Consensual Approaches to Resolving Public Policy Disputes

This Comment will explore various consensual approaches and their application to public disputes. Specifically, unassisted and assisted negotiation will be examined in detail.9 In addition, the specific application of consensual approaches will be explored in the context of public environmental disputes.\u270 Finally, the issue of alternative resolution to public disputes at the federal administrative level will be examined

Attitudes of Paramedic Students towards Specific Medical Conditions: A Four-Year Study

Purpose: The purpose of this study was to determine the attitude of first year students entering a paramedic course over 4 consecutive yearly intakes toward patients with intellectual disability, substance abuse, attempted suicide, and acute mental illness. Method: The students’ attitude towards four medical conditions commonly encountered in the out-of-hospital setting was assessed using the Medical Condition Regard Scale (MCRS). The MCRS score ranges from 11 to 66. Results: 230 students in Victoria, Australia, participated in the study; 66% were female, and 76% of all students \u3c 21 years of age. Students showed the most negative attitudes towards substance abuse, mean 35(SD+6.6), and the most positive attitude toward intellectual disability, mean 38.2(SD+6.3). Students in 2008 cohort displayed significantly higher regard for all medical conditions (pConclusions: The study findings suggest that these students in Victoria, Australia, entering an undergraduate paramedic or paramedic/nursing course have a relatively poor attitude towards the four reviewed medical conditions, particularly substance abuse

Global Invasive Potential of 10 Parasitic Witchweeds and Related Orobanchaceae

The plant family Orobanchaceae includes many parasitic weeds that are also impressive invaders and aggressive crop pests with several specialized features (e.g. microscopic seeds, parasitic habits). Although they have provoked several large-scale eradication and control efforts, no global evaluation of their invasive potential is as yet available. We use tools from ecological niche modeling in combination with occurrence records from herbarium specimens to evaluate the global invasive potential of each of 10 species in this assemblage, representing several of the worst global invaders. The invasive potential of these species is considerable, with all tropical and subtropical countries, and most temperate countries, vulnerable to invasions by one or more of them.I do not have complete information on funding. The work was probably supported by a Department of Defense (USA) grant to Town Peterson. RAJW was supported by US National Science Foundation (Ref: KUCR 31000)

Relationship of Patient Self-Administered COPD Assessment Test to Physician Standard Assessment of Chronic Obstructive Pulmonary Disease in a Family Medicine Residency Training Program

Assessing the global impact of chronic obstructive pulmonary disease (COPD) on a patient’s life can be difficult to perform in the clinical setting due to time constraints and workflow challenges. The primary objective of this study was to compare disease impact ratings between patient selfadministered COPD Assessment Test (CAT) and physician standard office assessment. This prospective study was conducted at a family medicine residency clinic in northeast Tennessee. The study included two study groups: 1) adult patients seen at the clinic during the 3-month study period with an active diagnosis of COPD, and 2) their physicians. Physicians’ assessment of the impact of COPD on their patients’ daily lives was compared to patients’ self-administered CAT assessments. Physician assessment of COPD impact and patient ssessment of CAT categories significantly differed (χ2 =11.0, P=0.012). There was very poor agreement between patient and physician ratings (κ=0.003), with 42.9% of physician ratings underestimating the impact, 28.6% overestimating the impact, and 28.6% orrectly estimating the impact COPD had on their patients’ lives. These findings support the use of validated assessment tools to help providers understand the symptom burden for patients with COPD

Prey range and genome evolution of Halobacteriovorax marinus predatory bacteria from an estuary

