Linking alkaline phosphatase activity with bacterial phoD gene abundance in soil from a long-term management trial

Changes in land management practices may have significant implications for soil microbial communities important in organic P turnover. Soil bacteria can increase plant P availability by excreting phosphatase enzymes which catalyze the hydrolysis of ester-phosphate bonds. Examining the diversity and abundance of alkaline phosphatase gene harboring bacteria may provide valuable insight into alkaline phosphatase production in soils. This study examined the effect of 20 years of no input organic (ORG), organic with composted manure (ORG + M), conventional (CONV) and restored prairie (PRA) management on soil P bioavailability, alkaline phosphatase activity (ALP), and abundance and diversity of ALP gene (phoD) harboring bacteria in soils from the northern Great Plains of Canada. Management system influenced bioavailable P (P < 0.001), but not total P, with the lowest concentrations in the ORG systems and the highest in PRA. Higher rates of ALP were observed in the ORG and ORG + M treatments with a significant negative correlation between bioavailable P and ALP in 2011 (r2 = 0.71; P = 0.03) and 2012 (r2 = 0.51; P = 0.02), suggesting that ALP activity increased under P limiting conditions. The phoD gene abundance was also highest in ORG and ORG + M resulting in a significant positive relationship between bacterial phoD abundance and ALP activity (r2 = 0.71; P = 0.009). Analysis of phoD bacterial community fingerprints showed a higher number of species in CONV compared to ORG and ORG + M, contrary to what was expected considering greater ALP activity under ORG management. In 2012, banding profiles of ORG + M showed fewer phoD bacterial species following the second manure application, although ALP activity is higher than in 2011. This indicates that a few species may be producing more ALP and that quantitative gene analysis was a better indicator of activity than the number of species present.

Soil bacterial phoD gene abundance and expression in response to applied phosphorus and long-term management

Bacterial transformation of phosphorus (P) compounds in soil is largely dependent on soil microbial community function, and is therefore sensitive to anthropogenic disturbances such as fertilization or cropping systems. However, the effect of soil management on the transcription of bacterial genes that encode phosphatases, such as phoD, is largely unknown. This greenhouse study examined the effect of long-term management and P amendment on potential alkaline phosphatase (ALP) activity and phoD gene (DNA) and transcript (RNA) abundance. Soil samples (0–15 cm) were collected from the Glenlea Long-term Rotation near Winnipeg, Manitoba, to compare organic, conventional and prairie management systems. In the greenhouse, pots of soil from each management system were amended with P as either soluble mineral fertilizer or cattle manure and then planted with Italian ryegrass (Lolium multiforum). Soils from each pot were sampled for analysis immediately and after 30 and 106 days. Significant differences among the soil/P treatments were detected for inorganic P, but not the organic P in NaHCO3-extracts. At day 0, ALP activity was similar among the soil/P treatments, but was higher after 30 days for all P amendments in soil from organically managed plots. In contrast, ALP activity in soils under conventional and prairie management responded to increasing rates of manure only, with significant effects from medium and high manure application rates at 30 and 106 days. Differences in ALP activity at 30 days corresponded to the abundance of bacterial phoD genes, which were also significantly higher in soils under organic management. However, this correlation was not significant for transcript abundance. Next-generation sequencing allowed the identification of 199 unique phoD operational taxonomic units (OTUs) from the metagenome (soil DNA) and 35 unique OTUs from the metatranscriptome (soil RNA), indicating that a subset of phoD genes was being transcribed in all soils.

Automated two-dimensional separation flow system with electrochemical preconcentration, stripping, capillary electrophoresis and contactless conductivity detection for trace metal ion analysis

