A Participatory Approach to Identifying Gaps in and Recommendations for Sexually Transmitted Infection and Preexposure Prophylaxis Clinical Services in Pierce County, Washington.

BACKGROUND: Pierce County, Washington, has a high burden of sexually transmitted infections (STIs) relative to Washington State and the United States. We used a participatory approach to identify gaps in STI and preexposure prophylaxis (PrEP) service provision in Pierce County and generate recommendations to address these gaps. METHODS: In collaboration with the Tacoma-Pierce County Health Department (TPCHD), we conducted 14 key informant interviews with local STI/PrEP providers from varied clinical settings. Using rapid qualitative analysis, we identified key gaps and strengths in service provision. Local, state, and national HIV/STI subject matter experts (SMEs) prioritized the gaps and recommendations to address them via an online survey. RESULTS: The primary 6 gaps ranked by SMEs (N = 32) in order of importance included the following: (1) inadequate availability of STI and PrEP services, (2) lack of awareness of STI and PrEP services, (3) need for free/low cost STI and PrEP care, (4) need for stronger relationships among providers and TPCHD, (5) reduced accessibility related to geographically distributed population and centralized services, and (6) frequent referrals pose a service barrier. Subject matter experts prioritized recommendations for each gap as follows: (1) create an STI specialty clinic, (2) implement an STI/PrEP service availability outreach campaign, (3) strengthen referral relationships between TPCHD and free/low-cost providers, (4) develop a provider support network, (5) create a mobile STI clinic, and (6) develop an STI specialty clinic. CONCLUSIONS: Sexually transmitted infection specialty clinics were prioritized by SMEs to improve access to STI and PrEP care in Pierce County, and to serve as a resource for local providers.

Mammography screening beliefs and barriers through the lens of Black women during the COVID-19 pandemic.

BACKGROUND: Mammography is an effective screening tool that leads to decreased breast cancer mortality, yet minority women continue to experience barriers. The coronavirus disease 2019 (COVID-19) pandemic has been proven to have negatively affected minority communities, yet its effect on mammography screening habits in Black women is uncertain. The purpose of this study was to evaluate breast cancer mammography screening habits and barriers for Black women in two northeast communities amid the COVID-19 pandemic. METHODS: The study participants were Black women aged 40 years or older who were recruited from community outreach initiatives. Study coordinators conducted telephone surveys to determine mammography screening behaviors, perceptions, and psychosocial factors. RESULTS: Two hundred seventy-seven surveys were completed. Two hundred fifty-six patients who reported ever having a mammogram became the study population of interest. One hundred seventy-four of these patients (68%) reported having a mammogram within the past year (nondelayed), and 82 (32%) had a mammogram more than a year ago (delayed). Only thirty-one of the delayed participants (37.8%) had private insurance. There was a significant difference in the mean score for mammography screening perceived barriers for nondelayed participants (mean = 9.9, standard deviation [SD] = 3.6) versus delayed participants (mean = 11.2, SD = 4.3, p = .03). There was also a significant difference in the mean score when they were asked, "How likely is it that 'other health problems would keep you from having a mammogram'?" (p = .002). CONCLUSIONS: Barriers to mammography screening for Black women during the COVID-19 era include insurance, competing health issues, and perceptions of screening. Community outreach efforts should concentrate on building trust and collaborating with organizations to improve screening despite the COVID-19 pandemic.

Encapsulation of wild oregano, Plectranthus amboinicus (Lour.) Spreng, phenolic extract in baker's yeast for the postharvest control of anthracnose in papaya.

