Reliance on pumped mother’s milk has an environmental impact

peer-reviewedBreastfeeding is an environmentally friendly process; however when feeding relies on pumped mother’s milk, the environmental picture changes. Waste plastics and heavy metals raise concerns regarding resource efficiency, waste treatment, and detrimental effects on health. Reliance on pumped milk rather than breastfeeding may also effect obesity and family size, which in turn have further environmental impacts. Information on pump equipment rarely includes environmental information and may focus on marketing the product for maximum profit. In order for parents, health workers, and health policy makers to make informed decisions about the reliance on pumped mother’s milk, they need information on the broad and far reaching environmental aspects. There was no published research found that examined the environmental impact of using pumped mother’s milk. A project is ongoing to examine this issue

Post-Frey Procedure Quality of Life in South African Patients with Painful Chronic Pancreatitis

Context Pre- and post-Frey procedure data assessing quality of life in South African patients with painful chronic pancreatitis were compared using two instruments of measure. Objective The objective was to evaluate the post-Frey procedure quality of life and to evaluate which of the two instruments was most appropriate in such patients. Methods A prospective, observational, longitudinal study using the EORTC QLQ-C30 and a locally developed structured interview was performed. Results Between January 2002, when the QLQ-C30 was introduced, and February 2009, 45 consecutive patients underwent a Frey procedure at the Chris Hani Baragwanath Hospital in Soweto, Johannesburg, South Africa. Thirteen of these patients were lost to follow up. Thirty two participants answered both instruments before and after the procedure. Follow up data were analyzed until June 2009. The mean follow up was 24.8 months ranging from 1 to 83 months. There were clinically relevant improvements in most QLQ-C30 domains and structured interview items at the last post-operative visit. The mean pain levels (VAS 0-10 and QLQ-C30 PA) were significantly reduced post-operatively. Twenty five participants answered both instruments within six months and again later at a minimum of six months after surgery with no significant differences in the overall QLQ-C30 functional (P=0.967) and symptom (P=0.253) scale scores between the two time periods. In general, outcomes measured by the two instruments were similar. Conclusions Although the follow up period was short, results suggest that benefits were mostly made manifest within six months post-operatively and were sustained during the follow up period. The structured interview included a counseling component and locally pertinent issues not addressed in the QLQ-C30 and it is therefore recommended as the instrument of choice in this setting.Image: Chris Hani Baragwanath Academic Hospital. Johannesburg, South Afric

Embedding education for sustainable development in healthcare: opportunities for long range environmental impact mitigation from the maternity service to the home

Paper presented at Global Cleaner Production & Sustainable Consumption Conference, http://www.cleanerproductionconference.com/Significant environmental degradation and pollution effects can be attributed to healthcare. Improving the environmental performance of both hospital facilities and wider healthcare services requires healthcare professionals to respond to both challenging and changing environments. It is increasingly evident that regulation is unlikely to succeed in greening healthcare, due, in part, to differences across nations and speed at which new products and processes are developed. Within maternity services, infant feeding actions contribute to resource inefficiency, liquid, solid and electronic wastes such as single use bottles, composite material teats and collars, and breast-pumps. Given that the importance of breastfeeding is well established it should not be assumed that breastfeeding does not incur environmental impacts, as the use of breast-pumps and sterilising equipment has increased over time. The birth of a child, a significant life event, provides opportunities to influence long term behaviour and choices with respect to wider environmental considerations when raising children. Correlations between information provided by healthcare professionals and infant feeding actions among parents reveals the potential extension of this key relationship to drive change. The visibility of environmental initiatives and best practice within maternity services may serve as living laboratories for families to witness and adopt environmentally beneficial measures. Environmental education resources, for new parents and healthcare staff, have potential to deliver both wide and far reaching impacts. This paper identifies opportunities for environmental education within maternity services, assesses delivery modes using case studies, and evaluates potential impacts for both health and environmental sustainability