This paper describes the automation of a fully electrochemical system for preconcentration, cleanup, separation and detection, comprising the hyphenation of a thin layer electrochemical flow cell with CE coupled with contactless conductivity detection (CE-C(4)D). Traces of heavy metal ions were extracted from the pulsed-flowing sample and accumulated on a glassy carbon working electrode by electroreduction for some minutes. Anodic stripping of the accumulated metals was synchronized with hydrodynamic injection into the capillary. The effect of the angle of the slant polished tip of the CE capillary and its orientation against the working electrode in the electrochemical preconcentration (EPC) flow cell and of the accumulation time were studied, aiming at maximum CE-C(4)D signal enhancement. After 6 min of EPC, enhancement factors close to 50 times were obtained for thallium, lead, cadmium and copper ions, and about 16 for zinc ions. Limits of detection below 25 nmol/L were estimated for all target analytes but zinc. A second separation dimension was added to the CE separation capabilities by staircase scanning of the potentiostatic deposition and/or stripping potentials of metal ions, as implemented with the EPC-CE-C(4)D flow system. A matrix exchange between the deposition and stripping steps, highly valuable for sample cleanup, can be straightforwardly programmed with the multi-pumping flow management system. The automated simultaneous determination of the traces of five accumulable heavy metals together with four non-accumulated alkaline and alkaline earth metals in a single run was demonstrated, to highlight the potentiality of the system.

Clustering Lab value working with medical data

Data mining is a relatively new field of research that its objective is to acquire knowledge from large amounts of data. In medical and health care areas, due to regulations and due to the availability of computers, a large amount of data is becoming available [27]. On the one hand, practitioners are expected to use all this data in their work but, at the same time, such a large amount of data cannot be processed by humans in a short time to make diagnosis, prognosis and treatment schedules. A major objective of this thesis is to evaluate data mining tools in medical and health care applications to develop a tool that can help make rather accurate decisions. In this thesis, the goal is finding a pattern among patients who got pneumonia by clustering of lab data values which have been recorded every day. By this pattern we can generalize it to the patients who did not have been diagnosed by this disease whose lab values shows the same trend as pneumonia patients does. There are 10 tables which have been extracted from a big data base of a hospital in Jena for my work .In ICU (intensive care unit), COPRA system which is a patient management system has been used. All the tables and data stored in German Language database.

Violence and reproductive health preceding flight from war : accounts from Somali born women in Sweden

Background: Political violence and war are push factors for migration and social determinants of health among migrants. Somali migration to Sweden has increased threefold since 2004, and now comprises refugees with more than 20 years of war experiences. Health is influenced by earlier life experiences with adverse sexual and reproductive health, violence, and mental distress being linked. Adverse pregnancy outcomes are reported among Somali born refugees in high-income countries. The aim of this study was to explore experiences and perceptions on war, violence, and reproductive health before migration among Somali born women in Sweden. Method: Qualitative semi-structured individual interviews were conducted with 17 Somali born refugee women of fertile age living in Sweden. Thematic analysis was applied. Results: Before migration, widespread war-related violence in the community had created fear, separation, and interruption in daily life in Somalia, and power based restrictions limited access to reproductive health services. The lack of justice and support for women exposed to non-partner sexual violence or intimate partner violence reinforced the risk of shame, stigmatization, and silence. Social networks, stoicism, and faith constituted survival strategies in the context of war. Conclusions: Several factors reinforced non-disclosure of violence exposure among the Somali born women before migration. Therefore, violence-related illness might be overlooked in the health care system. Survival strategies shaped by war contain resources for resilience and enhancement of well-being and sexual and reproductive health and rights in receiving countries after migration.

Facilitators and barriers to applying a national quality registry for quality improvement in stroke care

