Risk of Gastroenteritis from Swimming at a Wastewater-Impacted Tropical Beach Varies across Localized Scales.

Population growth and changing climate are expected to increase human exposure to pathogens in tropical coastal waters. We examined microbiological water quality in three rivers within 2.3 km of each other that impact a Costa Rican beach and in the ocean outside their plumes during the rainy and dry seasons. We performed quantitative microbial risk assessment (QMRA) to predict the risk of gastroenteritis associated with swimming and the amount of pathogen reduction needed to achieve safe conditions. Recreational water quality criteria based on enterococci were exceeded in >90% of river samples but in only 13% of ocean samples. Multivariate analysis grouped microbial observations by subwatershed and season in river samples but only by subwatershed in the ocean. The modeled median risk from all pathogens in river samples was between 0.345 and 0.577, 10-fold above the U.S. Environmental Protection Agency (U.S. EPA) benchmark of 0.036 (36 illnesses/1,000 swimmers). Norovirus genogroup I (NoVGI) contributed most to risk, but adenoviruses raised risk above the threshold in the two most urban subwatersheds. The risk was greater in the dry compared to the rainy season, due largely to the greater frequency of NoVGI detection (100% versus 41%). Viral log10 reduction needed to ensure safe swimming conditions varied by subwatershed and season and was greatest in the dry season (3.8 to 4.1 dry; 2.7 to 3.2 rainy). QMRA that accounts for seasonal and local variability of water quality contributes to understanding the complex influences of hydrology, land use, and environment on human health risk in tropical coastal areas and can contribute to improved beach management. IMPORTANCE This holistic investigation of sanitary water quality at a Costa Rican beach assessed microbial source tracking (MST) marker genes, pathogens, and indicators of sewage. Such studies are still rare in tropical climates. Quantitative microbial risk assessment (QMRA) found that rivers impacting the beach consistently exceeded the U.S. EPA risk threshold for gastroenteritis of 36/1,000 swimmers. The study improves upon many QMRA studies by measuring specific pathogens, rather than relying on surrogates (indicator organisms or MST markers) or estimating pathogen concentrations from the literature. By analyzing microbial levels and estimating the risk of gastrointestinal illness in each river, we were able to discern differences in pathogen levels and human health risks even though all rivers were highly polluted by wastewater and were located less than 2.5 km from one another. This variability on a localized scale has not, to our knowledge, previously been demonstrated.

"Yo trato de no llorar": Rethinking Obstetric Violence in Costa Rica.

Obstetric violence is an emergent paradigm that uses gender-based violence to frame traumatic childbirth. Despite its growing popularity in the literature, it may not adequately address the nuanced ways that all actors experience these interactions. While Costa Rica adopted a nationally endorsed humane birthing policy, the semi-structured interviews on which I draw in this article show that health care personnel continue to dehumanize and objectify women; experiences considered characteristic of obstetric violence. However, women's own interpretations of their experiences are not aligned with definitions of obstetric violence. This lacuna in praxis highlights the need to critically reevaluate how birth trauma is conceptualized within a contemporary context.

Expertise effects in the Moses illusion: detecting contradictions with stored knowledge.

People frequently miss contradictions with stored knowledge; for example, readers often fail to notice any problem with a reference to the Atlantic as the largest ocean. Critically, such effects occur even though participants later demonstrate knowing the Pacific is the largest ocean (the Moses Illusion) [Erickson, T. D., & Mattson, M. E. (1981). From words to meaning: A semantic illusion. Journal of Verbal Learning & Verbal Behavior, 20, 540-551]. We investigated whether such oversights disappear when erroneous references contradict information in one's expert domain, material which likely has been encountered many times and is particularly well-known. Biology and history graduate students monitored for errors while answering biology and history questions containing erroneous presuppositions ("In what US state were the forty-niners searching for oil?"). Expertise helped: participants were less susceptible to the illusion and less likely to later reproduce errors in their expert domain. However, expertise did not eliminate the illusion, even when errors were bolded and underlined, meaning that it was unlikely that people simply skipped over errors. The results support claims that people often use heuristics to judge truth, as opposed to directly retrieving information from memory, likely because such heuristics are adaptive and often lead to the correct answer. Even experts sometimes use such shortcuts, suggesting that overlearned and accessible knowledge does not guarantee retrieval of that information.

The Obstetric Hemorrhage Initiative (OHI) in Florida: The Role of Intervention Characteristics in Influencing Implementation Experiences among Multidisciplinary Hospital Staff.

