An Investigation of Social Ecological Barriers to and Facilitators of WIC Farmers Market Nutrition Program Voucher Redemption.

In the United States, many communities lack sufficient access to fresh produce. To improve access to fresh fruits and vegetables, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides eligible participants vouchers through the Farmers Market Nutrition Program (FMNP) that can be redeemed directly from farmers at markets or farm stands. However, FMNP voucher redemption rates in New Jersey remain lower than those in neighboring states. This article used the social ecological model to examine differences between FMNP participants who redeem vouchers (Redeemers) and those who do not (non-Redeemers) in the areas of: produce procurement practices and consumption frequency, and barriers to and facilitators of FMNP voucher redemption. This cross-sectional study included WIC FMNP participants (N = 329) in northern New Jersey, USA. Analyses were conducted using descriptive statistics, independent sample t-tests, and one-way ANOVA. Compared to Redeemers, non-Redeemers consumed fewer average daily vegetable servings, were more likely to shop at small grocery/corner stores, and encountered significant barriers to FMNP redemption, e.g., difficulty finding time to redeem vouchers.

Public preferences for green infrastructure improvements in Northern New Jersey: a discrete choice experiment approach.

Significant water pollution caused by flooding due to heavy precipitation and extreme weather events has become a considerable problem in urbanized areas such as in Northern New Jersey. These cities experience heavy downpour-related contamination and water pollution when stormwater and untreated sewage are diverted through combined sewer overflow drainage systems to adjacent water bodies. Green infrastructure has proven a successful intervention method for mitigating these unintended environmental consequences. However, while the effects of CSOs and the ability of GI to reduce them are well documented, there has been considerably less study addressing public preferences and willingness to pay for GI-based solutions. As such, this study seeks to understand these facets of GI management in urbanized areas of New Jersey, focusing on Newark, Paterson, and Elizabeth townships. A discrete choice experiment method was used to analyze the willingness of residents to pay for additional CSO infrastructure through the installation of GI options such as bioretention gardens, rain barrels, and green roofs. Furthermore, study identified attributes such as secondary benefits, proximity, and water retention that respondents found the most utility in when choosing GI stormwater management interventions. We found that several attributes, including improved air quality ($58.60), increased water supply ($49.71), and closer proximity ($110.01-$125.97) had the highest utility and similarly were associated with a higher willingness to pay than other tested attributes. These findings are important in assessing the overall attitude toward these fixtures, and may be critical in crafting local policy and development, especially to address environmental equity.

Extraction of Rhododendron arboreum Smith flowers from the forest for the livelihood and rural income in Garhwal Himalaya, India.

Rhododendron arboreum locally known as 'Burans', that bears magnificent flowers is one of the valuable non timber forest produces (NTFPs) in Garhwal Himalaya. These flowers are good source of income for local populace and help them to their subsistence up to some extent. R. arboreum flower can help local population to improve their livelihoods if potential harvesting is carried out sustainably. An attempt has been made to estimate the flower yield, examine extraction techniques, marketing trends and various uses of flowers. Stratified random sampling method was carried out in eight sites varying in altitudes and geographic locations. Flower yield kg/ha for each site was calculated as standard process. Questionnaire based survey was carried out in selected villages for flower extraction and marketing trends. Projections of potential (probable/-could generate) income were made and cost-benefit analysis was also estimated. Tree density of R. arboreum ranked first and Q. leucotrichophora had second rank while 16-25 cm cbh class tree density for R. arboreum was found highest across the sites. Flower yield was significantly (p < 0.001) higher at Khirsu site with 26-35 and 46-55 cm cbh class. There was positively significant correlation (n = 446, p < 0.001, r = 0.53) between flower yield and actual cbh. Flower yield has a direct relation with size of tree whereas yield has been less impacted by the sites. Average yield of flowers across the sites was about 25.3 ton/ha. On average 30% households are engaged in the extraction and trade activities with the extraction rate of 25-350 kg/household/year. A net household income of Rs. 6000-37,000 (89-545 USD) per year was computed from Rhododendron flower extraction and marketing business. The total monetary benefit was significantly higher than the inputs for all value added items on a per day basis. R. arboreum plays important role in ecological and economic sustainability of poor rural people and unemployed youths in Himalayan region. This can reduce unemployment through development of small cottage industry and entrepreneurship at village level by making different food products i.e. juice, squash, sauce and pickle etc.

Inaction on Lead Despite the Relevant Knowledge: Predictors, Covariates, and Outreach Implications.