BACKGROUND: National quality registries (NQRs) purportedly facilitate quality improvement, while neither the extent nor the mechanisms of such a relationship are fully known. The aim of this case study is to describe the experiences of local stakeholders to determine those elements that facilitate and hinder clinical quality improvement in relation to participation in a well-known and established NQR on stroke in Sweden. METHODS: A strategic sample was drawn of 8 hospitals in 4 county councils, representing a variety of settings and outcomes according to the NQR's criteria. Semi-structured telephone interviews were conducted with 25 managers, physicians in charge of the Riks-Stroke, and registered nurses registering local data at the hospitals. Interviews, including aspects of barriers and facilitators within the NQR and the local context, were analysed with content analysis. RESULTS: An NQR can provide vital aspects for facilitating evidence-based practice, for example, local data drawn from national guidelines which can be used for comparisons over time within the organisation or with other hospitals. Major effort is required to ensure that data entries are accurate and valid, and thus the trustworthiness of local data output competes with resources needed for everyday clinical stroke care and quality improvement initiatives. Local stakeholders with knowledge of and interest in both the medical area (in this case stroke) and quality improvement can apply the NQR data to effectively initiate, carry out, and evaluate quality improvement, if supported by managers and co-workers, a common stroke care process and an operational management system that embraces and engages with the NQR data. CONCLUSION: While quality registries are assumed to support adherence to evidence-based guidelines around the world, this study proposes that a NQR can facilitate improvement of care but neither the registry itself nor the reporting of data initiates quality improvement. Rather, the local and general evidence provided by the NQR must be considered relevant and must be applied in the local context. Further, the quality improvement process needs to be facilitated by stakeholders collaborating within and outside the context, who know how to initiate, perform, and evaluate quality improvement, and who have the resources to do so.

Violence and reproductive health preceding flight from war : accounts from Somali born women in Sweden

Background: Political violence and war are push factors for migration and social determinants of health among migrants. Somali migration to Sweden has increased threefold since 2004, and now comprises refugees with more than 20 years of war experiences. Health is influenced by earlier life experiences with adverse sexual and reproductive health, violence, and mental distress being linked. Adverse pregnancy outcomes are reported among Somali born refugees in high-income countries. The aim of this study was to explore experiences and perceptions on war, violence, and reproductive health before migration among Somali born women in Sweden. Method: Qualitative semi-structured individual interviews were conducted with 17 Somali born refugee women of fertile age living in Sweden. Thematic analysis was applied. Results: Before migration, widespread war-related violence in the community had created fear, separation, and interruption in daily life in Somalia, and power based restrictions limited access to reproductive health services. The lack of justice and support for women exposed to non-partner sexual violence or intimate partner violence reinforced the risk of shame, stigmatization, and silence. Social networks, stoicism, and faith constituted survival strategies in the context of war. Conclusions: Several factors reinforced non-disclosure of violence exposure among the Somali born women before migration. Therefore, violence-related illness might be overlooked in the health care system. Survival strategies shaped by war contain resources for resilience and

The Adequacy of Health Care Services for the Elderly in China

This study examines the adequacy of health care services for the elderly in China, specifically focusing on the influence of location, method of payment, living situation, and financial status. The study finds that rural residents, respondents living alone and respondents unable to meet all of their daily costs have a lower probability of reporting the availability of adequate health care. It also investigates the reasons why elderly respondents do not visit the hospital when it is necessary, concluding that financial and distance constraints are main deterrents. Finally, changes in the reported adequacy of health care over time are taken into consideration, and are found to follow a likely pattern given the history of the health care system in China. This is an important investigation given the historical background of health care in China, the current cost problems facing residents, and, consequently, the policy changes that will need to be implemented by the Chinese government in the near future.

Effective Data Management Enables Intelligent Utility Management

Instrumentation and automation plays a vital role to managing the water industry. These systems generate vast amounts of data that must be effectively managed in order to enable intelligent decision making. Time series data management software, commonly known as data historians are used for collecting and managing real-time (time series) information. More advanced software solutions provide a data infrastructure or utility wide Operations Data Management System (ODMS) that stores, manages, calculates, displays, shares, and integrates data from multiple disparate automation and business systems that are used daily in water utilities. These ODMS solutions are proven and have the ability to manage data from smart water meters to the collaboration of data across third party corporations. This paper focuses on practical, utility successes in the water industry where utility managers are leveraging instantaneous access to data from proven, commercial off-the-shelf ODMS solutions to enable better real-time decision making. Successes include saving $650,000 / year in water loss control, safeguarding water quality, saving millions of dollars in energy management and asset management. Immediate opportunities exist to integrate the research being done in academia with these ODMS solutions in the field and to leverage these successes to utilities around the world.

