Shift in the microbial ecology of a hospital hot water system following the introduction of an on-site monochloramine disinfection system

Drinking water distribution systems, including premise plumbing, contain a diverse microbiological community that may include opportunistic pathogens. On-site supplemental disinfection systems have been proposed as a control method for opportunistic pathogens in premise plumbing. The majority of on-site disinfection systems to date have been installed in hospitals due to the high concentration of opportunistic pathogen susceptible occupants. The installation of on-site supplemental disinfection systems in hospitals allows for evaluation of the impact of on-site disinfection systems on drinking water system microbial ecology prior to widespread application. This study evaluated the impact of supplemental monochloramine on the microbial ecology of a hospital's hot water system. Samples were taken three months and immediately prior to monochloramine treatment and monthly for the first six months of treatment, and all samples were subjected to high throughput Illumina 16S rRNA region sequencing. The microbial community composition of monochloramine treated samples was dramatically different than the baseline months. There was an immediate shift towards decreased relative abundance of Betaproteobacteria, and increased relative abundance of Firmicutes, Alphaproteobacteria, Gammaproteobacteria, Cyanobacteria and Actinobacteria. Following treatment, microbial populations grouped by sampling location rather than sampling time. Over the course of treatment the relative abundance of certain genera containing opportunistic pathogens and genera containing denitrifying bacteria increased. The results demonstrate the driving influence of supplemental disinfection on premise plumbing microbial ecology and suggest the value of further investigation into the overall effects of premise plumbing disinfection strategies on microbial ecology and not solely specific target microorganisms. © 2014 Baron et al

Communicating the promise, risks, and ethics of large-scale, open space microbiome and metagenome research

The public commonly associates microorganisms with pathogens. This suspicion of microorganisms is understandable, as historically microorganisms have killed more humans than any other agent while remaining largely unknown until the late seventeenth century with the works of van Leeuwenhoek and Kircher. Despite our improved understanding regarding microorganisms, the general public are apt to think of diseases rather than of the majority of harmless or beneficial species that inhabit our bodies and the built and natural environment. As long as microbiome research was confined to labs, the public's exposure to microbiology was limited. The recent launch of global microbiome surveys, such as the Earth Microbiome Project and MetaSUB (Metagenomics and Metadesign of Subways and Urban Biomes) project, has raised ethical, financial, feasibility, and sustainability concerns as to the public's level of understanding and potential reaction to the findings, which, done improperly, risk negative implications for ongoing and future investigations, but done correctly, can facilitate a new vision of "smart cities." To facilitate improved future research, we describe here the major concerns that our discussions with ethics committees, community leaders, and government officials have raised, and we expound on how to address them. We further discuss ethical considerations of microbiome surveys and provide practical recommendations for public engagement

Designing water supply and sanitation projects to meet demand in rural and peri-urban communities - Book 1: Concept, principles and practice

These guidelines are the result of two years collaborative research undertaken by WEDC with partners in Africa and South Asia. They demonstrate how water supply and sanitation projects in rural and peri-urban areas can be designed to meet user demand. The aim is to improve the use and sustainability of the services provided. The guidelines consist of three books: Book 1: Concept, Principles and Practice Book, 2: Additional Notes for Policy Makers and Planners, Book 3: Ensuring the Participation of the Poor. Concepts, Principles and Practice is intended for practitioners - engineers, social facilitators, financial specialists and managers - implementing water supply and sanitation projects in rural and peri-urban areas. This book is divided into two parts. The concept of demand is introduced in Part I, explaining what demand is and how it can be used to guide project design. Part II shows how the concept and principles described in Part I can be translated into practice, ensuring that vulnerable groups are included in the process

Designing water supply and sanitation projects to meet demand in rural and peri-urban communities - Book 2: Additional notes for policy makers and planners

These guidelines are the result of two years collaborative research undertaken by WEDC with partners in Africa and South Asia. They demonstrate how water supply and sanitation projects in rural and peri-urban areas can be designed to meet user demand. The aim is to improve the use and sustainability of the services provided. The guidelines consist of three books: Book 1: Concept, Principles and Practice, Book 2: Additional Notes for Policy Makers and Planners, Book 3: Ensuring the Participation of the Poor. This book has been written for policy makers and planners responsible for water supply and sanitation in rural and peri-urban areas. Potential readers include government staff at national, state and local levels, senior managers in non-governmental organisations and the private sector, and donor staff and advisers. This book supplements Book 1 of these guidelines. Readers should ensure they are familiar with the contents of Book 1 before reading this volume

Designing water supply and sanitation projects to meet demand in rural and peri-urban communities - Book 3: Ensuring the participation of the poor

These guidelines are the result of two years collaborative research undertaken by WEDC with partners in Africa and South Asia. They demonstrate how water supply and sanitation projects in rural and peri-urban areas can be designed to meet user demand. The aim is to improve the use and sustainability of the services provided.The guidelines consist of three books: Book 1: Concept, Principles and Practice, Book 2: Additional Notes for Policy Makers and Planners, Book 3: Ensuring the Participation of the Poor. This booklet is designed to be read in conjunction with books 1 and 2 of the Designing to Meet Demand guidelines. Whilst these describe a number of practical approaches, this third booklet focuses on a single albeit very important issue: how to ensure the participation of the poor within a demand responsive approach. If this is not done, those in most need of improved services stand every chance of being further marginalised

