TFAH says US public health spending still below pre-recession levelsA nonprofit group’s annual report on US public health spending says overall funding is still stuck below where it was before the recession of 2008-09, although spending by states may be picking up a bit.”Federal funding for public health has remained relatively level for years,” says the report by the Trust for America’s Health (TFAH), based in Washington, DC.For example, funding for the Public Health Emergency Preparedness (PHEP) program, which supports state and local preparedness, is $651 million for fiscal year (FY) 2016, TFAH says, compared with $643 million in FY 2015. The program peaked at $940 million in FY 2002. The Hospital Preparedness Program is funded at $255 million this year, the same as last year.Federal dollars for preventing disease and improving health in states in FY 2016 range from $15.99 per person in Indiana to $53.06 in Alaska, according to TFAH. That compares with a range of $15.14 to $50.09, bookended by the same states, cited in last year’s TFAH report.The FY 2016 budget for the Centers for Disease Control and Prevention is $6.34 billion, about $600 million less than in FY 2015 when adjusted for inflation, the report states.As for state spending on public health, the median amount for FY 2014-15 was $33.50 per person, compared with $31.06 in FY 2013-14, according to TFAH. The amounts varied all the way from $4.10 in Nevada to $220.80 in West Virginia. The current level is about the same as the 2008 figure of $33.71, but when adjusted for inflation it represents an overall cut of $1.2 billion, the report contends.Further, TFAH’s analysis concluded that 16 states decreased their public health budgets from FY 2014 to 2015, and six states—Alabama, Indiana, Kansas, North Carolina, Ohio, and Oklahoma—cut their budgets 3 or more years in a row. A year ago TFAH reported that 22 states and Washington, DC, had cut their budgets in the preceding year.TFAH offers a set of recommendations for increasing public health funding, with a priority of ensuring that “foundational public health capabilities and services” are provided nationwide.Apr 19 TFAH report summary Full TFAH report Apr 16, 2015, CIDRAP News item on 2015 TFAH report Saudi officials report 2 new MERS cases, 1 of them healthcare-relatedSaudi Arabia’s Ministry of Health (MOH) today reported two new MERS-CoV cases, one of which involved a healthcare worker.The first MERS-CoV (Middle East respiratory syndrome coronavirus) case involved a 31-year-old foreign male healthcare worker in Riyadh. He is in stable condition, and his infection was healthcare-acquired, the MOH said. He had no contact with camels.The second case involves a 24-year-old Saudi man from Hofuf who is asymptomatic. He is not a healthcare worker, and the probable source of his infection is contact with camels, the MOH said.The country has now confirmed 1,376 cases since the outbreak began in 2012, including 587 deaths. Twelve patients are still being treated, the MOH said.Apr 19 MOH update PAHO reports 2,500 new chikungunya cases in AmericasThe Pan American Health Organization (PAHO) late last week reported 2,508 new cases of chikungunya in the Americas, bringing the 2016 outbreak total to 43,624 confirmed and suspected cases.The previous update, which included 2 weeks’ worth of data, noted 4,587 new cases. The outbreak total since 2013 has now reached 1,923,170 cases.According to the Apr 15 report, Colombia, the hardest-hit nation so far in 2016, reported the largest gain, with 1,628 new cases and 12,043 for the year. Honduras was next, with 579 newly reported cases and 7,181 for the year, followed by Venezuela, which logged 180 new infections, bringing its 2016 total to 2,080 cases. Many countries, however, have not reported new numbers for many weeks.PAHO did report did not report any new chikungunya-related deaths for the year, leaving that number at two. The outbreak was first reported in December 2013 on St. Martin in the Caribbean with the first recorded cases of the disease in the Americas.Apr 15 PAHO update China and Hong Kong report pair of H7N9 casesHealth officials on China’s mainland reported a case of H7N9 avian flu from Anhui province today, while Hong Kong reported an imported infection from Guangdong province, with live-poultry market exposure reported in both instances.The health department in Anhui today said the virus sickened a 62-year-old man, according to a statement translated and posted by Avian Flu Diary, an infectious disease news blog.An investigation revealed that the patient had visited a live poultry market before he got sick. The man is hospitalized in critical condition in the city of Ma’anshan. Anhui province, in eastern China, has reported six cases, four of them fatal, this year.Also today, Hong Kong’s Centre for Health Protection (CHP) reported its third imported case of the year, in an 80-year-old man who is hospitalized in stable condition.The patient had traveled to Dongguan in Guangdong province during the first days of April, where he got sick a few days after buying a live chicken at a poultry market and slaughtering the bird. So far his two travel companions are asymptomatic, as are three of his close contacts, the CHP said, adding that further contact tracing efforts are under way.Today’s new cases, the region’s fourth in recent days, raises the global H7N9 total to 780, according to a case list kept by FluTrackers, an infectious disease news message board.Apr 19 Avian Flu Diary post Apr 19 CHP statement FluTrackers H7N9 case list Athletes have high rate of MRSA colonization, risk of infectionThe prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization in asymptomatic athletes, particularly college athletes, is comparable to that in people with chronic disease and higher than that in intensive care unit (ICU) patients, plus it is associated with a sevenfold risk for future infection, according to study findings published yesterday in Clinical Infectious Diseases.Brown University researchers analyzed 15 studies of community-acquired MRSA in 1,485 asymptomatic athletes and athletic staff. Overall MRSA colonization prevalence was 5% (6% when only athletes were included), a rate that rose to 13% among collegiate athletes. Among the latter, prevalence was highest in wrestlers (22%), followed by football and basketball players (8% each), the authors said.Once colonized, college athletes had a sevenfold increased risk of skin and soft tissue infections within 90 days. Decolonization treatment reduced subsequent infection risk by 33%, though treatment effectiveness was documented in only three studies, the authors said.The USA300 strain, which has been associated with fatal MRSA infections, was the most common strain present, colonizing 22% of athletes. More than half of cases (62%) were resistant to clindamycin, while high rates of resistance were also observed for erythromycin (40%), trimethoprim/sulfamethoxazole (36%), tetracycline (31%), and rifampin (23%). Given potential resistance, the authors cautioned against using clindamycin and trimethoprim/sulfamethoxazole as empiric treatment.Rates of MRSA colonization in college athletes were almost twice as high as those observed in ICU patients (7%) and higher than documented rates in people with HIV (6.9%) and people undergoing dialysis (6%).Among the factors thought to increase the risk of MRSA in athletes are equipment sharing, close contact, and frequent skin trauma, notes the article. The authors conclude that “Infection control and decontamination protocols for this population need to be studied and implemented with urgency.”Apr 18 Clin Infect Dis study
