Exploring the Process, Models, and Outcomes of Hospital-Public Health Partnerships

Health care reform has resulted in changes throughout the health system, including the Affordable Care Act (ACA) requirement that hospitals conduct community health needs assessments, taking into greater consideration the public health of their respective communities. This has led to growing strategies to develop partnerships between hospitals and public health (PH) as a way to meet these needs1. Meantime, there is a need for data on Hospital-PH partnerships, due to the growing emphasis that these types of partnerships get implemented in practice. In this paper we analyze a secondary data set to explore how hospitals and public health have engaged in partnerships prior to the ACA. We asked “How amenable have hospitals and public health agencies been to forming partnerships?” We found that while Hospitals traditionally have fewer partners, contribute fewer resources, and report fewer outcomes, they tend to report high perceptions of value and more frequent, complex partnerships. The impact of these results are important to efforts to build an evidenced-based foundation by which hospital and public health personnel can develop skills to manage these complex relationships

Radio observations of the planetary nebula around the OH/IR Star OH354.88-0.54 (V1018 Sco)

We present radio observations of the unique, recently formed, planetary nebula (PN) associated with a very long-period OH/IR variable star V1018 Sco that is unequivocally still in its asymptoticgiant branch phase. Two regions within the optical nebula are clearly detected in nonthermal radio continuum emission, with radio spectral indices comparable to those seen in colliding-wind Wolf-Rayet binaries. We suggest that these represent shocked interactions between the hot, fast stellar wind and the cold nebular shell that represents the PN's slow wind moving away from the central star. This same interface produces both synchrotron radio continuum and the optical PN emission. The fast wind is neither spherical in geometry nor aligned withany obvious optical or radio axis. We also report the detection of transient H2O maser emission in this nebula.Comment: 11 pages, LaTeX (mn2e.cls), incl. 9 PostScript (ps or eps) figures and 2 tables. Accepted by MNRA

Sex and seasonal differences in diet and nutrient intake in Verreaux\u27s sifakas (Propithecus verreauxi)

Fluctuations in food availability are a major challenge faced by primates living in seasonal climates. Variation in food availability can be especially challenging for females, because of the high energetic costs of reproduction. Therefore, females must adapt the particular demands of the different reproductive stages to the seasonal availability of resources. Madagascar has a highly seasonal climate, where food availability can be extremely variable. We investigated the seasonal changes in diet composition, nutrient and energy intake of female and male sifakas (Propithecus verreauxi) in a dry deciduous forest in western Madagascar. We examined how females adjust their diet to different reproductive stages. Seasonality affected the diet of both sexes; particularly in the dry season (Apr–Oct) with low availability of food items, especially fruits, males and females had a reduced nutrient and energy intake compared to the wet season (Nov–Mar) with higher food and fruit availability. The comparison of the diet between sexes in different reproductive stages showed that during the late stage of lactation (Nov–Jan) females had higher food intake, and as a result they had a higher intake of macronutrients (crude protein, fat and non-structured carbohydrates (TNC)) and energy than males. These differences were not present during the pregnancy of females, with both sexes having similar intake of macronutrients and energy during that stage. The increase in the intake of macronutrients observed for females during late lactation could be related to the higher energetic demands of this stage of reproduction. Thus, the observed pattern in the diet indicates that sifaka females are following a capital breeding strategy, whereby females potentially store enough nutrients to cope with the reproduction costs in periods of low food availability

The cost of living in larger primate groups includes higher fly densities

Flies are implicated in carrying and mechanically transmitting many primate pathogens. We investigated how fly associations vary across six monkey species (Cercopithecus ascanius, Cercopithecus mitis, Colobus guereza, Lophocebus albigena, Papio anubis, and Piliocolobus tephrosceles) and whether monkey group size impacts fly densities. Fly densities were generally higher inside groups than outside them, and considering data from these primate species together revealed that larger groups harbored more flies. Within species, this pattern was strongest for colobine monkeys, and we speculate this might be due to their smaller home ranges, suggesting that movement patterns may influence fly–primate associations. Fly associations increase with group sizes and may thus represent a cost to sociality

Making waves. Bridging theory and practice towards multiple stressor management in freshwater ecosystems

Embargo until February 26, 2023Despite advances in conceptual understanding, single-stressor abatement approaches remain common in the management of fresh waters, even though they can produce unexpected ecological responses when multiple stressors interact. Here we identify limitations restricting the development of multiple-stressor management strategies and address these, bridging theory and practice, within a novel empirical framework. Those critical limitations include that (i) monitoring schemes fall short of accounting for theory on relationships between multiple-stressor interactions and ecological responses, (ii) current empirical modelling approaches neglect the prevalence and intensity of multiple-stressor interactions, and (iii) mechanisms of stressor interactions are often poorly understood. We offer practical recommendations for the use of empirical models and experiments to predict the effects of freshwater degradation in response to changes in multiple stressors, demonstrating this approach in a case study. Drawing on our framework, we offer practical recommendations to support the development of effective management strategies in three general multiple-stressor scenarios.acceptedVersio

HIV Infection Linked to Injection Use of Oxymorphone in Indiana, 2014-2015

BACKGROUND: In January 2015, a total of 11 new diagnoses of human immunodeficiency virus (HIV) infection were reported in a small community in Indiana. We investigated the extent and cause of the outbreak and implemented control measures. METHODS: We identified an outbreak-related case as laboratory-confirmed HIV infection newly diagnosed after October 1, 2014, in a person who either resided in Scott County, Indiana, or was named by another case patient as a syringe-sharing or sexual partner. HIV polymerase (pol) sequences from case patients were phylogenetically analyzed, and potential risk factors associated with HIV infection were ascertained. RESULTS: From November 18, 2014, to November 1, 2015, HIV infection was diagnosed in 181 case patients. Most of these patients (87.8%) reported having injected the extended-release formulation of the prescription opioid oxymorphone, and 92.3% were coinfected with hepatitis C virus. Among 159 case patients who had an HIV type 1 pol gene sequence, 157 (98.7%) had sequences that were highly related, as determined by phylogenetic analyses. Contact tracing investigations led to the identification of 536 persons who were named as contacts of case patients; 468 of these contacts (87.3%) were located, assessed for risk, tested for HIV, and, if infected, linked to care. The number of times a contact was named as a syringe-sharing partner by a case patient was significantly associated with the risk of HIV infection (adjusted risk ratio for each time named, 1.9; P<0.001). In response to this outbreak, a public health emergency was declared on March 26, 2015, and a syringe-service program in Indiana was established for the first time. CONCLUSIONS: Injection-drug use of extended-release oxymorphone within a network of persons who inject drugs in Indiana led to the introduction and rapid transmission of HIV. (Funded by the state government of Indiana and others.)