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1.
Chemosphere ; 339: 139626, 2023 Oct.
Article in English | MEDLINE | ID: mdl-37487980

ABSTRACT

This study evaluated the effects of acetone on the anaerobic degradation of synthetic latex wastewater, which was simulated from the wastewater of the deproteinized natural rubber production process, including latex, acetate, propionate, and acetone as the main carbon sources, at a batch scale in 5 cycles of a total of 60 days. Fe3O4 was applied to accelerate the treatment performance from cycle 3. Acetone was added in concentration ranges of 0%, 0.05%, 0.1%, 0.15%-included latex, and 0.15%-free latex (w/v). In the Fe3O4-free cycles, for latex-added vials, soluble chemical oxygen demand (sCOD) was removed at 43.20%, 43.20%, and 12.65%, corresponding to the input acetone concentrations varying from 0.05% to 0.15%, indicating the interference of acetone for COD reduction. After adding Fe3O4, all flasks reported a significant increase in COD removal efficiency, especially for acetone-only and latex-only vials, from 36.9% to 14.30%-42.95% and 83.20%, respectively. Other highlighted results of COD balance showed that Fe3O4 involvement improved the degradation process of acetate, propionate, acetone, and the other COD parts, including the intermediate products of latex reduction. Besides, during the whole batch process, the order of reduction priority of the carbon sources in the synthetic wastewater was acetate, propionate and acetone. We also found that the acetate concentration appeared to be strongly related to reducing other carbon sources in natural rubber wastewater. Microbial community analysis revealed that protein-degrading bacteria Bacteroidetes vadinHA17 and Proteinniphilum and methylotrophic methanogens might play key roles in treating simulated deproteinized-natural-rubber wastewater.


Subject(s)
Latex , Wastewater , Latex/metabolism , Ferrosoferric Oxide/metabolism , Anaerobiosis , Acetone , Rubber , Propionates , Bioreactors/microbiology , Carbon , Acetates , Waste Disposal, Fluid/methods
2.
Microorganisms ; 10(12)2022 Nov 24.
Article in English | MEDLINE | ID: mdl-36557577

ABSTRACT

Microbial degradation of natural rubber and synthetic poly(cis-1,4-isoprene) is expected to become an alternative treatment system for waste from poly(cis-1,4-isoprene) products including scrap tires. Nocardia farcinica NBRC 15,532, a gram-positive rubber-degrading bacterium, can utilize poly(cis-1,4-isoprene) as the sole source of carbon and energy to produce oligo-isoprene metabolites containing aldehyde and keto end groups. A homology-based search of the genome revealed a gene encoding a latex-clearing protein (Lcp). Gene disruption analysis indicated that this gene is essential for the utilization of poly(cis-1,4-isoprene) in this strain. Further analysis of the genome sequence identified aldehyde dehydrogenase (ALDH) genes as potential candidates for oxidative degradation of oligo-isoprene aldehydes. Based on the enzymatic activity of the ALDH candidates, NF2_RS14000 and NF2_RS14385 may be involved in the degradation of oligo-isoprene aldehydes. Analysis of the reaction products revealed that these ALDHs oxidized tri- to penta-isoprene aldehydes, which were generated by the reaction of Lcp. Based on the inability of ALDH gene deletion mutants, we concluded that NF2_RS14000 is mainly involved in the utilization of poly(cis-1,4-isoprene) and the oxidative degradation of oligo-isoprene aldehydes in Nocardia farcinica NBRC 15,532.

