The Threat of Hospital Wastewater: An Evidence-Based Call to Action

Introduction: Hospital wastewater carries a unique composition of pollutants, a burden that includes high chemical and biological residuals. These pollutants are discharged into sewage treatment plants and natural environments where they contaminate human water sources and larger ecosystems. Water treatment plants are not designed to treat the high loads of biomedical waste and persistent organic compounds found in hospital wastewater and therefore pollutants survive in conventionally treated water. Evidence of contaminated soil, municipal wastewater, surface water, ground water, and even drinking water have been demonstrated in studies conducted around the world highlighting the ubiquity of the problem. Hospital effluent as also been implicated in the increase of antimicrobial resistance. This manuscript serves as an integrated literature review investigating the effects of hospital wastewater and its implications on environmental health. Methods: A literature search was conducted on the effects of hospital effluent through the Scopus, CINAHL, and PubMed databases using the keyword combinations: “hospital” AND “wastewater” OR “effluent”. After set inclusion and exclusion criteria, Scopus yielded 2 results, CINAHL 0, and PubMed 4 (with one duplicate article yielded by both Scopus and PubMed). A synthesis of the articles are explored herein highlighting the effect of hospital effluent on human and ecological health and implications are discussed. Results: The articles discussed in this manuscript focus on the pathogenic burden of hospital wastewater, the pharmaceutical components found in hospital wastewater and its effects on local and larger ecosystems, and the implication of hospital wastewater on antibiotic resistance. Conclusion: The management of healthcare wastewater is a topic gaining international attention. Hospital wastewater is unique in that it carries a high burden of pathogens and active pharmaceutical compounds, and provides an ideal environment for promoting antibiotic resistance. Insufficient management and removal of chemical and biological pollutants found in hospital wastewater greatly impacts environmental and human health. These consequences demand that the issue be a high priority concern for public health organizations and to enact strict policies to surveillance and regulate pollutants released into waterways. There remains a strong need to bolster research efforts in order to measure the acute and longitudinal effects of hospital wastewater on human health

Implementing an Infant-Driven Feeding Practice Model

Neonatal feeding practices have been the focus of many quality improvement studies due to large variations in care practices. Traditionally, the model for neonatal feeding has been a volume-based approach, one that focuses on a prescribed quantity consumed rather than the infant’s physiologic and developmental maturity (Fry et al., 2018). Recent literature has emphasized the benefits of a more developmentally supportive feeding approach in neonatal intensive care units (NICU), the infant-driven feeding model (IDF). The IDF model focuses on individualized care, quality of the feed, and continuous assessment of feeding cues both before and during the feeding experience. Current literature has associated the infant-driven approach with numerous positive outcomes including shorter time to attainment of oral feedings, increased velocity of weight gain, shorter length of stay, increased caregiver satisfaction, and lower cost to the family and organization (Fry et al., 2018). This Doctor of Nursing Practice (DNP) quality improvement project herein details an evidence-based educational intervention to assist in transitioning clinical staff from a volume-based to an IDF approach. This intervention draws on the PRECEDE-PROCEED framework and Theory of Reasoned Action/Planned Behavior conceptual models for support. The Outcomes were measured via pre-and post-intervention surveys to measure the effectiveness of the educational intervention on staff attitudes, knowledge, and skills. In general, the pre- and post-intervention survey results were comparable demonstrating a \u3c0.75 point deviation between intervals, however analysis and conclusions are limited due to a small sample size

The Effects Of Host Nutritional Status And Dietary Factors On The Treatment Efficacy Of Albendazole In School-Age Children Infected With Hookworm In The Kintampo North District Of Ghana

Background: In endemic settings unable to support economic growth, inexpensive anthelminthics, such as albendazole, are the cornerstone for hookworm infection treatment and control. However, the overall efficacy of albendazole against hookworm may be reduced after periodic chemotherapy. (Hotez et al., 2004) In addition, there are few studies exploring the role of nutritional status as a potential host factor influencing drug response and the constituents of diet has often been overlooked when determining anthelminthic efficacy, despite previous accounts of nutrient content of a meal or consumed food item affecting drug metabolism. Evaluating nutritional status as a potential host factor may partly explain the wide variability of drug efficacy. (Vercruysse et al., 2011) Methodology: Ghanaian school children that met inclusion criteria were selected from five communities previously identified as having high prevalence of hookworm infection. After enrolling 141 eligible school-age children for baseline assessment, those positive for hookworm infection were treated with single-dose 400 mg albendazole. Nutritional status and dietary data were assessed to identify modifiable host factors affecting treatment response. Principal Findings: Our results showed that the efficacy of single-dose oral albendazole for curing hookworm infection was significantly reduced for children with lower dietary diversity and protein intake on treatment day. In addition, children with higher dietary diversity scores within the same reference period were 3.08 times more likely than those with lower scores to experience the highest egg reduction rates (p-value 0.0430). Conclusion: The cross-sectional study provides new data on the nutritional status and dietary patterns of children in the Kintampo North Municipality and elucidates the potential role of modifiable host factors in affecting response to treatment

Communication Media for Distributed Software Design

As virtual software projects are becoming more popular, it is also more common for software design, one of the key activities in software development process, to be conducted in the distributed context. Previous research has shown that communication media had an impact on the development of shared-understanding among team members in virtual teams. However, how communication media influences the development of shared-understanding among team members in software design, an activity where communication among team members are intense and complicated, is not well-understood. Therefore, within the scope of this study, we would like to conduct a case study to examine how virtual software development teams use communication media in their software design activities and how their usage influence their shared-understanding of the user requirements and design solutions. The outcome of the study is expected to validate the Media Synchronicity Theory in the distributed software design context as well as informing practitioners of the appropriate communication media usage for conducting distributed software design

STELLAR ORIGINS OF EXTREMELY C-13- AND N-15-ENRICHED PRESOLAR SIC GRAINS: NOVAE OR SUPERNOVAE?

Extreme excesses of 13C (12C/13C < 10) and 15N (14N/15N < 20) in rare presolar SiC grains have been considered diagnostic of an origin in classical novae, though an origin in core collapse supernovae (CCSNe) has also been proposed. We report C, N, and Si isotope data for 14 submicron- to micron-sized 13C- and 15N-enriched presolar SiC grains (12C/13C < 16 and 14N/15N < ~100) from Murchison, and their correlated Mg–Al, S, and Ca–Ti isotope data when available. These grains are enriched in 13C and 15N, but with quite diverse Si isotopic signatures. Four grains with 29,30Si excesses similar to those of type C SiC grains likely came from CCSNe, which experienced explosive H burning occurred during explosions. The independent coexistence of proton- and neutron-capture isotopic signatures in these grains strongly supports heterogeneous H ingestion into the He shell in pre-supernovae. Two of the seven putative nova grains with 30Si excesses and 29Si depletions show lower-than-solar 34S/32S ratios that cannot be explained by classical nova nucleosynthetic models. We discuss these signatures within the CCSN scenario. For the remaining five putative nova grains, both nova and supernova origins are viable because explosive H burning in the two stellar sites could result in quite similar proton-capture isotopic signatures. Three of the grains are sub-type AB grains that are also 13C enriched, but have a range of higher 14N/15N. We found that 15N-enriched AB grains (~50 < 14N/15N < ~100) have distinctive isotopic signatures compared to putative nova grains, such as higher 14N/15N, lower 26Al/27Al, and lack of 30Si excess, indicating weaker proton-capture nucleosynthetic environments