Testing residential soil and paint for lead provides actionable information. By showing where and how much lead exists on the residence, it allows one to quantify risk and determine the best ways to reduce exposure along with the corresponding health and financial costs. For these reasons, several federal and state programs offer outreach to audiences on the benefits of testing residential soil and paint for lead. Not all individuals who know about lead's adverse health effects, however, test their residence for lead, potentially limiting the actionable information that could have helped to reduce their exposure. Such individuals represent a challenge to outreach programs and the broader public health objectives. There is, thus, a need to understand who such individuals are and why they behave this way, allowing us to develop a specialized outreach program that addresses the problem by targeting the relevant sub-population. Using survey data, we quantitatively determine the profiles of individuals who, despite knowing about lead's adverse health effects, are unlikely to test their residence for lead, finding statistically significant socio-economic predictors and behavioral covariates. We also find a geographic component to it, further helping outreach professionals learn how to allocate their limited resources.

Modeling Agrilus planipennis F. (Coleoptera: Buprestidae) Spread in New Jersey.

Pests and disease have become an increasingly common issue as globalized trade brings non-native species into unfamiliar systems. Emerald ash borer (Agrilus planipennis), is an Asiatic species of boring beetle currently devastating the native population of ash (Fraxinus) trees in the northern forests of the United States, with 85 million trees having already succumbed across much of the Midwest. We have developed a reaction-diffusion partial differential equation model to predict the spread of emerald ash borer over a heterogeneous 2-D landscape, with the initial ash tree distribution given by data from the Forest Inventory and Analysis. As expected, the model predictions show that emerald ash borer consumes ash which causes the local ash population to decline, while emerald ash borer spreads outward to other areas. Once the local ash population begins to decline emerald ash borer also declines due to the loss of available habitat. Our model's strength lies with its focus on the county scale and its linkage between emerald ash borer population growth and ash density. This enables one to make accurate predictions regarding emerald ash borer spread which allows one to consider various methods of control as well as to accurately study the economic effects of emerald ash borer spread.

Comparative Optimism: Relative Risk Perception and Behavioral Response to Lead Exposure.

Despite their true exposure, individuals with Comparative Optimism consider themselves less prone to the adverse health effects of pollution. Since individuals' response to a given environmental risk is affected by their appraisal of the risk, those with Comparative Optimism may be less likely to engage in prescribed behaviors or to do so at the urgency required of the given risk. Such limited or delayed response can amplify the risk instead of reducing it. Thus, there is a need to understand if Comparative Optimism applies to pollutants with irreversible adverse health effects as it would impose a higher burden. There is also a need to know which segments of the population are prone to Comparative Optimism and how it manifests in terms of activities that can enhance exposure. Doing so will allow public health professionals address gaps in risk communication and management efforts and help improve environmental health outcomes. Using survey data, we assess the presence, behavioral and socioeconomic predictors, and implications of Comparative Optimism for communicating and managing lead exposure risk in an urban setting. Our results indicate that a large share of the population has Comparative Optimism for lead exposure, despite living in a city that has a relatively higher lead poisoning burden. We also found that ethnicity, income, length of stay at residence, among others, predict Comparative Optimism, suggesting that Comparative Optimism may predict elevated blood lead level.

Adjunctive rifampicin to reduce early mortality from Staphylococcus aureus bacteraemia: the ARREST RCT.