3.
J Biosci Bioeng ; 133(5): 452-458, 2022 May.
Article in English | MEDLINE | ID: mdl-35216932

ABSTRACT

The microbial degradation of synthetic and natural poly(cis-1,4-isoprene) rubber is expected to become an alternative treatment technique for waste from poly(cis-1,4-isoprene) products, such as scrap tires. A gram-positive rubber-degrading bacterium, Rhodococcus sp. strain RDE2, was isolated from the waste of a rubber-processing factory in Vietnam. This strain grew on natural rubber as a sole source of carbon and energy and produced oligo-isoprenoid metabolites containing aldehyde groups from poly(cis-1,4-isoprene). To identify the genes responsible for poly(cis-1,4-isoprene) degradation, the complete genome sequence of this strain was determined. The complete genome sequence consists of a 5,715,406 bp chromosome and 6 plasmids (GenBank accession numbers AP025186.1 to AP025192.1) with an average GC content of 67.9%. The genome contains 5358 protein-coding sequences and 12 and 68 copies of rRNA and tRNA genes, respectively. Based on genome sequence analysis, the lcp gene (RDE2_08,770), responsible for the initial step of poly(cis-1,4-isoprene) degradation, was identified. The gene product obtained from Escherichia coli depolymerizes poly(cis-1,4-isoprene) to low-molecular-weight oligo-isoprenoids. The transcription of this gene is activated during the utilization of poly(cis-1,4-isoprene) in strain RDE2. The lcpR gene (RDE2_08,760), which encodes a putative transcriptional regulator, is located upstream of lcp. The lcpR gene product recognizes the promoter region of lcp. When the lcpR gene is deleted, the constitutive transcription of lcp is observed. Thus, it is inferred that the LcpR negatively regulates lcp transcription. These results strongly suggest that the lcp and lcpR genes are involved in poly(cis-1,4-isoprene) utilization in strain RDE2.


Subject(s)
Rhodococcus , Rubber , Bacterial Proteins/metabolism , Biodegradation, Environmental , Escherichia coli/genetics , Gram-Positive Bacteria/metabolism , Hemiterpenes/metabolism , Latex/metabolism , Rhodococcus/genetics , Rhodococcus/metabolism , Rubber/metabolism
4.
J Biosci Bioeng ; 123(4): 412-418, 2017 Apr.
Article in English | MEDLINE | ID: mdl-28065456

ABSTRACT

A rubber-degrading bacterial consortium named H2DA was obtained from an enrichment culture with natural rubber latex and rubber-processing factory waste in Vietnam. Gel permeation chromatography analysis revealed that only the strain NVL3 degraded synthetic poly(cis-1,4-isoprene) into low-molecular-weight intermediates among the three strains found in the H2DA. The 16S-rRNA gene sequence of NVL3 showed the highest identity with that of Nocardia farcinica DSM 43665T. NVL3 accumulated aldehyde intermediates from synthetic poly(cis-1,4-isoprene) on a rubber-overlay plate as indicated by Schiff's staining. NVL3 also degraded deproteinized natural rubber into low-molecular-weight aldehyde intermediates. A latex-clearing protein (lcp) gene ortholog was identified within the genome sequence of NVL3, and it showed a moderate amino-acid identity (54-75%) with the lcp genes from previously reported rubber degraders. The heterologous expression of the NVL3 lcp in Escherichia coli BL21(DE3) allowed us to purify the 46.8-kDa His-tagged lcp gene product (His-Lcp). His-Lcp degraded synthetic poly(cis-1,4-isoprene) and accumulated aldehyde intermediates from deproteinized natural rubber suggesting the functional expression of the lcp gene from a Nocardia degrader in E. coli. Quantitative reverse transcription PCR analysis indicated the strong transcriptional induction of the lcp gene in NVL3 in the presence of synthetic poly(cis-1,4-isoprene). These results suggest the involvement of the lcp gene in rubber degradation in NVL3.


Subject(s)
Genes, Bacterial/genetics , Industry , Nocardia/genetics , Nocardia/metabolism , Rubber/metabolism , Aldehydes/chemistry , Aldehydes/metabolism , Base Sequence , Escherichia coli/genetics , Hemiterpenes/chemistry , Hemiterpenes/metabolism , Latex/chemistry , Latex/metabolism , Nocardia/classification , Rubber/chemistry , Vietnam
5.
J Sep Sci ; 39(24): 4712-4722, 2016 Dec.
Article in English | MEDLINE | ID: mdl-27778478

ABSTRACT

A high-performance liquid chromatography with electrospray ionization ion trap tandem mass spectrometry method was developed and validated for the robust profiling and characterization of biosynthetic congeners in the 2-deoxy-aminocyclitol istamycin pathway, from the fermentation broth of Streptomyces tenjimariensis ATCC 31603. Gradient elution on an Acquity CSH C18 column was performed with a gradient of 5 mM aqueous pentafluoropropionic acid and 50% acetonitrile. Sixteen natural istamycin congeners were profiled and quantified in descending order; istamycin A, istamycin B, istamycin A0 , istamycin B0 , istamycin B1 , istamycin A1 , istamycin C, istamycin A2 , istamycin C1 , istamycin C0 , istamycin X0 , istamycin A3 , istamycin Y0 , istamycin B3 , and istamycin FU-10 plus istamycin AP. In addition, a total of five sets of 1- or 3-epimeric pairs were chromatographically separated using a macrocyclic glycopeptide-bonded chiral column. The lower limit of quantification of istamycin-A present in S. tenjimariensis fermentation was estimated to be 2.2 ng/mL. The simultaneous identification of a wide range of 2-deoxy-aminocyclitol-type istamycin profiles from bacterial fermentation was determined for the first time by employing high-performance liquid chromatography with tandem mass spectrometry analysis and the separation of istamycin epimers.


