Mixed methods study: a one-week international service project enhances healthcare competencies.

Interprofessional Education Collaborative (IPEC) core competencies are widely accepted as a guide to prepare healthcare professionals. Two competency domains, values/ethics and roles and responsibilities, have specific relevance when investigating the effectiveness of a transcultural interprofessional experience. Participants were University of South Alabama students from the Colleges of Allied Health Professions, Medicine, and Nursing, who volunteered for a 7-day service learning experience in Trinidad. A convergent mixed methods research design was used. Students completed two Likert scale surveys, the Interprofessional Education Collaborative Competency Survey (IPECC) and the Transcultural Self-Efficacy Tool- Multidisciplinary Healthcare Provider Version (TSET-MHP), prior to and following the experience. A Wilcoxon Sign Test was used to analyze quantitative data. Qualitative data, guided by the Critical Incident Technique, was obtained from diary entries during the trip and a selected member focus group post-trip. There was a significant improvement in all three cultural competency domains of the TSET-MHP (p < .001). The most frequently reported IPEC sub-competencies were the ability to work in cooperation with those who receive, provide, and support care; and the ability to engage diverse healthcare providers to complement one's own professional expertise. Based on participant report, an international interprofessional clinical experience appears to be effective in enhancing health care competencies.

Relationship of human-associated microbial source tracking markers with Enterococci in Gulf of Mexico waters.

Human and ecosystem health can be damaged by fecal contamination of recreational waters. Microbial source tracking (MST) can be used to specifically detect domestic sewage containing human waste, thereby informing both risk assessment and remediation strategies. Previously, an inter-laboratory collaboration developed standardized PCR methods for a bacterial, an archaeal, and a viral indicator of human sewage. Here we present results for two subsequent years of field testing in fresh and salt water by five laboratories across the U.S. Gulf Coast (two in Florida and one each in Mississippi, Louisiana and Texas) using common standard operating procedures (SOPs) developed previously. Culturable enterococci were enumerated by membrane filtration, and PCR was used to detect three MST markers targeting domestic sewage: human-associated Bacteroides (HF183), Methanobrevibacter smithii and human polyomaviruses BK and JC (HPyVs). Detection of sewage markers in surface waters was significantly associated with higher enterococci levels and with exceedance of the recreational water quality standard in four or three regions, respectively. Sewage markers were frequently co-detected in single samples, e.g., M. smithii and HF183 were co-detected in 81% of Louisiana samples, and HPyVs and M. smithii were co-detected in over 40% of southwest Florida and Mississippi samples. This study demonstrates the robustness and inter-laboratory transferability of these three markers for the detection of pollution from domestic sewage in the waters impacting the Gulf of Mexico over a coastal range of over 1000 miles.

Validation and field testing of library-independent microbial source tracking methods in the Gulf of Mexico.

Water quality is frequently impacted by microbial pollution from human and animal feces. Microbial source tracking (MST) can identify dominant pollution sources and improve assessment of health risk compared to indicator bacteria alone. This study aims to standardize and validate MST methods across laboratories in coastal Gulf of Mexico states. Three laboratories evaluated library-independent MST methods for human sewage detection via conventional PCR: (1) human-associated Bacteroidales, (2) human polyomaviruses (HPyVs), and (3) Methanobrevibacter smithii. All methods detected targets in human sewage seeded into buffer, freshwater or marine water (100% sensitivity). The limit of detection (LOD) for human sewage was lowest for the Bacteroidales assay (10(-5)-10(-6) dilution). LODs for HPyVs and M. smithii assays were similar to each other (10(-3)-10(-4)), but were higher than Bacteroidales. The HPyVs assay was 100% specific, showing no cross-reactivity to dog, cow, cat, bird, or wild animal feces among >300 samples from three Gulf Coast regions. The human Bacteroidales assay was 96% specific, but cross-reacted with 10% of dog and some chicken samples. The M. smithii assay was 98% specific with limited cross-reactivity with cow, dog and seagull samples. An experts' workshop concluded that all methods showed sufficient accuracy and reliability to move forward. SOPs will be distributed to collaborating laboratories for further inter-laboratory comparison, and field validation will occur in year 2.