BACKGROUND: Anthracnose caused by Colletotrichum gloeosporioides is considered as a major postharvest disease affecting many fruits. This plant disease is traditionally managed with synthetic fungicides, which are generally toxic and are linked to pathogen resistance. Recently, microencapsulated bioactives have been developed as potential alternative strategies to these methods, while utilizing natural fungicides and other phytochemicals. Wild oregano, Plectranthus amboinicus (Lour.) Spreng, contains potent antimicrobial phenolics, but these compounds are volatile and relatively unstable, which limits their efficacy during application. Herein, a baker's yeast microencapsulation system was applied to improve the stability of wild oregano phenolic extract (WOPE) and enhance its antifungal activity against anthracnose. RESULTS: Encapsulation of WOPE in plasmolyzed yeast cells afforded a high encapsulation efficiency (93%) and yielded WOPE-loaded yeast microcapsules (WLYMs) with an average diameter of 2.65 µm. Storage stability studies showed WLYMs are stable for at least 4 months. A 24 -h in vitro release experiment showed that WLYMs had an initial burst release upon redispersion in water, followed by a controlled release to about 80% of the loaded WOPE. Upon application as a spray-type postharvest treatment for papaya, WLYMs exhibited a significantly improved mycelial inhibitory action against C. gloeosporioides and greatly reduced the anthracnose symptoms in papaya fruits. CONCLUSION: This study presented a yeast microencapsulation system that can effectively stabilize WOPE and enhance its antifungal activity, making this microparticle formulation a promising environmentally safe postharvest treatment option to combat anthracnose symptoms in papaya fruits. © 2022 Society of Chemical Industry.

Implementation and evaluation of a Project ECHO telementoring program for the Namibian HIV workforce.

BACKGROUND: The Namibian Ministry of Health and Social Services (MoHSS) piloted the first HIV Project ECHO (Extension for Community Health Outcomes) in Africa at 10 clinical sites between 2015 and 2016. Goals of Project ECHO implementation included strengthening clinical capacity, improving professional satisfaction, and reducing isolation while addressing HIV service challenges during decentralization of antiretroviral therapy. METHODS: MoHSS conducted a mixed-methods evaluation to assess the pilot. Methods included pre/post program assessments of healthcare worker knowledge, self-efficacy, and professional satisfaction; assessment of continuing professional development (CPD) credit acquisition; and focus group discussions and in-depth interviews. Analysis compared the differences between pre/post scores descriptively. Qualitative transcripts were analyzed to extract themes and representative quotes. RESULTS: Knowledge of clinical HIV improved 17.8% overall (95% confidence interval 12.2-23.5%) and 22.3% (95% confidence interval 13.2-31.5%) for nurses. Professional satisfaction increased 30 percentage points. Most participants experienced reduced professional isolation (66%) and improved CPD credit access (57%). Qualitative findings reinforced quantitative results. Following the pilot, the Namibia MoHSS Project ECHO expanded to over 40 clinical sites by May 2019 serving more than 140 000 people living with HIV. CONCLUSIONS: Similar to other Project ECHO evaluation results in the United States of America, Namibia's Project ECHO led to the development of ongoing virtual communities of practice. The evaluation demonstrated the ability of the Namibia HIV Project ECHO to improve healthcare worker knowledge and satisfaction and decrease professional isolation.

Sexually Transmitted Disease Partner Services Costs, Other Resources, and Strategies Across Jurisdictions to Address Unique Epidemic Characteristics and Increased Incidence.

BACKGROUND: Sexually transmitted disease (STD) partner services (PS) are a core component of STD programs. Data on costs are needed to support PS programming. METHODS: In Washington State STD PS programs, disease intervention specialists (DIS) conduct telephone-based interviews and occasional field visits, offer expedited partner therapy to heterosexuals with gonorrhea or chlamydia, and promote human immunodeficiency virus (HIV) testing, preexposure prophylaxis, and HIV care. We conducted activity-based microcosting of PS, including: observational and self-reported time studies and interviews. We analyzed cost, surveillance, and service delivery data to determine costs per program outcomes. RESULTS: In King, Pierce, and Spokane counties, respectively, DIS allocated 6.5, 6.4, and 28.8 hours per syphilis case and 1.5, 1.6, and 2.9 hours per gonorrhea/chlamydia case, on average. In 2016, each full-time DIS investigated 270, 268, and 61 syphilis and 1177, 1105, and 769 gonorrhea/chlamydia cases. Greater than 80% of syphilis cases in King and Pierce were among men who have sex with men versus 38% in Spokane. Disease intervention specialists spent 12% to 39% of their time actively interviewing cases and notifying partners (clients), and the remaining time locating clients, coordinating and verifying care, and managing case reports. Time spent on expedited partner therapy, HIV testing, and referrals to HIV treatment or preexposure prophylaxis, was minimal (<5 minutes per interview) at locations with resources outside PS staff. Program cost-per-interview ranged from US $527 to US $2210 for syphilis, US $219 to US $484 for gonorrhea, and US $164 to US $547 for chlamydia. DISCUSSION: The STD PS resource needs depended on epidemic characteristics and program models. Integrating HIV prevention objectives minimally impacted PS-specific program costs. Results can inform program planning, future budget impact, and cost-effectiveness analyses.