Subject(s)
Aminoglycosides/biosynthesis , Anti-Bacterial Agents/biosynthesis , Streptomyces/metabolism , Chromatography, High Pressure Liquid , Spectrometry, Mass, Electrospray Ionization , Tandem Mass Spectrometry
6.
AMB Express ; 6(1): 52, 2016 Dec.
Article in English | MEDLINE | ID: mdl-27485517

ABSTRACT

Kinetics of a recombinant uridine diphosphate-glucose: sterol glycosyltransferase from Micromonospora rhodorangea ATCC 27932 (MrSGT) were studied using a number of sterols (including phytosterols) as glycosyl acceptors. The lowest K m value and the highest catalytical efficiency (k cat/K m) were found when ß-sitosterol was the glycosyl acceptor in the enzymatic reaction. In contrast to the enzyme's flexibility toward the glycosyl acceptor substrate, this recombinant enzyme was highly specific to uridine diphosphate (UDP)-glucose as the donor substrate. Besides, the UDP-glucose-dependent MrSGT was able to attach one glucose moiety specifically onto the C-3 hydroxyl group of other phytosterols such as fucosterol and gramisterol, yielding stereo-specific fucosterol-3-O-ß-D-glucoside and gramisterol-3-O-ß-D-glucoside, respectively. Based on kinetic data obtained from the enzyme's reactions using five different sterol substrates, the significance of the alkene (or ethylidene) side chains on the C-24 position in the sterol scaffolds was described and the possible relationship between the substrate structure and enzyme activity was discussed. This is the first report on the enzymatic bioconversion of the above two phytosteryl 3-O-ß-glucosides, as well as on the discovery of a stereospecific bacterial SGT which can attach a glucose moiety in ß-conformation at the C-3 hydroxyl group of diverse sterols, thus highlighting the catalytic potential of this promiscuous glycosyltransferase to expand the structural diversity of steryl glucosides.

7.
Water Sci Technol ; 74(2): 500-7, 2016.
Article in English | MEDLINE | ID: mdl-27438256

ABSTRACT

In this study, granular sludge formation was carried out using an aluminum chloride supplement in an upflow anaerobic sludge blanket (UASB) reactor treating natural rubber processing wastewater. Results show that during the first 75 days after the start-up of the UASB reactor with an organic loading rate (OLR) of 2.65 kg-COD·m(-3)·day(-1), it performed stably with a removal of 90% of the total chemical oxygen demand (COD) and sludge still remained in small dispersed flocs. However, after aluminum chloride was added at a concentration of 300 mg·L(-1) and the OLR range was increased up to 5.32 kg-COD·m(-3)·day(-1), the total COD removal efficiency rose to 96.5 ± 2.6%, with a methane recovery rate of 84.9 ± 13.4%, and the flocs began to form granules. Massively parallel 16S rRNA gene sequencing of the sludge retained in the UASB reactor showed that total sequence reads of Methanosaeta sp. and Methanosarcina sp., reported to be the key organisms for granulation, increased after 311 days of operation. This indicates that the microbial community structure of the retained sludge in the UASB reactor at the end of the experiment gave a good account of itself in not only COD removal, but also granule formation.


Subject(s)
Aluminum Compounds/analysis , Chlorides/analysis , Industrial Waste/analysis , Microbiota , Sewage/microbiology , Waste Disposal, Fluid/methods , Water Pollution, Chemical/analysis , Aluminum Chloride , Anaerobiosis , Bacteria/genetics , Bacteria/metabolism , Bioreactors , Microbiota/drug effects , RNA, Bacterial/genetics , RNA, Bacterial/metabolism , RNA, Ribosomal, 16S/genetics , RNA, Ribosomal, 16S/metabolism , Rubber , Waste Disposal, Fluid/instrumentation
8.
Anal Bioanal Chem ; 408(6): 1667-78, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26753981

