气溶胶中抗生素抗性基因研究进展:以养殖场和医院为例

抗生素在医药和养殖业的大量使用导致耐药菌的出现,加速了抗生素抗性基因(antibiotic resistance genes,ARGs)在不同环境介质中的传播扩散,抗生素耐药性已成为目前全球卫生、食品安全和发展的最大威胁之一。气溶胶作为ARGs的潜在储存库缺乏系统的研究数据,而通过空气传播具有较高抗生素抗性水平的细菌可能是引起重要疾病的主要传播途径。本文针对养殖场和医院2个抗生素大量使用的典型场所,对气溶胶中ARGs的污染现状、样品采集与检测技术进行综述,并探讨了这一环境污染的潜在风险,表明开展气溶胶中ARGs研究的必要性,并为以后需开展的工作提出几点建议。     

Violence breeds violence: burnout as a mediator between patient violence and nurse violence

The present study examines whether patient-perpetrated violence triggers anger, hatred and other negative emotions that, under certain circumstances, might motivate nurses to behave violently with patients. In doing so, this study considers burnout as a mediator in the patient violence–nurse violence relationship. To test the causal paths, data were collected from 182 nurses working in two government-sector teaching hospitals of Pakistan's Punjab province. Results confirm that patient violence toward nurses leads to nurse violence toward patients through the mediating effect of burnout. The study advises hospitals to provide wellness and stress management programs to nurses who regularly experience events involving patient violence. Hospitals may consider allowing nurses to take short breaks after an encounter with violently behaving patients. In addition, hospitals should conduct empathy-promoting training, emotional intelligence training and ‘lens of the patient’ training programs to sensitize their nursing staff.     

Mercury Vapor Determination in Hospitals

The measurements of metallic mercury vapor were carried out in seven local hospitals, where mercury-containing products are widely used, as well as in one residence to check effectiveness of decontamination after mercury spillage. Hopcalite as a solid sorbent was used in active and passive sampling methods, and mercury was analyzed by CV-AAS technique. Good agreement was found between results of mercury measurements using active samplers (pumped hopcalite adsorption tubes) and passive (diffusion) monitors applied in indoor atmosphere. The results indicated the presence of metallic mercury vaporization sources in the assessed hospital rooms but in the majority of cases mercury levels did not exceed 1 g/m³ i.e. Polish permissible concentration for residence. However, in some of the hospital rooms, elevated concentrations of mercury vapor were found and airborne levels of up to 13.9 g/m³ were recorded. Higher concentrations of mercury vapor were observed in autumn season when compared to summer.     

广州医院低分子量羰基化合物研究

2004年1月2日-3月20日对广州市区4家医院室内外的低分子量羰基化合物进行了检测.实验方法是应用羰基化合物和2,4-二硝基苯肼(DNPH)迅速反应生成衍生物,产物在高效液相色谱上进行检测;每家医院连续采样5 d.结果表明:广州医院丙酮的质量浓度最高,其次是乙醛和甲醛,除甲醛外,室内羰基化合物的质量浓度稍高于室外;羰基化合物之间的相关性不好,可能是它们的来源比较复杂,如车辆排放、建筑装饰材料、医用试剂等,其中广泛使用酒精消毒可能是医院乙醛质量浓度偏高的原因.对医院甲醛、乙醛在人体内的暴露水平做了讨论,与其他类似场所相比,医院的暴露风险相对较小.      

A biotechnological agenda for the third world

Third World countries should exploit the genetic information stored in their flora and fauna to develop independent and highly competitive biotechnological and pharmaceutical industries. The necessary condition for this policy to succeed is the reshaping of their universities and hospitals—to turn them into high-caliber research institutions dedicated to the creation of original knowledge and biomedical invention. Part of the service of the Third World foreign debt should be co-invested with the lending banks in high technology enterprises. This should be complemented with an active program of investments in First World biotech companies and university research departments which could contribute to the solving of problems connected with the First World. These strategic alliances would allow effective training of molecular biologists, improvement of South American universities, and education of biotechnologists, managers, and lawyers in the complexities of high-technology business. The establishment of real joint ventures between developed and underdeveloped countries might contribute to change the present strained relations between the North and the South, and science and technology could become real forces of social and economic development.     