On Real-Time Monitoring And Control For Efficient Management Of Drinking Water Networks: Barcelona Case Study

Drinking water utilities in urban areas are focused on finding smart solutions facing new challenges in their real-time operation because of limited water resources, intensive energy requirements, a growing population, a costly and ageing infrastructure, increasingly stringent regulations, and increased attention towards the environmental impact of water use. Such challenges force water managers to monitor and control not only water supply and distribution, but also consumer demand. This paper presents and discusses novel methodologies and procedures towards an integrated water resource management system based on advanced ICT technologies of automation and telecommunications for largely improving the efficiency of drinking water networks (DWN) in terms of water use, energy consumption, water loss minimization, and water quality guarantees. In particular, the paper addresses the first results of the European project EFFINET (FP7-ICT2011-8-318556) devoted to the monitoring and control of the DWN in Barcelona (Spain). Results are split in two levels according to different management objectives: (i) the monitoring level is concerned with all the aspects involved in the observation of the current state of a system and the detection/diagnosis of abnormal situations. It is achieved through sensors and communications technology, together with mathematical models; (ii) the control level is concerned with computing the best suitable and admissible control strategies for network actuators as to optimize a given set of operational goals related to the performance of the overall system. This level covers the network control (optimal management of water and energy) and the demand management (smart metering, efficient supply). The consideration of the Barcelona DWN as the case study will allow to prove the general applicability of the proposed integrated ICT solutions and their effectiveness in the management of DWN, with considerable savings of electricity costs and reduced water loss while ensuring the high European standards of water quality to citizens.

O gerenciamento dos resíduos dos serviços de saúde de uma amostra de hospitais nacionais

O presente trabalho constitui o Relatório Final de um projeto de pesquisa financiado pelo Núcleo de Pesquisas e Publicações da FGV-EAESP. Analisam-se nele os Planos de Gestão de Resíduos de Serviços de Saúde PGRSS de uma amostra de 70 hospitais nacionais, elaborados em 2003, como resultado de um curso de educação a distância, ministrado por um consórcio formado entre a Universidade Federal de Santa Catarina e a Fundação Getulio Vargas. O curso foi sugerido pela UNESCO e financiado por bancos internacionais, com intermediação do REFORSUS. Para cada Plano, foram tabulados, em planilha EXCEL, 164 itens, sendo 12 informações gerais sobre o hospital, 141 relativas à infra-estrutura e aos procedimentos atualmente usados e 11 referentes ao plano futuro de gestão de resíduos. Diagnosticou-se a situação desses hospitais no tocante ao manejo dos resíduos, classificados como infectantes, químicos, radioativos, comuns e perfurocortantes, desde a coleta, o armazenamento e o tratamento interno até a remoção, o tratamento externo e a disposição final. A água, desde a fonte de suprimento até seu consumo, os efluentes líquidos e as emissões gasosas também foram objeto de investigação. Foram avaliados ainda, sob os aspectos técnico e econômico, os planos elaborados pelos hospitais para a gestão futura dos seus resíduos. Os resultados da pesquisa indicam que os hospitais estudados se encontram em sua maioria numa fase incipiente em matéria de gestão dos seus resíduos, carecendo de infra-estrutura, recursos financeiros e humanos e gerenciamento, existindo considerável distância entre a gestão atual dos resíduos e as exigências legais que os hospitais devem cumprir nas áreas sanitária e ambiental.

Informatização da operação e da gestão de uma unidade de saúde de alta complexidade do sistema único de saúde (SUS): estudo de caso do instituto de medicina integral Prof. Fernando Figueira (Imip) sob o enfoque do isomorfismo institucional