BACKGROUND: Staphylococcus aureus bacteraemia is a common and frequently fatal infection. Adjunctive rifampicin may enhance early S. aureus killing, sterilise infected foci and blood faster, and thereby reduce the risk of dissemination, metastatic infection and death. OBJECTIVES: To determine whether or not adjunctive rifampicin reduces bacteriological (microbiologically confirmed) failure/recurrence or death through 12 weeks from randomisation. Secondary objectives included evaluating the impact of rifampicin on all-cause mortality, clinically defined failure/recurrence or death, toxicity, resistance emergence, and duration of bacteraemia; and assessing the cost-effectiveness of rifampicin. DESIGN: Parallel-group, randomised (1 : 1), blinded, placebo-controlled multicentre trial. SETTING: UK NHS trust hospitals. PARTICIPANTS: Adult inpatients (≥ 18 years) with meticillin-resistant or susceptible S. aureus grown from one or more blood cultures, who had received < 96 hours of antibiotic therapy for the current infection, and without contraindications to rifampicin. INTERVENTIONS: Adjunctive rifampicin (600-900 mg/day, oral or intravenous) or placebo for 14 days in addition to standard antibiotic therapy. Investigators and patients were blinded to trial treatment. Follow-up was for 12 weeks (assessments at 3, 7, 10 and 14 days, weekly until discharge and final assessment at 12 weeks post randomisation). MAIN OUTCOME MEASURES: The primary outcome was all-cause bacteriological (microbiologically confirmed) failure/recurrence or death through 12 weeks from randomisation. RESULTS: Between December 2012 and October 2016, 758 eligible participants from 29 UK hospitals were randomised: 370 to rifampicin and 388 to placebo. The median age was 65 years [interquartile range (IQR) 50-76 years]. A total of 485 (64.0%) infections were community acquired and 132 (17.4%) were nosocomial; 47 (6.2%) were caused by meticillin-resistant S. aureus. A total of 301 (39.7%) participants had an initial deep infection focus. Standard antibiotics were given for a median of 29 days (IQR 18-45 days) and 619 (81.7%) participants received flucloxacillin. By 12 weeks, 62 out of 370 (16.8%) patients taking rifampicin versus 71 out of 388 (18.3%) participants taking the placebo experienced bacteriological (microbiologically confirmed) failure/recurrence or died [absolute risk difference -1.4%, 95% confidence interval (CI) -7.0% to 4.3%; hazard ratio 0.96, 95% CI 0.68 to 1.35; p = 0.81]. There were 4 (1.1%) and 5 (1.3%) bacteriological failures (p = 0.82) in the rifampicin and placebo groups, respectively. There were 3 (0.8%) versus 16 (4.1%) bacteriological recurrences (p = 0.01), and 55 (14.9%) versus 50 (12.9%) deaths without bacteriological failure/recurrence (p = 0.30) in the rifampicin and placebo groups, respectively. Over 12 weeks, there was no evidence of differences in clinically defined failure/recurrence/death (p = 0.84), all-cause mortality (p = 0.60), serious (p = 0.17) or grade 3/4 (p = 0.36) adverse events (AEs). However, 63 (17.0%) participants in the rifampicin group versus 39 (10.1%) participants in the placebo group experienced antibiotic or trial drug-modifying AEs (p = 0.004), and 24 (6.5%) participants in the rifampicin group versus 6 (1.5%) participants in the placebo group experienced drug-interactions (p = 0.0005). Evaluation of the costs and health-related quality-of-life impacts revealed that an episode of S. aureus bacteraemia costs an average of £12,197 over 12 weeks. Rifampicin was estimated to save 10% of episode costs (p = 0.14). After adjustment, the effect of rifampicin on total quality-adjusted life-years (QALYs) was positive (0.004 QALYs), but not statistically significant (standard error 0.004 QALYs). CONCLUSIONS: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S. aureus bacteraemia. FUTURE WORK: Given the substantial mortality, other antibiotic combinations or improved source management should be investigated. TRIAL REGISTRATIONS: Current Controlled Trials ISRCTN37666216, EudraCT 2012-000344-10 and Clinical Trials Authorisation 00316/0243/001. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 59. See the NIHR Journals Library website for further project information.

Valuing visitor access to forested areas and exploring willingness to pay for forest conservation and restoration finance: The case of small island developing state of Mauritius.

Small island developing states share as common constraints their small size, geographical dispersion, greater vulnerability to rapid and drastic environmental change, and limited administrative and technical resources. Within these, they have to cater for urban and agricultural areas, as well as enough natural landscape for ecosystem services. Funding for conservation of forest ecosystems on these islands has received relatively less attention and national park systems are chronically underfunded. We used Mauritius as a case study to investigate the willingness to pay for conservation of state and privately owned forests. It is part of a biodiversity hotspot with highly threatened forest ecosystems, but has known some conservation successes. We designed and administered survey based contingent valuation approach to estimate the willingness to pay entry fees to visit forest areas across the island. Study results suggest international and domestic tourists have a mean willingness to pay of USD 7.73 and USD 3.74 respectively, for conservation. These values represent amounts visitors are willing to pay every time they visit a public or private forested site. Results show that mid-level supervisory roles positively influence willingness to pay values. Results also show that people aged 50 and above, not having any supervisory role, married with one child or less, tend to have lower willingness to pay for conservation.

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment.

Evaluation of the role of risk perception in stakeholder engagement to prevent lead exposure in an urban setting.

Stakeholder engagement is a vital sustainable remediation practice for obtaining useful feedback and identifying societal needs. Evaluating and integrating risk perception of stakeholders into remediation and outreach efforts allows for greater insight, increases the likelihood of success and ultimately, benefits the community by protecting its members from environmental hazards. In this study, we identified risk perception factors that influenced residents' level of concern for mitigating their exposure to elevated concentrations of lead in household paint and historic fill material. Risk perception factors were assessed by an in-person survey conducted in public green spaces. The analysis of survey participants' responses indicated that their perception of risk to exposed lead was mostly influenced by the presence of hazardous materials in close proximity to their residence, the ability to address pollution, and awareness, interest, and individual accountability in mitigating environmental risks. Responses also revealed that residents considered risk of lead and soil pollution as less menacing than the presence of more immediate and perceptible risks posed by factors such as air and water pollution. In addition, the community seemed to exhibit "optimism bias" and did not identify itself at high risk to susceptible and immediate hazards, including lead exposure. This lack of concern over lead exposure created a significant obstacle to community participation in state-led education and outreach programs. By integrating risk perception analysis and increasing stakeholder engagement, we can bring more attention to this issue, educate the public about the threat of lead pollution, and efficiently use financial resources to implement a more sustainable solution.