Enhanced bioactivity and efficient delivery of quercetin through nanoliposomal encapsulation using rice bran phospholipids.

BACKGROUND: Quercetin is a phenolic compound occurring in many food plants and agricultural crops. It is reported to possess various health-promoting properties. However, the poor bioavailability of quercetin, due to its low aqueous solubility and its degradation during digestion, limits its nutraceutical applications. This study aimed to encapsulate quercetin in nanoliposomes using rice-bran phospholipids for its efficient delivery and controlled release, the protection of its structural stability, and enhancement of its bioactivity. RESULTS: Nanoliposomal encapsulation of quercetin by thin film-sonication method yielded spherical nanoparticles (157.33 ± 23.78 nm) with high encapsulation efficiency (84.92 ± 0.78%). Storage stability studies showed that nanoliposomal quercetin was stable at 4 °C and 27 °C for 6 and 5 months, respectively, as indicated by unchanged antioxidant activity and quercetin retention. Nanoliposomal quercetin showed a slow, limited release pattern in simulated gastric fluid (SGF), and an initial burst release followed by a slow constant releasing pattern in simulated intestinal fluid (SIF). A 1004-fold increase in 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical-scavenging activity was observed in quercetin nanoliposomes (SC50 = 4.04 ± 0.01 ppm) compared to non-encapsulated quercetin (SC50 = 4053.03 ± 5.61 ppm). Similarly, the anti-angiogenic activity of quercetin, as evaluated by duck embryo chorioallantoic membrane (CAM) assay, was enhanced twofold to fivefold by nanoliposomal encapsulation. CONCLUSION: This study showed that nanoliposomal encapsulation in rice-bran phospholipids enhanced the radical-scavenging and anti-angiogenic activities of quercetin. Furthermore, this study demonstrated that nanoliposomes can serve as efficient oral delivery system for quercetin. © 2018 Society of Chemical Industry.

Health-promoting bioactivities of betalains from red dragon fruit (Hylocereus polyrhizus (Weber) Britton and Rose) peels as affected by carbohydrate encapsulation.

BACKGROUND: Betalains, which are red-purple and yellow pigments, are ideal alternatives to synthetic colorants as they possess strong coloring potential and excellent health-contributing properties. However, the instability of betalains toward normal storage and biological conditions, in addition to the limited number of betalain sources, impedes their food application and diminishes their bioactivities. This study aimed to evaluate the health-promoting bioactivities of betalains from red dragon fruit (Hylocereus polyrhizus (Weber) Britton and Rose) peels as affected by encapsulation in maltodextrin-gum Arabic and maltodextrin-pectin matrices. RESULTS: Encapsulation in maltodextrin-gum Arabic and maltodextrin-pectin matrices afforded dry betalain powders after lyophilization. Optical microscopy imaging showed that the betalain powders consisted of matrix-type and shard-like microparticles. ABTS antioxidant assay revealed that maltodextrin-gum Arabic-betalain (MGB) and maltodextrin-pectin-betalain (MPB) microparticles possessed higher antioxidant capacities (195.39 ± 8.63 and 201.76 ± 4.06 µmol Trolox g-1 microparticles respectively) than the non-encapsulated betalain extract (151.07 ± 2.57 µmol Trolox g-1 extract). Duck embryo chorioallantoic membrane (CAM) vascular irritation assay showed that the anti-inflammatory activity of encapsulated betalains was five- to six-fold higher than that of non-encapsulated betalains (P ≤ 0.05). Antiangiogenic activity, as evaluated by duck embryo CAM assay, was enhanced two- to four-fold by carbohydrate encapsulation. Glutathione S-transferase (GST)-inducing activity of betalains was likewise improved four- to five-fold. CONCLUSION: The study showed that the antioxidant, anti-inflammatory, antiangiogenic and GST-inducing activities of betalains from red dragon fruit peels were enhanced through carbohydrate encapsulation. © 2016 Society of Chemical Industry.

Women's Knowledge of Genomic Testing and Precision Medicine in Breast Cancer Treatment Decision-Making.