Water quality supply in a Portuguese teaching hospital: monitoring and studies on detection of critical points

Surveillance of drinking water quality is extremely important to human health, assuming greater relevance in hospital environments, especially to those individuals who are immunocompromised. This study is aimed to determine the effect of increasing free chlorine (Cl) concentration in a hospital water network in regard to water quality monitoring and microbial growth control, between 2010 and 2013 in Porto. The average of free Cl concentration in the period under analysis showed some heterogeneity per floor, varying between 0.84 and 1.25 mg/L. In addition, there was a rise in proportion of samples that exceeded WHO guidelines (free Cl ≥ 0.5 mg/L), particularly in the last two years of the same period. With respect to microbial analysis, 22.4% of the samples were positive for Legionella spp., 6.4% for Pseudomonas aeruginosa, 15% and 30.4% for aerobic plate counts at 36 and 22 ºC, respectively. The proportion of positive samples decreased throughout the period under analysis, in particular for Legionella spp. (41.7% in 2010 vs. non-detectable in 2013) and P. aeruginosa (10.8% in 2010 vs. 3.3% in 2013). These results are in accordance with the gradual rise in free Cl concentration (0.78 ± 0.94 mg/L in 2010 vs. 1.16 ± 0.51 mg/L in 2013). In conclusion, a suitable plan for drinking water quality was instituted which resulted in reducing microbiological growth in the waterwork network, improving public health protection. However, the detection of critical points associated with lower levels of free Cl were found on certain floors/points-of-use, requiring the need to improve the monitoring water treatment system and/or implementation of additional technologies.     

Studies on the drug resistance profile of Enterococcus faecium distributed from poultry retailers to hospitals

The multidrug resistant Enterococcus faecium (MEF) strains originating from farm animals are proliferating at a substantial pace to impact downstream food chains and could reach hospitals. This study was conducted to elucidate the drug susceptibility profile of MEF strains collected from poultry products in Ann Arbor, MI area and clinical settings from Michigan State Lab and Moffitt Cancer Center (MCC) in Florida. Presumptive positive Enterococcus isolates at species level were identified by Matrix Assisted Laser Desorption/Ionization Time-of-Flight (MALDI-TOF) analysis. The antibiotic susceptibility profile for both poultry and clinical strains was determined by the Thermo Scientific's Sensititre conform to the National Committee for Clinical Laboratory Standards (NCCLS) and validated via quantitative real-time PCR (qPCR) methods. Out of 50 poultry samples (Turkey: n = 30; Chicken: n = 20), 36 samples were positive for Enterococcus species from which 20.83% were identified as E. faecium. All the E. faecium isolates were multidrug resistant and displayed resistance to the last alternative drug, quinupristin/dalfopristin (QD) used to treat vancomycin resistant E. faecium (VRE) in hospitals. Results indicate the presence of MEF strains in food animals and clinical settings that are also resistant to QD.     

Accidents, claiming, and regional subcultures: are medical errors and malpractice lawsuits related to social capital?

METHOD: This study examined states' performance on Patient Safety Indicators (PSIs), statistics on malpractice lawsuits, and analogous data on automobile accidents to identify state-level patterns in safety and claiming. RESULTS: Hospital safety varied in a pattern similar to highway safety on the state level, suggesting that cultural traits may play a greater role than differences in legal or other environmental factors. States performing well or poorly in hospital and driver safety tended to correspond with states grouped together in regional culture typologies developed by Elazar and Lieske. Traits of regional culture also are associated with variations in tort claiming. CONCLUSIONS: The paper offers a theory of social capital as an important factor affecting safety and tort claiming. Where the regional culture is one of high cohesion and trust, people may exercise a higher degree of caution and vigilance in their interaction with others, and feel less inclination to file lawsuits subsequent to accidents.     

考虑移动医院的因灾受损血液供应链网络重构

为快速恢复因灾受损的血液供应链的救援能力,针对血液这一重要医疗物资,研究考虑移动医院的应急供应链重构。设计包含移动医院和临时献血点选址、血液外调与自采和血液与伤员转运的混合整数规划模型,并以红细胞为例,将模型应用于我国龙门山地震带的灾害救治案例中。结果表明:重构的供应链能够综合运用移动医院等资源,快速恢复血液救援能力,最大程度缓解灾害影响。即便是在灾情最严重的情况下,缺血量可减少12.95%。管理者在进行人道主义应急救援决策时,应综合考虑移动医院等医疗资源的有效利用。