1 microgram/ml, respectively. A cell-free medium in which monocytes had been incubated increased the antibacterial activity of kanamycin, indicating that monocytes secrete a factor that enhances the antibacterial activity of aminoglycosides.

Comparison of the effect of phenoxymethylpenicillin, cloxacillin, and flucloxacillin on Staphylococcus aureus phagocytosed by human monocytes.

The antibacterial effect of phenoxymethylpenicillin, cloxacillin, and flucloxacillin on pre-opsonized Staphylococcus aureus ingested by human monocytes and on preopsonized S. aureus in suspension was compared. The antibiotics were 1.7-3 times more effective against intracellular S. aureus than against S. aureus in suspension. No influence of acid stability or lipid solubility of the drugs on the antibacterial effect against intracellular S. aureus was demonstrated.

Effect of penicillin G on Staphylococcus aureus phagocytosed by human monocytes.

The effect of penicillin G on Staphylococcus aureus after phagocytosis by human monocytes was compared with the effect on nonphagocytosed bacteria. Intracellular S. aureus was obtained by incubation of monocytes and preopsonized S. aureus for 3 min at 37 C; phagocytosis was stopped by cooling the test tubes in crushed ice. Nonphagocytosed bacteria were removed by differential centrifugation followed by two washes of the cells. Morphological studies with lysostaphin confirmed the intracellular localization of approximately 70% of the bacteria after this procedure. The antibacterial activity of penicillin G was assessed by incubation of monocytes containing ingested S. aureus with the drug at 37 C, and determination of the number of viable cell-associated bacteria was assessed microbiologically at various intervals. Inactivation of the intracellular killing mechanism of the monocytes by omission of serum during incubation allowed measurement of the effect of penicillin G apart from the bactericidal activity of the cells. The effect of penicillin G on nonphagocytosed bacteria was assessed after incubation of preopsonized S. aureus in medium with the drug. The results show that the effect of penicillin G on intracellular S. aureus is two to seven times stronger than the effect on nonphagocytosed S. aureus.

Interaction between human monocytes and penicillin G in relation to the antibacterial effect on Staphylococcus aureus.

The influence of the presence of monocytes on the effect of penicillin G on Staphylococcus aureus was studied. Conditions were varied in such a way that phagocytosis and intracellular killing of S. aureus by monocytes did not occur, was short lasting and limited, or long lasting and extensive. Synergism between penicillin G and monocytes was observed in the absence of and during limited phagocytosis and intracellular killing by the monocytes. When phagocytosis and intracellular killing were optimal, addition or antagonism between penicillin G and monocytes was observed. Enhancement of the antibacterial effect of penicillin G was also obtained in the presence of monocyte supernatant (the cell-free medium in which monocytes had been incubated for 3 hr). This indicates that monocytes secrete a factor that enhances the antibacterial activity of penicillin G. Serum inhibits the activity of this factor.

Adherence of lysostaphin to and penetration into human monocytes.

The effect of lysostaphin on Staphylococcus aureus phagocytosed by monocytes was investigated. The results showed that lysostaphin adheres to monocytes by a temperature-independent mechanism, is not adequately removed from monocytes by washing, and penetrates by means of a temperature-dependent mechanism. In in vitro assays of monocyte function, phagocytosed S. aureus can be killed by lysostaphin after penetration of the cells during incubation or by adhering lysostaphin when the monocytes are disrupted.

Interaction of povidone-iodine compounds, phagocytic cells, and microorganisms.

The interaction between povidone-iodine, phagocytic cells, and microorganisms was studied. Three preparations of povidone-iodine were investigated: commercially available povidone-iodine solution Betadine, pure high-molecular-weight povidone-iodine as used in Betadine, and a low-molecular-weight povidone-iodine. Low concentrations of povidone-iodine (approximately 0.005%) have considerable activity in vitro. The concentrations used clinically (0.1 to 20%) are toxic for granulocytes and monocytes. Leukocytes reduce the in vitro microbicidal activity of povidone-iodine. No differences of any importance were found between the three preparations of povidone-iodine.