PURPOSE: To understand awareness of genetic and genomic testing, as well as decision-making, in women diagnosed with breast cancer. PARTICIPANTS & SETTING: 29 African American/Black and Latina/Hispanic women diagnosed with breast cancer. METHODOLOGIC APPROACH: A semistructured interview guide was used in focus groups conducted via videoconference. Transcripts were analyzed using thematic analysis. FINDINGS: Many of the women understood the concept of genetic testing to identify the BRCA1/BRCA2 variant, but none of them were aware of genomic testing and its implications for personalized medicine. Participants discussed provider and patient roles in treatment decision-making, identifying roles that the physician might play in treatment planning, from primary decision-maker to collaborator. IMPLICATIONS FOR NURSING: As the number of precision cancer treatments expands, patients must be able to comprehend the information provided to make informed decisions about their treatment. Providers should do a better job of explaining potential treatments so that patients feel they are part of the decision-making process. Addressing gaps in treatment access and uptake requires providers to prioritize patient engagement and understanding.

Sister, Give Me Your Hand: a Qualitative Focus Group Study on Beliefs and Barriers to Mammography Screening in Black Women During the COVID-19 Era.

AIMS/PURPOSE: To evaluate current day challenges and beliefs about breast cancer screening for Black women in two diverse northeast communities in the midst of the COVID-19 pandemic. BACKGROUND: Breast cancer is the second leading cause of cancer-related death in women in the USA. Although Black women are less likely to be diagnosed with breast cancer, they suffer a higher mortality. Early detection of breast cancer can be accomplished through routine screening mammography, yet the effect of the COVID-19 pandemic on mammography screening barriers and perception in minority communities is uncertain. METHODS: Five focus group interviews were conducted as the first phase of a mixed method study across two heterogeneously diverse locations, Camden, New Jersey, and Brooklyn, New York. RESULTS: Thirty-three women participated in this study; sixteen women were recruited at the New Jersey location and seventeen at the New York location. Only two thirds of the women stated that they had received a mammogram within the last 2 years. The major themes were binary: I get screened or I do not get screened. Subthemes were categorized as patient related or system related. CONCLUSIONS: Our findings on factors that affect breast cancer screening decisions during the COVID-19 era include barriers that are related to poverty and insurance status, as well as those that are related to medical mistrust and negative healthcare experiences. Community outreach efforts should concentrate on building trust, providing equitable digital access, and skillfully addressing breast health perceptions.

The Impact of Delays in Low-Income Women's Breast Cancer Experiences.

BACKGROUND: Low-income, underinsured and uninsured women are less likely to be diagnosed via mammogram and more often diagnosed at later stages, with a resultant negative impact on survival. The New Jersey Cancer Education and Early Detection Program provides access to cancer screening services for low-income, underinsured and uninsured individuals. This program was recently evaluated, and it was found that enrollees were more likely to be diagnosed at later stages than nonenrollees, which may be related to delays in diagnosis and treatment OBJECTIVE: The aim of this study was to determine if there were delays in diagnosis and treatment for program enrollees and, if so, what were the causes of these delays. METHODS: A qualitative methodology was used incorporating in-depth interviews with 20 women diagnosed with breast cancer through the New Jersey Cancer Education and Early Detection Program. Qualitative content analysis was used for data analysis. RESULTS: Three themes emerged: poor access to healthcare, lack of knowledge, and sense of spirituality. Nineteen of 20 women experienced delays in care; 9 were diagnosed with late stage (III or IV) disease. CONCLUSIONS: While the lack of insurance was a factor, fear, family needs, and a tendency to not prioritize their own health were additional reasons for delays in diagnosis and treatment. IMPLICATIONS FOR PRACTICE: Programs such as this are integral to the care of low-income, uninsured individuals. However, such programs are not sufficient to meet the needs of low-income women. The lack of a usual source of care is likely to be a factor in the delays these women experienced.

Task Shifting for Initiation and Monitoring of Antiretroviral Therapy for HIV-Infected Adults in Uganda: The SHARE Trial.