Clinical effectiveness and cost-effectiveness of supported mindfulness-based cognitive therapy self-help compared with supported cognitive behavioral therapy self-help for adults experiencing depression: The low-intensity guided help through mindfulness (LIGHTMind) randomized clinical trial

Importance Depression is prevalent. Treatment guidelines recommend practitioner-supported cognitive behavioral therapy self-help (CBT-SH) for mild to moderate depression in adults; however, dropout rates are high. Alternative approaches are required. Objective To determine if practitioner-supported mindfulness-based cognitive therapy self-help (MBCT-SH) is superior to practitioner-supported CBT-SH at reducing depressive symptom severity at 16 weeks postrandomization among patients with mild to moderate depression and secondarily to examine if practitioner-supported MBCT-SH is cost-effective compared with practitioner-supported CBT-SH. Design, Setting, and Participants This was an assessor- and participant-blinded superiority randomized clinical trial with 1:1 automated online allocation stratified by center and depression severity comparing practitioner-supported MBCT-SH with practitioner-supported CBT-SH for adults experiencing mild to moderate depression. Recruitment took place between November 24, 2017, and January 31, 2020. The study took place in 10 publicly funded psychological therapy services in England (Improving Access to Psychological Therapies [IAPT]). A total of 600 clients attending IAPT services were assessed for eligibility, and 410 were enrolled. Participants met diagnostic criteria for mild to moderate depression. Data were analyzed from January to October 2021. Interventions Participants received a copy of either an MBCT-SH or CBT-SH workbook and were offered 6 support sessions with a trained practitioner. Main Outcomes and Measures The preregistered primary outcome was Patient Health Questionnaire (PHQ-9) score at 16 weeks postrandomization. The primary analysis was intention-to-treat with treatment arms masked. Results Of 410 randomized participants, 255 (62.2%) were female, and the median (IQR) age was 32 (25-45) years. At 16 weeks postrandomization, practitioner-supported MBCT-SH (n = 204; mean [SD] PHQ-9 score, 7.2 [4.8]) led to significantly greater reductions in depression symptom severity compared with practitioner-supported CBT-SH (n = 206; mean [SD] PHQ-9 score, 8.6 [5.5]), with a between-group difference of −1.5 PHQ-9 points (95% CI, −2.6 to −0.4; P = .009; d = −0.36). The probability of MBCT-SH being cost-effective compared with CBT-SH exceeded 95%. However, although between-group effects on secondary outcomes were in the hypothesized direction, they were mostly nonsignificant. Three serious adverse events were reported, all deemed not study related. Conclusions and Relevance In this randomized clinical trial, practitioner-supported MBCT-SH was superior to standard recommended treatment (ie, practitioner-supported CBT-SH) for mild to moderate depression in terms of both clinical effectiveness and cost-effectiveness. Findings suggest that MBCT-SH for mild to moderate depression should be routinely offered to adults in primary care services. Trial Registration isrctn.org Identifier: ISRCTN1349575

Mathematical stories: Why do more boys than girls choose to study mathematics at AS-level in England?

Copyright @ 2005 Taylor & FrancisIn this paper I address the question: How is it that people come to choose mathematics and in what ways is this process gendered? I draw on the findings of a qualitative research study involving interviews with 43 young people all studying mathematics in post-compulsory education in England. Working within a post-structuralist framework, I argue that gender is a project and one that is achieved in interaction with others. Through a detailed reading of Toni and Claudia’s stories I explore the tensions for young women who are engaging in mathematics, something that is discursively inscribed as masculine, while (understandably) being invested in producing themselves as female. I conclude by arguing that seeing ‘doing mathematics’ as ‘doing masculinity’ is a productive way of understanding why mathematics is so male dominated and by looking at the implications of this understanding for gender and mathematics reform work.This work is funded by the ESR

Exposures to Air Pollutants during Pregnancy and Preterm Delivery

The association between preterm delivery (PTD) and exposure to air pollutants has recently become a major concern. We investigated this relationship in Incheon, Republic of Korea, using spatial and temporal modeling to better infer individual exposures. The birth cohort consisted of 52,113 singleton births in 2001–2002, and data included residential address, gestational age, sex, birth date and order, and parental age and education. We used a geographic information system and kriging methods to construct spatial and temporal exposure models. Associations between exposure and PTD were evaluated using univariate and multivariate log-binomial regressions. Given the gestational age, birth date, and the mother’s residential address, we estimated each mother’s potential exposure to air pollutants during critical periods of the pregnancy. The adjusted risk ratios for PTD in the highest quartiles of the first trimester exposure were 1.26 [95% confidence interval (CI), 1.11–1.44] for carbon monoxide, 1.27 (95% CI, 1.04–1.56) for particulate matter with aerodynamic diameter ≤ 10 μm, 1.24 (95% CI, 1.09–1.41) for nitrogen dioxide, and 1.21 (95% CI, 1.04–1.42) for sulfur dioxide. The relationships between PTD and exposures to CO, NO(2), and SO(2) were dose dependent (p < 0.001, p < 0.02, p < 0.02, respectively). In addition, the results of our study indicated a significant association between air pollution and PTD during the third trimester of pregnancy. In conclusion, our study showed that relatively low concentrations of air pollution under current air quality standards during pregnancy may contribute to an increased risk of PTD. A biologic mechanism through increased prostaglandin levels that are triggered by inflammatory mediators during exposure periods is discussed