ABSTRACT

In this study, an efficient high-performance liquid chromatography (HPLC)-electrospray ionization (ESI)-ion trap-tandem mass spectrometry (MS/MS) was developed for the identification of the biosynthetic congeners involved in the aminocyclitol aminoglycosidic fortimicin pathway from Micromonospora olivasterospora fermentation. The usage of both acid extraction (pH ∼2.5) followed by an cationic-exchanging SPE cleanup and pentafluoropropionic acid mediated ion-pairing chromatography with ESI-ion trap-MS/MS detection was determined to be sufficiently practical to profile the fortimicin (FOR) congeners produced in a culture broth. The limit of the quantification for the fortimicin A (FOR-A) standard spiked in the culture broth was ∼1.6 ng mL(-1). The average recovery rate was 93.6%, and the intra- and inter-day precisions were <5% with accuracy in the range from 87.1 to 94.2%. Moreover, the epimeric mixtures including FOR-KH, FOR-KR, and FOR-B were separately resolved through a macrocyclic glycopeptide (teicoplanin)-bonded chiral column. As a result, ten natural FOR pseudodisaccharide analogs were identified and semi-quantified in descending order as follows: FOR-A, FOR-B, DCM, FOR-KH plus FOR-KR, FOR-KK1, FOR-AP, FOR-KL1, FOR-AO, and FOR-FU-10. This is the first report on both the simultaneous characterization of diverse structurally closely related FORs derived from bacterial fermentation using HPLC-ESI-ion trap-MS/MS analysis and the chromatographic separation of the three FOR epimers.


Subject(s)
Aminoglycosides/analysis , Aminoglycosides/chemistry , Chromatography, High Pressure Liquid/methods , Micromonospora/metabolism , Spectrometry, Mass, Electrospray Ionization/methods , Aminoglycosides/metabolism , Fermentation , Limit of Detection , Magnetic Resonance Spectroscopy , Tandem Mass Spectrometry/methods
9.
Environ Technol ; 37(4): 459-465, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26593041

ABSTRACT

Natural rubber processing wastewater contains high concentrations of organic compounds, nitrogen, and other contaminants. In this study, a treatment system composed of a baffled reactor (BR), an upflow anaerobic sludge blanket (UASB) reactor, and a downflow hanging sponge (DHS) reactor was used to treat natural rubber processing wastewater in Vietnam. The BR showed good total suspended solids (TSS) removal of 47.6%, as well as acidification of wastewater. The UASB reactor achieved a high chemical oxygen demand (COD) removal efficiency of 92.7 ± 2.3% and energy recovery in the form of methane with an organic loading rate of 12.2 ± 6.6 kg-COD m-3 day-1. The DHS reactor showed high performance in residual organic matter removal from UASB effluent. In total, the system achieved high-level total COD removal of 98.6% ± 1.2% and TSS removal of 98.0% ± 1.4%. Massive parallel 16S rRNA gene sequencing of the retained sludge in the UASB reactor showed the predominant microbial phyla to be Bacteroidetes, Firmicutes, Proteobacteria, WWE1, and Euryarchaeota. Uncultured bacteria belonging to the phylum Bacteroidetes and Phylum WWE1 were predominant in the UASB reactor. This microbial assemblage utilizes the organic compounds contained in natural rubber processing wastewater. In addition, the methane-producing archaea Methanosaeta sp. and Methanolinea sp. were detected.

10.
J Microbiol Biotechnol ; 26(3): 477-82, 2016 Mar.
Article in English | MEDLINE | ID: mdl-26643965

ABSTRACT

A uridine diphosphate-glucose:sterol glycosyltransferase-encoding gene was isolated and cloned from the established fosmid library of Micromonospora rhodorangea ATCC 27932 that usually produces the aminoglycoside antibiotic geneticin. The gene consists of 1,185 base pairs and encodes a 41.4 kDa protein, which was heterologously expressed in Escherichia coli BL21(DE3). In silico analyses of the deduced gene product suggested that it is a member of the family 1 glycosyltransferases. The recombinant protein MrSGT was able to catalyze the transfer of a glucosyl moiety onto the C-3 hydroxy function in sterols (ß-sitosterol, campesterol, and cholesterol), resulting in the corresponding steryl glucosides (ß-sitosterol-3-O-ß-D-glucoside, campesterol-3-O-ß-D-glucoside, and cholesterol-3-O-ß-D-glucoside). This enzyme prefers phytosterols to cholesterol, and also shows substrate flexibility to some extent, in that it could recognize a number of acceptor substrates.