BACKGROUND: With countries moving toward the World Health Organization's "Treat All" recommendation, there is a need to initiate more HIV-infected persons into antiretroviral therapy (ART). In resource-limited settings, task shifting is 1 approach that can address clinician shortages. SETTING: Uganda. METHODS: We conducted a randomized controlled trial to test if nurse-initiated and monitored ART (NIMART) is noninferior to clinician-initiated and monitored ART in HIV-infected adults in Uganda. Study participants were HIV-infected, ART-naive, and clinically stable adults. The primary outcome was a composite end point of any of the following: all-cause mortality, virological failure, toxicity, and loss to follow-up at 12 months post-ART initiation. RESULTS: Over half of the study cohort (1,760) was women (54.9%). The mean age was 35.1 years (SD 9.51). Five hundred thirty-three (31.6%) participants experienced the composite end point. At 12 months post-ART initiation, nurse-initiated and monitored ART was noninferior to clinician-initiated and monitored ART. The intention-to-treat site-adjusted risk differences for the composite end point were -4.1 [97.5% confidence interval (CI): = -9.8 to 0.2] with complete case analysis and -3.4 (97.5% CI: = -9.1 to 2.5) with multiple imputation analysis. Per-protocol site-adjusted risk differences were -3.6 (97.5% CI: = -10.5 to 0.6) for complete case analysis and -3.1 (-8.8 to 2.8) for multiple imputation analysis. This difference was within hypothesized margins (6%) for noninferiority. CONCLUSIONS: Nurses were noninferior to clinicians for initiation and monitoring of ART. Task shifting to trained nurses is a viable means to increase access to ART. Future studies should evaluate NIMART for other groups (e.g., children, adolescents, and unstable patients).

Mental Health Problems among COVID-19 Frontline Healthcare Workers and the Other Country-Level Epidemics: The Case of Mexico.

COVID-19 frontline healthcare workers (FHCW) are struggling to cope with challenges that threaten their wellbeing. We examine the frequency and predictors of the most frequent mental health problems (MHP) among FHCW during the first COVID-19 peak in Mexico, one of the most severely affected countries in terms of FHCW's COVID-19 mortality. A cross-sectional survey was conducted between May 8 and August 18, 2020. A total of 47.5% of the sample (n = 2218) were FHCW. The most frequent MHP were insomnia, depression, posttraumatic stress symptoms, and health anxiety/somatization (whole sample: 45.7, 37.4, 33.9, and 21.3%; FHCW: 52.4, 43.4, 40.3 and 26.1, respectively). As compared to during the initial COVID-19 phase, depression and health anxiety/somatization symptoms as well as experiences of grieving due to COVID-19, personal COVID-19 status, and having relatives and close friends with COVID-19 were more frequent during the COVID-19 peak. Obesity, domestic violence, personal COVID-19 status, and grieving because of COVID-19 were included in regression models for main FHCW's MHP during the COVID-19 peak. In conclusion, measures to decrease other country-level epidemics contributing to the likelihood of COVID-19 complications (obesity) and MHP (domestic violence) as well as FHCW´s probability of COVID-19 infection could safeguard not only their physical but also mental health.

Mental health problems among healthcare workers involved with the COVID-19 outbreak.

OBJECTIVE: The mental health problems and perceived needs of healthcare workers involved with coronavirus disease (COVID-19) may vary due to individual and contextual characteristics. The objective of this study was to evaluate healthcare workers' mental health problems during the common COVID-19 exposure scenario in Mexico, comparing those on the frontline with other healthcare workers according to gender and profession, determining the main risk factors for the most frequent mental health problems. METHODS: A cross-sectional online study was conducted with a non-probabilistic sample of 5,938 Mexican healthcare workers who completed brief screening measures of mental health problems and ad hoc questions about sociodemographic professional characteristics, conditions related to increased risk of COVID-19 infection, life stressors during the COVID-19 emergency, and perceived need to cope with COVID-19. RESULTS: The identified mental health problems were insomnia, depression, and posttraumatic stress disorder (PTSD), all of which were more frequent in frontline healthcare workers (52.1, 37.7, and 37.5%, respectively) and women (47.1, 33.0 %, and 16.3%, respectively). A lack of rest time was the main risk factor for insomnia (OR = 3.1, 95%CI 2.6-3.7, p ≤ 0.0001). Mourning the death of friends or loved ones due to COVID-19 was the main risk factor for depression (OR = 2.2, 95%CI 1.8-2.7, p ≤ 0.0001), and personal COVID-19 status was the main risk factor for PTSD (OR = 2.2, 95%CI 1.7-2.9, p ≤ 0.0001). CONCLUSION: The most frequent mental health problems during the common exposure scenario for COVID-19 in Mexico included the short-term psychological consequences of intense adversity. A comprehensive strategy for preventing mental health problems should focus on individuals with cumulative vulnerability and specific risk factors.