© The Author(s), 2018. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in mSphere 3 (2018): e00508-17, doi:10.1128/mSphere.00508-17.Halobacteriovorax strains are saltwater-adapted predatory bacteria that attack Gram-negative bacteria and may play an important role in shaping microbial communities. To understand how Halobacteriovorax strains impact ecosystems and develop them as biocontrol agents, it is important to characterize variation in predation phenotypes and investigate Halobacteriovorax genome evolution. We isolated Halobacteriovorax marinus BE01 from an estuary in Rhode Island using Vibrio from the same site as prey. Small, fast-moving, attack-phase BE01 cells attach to and invade prey cells, consistent with the intraperiplasmic predation strategy of the H. marinus type strain, SJ. BE01 is a prey generalist, forming plaques on Vibrio strains from the estuary, Pseudomonas from soil, and Escherichia coli. Genome analysis revealed extremely high conservation of gene order and amino acid sequences between BE01 and SJ, suggesting strong selective pressure to maintain the genome in this H. marinus lineage. Despite this, we identified two regions of gene content difference that likely resulted from horizontal gene transfer. Analysis of modal codon usage frequencies supports the hypothesis that these regions were acquired from bacteria with different codon usage biases than H. marinus. In one of these regions, BE01 and SJ carry different genes associated with mobile genetic elements. Acquired functions in BE01 include the dnd operon, which encodes a pathway for DNA modification, and a suite of genes involved in membrane synthesis and regulation of gene expression that was likely acquired from another Halobacteriovorax lineage. This analysis provides further evidence that horizontal gene transfer plays an important role in genome evolution in predatory bacteria.This research was supported by an Institutional Development award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health under grant no. P20GM103430 and funding from Providence College

Evaluating molecular diagnostic techniques for seed detection of Pseudomonas savastanoi pv. phaseolicola, causal agent of halo blight disease in mungbean (Vigna radiata)

Halo blight of mungbean (Vigna radiata var. radiata) is caused by the bacterium Pseudomonas savastanoi pv. phaseolicola. This pathogen is transmitted via infected seed, facilitating the spread of the disease into new cultivated areas. Prospective mungbean seed crops are currently subjected to visual inspection as a means of determining disease status, however, this is a poor method that relies on visible symptoms and does not account for latent infections. A range of molecular diagnostics targeting P. savastanoi pv. phaseolicola have been developed, but these have not been deployed on seeds. Quantitative PCR (qPCR) SYBR assay, hydrolysis probe, and conventional PCR, using the same primers were optimised against a plate-truthed dilution series of P. savastanoi pv. phaseolicola. The detection limit of the conventional PCR assay was approximately 9,000 CFU µl-1, while both qPCR assays could detect 9 CFU µl-1. These tests were then used to screen DNA extracted from 200 g allotments of 38 seed lots comprising six mungbean cultivars representing the primary Australian production area, and two seed lots of known infection status. Of these, the pathogen was detected in six seed lots by conventional PCR. The SYBR assay and hydrolysis probe methods detected 20 and 24 infected seed lots respectively. This shows that the hydrolysis probe method was the most effective at diagnosing the presence of P. savastanoi pv. phaseolicola in mungbean seed, providing a valuable molecular diagnostic to aid in integrated disease management and seed certification, substantially mitigating losses to halo blight disease

Preschool children perceived by mothers as irregular eaters: physical and psychosocial predictors from a Birth Cohort Study

Objective: Parents often report their children display irregular eating patterns. Our aim is to describe the stability of maternal-perceived irregular eating of their offspring from 6 months to 2-4 years of age and to investigate factors that are associated with maternal perceived irregular eating of their 2-4 year old offspring. Methods: A longitudinal mother-child linked analysis was carried out using 5 year follow-up data from a population-based prospective birth cohort of 5122 mothers who were participants in the Mater-University Study of Pregnancy, Brisbane. Measures included responses to standardized questionnaires, pediatrician review and standardized measures such as the Peabody Picture Vocabulary Test-Revised and the Child Behavior Checklist. Results: 20.2% and 7.6% of mothers respectively stated their 2-4 year old was sometimes or often an irregular eater. Continuity of feeding difficulties from age 6 months was prominent: 48% of 6 month Olds with a feeding problem were 'sometimes' or 'often' irregular eaters at age 2-4 years. From a multivariable analysis, both child-intrinsic factors (chronic physical morbidity, sleeplessness and anxiety-depressive symptoms) and factors that impinge upon the child (poor maternal health and maternal depression and anxiety) independently contributed to irregular eating status at age 2-4 years. Conclusions: We conclude that approximately one third of mothers had some concern with their child's irregular eating, 7.6% of mothers were often concerned. irregular eating children were usually physically well, more likely to have persisting feeding problems, sleeplessness, behavioral problems and lived with mothers with perceived poor physical and mental health. Ontervention strategies should be family orientated and include child, mother and mother-child psychosocial approaches

Curvature contraction of convex hypersurfaces by nonsmooth speeds

We consider contraction of convex hypersurfaces by convex speeds, homogeneous of degree one in the principal curvatures, that are not necessarily smooth. We show how to approximate such a speed by a sequence of smooth speeds for which behaviour is well known. By obtaining speed and curvature pinching estimates for the flows by the approximating speeds, independent of the smoothing parameter, we may pass to the limit to deduce that the flow by the nonsmooth speed converges to a point in finite time that, under a suitable rescaling, is round in the C^2 sense, with the convergence being exponential

Relation between falciparum malaria and bacteraemia in Kenyan children: a population-based, case-control study and a longitudinal study.