Backcasting to identify food waste prevention and mitigation opportunities for infant feeding in the maternity services

peer-reviewedFood waste in hospitals is of major concern for two reasons: first, healthcare needs to move toward preventative and demand led models for sustainability and second, food system sustainability needs to seek preventative measures such as diet adaptation and waste prevention. The impact of breast-milk substitute use on health services is well established in literature in terms of healthcare implications, cost and resourcing, however as a food demand and waste management issue little has been published to date. This paper presents the use of a desk based backcasting method to analyse food waste prevention, mitigation and management options within the Irish Maternity Service. Best practice in healthcare provision and waste management regulations are used to frame solutions. Strategic problem orientation revealed that 61% of the volume of ready to use breast-milk substitutes purchased by maternity services remains unconsumed and ends up as waste. Thirteen viable strategies to prevent and manage this waste were identified. Significant opportunities exist to prevent waste and also decrease food demand leading to both positive health and environmental outcomes. Backcasting methods display great promise in delivering food waste management strategies in healthcare settings, especially where evidenced best practice policies exist to inform solution forming processes. In terms of food waste prevention and management, difficulties arise in distinguishing between demand reduction, waste prevention and waste reduction measures under the current Waste Management Hierarchy definitions. Ultimately demand reduction at source requires prioritisation, a strategy which is complimentary to health policy on infant feeding

Effects of a Four-Week High-Dosage Zinc Oxide Supplemented Diet on Commensal Escherichia coli of Weaned Pigs

Strategies to reduce economic losses associated with post-weaning diarrhea in pig farming include high-level dietary zinc oxide supplementation. However, excessive usage of zinc oxide in the pig production sector was found to be associated with accumulation of multidrug resistant bacteria in these animals, presenting an environmental burden through contaminated manure. Here we report on zinc tolerance among a random selection of intestinal Escherichia coli comprising of different antibiotic resistance phenotypes and sampling sites isolated during a controlled feeding trial from 16 weaned piglets: In total, 179 isolates from “pigs fed with high zinc concentrations” (high zinc group, [HZG]: n = 99) and a corresponding “control group” ([CG]: n = 80) were investigated with regard to zinc tolerance, antimicrobial- and biocide susceptibilities by determining minimum inhibitory concentrations (MICs). In addition, in silico whole genome screening (WGSc) for antibiotic resistance genes (ARGs) as well as biocide- and heavy metal tolerance genes was performed using an in-house BLAST-based pipeline. Overall, porcine E. coli isolates showed three different ZnCl2 MICs: 128 μg/ml (HZG, 2%; CG, 6%), 256 μg/ml (HZG, 64%; CG, 91%) and 512 μg/ml ZnCl2 (HZG, 34%, CG, 3%), a unimodal distribution most likely reflecting natural differences in zinc tolerance associated with different genetic lineages. However, a selective impact of the zinc-rich supplemented diet seems to be reasonable, since the linear mixed regression model revealed a statistically significant association between “higher” ZnCl2 MICs and isolates representing the HZG as well as “lower ZnCl2 MICs” with isolates of the CG (p = 0.005). None of the zinc chloride MICs was associated with a particular antibiotic-, heavy metal- or biocide- tolerance/resistance phenotype. Isolates expressing the 512 μg/ml MIC were either positive for ARGs conferring resistance to aminoglycosides, tetracycline and sulfamethoxazole-trimethoprim, or harbored no ARGs at all. Moreover, WGSc revealed a ubiquitous presence of zinc homeostasis and – detoxification genes, including zitB, zntA, and pit. In conclusion, we provide evidence that zinc-rich supplementation of pig feed selects for more zinc tolerant E. coli, including isolates harboring ARGs and biocide- and heavy metal tolerance genes – a putative selective advantage considering substances and antibiotics currently used in industrial pork production systems

Die digitale Selbstvermessung in Lifestyle und Medizin : eine Studie zur Technikfolgenabschätzung

Digital self-quantification, also known as quantified self (QS), refers to the measuring and recording of body parameters and conditions using apps and wearables. Self-quantification aims at improved efficacy and self-optimization for better health and well-being. In medicine, QS is used rather hesitantly since products are of poor quality, particularly in terms of user data protection, and the evidence of effectiveness is often lacking. The article is based on results of the TA-SWISS study “Quantified Self – Interface between Lifestyle and Medicine”. It describes the QS phenomenon from the medical, legal, ethical, economic, and social perspectives. Future developments and potential solutions are outlined for the exploitation of opportunities arising from the use of QS in medicine and lifestyle while controlling the associated risks.Die digitale Selbstvermessung, auch Quantified Self (QS) genannt, bezeichnet das Messen und Aufzeichnen von Körperparametern und -zuständen mittels Anwenderprogrammen (Apps) und Wearables. Das Messen geschieht meist zum Zweck der Effizienzsteigerung und Selbstoptimierung für mehr Wohlbefinden und eine bessere Gesundheit. In der Medizin wird QS erst zögerlich eingesetzt, da die Qualität der Apps, insbesondere in Datenschutzbelangen, unzureichend ist und die Wirksamkeitsevidenz weitgehend fehlt. Der Artikel basiert auf Ergebnissen der TA-SWISS-Studie „Quantified Self – zwischen Lifestyle und Medizin“ und umreißt das QS-Phänomen aus medizinischer, rechtlicher, ethischer, wirtschaftlicher und gesellschaftlicher Sicht. Zudem werden künftige Entwicklungen sowie Lösungs- und Gestaltungspotenziale dargelegt