Fungal contamination of stored automobile-fuels in a tropical environment.

Because of the lack of reports, the base levels of microbial contamination on stored fuels are unknown in tropical regions and it is unclear whether these levels have some influence on fuel quality parameters. Therefore, fungal quality in automobile fuels stored across Costa Rican territory was evaluated during two years according to the standard ASTM D6974-04. For a total of 96 samples, counts and identification of molds and yeasts were performed on regular gas, premium gas and diesel taken from the bottom and superior part of the container tanks. The highest contamination was found on the bottom of the tanks, where an aqueous phase was usually identified, showing populations over the ones present in the hydrocarbon itself (up to 10(8) CFU/L). Diesel was the most contaminated fuel (up to 10(7) CFU/L); however, an alteration on the physicochemical parameters was not observed in any kind of fuel. Seventy-five mold strains were isolated, Penicillium sp. being the most common genus (45.8% of the samples), and ten yeast strains, from the genera Candida sp. and Rhodotorula sp. Four of the yeasts were able to grow on diesel as the sole carbon source, at concentrations ranging from 0.5% to 25%. Increasing the frequency of tank cleaning, adding antimicrobial agents and monitoring microbial populations are recommended strategies to improve microbial quality of stored fuels.

Trypanosoma cruzi calmodulin: cloning, expression and characterization.

We have cloned and expressed calmodulin (CaM) from Trypanosoma cruzi, for the first time, to obtain large amounts of protein. CaM is a very well conserved protein throughout evolution, sharing 100% amino acid sequence identity between different vertebrates and 99% between trypanosomatids. However, there is 89% amino acid sequence identity between T. cruzi and vertebrate CaMs. The results demonstrate significant differences between calmodulin from T. cruzi and mammals. First, a polyclonal antibody developed in an egg-yolk system to the T. cruzi CaM recognizes the autologous CaM but not the CaM from rat. Second, it undergoes a larger increase in the alpha-helix content upon binding with Ca(2+), when compared to CaM from vertebrates. Finally, two classic CaM antagonists, calmidazolium and trifluoperazine, capable of inhibiting the action of CaM in mammals when assayed on the plasma membrane Ca(2+) pump, showed a significant loss of activity when assayed upon stimulation with the T. cruzi CaM.

Molecular and biochemical characterisation of Trypanosoma cruzi phosphofructokinase.

The characterisation of the gene encoding Trypanosoma cruzi CL Brener phosphofructokinase (PFK) and the biochemical properties of the expressed enzyme are reported here. In contradiction with previous reports, the PFK genes of CL Brener and YBM strain T. cruzi were found to be similar to their Leishmania mexicana and Trypanosoma brucei homologs in terms of both kinetic properties and size, with open reading frames encoding polypeptides with a deduced molecular mass of 53,483. The predicted amino acid sequence contains the C-terminal glycosome-targeting tripeptide SKL; this localisation was confirmed by immunofluorescence assays. In sequence comparisons with the genes of other eukaryotes, it was found that, despite being an adenosine triphosphate-dependent enzyme, T. cruzi PFK shows significant sequence similarity with inorganic pyrophosphate-dependent PFKs.

A biochemical and genetic study of Leishmania donovani pyruvate kinase.

Here we present a biochemical and molecular biology study of the enzyme pyruvate kinase (PYK) from the parasitic protozoa Leishmania donovani. The PYK gene was cloned, mutagenised and over expressed and its kinetic parameters determined. Like in other kinetoplastids, L. donovani PYK is allosterically stimulated by the effector fructose 2,6 biphosphate and not by fructose 1,6 biphosphate. When the putative effector binding site of L. donovani PYK was mutagenised, we obtained two mutants with extreme kinetic behavior: Lys453Leu, which retained a sigmoidal kinetics and was little affected by the effector; and His480Gln, which deployed a hyperbolic kinetics that was not changed by the addition of the effector. Molecular Dynamics (MD) studies revealed that the mutations not only altered the effector binding site of L. donovani PYK but also changed the folding of its domain C.