Subject(s)
Bacterial Proteins/chemistry , Bacterial Proteins/metabolism , Glucosides/biosynthesis , Glycosyltransferases/chemistry , Glycosyltransferases/metabolism , Micromonospora/enzymology , Uridine Diphosphate Glucose/metabolism , Amino Acid Sequence , Bacterial Proteins/genetics , Glycosyltransferases/genetics , Micromonospora/genetics , Molecular Sequence Data , Recombinant Proteins/chemistry , Recombinant Proteins/genetics , Recombinant Proteins/metabolism , Sequence Alignment , Sterols/metabolism
11.
Talanta ; 123: 89-94, 2014 Jun.
Article in English | MEDLINE | ID: mdl-24725868

ABSTRACT

Cyclosporin A (CyA), a cyclic undecapeptide produced by a number of fungi, contains 11 unusual amino acids, and has been one of the most commonly prescribed immunosuppressive drugs. To date, there are over sixty different analogs reported as congeners and analogs resulting from precursor-directed biosynthesis, human CYP-mediated metabolites, or microbial bio-transformed analogs. However, there is still a need for more structurally diverse CyA analogs in order to discover new biological potentials and/or improve the physicochemical properties of the existing cyclosporins. As a result of the complexity of the resulting mass spectrometric (MS) data caused by its unusual amino acid composition and its cyclic nature, structural characterization of these cyclic peptides based on fragmentation patterns using multiple tandem MS analyses is challenging task. Here, we describe, an efficient HPLC-ESI-ion trap MS(n) (up to MS(8)) was developed for the identification of CyA and CyC, a (Thr(2))CyA congener in which L-aminobutyric acid (Abu) is replaced by L-threonine (Thr). In addition, we examined the fragmentation patterns of a CyA analog obtained from the cultivation of a recombinant Streptomyces venezuelae strain fed with CyA, assigning this analog as (γ-hydroxy-MeLeu(6))CyA (otherwise, known as an human CYP metabolite AM6). This is the first report on both the MS(n)-aided identification of CyC and the structural characterization of a CyA analog by employing HPLC-ESI-ion trap MS(n) analysis.


Subject(s)
Chromatography, High Pressure Liquid/methods , Cyclosporine/analysis , Spectrometry, Mass, Electrospray Ionization/methods , Tandem Mass Spectrometry/methods , Cyclosporine/chemistry , Fungi/metabolism , Humans , Molecular Structure , Peptides, Cyclic/analysis , Peptides, Cyclic/chemistry , Reproducibility of Results , Streptomyces/metabolism
12.
J Microbiol Biotechnol ; 24(1): 44-7, 2014 Jan.
Article in English | MEDLINE | ID: mdl-24064918

ABSTRACT

A biotransformation approach using microbes as biocatalysts can be an efficient tool for the targeted modification of existing antibiotic chemical scaffolds to create previously uncharacterized therapeutic agents. By employing a recombinant Streptomyces venezuelae strain as a microbial catalyst, a reduced macrolide, 10,11-dihydrorosamicin, was created from rosamicin macrolide. Its chemical structure was spectroscopically elucidated, and the new rosamicin analog showed 2-4-fold higher antibacterial activity against two strains of methicillin-resistant Staphylococcus aureus compared with its parent rosamicin. This kind of biocatalytic approach is able to expand existing antibiotic entities and can also provide more diverse therapeutic resources.


Subject(s)
Anti-Bacterial Agents/metabolism , Anti-Bacterial Agents/pharmacology , Leucomycins/metabolism , Leucomycins/pharmacology , Methicillin-Resistant Staphylococcus aureus/drug effects , Streptomyces/metabolism , Anti-Bacterial Agents/chemistry , Biotransformation , Leucomycins/chemistry , Macrolides/metabolism , Macrolides/pharmacology , Microbial Sensitivity Tests , Spectrum Analysis
13.
Traffic Inj Prev ; 13(2): 109-14, 2012.
Article in English | MEDLINE | ID: mdl-22458787