Objectives Obstetric hemorrhage is one of the leading causes of maternal mortality. The Florida Perinatal Quality Collaborative coordinates a state-wide Obstetric Hemorrhage Initiative (OHI) to assist hospitals in implementing best practices related to this preventable condition. This study examined intervention characteristics that influenced the OHI implementation experiences among Florida hospitals. Methods Purposive sampling was employed to recruit diverse hospitals and multidisciplinary staff members. A semi-structured interview guide was developed based on the following constructs from the intervention characteristics domain of the Consolidated Framework for Implementation Research: evidence strength; complexity; adaptability; and packaging. Interviews were audio-recorded, transcribed and analyzed using Atlas.ti. Results Participants (n = 50) across 12 hospitals agreed that OHI is evidence-based and supported by various information sources (scientific literature, experience, and other epidemiologic or quality improvement data). Participants believed the OHI was 'average' in complexity, with variation depending on participant's role and intervention component. Participants discussed how the OHI is flexible and can be easily adapted and integrated into different hospital settings, policies and resources. The packaging was also found to be valuable in providing materials and supports (e.g., toolkit; webinars; forms; technical assistance) that assisted implementation across activities. Conclusions for Practice Participants reflected positively with regards to the evidence strength, adaptability, and packaging of the OHI. However, the complexity of the initiative adversely affected implementation experiences and required additional efforts to maximize the initiative effectiveness. Findings will inform future efforts to facilitate implementation experiences of evidence-based practices for hemorrhage prevention, ultimately decreasing maternal morbidity and mortality.

Multiple-choice tests stabilize access to marginal knowledge.

Marginal knowledge refers to knowledge that is stored in memory, but is not accessible at a given moment. For example, one might struggle to remember who wrote The Call of the Wild, even if that knowledge is stored in memory. Knowing how best to stabilize access to marginal knowledge is important, given that new learning often requires accessing and building on prior knowledge. While even a single opportunity to restudy marginal knowledge boosts its later accessibility (Berger, Hall, & Bahrick, 1999), in many situations explicit relearning opportunities are not available. Our question is whether multiple-choice tests (which by definition expose the learner to the correct answers) can also serve this function and, if so, how testing compares to restudying given that tests can be particularly powerful learning devices (Roediger & Karpicke, 2006). In four experiments, we found that multiple-choice testing had the power to stabilize access to marginal knowledge, and to do so for at least up to a week. Importantly, such tests did not need to be paired with feedback, although testing was no more powerful than studying. Overall, the results support the idea that one's knowledge base is unstable, with individual pieces of information coming in and out of reach. The present findings have implications for a key educational challenge: ensuring that students have continuing access to information they have learned.

Using a biocultural approach to examine migration/globalization, diet quality, and energy balance.

The aim of this paper is to examine the role and impact that globalization and migration (e.g., intra-/intercontinental, urban/rural, and circular) have had on diet patterns, diet quality, and energy balance as reported on in the literature during the last 20 years. Published literature from the fields of anthropology, public health, nutrition, and other disciplines (e.g., economics) was collected and reviewed. In addition, case studies from the authors' own research are presented in order to elaborate on key points and dietary trends identified in the literature. While this review is not intended to be comprehensive, the findings suggest that the effects of migration and globalization on diet quality and energy balance are neither lineal nor direct, and that the role of social and physical environments, culture, social organization, and technology must be taken into account to better understand this relationship. Moreover, concepts such as acculturation and the nutrition transition do not necessarily explain or adequately describe all of the global processes that shape diet quality and energy balance. Theories from nutritional anthropology and critical bio-cultural medical anthropology are used to tease out some of these complex interrelationships.

"We never ate like that, not fast food, or junk foods": accounts of changing maternal diet in a tourist community in rural Costa Rica.

This investigation examines maternal diet in rural Costa Rica in the context of recent political economic changes. Results show that increased availability of non-local food items, (i.e., pizza and processed foods) has influenced maternal dietary choices. Information pathways, which have traditionally provided women with knowledge about maternal diet from family members, are also shifting. Younger women turn to the local clinic and the media for information about maternal diet, and traditional practices, such as cuarentena (40-day postpartum period), are no longer being observed. Changing practices may be linked with shifting information pathways, as well as self-reported weight gain among women.

Human maternal placentophagy: a survey of self-reported motivations and experiences associated with placenta consumption.

Maternal placentophagy, although widespread among mammals, is conspicuously absent among humans cross-culturally. Recently, however, advocates for the practice have claimed it provides human postpartum benefits. Despite increasing awareness about placentophagy, no systematic research has investigated the motivations or perceived effects of practitioners. We surveyed 189 females who had ingested their placenta and found the majority of these women reported perceived positive benefits and indicated they would engage in placentophagy again after subsequent births. Further research is necessary to determine if the described benefits extend beyond those of placebo effects, or are skewed by the nature of the studied sample.