BACKGROUND: Many investigators have suggested that malaria infection predisposes individuals to bacteraemia. We tested this hypothesis with mendelian randomisation studies of children with the malaria-protective phenotype of sickle-cell trait (HbAS). METHODS: This study was done in a defined area around Kilifi District Hospital, Kilifi, Kenya. We did a matched case-control study to identify risk factors for invasive bacterial disease, in which cases were children aged 3 months to 13 years who were admitted to hospital with bacteraemia between Sept 16, 1999, and July 31, 2002. We aimed to match two controls, by age, sex, location, and time of recruitment, for every case. We then did a longitudinal case-control study to assess the relation between HbAS and invasive bacterial disease as malaria incidence decreased. Cases were children aged 0-13 years who were admitted to hospital with bacteraemia between Jan 1, 1999, and Dec 31, 2007. Controls were born in the study area between Jan 1, 2006, and June 23, 2009. Finally, we modelled the annual incidence of bacteraemia against the community prevalence of malaria during 9 years with Poisson regression. RESULTS: In the matched case-control study, we recruited 292 cases-we recruited two controls for 236, and one for the remaining 56. Sickle-cell disease, HIV, leucocyte haemozoin pigment, and undernutrition were positively associated with bacteraemia and HbAS was strongly negatively associated with bacteraemia (odds ratio 0·36; 95% CI 0·20-0·65). In the longitudinal case-control study, we assessed data from 1454 cases and 10,749 controls. During the study period, the incidence of admission to hospital with malaria per 1000 child-years decreased from 28·5 to 3·45, with a reduction in protection afforded by HbAS against bacteraemia occurring in parallel (p=0·0008). The incidence of hospital admissions for bacteraemia per 1000 child-years also decreased from 2·59 to 1·45. The bacteraemia incidence rate ratio associated with malaria parasitaemia was 6·69 (95% CI 1·31-34·3) and, at a community parasite prevalence of 29% in 1999, 62% (8·2-91) of bacteraemia cases were attributable to malaria. INTERPRETATION: Malaria infection strongly predisposes individuals to bacteraemia and can account for more than half of all cases of bacteraemia in malaria-endemic areas. Interventions to control malaria will have a major additional benefit by reducing the burden of invasive bacterial disease. FUNDING: Wellcome Trust

“I’d rather wait and see what’s around the corner”: a multi-perspective qualitative study of treatment escalation planning in frailty

Introduction People living with frailty risk adverse outcomes following even minor illnesses. Admission to hospital or the intensive care unit is associated with potentially burdensome interventions and poor outcomes. Decision-making during an emergency is fraught with complexity and potential for conflict between patients, carers and clinicians. Advance care planning is a process of shared decision-making which aims to ensure patients are treated in line with their wishes. However, planning for future care is challenging and those living with frailty are rarely given the opportunity to discuss their preferences. The aim of the ProsPECT (Prospective Planning for Escalation of Care and Treatment) study was to explore perspectives on planning for treatment escalation in the context of frailty. We spoke to people living with frailty, their carers and clinicians across primary and secondary care. Methods In-depth online or telephone interviews and online focus groups. The topic guide explored frailty, acute decision-making and planning for the future. Data were thematically analysed using the Framework Method. Preliminary findings were presented to a sample of study participants for feedback in two online workshops. Results We spoke to 44 participants (9 patients, 11 carers and 24 clinicians). Four main themes were identified: frailty is absent from treatment escalation discussions, planning for an uncertain future, escalation in an acute crisis is ‘the path of least resistance’, and approaches to facilitating treatment escalation planning in frailty. Conclusion Barriers to treatment escalation planning include a lack of shared understanding of frailty and uncertainty about the future. Emergency decision-making is focussed on survival or risk aversion and patient preferences are rarely considered. To improve planning discussions, we recommend frailty training for non-specialist clinicians, multi-disciplinary support, collaborative working between patients, carers and clinicians as well as broader public engagement