ABSTRACT

OBJECTIVE: To identify the extent and nature of the problem and the main contributing factors to drink driving crashes; determine the current mechanisms in place, particularly in terms of legislation and its enforcement; and identify baseline data and relevant stakeholders. METHODS: The situational assessment was based on the collection of secondary data from available reports and documents, in-depth interviews with key representatives at a central level, and field surveys in provinces. RESULTS: Vietnam has experienced phenomenal growth in motor vehicles, especially motorcycles, in the last decade (400%). This initially led to an increase in deaths from road crashes, but since 2006 the number has stayed fairly level according to police statistics. However, comparisons with health data suggest that the number of deaths is much higher and there are clearly a number of problems with the relevant data systems. Data on the percentage of drivers exceeding legal limits are not available, but police statistics indicated that drinking alcohol was a contributory factor in 7 percent of motor vehicle crashes. This is likely to be an underestimate, because the police and health services do not have the equipment to measure the blood alcohol concentration (BAC) levels of all drivers in crashes. Motorcycle riders and young people are in the high-risk groups. There are strict BAC limits starting at over zero and severe punishments for drunk drivers involved in serious crashes. However, the police do not have adequate manpower or equipment to conduct regular and frequent roadside checking for drivers who have been drinking. There have also been a number of education programs on road safety including drinking and driving, but these have not included sustained and intensive campaigns targeting the high-risk groups. The National Traffic Safety Committee (NTSC) is responsible for coordinating the relevant agencies but there is still a problem with lack of information sharing between agencies. CONCLUSIONS: This study completed a comprehensive situational assessment that examined the problem of drinking and driving and identified some of the weaknesses in the current prevention system. Vietnam currently has 2 international projects on road safety and it is hoped that these together with support from the International Center for Alcohol Policies (ICAP) Global Actions program will provide opportunities for strengthening drinking and drive prevention initiatives by improving the road crash and injury database, building the capacity of the key organizations, strengthening the coordination mechanisms, and implementing and evaluating trial drink-drive interventions.


Subject(s)
Accidents, Traffic/statistics & numerical data , Alcohol Drinking/epidemiology , Automobile Driving/statistics & numerical data , Adolescent , Alcohol Drinking/legislation & jurisprudence , Alcohol Drinking/prevention & control , Automobile Driving/legislation & jurisprudence , Female , Humans , Law Enforcement , Male , Motorcycles/statistics & numerical data , Motorcycles/supply & distribution , Risk Factors , Vietnam/epidemiology , Young Adult
14.
Lancet ; 377(9767): 769-81, 2011 Feb 26.
Article in English | MEDLINE | ID: mdl-21269674

ABSTRACT

In this paper, we address the issues of shortage and maldistribution of health personnel in southeast Asia in the context of the international trade in health services. Although there is no shortage of health workers in the region overall, when analysed separately, five low-income countries have some deficit. All countries in southeast Asia face problems of maldistribution of health workers, and rural areas are often understaffed. Despite a high capacity for medical and nursing training in both public and private facilities, there is weak coordination between production of health workers and capacity for employment. Regional experiences and policy responses to address these challenges can be used to inform future policy in the region and elsewhere. A distinctive feature of southeast Asia is its engagement in international trade in health services. Singapore and Malaysia import health workers to meet domestic demand and to provide services to international patients. Thailand attracts many foreign patients for health services. This situation has resulted in the so-called brain drain of highly specialised staff from public medical schools to the private hospitals. The Philippines and Indonesia are the main exporters of doctors and nurses in the region. Agreements about mutual recognition of professional qualifications for three groups of health workers under the Association of Southeast Asian Nations Framework Agreement on Services could result in increased movement within the region in the future. To ensure that vital human resources for health are available to meet the needs of the populations that they serve, migration management and retention strategies need to be integrated into ongoing efforts to strengthen health systems in southeast Asia. There is also a need for improved dialogue between the health and trade sectors on how to balance economic opportunities associated with trade in health services with domestic health needs and equity issues.


Subject(s)
Emigration and Immigration , Health Personnel/statistics & numerical data , Health Resources , Health Workforce/statistics & numerical data , Medical Tourism , Medically Underserved Area , Asia, Southeastern , Commerce , Emigration and Immigration/statistics & numerical data , Emigration and Immigration/trends , Health Personnel/education , Health Resources/organization & administration , Health Resources/standards , Health Resources/statistics & numerical data , Health Resources/supply & distribution , Health Resources/trends , Humans , Medical Tourism/statistics & numerical data , Medical Tourism/trends , Midwifery/statistics & numerical data , Nurses/statistics & numerical data , Physicians/statistics & numerical data , Public Policy/trends
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