Effect of the 2014 Clinical and Laboratory Standards Institute urine-specific breakpoints on cefazolin susceptibility rates at a community teaching hospital.

BACKGROUND: Enterobacteriaceae, which include Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis, are identified as the infectious etiology in the majority of urinary tract infections (UTIs) in community hospitals across the United States. The minimum inhibitory concentration (MIC) is a useful tool when choosing an appropriate antibacterial agent. Recent changes to the 2014 Clinical and Laboratory Standards Institute (CLSI) guidelines included reporting a urine-specific cefazolin breakpoint for enterobacteriaceae (susceptible ≤16 mcg/mL). The purpose of this study was to determine the clinical and financial impact of implementing the 2014 CLSI urine-specific breakpoints for cefazolin in a community-based teaching hospital in the Southern U.S.A. METHODS: A retrospective review of patients hospitalized from January 1, 2010 through October 1, 2014 was performed. Patients that met inclusion criteria had a documented initial clinical isolate of E. coli, K. pneumoniae, or P. mirabilis from urine cultures during each year. Descriptive statistics and two-proportion test of hypothesis were used in the analysis to compare susceptibility rates before and after implementation of the updated CLSI breakpoints for cefazolin. RESULTS: A total of 190 clinical isolates from patients were included in the study. E. coli was the most common organism isolated (63.7%), followed by K. pneumoniae (22.1%), and P. mirabilis (14.2%). 86% of the included isolates were susceptible to cefazolin using the 2010 breakpoints. Implementation of the 2014 breakpoints did not significantly impact susceptibility results for E. coli, K. pneumoniae, or P. mirabilis. CONCLUSION: Modification of breakpoints did not significantly impact susceptibility rates of cefazolin. Substituting cefazolin may decrease the overall drug cost by 77.5%. More data is needed to correlate in vitro findings with clinical outcomes using cefazolin for UTIs.

Instrument-assisted soft tissue mobilization: effects on the properties of human plantar flexors.

The effect of instrument-assisted soft tissue mobilization (ISTM) on passive properties and inflammation in human skeletal muscle has not been evaluated. Passive properties of muscle, inflammatory myokines and subjective reporting of functional ability were used to identify the effects of ISTM on the plantar flexors. 11 healthy men were measured for passive musculotendinous stiffness (MTS), passive range of motion (PROM), passive resistive torque (PASTQ) and maximum voluntary contraction peak torque (MVCPT) for plantar flexor muscles of the lower leg. Interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were measured from muscle biopsies from the gastrocnemius, and subjective measurements of functional ability were taken using the perception of functional ability questionnaire (PFAQ). MTS, PROM, PRT and MVCPT were measured in the treatment leg (TL) and control leg (CL) before, immediately after, 24 h, 48 h and 72 h following IASTM. Biopsies for IL-6 and TNF-α and PFAQ responses were collected before as well as 24 h, 48 h and 72 h after IASTM. There were no significant differences in MTS, PROM, PASTQ, MVCPT, IL-6 and TNF-α between the TL or CL. A significant decrease in the perception of function and a significant increase in pain for the TL were found following IASTM.

Mobile health technology-enabled community health workers as pesticide interventionists in rural Suriname

OBJECTIVE: To bolster access for vulnerable communities to urgent pesticide-related health information and services using a mobile health technology-enabled community health worker (CHW) strategy. DESIGN AND METHODS: The project was designed to demonstrate the effectiveness of mobile health technology–enabled CHWs in promoting safe pesticide use in pesticide-induced suicide-prone communities in Suriname. The team focused on three interconnected components: message mapping, validation, and delivery testing. The text messages were tested to assess content, literacy, and the ability to solicit a recipient response to determine the effectiveness of mobile technology as a health intervention tool. RESULTS: Thirty-nine text messages addressed the following key themes: pesticide miss/overuse, pesticide accessibility contributing to its use as an attempted or successful suicide strategy, and pesticide handling and disposal. For each of these themes, at least three messages were developed. Most text messages emphasized safe pesticide handling as the root cause of both misuse and access. (The pesticide awareness and education campaign will be expanded country-wide.) CONCLUSION: The mobile health technology- enabled CHWs functioning as pesticide interventionists demonstrated that bidirectional text messaging was a promising awareness and education intervention strategy. Focusing on safe handling was a reasonable target for intervention in the absence of a comprehensive national pesticide policy governing import, distribution, access, handling, and disposal. Of note is that none of the messages to date directly focused on suicide, confirming the strategy to address suicide prevention as a holistic public health issue under a safe pesticide use “umbrella” rather than as an isolated, stigma-provoking problem.