Isolates of Clostridium perfringens recovered from Costa Rican patients with antibiotic-associated diarrhoea are mostly enterotoxin-negative and susceptible to first-choice antimicrobials.

To assess the prevalence of enterotoxigenic Clostridium perfringens among adults suffering from antibiotic-associated diarrhoea in a Costa Rican hospital, faecal samples were analysed from 104 patients by a cultivation approach. The 29 strains obtained, which accounted for an isolation frequency of 28 %, were genotyped and investigated with regard to their in vitro susceptibility to penicillin, imipenem, cefotaxime, chloramphenicol and metronidazole using an agar-dilution method. A multiplex PCR for detection of the toxins alpha, beta and epsilon predictably classified all faecal isolates as biotype A. An agglutination assay revealed that only one isolate synthesized detectable amounts of enterotoxin (detection rate 3 %). This result was confirmed by a PCR targeting the cpe gene. The spores of the only CPE(+) isolate did not germinate after incubation for 30 min at temperatures above 80 degrees C. Most isolates were susceptible to first-choice antimicrobials. However, unusual MICs for penicillin (16 microg ml(-1)) and metronidazole (512 microg ml(-1)) were detected in one and three isolates, respectively. The low incidence of enterotoxigenic strains suggests that C. perfringens was not a major primary cause of antibiotic-associated diarrhoea in this hospital during the sampling period.

What does participation mean? An insider perspective from people with disabilities.

PURPOSE: Although participation is an important construct and valued goal, how it is conceptualized, defined and measured varies widely. This qualitative, multi-site study sought to gain an insider perspective from people with disabilities in grounding what participation means, how to characterize it, and the barriers and supports to participation. METHOD: Sixty-three people self-identifying with diverse disabilities participated in qualitative focus groups across sites. RESULTS: Participants conceptualized participation as a cluster of values that included active and meaningful engagement/being a part of, choice and control, access and opportunity/enfranchisement, personal and societal responsibilities, having an impact and supporting others, and social connection, inclusion and membership. CONCLUSIONS: No gold standard for ideal or optimal participation emerged; no one defined set or frequency of activities accounted for 'full' participation. Participants described needing to be free to define and pursue participation on their own terms rather than meeting predetermined societal norms. Participation was viewed as both a right and a responsibility, influenced by and ascribed to the person and to the society. Participation does not occur in a vacuum; the environment dynamically influences participation. Implications of this conceptual framing for assessment, research and systems level change to support participation of people with disabilities are discussed.

[Microbiological contamination and antimicrobial activity of cristalised cane sugar on some medically important microorganisms in Costa Rica]. / Contaminación microbiológica y actividad antimicrobiana del azúcar de caña cristalizado sobre algunos agentes de interés médico en Costa Rica.

Microbiological contamination and antimicrobial activity of cristalised cane sugar on some medically important microorganisms in Costa Rica. Unrefined cristalised cane sugar, obtained after the filtration and evaporation of sugar cane juice, is a nutritional product of traditional consumption in Costa Rica and other Neotropical countries. It has been used in the topic treatment of infected wounds, with satisfactory results even with some antibiotic-ressistant bacteria. We studied the microbiological quality of 50 commercial samples. The analyses included total aerobic and anaerobic bacteria plate count; aerobic and anaerobic spore count; mold and yeast count; total and fecal coliforms; and presence of Clostridium botulinum. The antimicrobial effect was tested for Staphylococcus aureus (ATCC 25923), S. epidermidis (UCR 2902), Pseudomonas aeruginosa (ATCC 9027), Escherichia coli (ATCC 25922), Salmonella enteritidis (ATCC 13076), Listeria monocytogenes (ATCC 19116) and Aspergillus niger (Asni 06). Most of the samples (76%) presented counts lower than 100 CFU/g especially for sporulated forms (90% lower than 20 CFU/g), the mold and yeast count was higher (38% higher than 10(2) CFU/g), demonstrating the importance of these microorganisms in the spoilage of the product; 76% of the samples presented fecal contamination; C. botulinum was not isolated with the methodology employed. No inhibitory effect was observed for A. niger, but all samples han an inhibitory effect over the other species, especially for P. aeruginosa and S. aureus.