O trabalho buscou identificar e avaliar a escolha do Imip à luz da teoria neoinstitucional, mediante os mecanismos isomórficos que caracterizam o campo das organizações de saúde. Trata-se de um estudo de caso, tendo o Imip como objeto de análise, voltado especificamente para dois modelos de informatização da operação e da gestão, a fim de verificar qual o mais adequado para as especificidades da instituição, incluindo o aspecto financeiro, custo/benefício. O primeiro modelo se refere a um sistema próprio de informatização; o segundo a um modelo de sistema de gestão já existente, comercializado por empresa especializada nesta tecnologia. A metodologia abrangeu pesquisas bibliográficas, documentais e de campo. O referencial teórico foi a teoria neoinstitucional e o trabalho de campo constou de uma pesquisa incluindo observação simples, visando compor variáveis dos dois modelos avaliados, e coleta de dados realizada por meio da aplicação de dois questionários: um questionário aberto, com os dirigentes do Imip, e um questionário misto, com cem colaboradores, utilizadores do sistema, escolhidos aleatoriamente, por sorteio. Entre os achados se identificou claras referências ao isomorfismo, principalmente o mimético, nas percepções dos indivíduos respondentes. Ao final da pesquisa, foi possível concluir que a contratação de um sistema de gestão hospitalar, já existente no mercado, concebido e comercializado por empresa de tecnologia especializada no segmento da saúde, justificou-se como a melhor escolha para a organização, pois, as semelhanças existentes entre os processos do Instituto e aqueles contidos no sistema eram muito mais relevantes que suas particularidades. Outro fator relevante levou em consideração os elevados custos para uma única instituição desenvolver e manter sozinha um sistema atualizado segundo as exigências normativas e técnicas necessárias às organizações de saúde e os padrões de qualidade da informação estabelecidos pelo SUS.

Parcerias com o setor privado em serviços de saúde e inovações na gestão da atenção básica: o caso da rede municipal de Suzano, SP

O objetivo dessa pesquisa é fazer uma avaliação dos resultados obtidos por novas políticas de saúde implementadas em escala municipal. Essa avaliação foi feita pela caracterização do processo de cessão parcial da rede de Atenção Básica de um município de médio porte - Suzano, SP - para gestão pelo setor privado por meio de convênio. A parceria com o setor privado na prestação de serviços de saúde é uma das mais importantes políticas introduzidas no Sistema Único de Saúde (SUS) desde sua criação; contudo, existem poucos estudos que avaliem o seu impacto na saúde da população ou no acesso aos serviços de saúde, e isso se deve à falta de compreensão sobre os variados tipos de interação entre o sistema de saúde e os atores sociais e instituições que estão envolvidos em sua implementação e gestão. O estudo foi realizado com pesquisa bibliográfica sobre a contratualização, convênios e parcerias na saúde brasileira, seguida de trabalho de campo no município de Suzano. Lá foram ouvidos gestores públicos na Secretaria Municipal de Saúde (SMS) e, depois, foram realizadas 19 entrevistas semi-estruturadas com gerentes, médicos e enfermeiros de 12 equipamentos de saúde da rede de Atenção Básica municipal. Depois foram realizadas outras 4 entrevistas com gestores da SMS. O conjunto de unidades investigado reflete a diversidade de bairros, populações e necessidades de saúde de um município de porte médio, com uma rede de saúde bastante sofisticada e avaliada positivamente dentro dos parâmetros nacionais. Verificou-se que, apesar das dificuldades e dos objetivos que ainda não foram alcançados, existe um padrão recorrente na gestão do SUS que é bastante positivo: as reformas federais que foram implementadas paulatinamente desde 1990 têm baseado-se em avaliações corretas sobre os problemas do SUS e, ainda que lentamente, têm conseguido produzir transformações positivas no mesmo.

O Sistema de Gestão do Ressarcimento ao SUS: análise de seu desempenho no período 2011-2014

O ressarcimento ao Sistema Único de Saúde (SUS), criado pela Lei n. 9.656, de 1998, apresentou resultados expressivos no período 2011-2014, em contraposição ao período 2007-2010. O presente estudo, de caráter exploratório, buscou analisar o ressarcimento ao SUS, sua origem, base legal, fundamentação jurídica, organização, funcionamento, desempenho operacional e efetividade, com foco nos resultados alcançados no período 2011-2014. Para isso, o autor apoiou-se em estudos anteriores, em documentos e relatórios oficiais, na legislação em vigor, nos acórdãos do Tribunal de Contas da União e nas ações ajuizadas perante o Supremo Tribunal Federal. As análises efetuadas indicam que os resultados alcançados nos últimos quatro anos são promissores, refletindo um cenário favorável à consolidação do ressarcimento ao SUS como um importante instrumento de regulação para o setor de saúde suplementar.