Determining Distribution and Size of Larval Pacific Geoduck Clams (Panopea Generosa Gould 1850) in Quartermaster Harbor (Washington, USA) Using a Novel Sampling Approach

Realistic species-specific information about larval life history is necessary for effective management of shellfish and parameterization of larval connectivity models. The patchiness of dispersing larvae, and the resources needed for sorting and identifying them, has limited many studies of larval distribution in the field, especially for species that are less common. In particular, little is known about in situ larval distribution of Pacific geoduck clams (Panopea generosa Gould 1850), a commercially important species found in Puget Sound, WA. A novel approach-time-integrating larval tube traps paired with molecular identification and sorting (FISH-CS)-was used to determine the distribution of geoduck larvae over 4 moat 3 stations in Quartermaster Harbor. Larvae were found consistently at the surface and thermocline rather than at the bottom. More and larger larvae were captured in the inside and middle of the harbor than the outer harbor, indicating at least some larval retention. Two pulses of larvae were captured, in March and late May to early June. Size frequency distributions of larvae indicate that these were 2 separate cohorts of larvae, with the possibility of a pulse of larvae from elsewhere toward the end of the season. The only physical parameter associated with relative larval abundance was degree of stratification, although the association was weak. These data represent the first reported study of geoduck larval distribution in the field and the first use of the FISH-CS technique for field collections. In the future, this approach can be used to answer many relevant management questions locally and more broadly, including quantifying larval export from shellfish farms, placement of restoration sites and marine protected areas, and spread of invasive species

Wer kandidiert für wen? Rekrutierungspotenziale politischer Parteien und kommunaler Wählergemeinschaften im Vergleich

In Germany, there are an estimated 200,000 seats to be filled at the local level in city and municipal councils, city council assemblies, and district councils. It is of fundamental importance for the functioning of local democracy that a sufficient number of candidates can be found for these mandates. Against this background, the recruitment potential of political parties and municipal voters’ associations with regard to candidates for mandates at the local level is examined comparatively. The data basis is a representative population survey conducted as part of the 2017 German Party Membership Study. It is shown that a good quarter of the population can in principle be won over to a candidacy at the municipal level. Ten percent would only run for a party, six percent only for a municipal voters’ association and a further ten percent for both political groups. These three candidate potentials each have a specific profile regarding their socio-structural composition and their political attitudes

Tolerance of biofilm of a carbapenem-resistant Klebsiella pneumoniae involved in a duodenoscopy-associated outbreak to the disinfectant used in reprocessing

Background One possible transmission route for nosocomial pathogens is contaminated medical devices. Formation of biofilms can exacerbate the problem. We report on a carbapenemase-producing Klebsiella pneumoniae that had caused an outbreak linked to contaminated duodenoscopes. To determine whether increased tolerance to disinfectants may have contributed to the outbreak, we investigated the susceptibility of the outbreak strain to disinfectants commonly used for duodenoscope reprocessing. Disinfection efficacy was tested on planktonic bacteria and on biofilm. Methods Disinfectant efficacy testing was performed for planktonic bacteria according to EN standards 13727 and 14561 and for biofilm using the Bead Assay for Biofilms. Disinfection was defined as ≥ 5log10 reduction in recoverable colony forming units (CFU). Results The outbreak strain was an OXA-48 carbapenemase-producing K. pneumoniae of sequence type 101. We found a slightly increased tolerance of the outbreak strain in planktonic form to peracetic acid (PAA), but not to other disinfectants tested. Since PAA was the disinfectant used for duodenoscope reprocessing, we investigated the effect of PAA on biofilm of the outbreak strain. Remarkably, disinfection of biofilm of the outbreak strain could not be achieved by the standard PAA concentration used for duodenoscope reprocessing at the time of outbreak. An increased tolerance to PAA was not observed in a K. pneumoniae type strain tested in parallel. Conclusions Biofilm of the K. pneumoniae outbreak strain was tolerant to standard disinfection during duodenoscope reprocessing. This study establishes for the first time a direct link between biofilm formation, increased tolerance to disinfectants, reprocessing failure of duodenoscopes and nosocomial transmission of carbapenem-resistant K. pneumoniae.Peer Reviewe