Identification, investigation and management of patient-to-patient hepatitis B transmission within an inpatient renal ward in North West England.

BACKGROUND: Transmission of hepatitis B virus (HBV) is rare within healthcare settings in developed countries. The aim of the article is to outline the process of identification and management of transmission of acute hepatitis B in a renal inpatient ward. METHODS: The case was identified through routine reporting to public health specialists, and epidemiological, virological and environmental assessment was undertaken to investigate the source of infection. An audit of HBV vaccination in patients with chronic kidney disease was undertaken. RESULTS: Investigations identified inpatient admission to a renal ward as the only risk factor and confirmed a source patient with clear epidemiological, virological and environmental links to the case. Multiple failures in infection control leading to a contaminated environment and blood glucose testing equipment, failure to isolate a non-compliant, high-risk patient and incomplete vaccination for patients with chronic kidney disease may have contributed to the transmission. CONCLUSIONS: Patient-to-patient transmission of hepatitis B was shown to have occurred in a renal ward in the UK, due to multiple failures in infection control. A number of policy changes led to improvements in infection control, including reducing multi-function use of wards, developing policies for non-compliant patients, improving cleaning policies and implementing competency assessment for glucometer use and decontamination. HBV vaccination of renal patients may prevent patient-to-patient transmission of HBV. Consistent national guidance should be available, and clear pathways should be in place between primary and secondary care to ensure appropriate hepatitis B vaccination and follow-up testing.

Assessing public preferences for forest biomass based energy in the southern United States.

This article investigated public preferences for forest biomass based liquid biofuels, particularly ethanol blends of 10% (E10) and 85% (E85). We conducted a choice experiment study in three southern states in the United States: Arkansas, Florida, and Virginia. Reducing atmospheric CO(2), decreasing risk of wildfires and pest outbreaks, and enhancing biodiversity were presented to respondents as attributes of using biofuels. Results indicated that individuals had a positive extra willingness to pay (WTP) for both ethanol blends. The extra WTP was greater for higher blends that offered larger environment benefits. The WTPs for E10 were $0.56 gallon(-1), $0.58 gallon(-1), and $0.48 gallon(-1), and for E85 they were $0.82 gallon(-1), $1.17 gallon(-1), and $1.06 gallon(-1) in Arkansas, Florida, and Virginia, respectively. Although differences in WTP for E10 were statistically insignificant among the three states, significant differences were found in the WTP for E85 between AR and FL and between AR and VA. Preferences for the environmental attributes appeared to be heterogeneous, as respondents' were willing to pay a premium for E10 in all three states to facilitate the reduction of CO(2) and the improvement of biodiversity but were not willing to pay more for E85 in order to enhance biodiversity.

Molecular typing of Salmonella enterica serotype Worthington isolates from infantile diarrhoea.

BACKGROUND AND OBJECTIVES: Salmonella Worthington has been known to be a causative agent for childhood diarrhoea. There is a paucity of information on the molecular relatedness of the strains isolated in various hospitals in India. The present study was carried out to attempt molecular typing of a cluster of Salmonella Worthington isolates obtained from cases of infantile diarrhoea during a six month period, from a tertiary care paediatric hospital in Delhi, India. METHODS: Nine isolates of S. Worthington obtained from faecal samples of infants suffering from diarrhoea during October 2001 to March 2002, were identified by the conventional biochemical methods and by serotyping. The antimicrobial susceptibility was determined by the disk diffusion method. Molecular typing was done by ribotyping. RESULTS: Eight patients were admitted to 3 different wards of the hospital and one was an outpatient. Four patients including the first patient visited the hospital with diarrhoea as the presenting symptom while five developed diarrhoea after admission. Stool microscopy showed no specific findings. Salmonella Worthington was isolated from stool cultures of these patients. Repeated cultures of the common drinking water source of the hospital and the milk supplied to children from central kitchen were negative for known pathogens. All S. Worthington isolates were resistant to all the beta-lactams tested including third generation cephalosporins. Eight isolates were sensitive to furazolidone and 6 to ciprofloxacin. Molecular characterization by ribotyping revealed four different clones. INTERPRETATION AND CONCLUSION: As four different ribotypes of the isolated Salmonella Worthington isolates were identified, it was clear that there was no single source of infection.