An evaluation of pesticide residue levels in selected produce and a medical plant in Suriname

OBJECTIVE: This specific study objective was to characterize pesticide contamination in produce and medicinal plants in Suriname. DESIGN AND METHODS: Samples were collected during different seasons from several markets in Suriname. The preliminary assessment collected 8 products from the largest market in Paramaribo during the rainy season. Results from the preliminary assessment informed the selection of products for the expanded assessment, which was focused on 7 products sampled from the same market, as well as the largest market in district Wanica during the dry season. Additionally, the vegetable Tannia was sampled at 3 other markets within Paramaribo. All samples were analyzed for pesticide residue with Gas Chromatography Electron Capture Detector. RESULTS: The preliminary assessment conveyed that 12.5% of the samples tested had pesticide residues. The expanded characterization showed that 35.3% of the samples tested positive for pesticide residues. Half of all the samples with pesticide residues exceeded either 1 or more Maximum Residual Levels (MRL) in the expanded assessment. Among the identified residues were Endosulfan and Lindane, which are banned for use in Suriname and are globally being phased out under the Stockholm Convention. CONCLUSIONS: A percentage of selected produce items cultivated in Suriname were contaminated with pesticides. To ascertain the association with adverse health effects, this research will be followed up by a human health assessment that includes a dietary assessment and biomarker testing.

Design and construction of wetlands for aqueous transfers and transformations of selected metals.

Two pilot-scale wetland cells (6.1 x 30.5 m) were integratively designed and constructed to emphasize and enhance transfers and transformations of selected metals (Cu, Pb, and Zn) in an aqueous matrix. A series of preliminary experiments and analyses were conducted to select macrofeatures (hydroperiod, hydrosoil, and vegetation) of the constructed wetland system. These wetland cells were designed to operate in series or parallel with nominal hydraulic retention times of 24-48 hr, respectively. With water at a depth of 30 cm, both wetland cells had hydrosoil (45 cm) planted with Scirpus californicus. After 250 days of wetland operation, average hydrosoil redox potentials in each wetland cell decreased from +90 mV to -165 mV, and average plant height increased from 0.3 to 2.7 m. Aqueous samples were collected over a 4.5-month period at the inflow and outflow sites of the wetland cells. Average inflow concentrations of total recoverable Cu, Pb, and Zn were 22.4, 10.5, and 565.9 micrograms/L, respectively. After a 46-hr HRT, average outflow concentrations of total recoverable Cu, Pb, and Zn were 15, 2.2, and 85.9 micrograms/L, resulting in removals of 33, 79, and 85%, respectively. Initial results suggest that these constructed wetlands can be designed to remove targeted metals in wastewater.

Relationships among petroleum refining, water and sediment contamination, and fish health.

Water, sediment, and fish were sampled from three streams that were receiving or had received effluents from oil refineries. Water and sediment samples were analyzed by gas chromatography/mass spectrometry. Each stream contained aromatic carbons including substituted benzenes and naphthalenes, which are related to oil refinery operations. Fish were identified, counted, and examined for external lesions. Lengths and weights were recorded for older bullhead catfish, and their livers were examined histologically. Differences were seen in the diversity and abundance of fish among the upstream, impacted (effluent-receiving), and downstream stations. In one stream, differences in liver pathology were observed between reference bullhead, collected from an upstream station, and those collected at impacted stations with more than 50% of the bullheads taken from impacted stations having some sort of pathological change, including one with a liver clear-cell focus, which is considered a preneoplastic lesion in rodents. These data suggest a correlation between contamination of water and sediments with aromatic hydrocarbons, presumably from refinery effluents, and compromised fish health.