A study today by scientists in England and China is providing new evidence that low concentrations of antibiotics in the environment could be contributing to the evolution of antibiotic resistance.In a study published in the journal mBio, researchers with the University of Exeter Medical School, the University of Hong Kong, and drug-maker AstraZeneca report that even when bacterial communities in wastewater are exposed to small amounts of the antibiotic cefotaxime, selection pressure for clinically important antibiotic-resistant genes occurs. Moreover, they also found that the selection pressure for resistance may be just as strong as when exposed to high concentrations of the drug.The findings are important because they suggest that environments that are commonly found to have trace amounts of antibiotics, such as hospital effluent and rivers and streams that receive wastewater, could be an important, and overlooked, breeding ground for antibiotic-resistant bacteria”The significance of this finding is that environments with very low antibiotic concentrations (eg, natural environments) may be just as important in selection for antibiotic resistance as environments with very high antibiotic concentrations (eg, hospitals, and in the human or animal gut during antibiotic therapy),” lead study author Aimee Murray, PhD, a research fellow at University of Exeter Medical School, said in an email to CIDRAP News.Selection for an important resistance geneIn the study, Murray and her colleagues exposed raw, untreated wastewater from a sewage treatment plant to varying amounts of cefotaxime, a third-generation cephalosporin that’s used to treat a wide variety of infections and has been recognized by the World Health Organization as a critically important antibiotic.”Wastewater can contain a cocktail of antibiotics and other chemicals which may select for antibiotic resistance,” Murray explained. “Therefore wastewater is ideal for studying the effects these antibiotics and chemicals may have on the very bacterial communities being exposed to them.”The levels of cefotaxime ranged from the minimal selective concentration—a sub-inhibitory amount that’s just enough to select for resistance and is similar to antibiotic levels previously found in treated wastewater and surface waters—to levels used to treat clinical bacterial infections. While previous research has shown that resistance can occur when individual species of bacteria are exposed to low concentrations of antibiotics, the impact on complex microbial communities, where different species of bacteria are competing against one another, is less clear.Metagenome analysis of the samples, and comparison with a control sample that wasn’t exposed to the antibiotics, revealed that the beta-lactam resistance gene blaCTX-M was the most abundant antibiotic-resistance mechanism. Even at the lowest concentration of cefotaxime, the abundance of blaCTX-M increased by eightfold over the control sample.In addition, while cefotaxime exposure killed off many species of bacteria in the wastewater samples, it also increased the presence of dangerous gram-negative pathogens such as Pseudomonas aeruginosa and Acinetobacter baumannii. Co-selection for other resistance to other antibiotics was also observed.”This increases the relevance of our research to real-world environments, as bacteria do not exist as single species but in complex communities where competition within and between different species may affect bacterial fitness and selection for antibiotic resistance,” Murray said. Murray and her colleagues theorize that the selection for blaCTX-M at environmentally relevant concentrations of cefotaxime is likely due to clonal expansion of bacteria carrying the gene, along with the horizontal transfer of plasmids carrying the gene. And the fact that blaCTX-M appeared to outcompete other resistance genes at all concentrations could explain the worldwide spread of CTX-M-type genes, which have become increasingly prevalent in urinary tract infections.But while the prevalence of the blaCTX-M gene increased over time and with higher amounts of cefotaxime, it ultimately reached a plateau and remained relatively constant until it was exposed to concentrations that were 30 and 50 times the amount used in clinical settings. The researchers believe this could be the result of the antibiotic-resistant bacteria degrading the cefotaxime and providing protection for susceptible bacteria.That discovery could have clinical relevance, the researchers suggest, because during antibiotic treatment, antibiotic concentrations can be different in different parts of the body. As a result, even sub-inhibitory levels of antibiotics in some parts of the body, like the gut, could be selecting for resistant bacteria.”This finding shows we need to understand how bacteria evolve in communities rather than isolation, and further work is needed to understand how we can use these findings to improve antibiotic stewardship and treatment,” Murray said.Environmental resistanceThe study adds to a growing concern about the environmental dimension of antibiotic resistance. Several studies in recent years have documented the presence of antibiotics, and antibiotic resistance genes, in agricultural soil, river and lake sediment, tidal estuaries, and wastewater facilities. Understanding how antibiotics and antibiotic resistance impact the environment, and how to mitigate the effects, is part of the One Health approach to antimicrobial stewardshipAntibiotic residues can follow several paths into the environment. According to a recent United Nations report, up to 80% of antibiotics are excreted unmetabolized through human urine and feces into sewage systems. Likewise, antibiotics used in food-producing animals are excreted through manure, which is spread onto fields as fertilizer and can be carried into nearby lakes and streams. Pharmaceutical production facilities also release antibiotic residues into waterways.The question is how much this environmental contamination is contributing to the evolution of antibiotic resistant bacteria, and how much of an impact, if any, it’s having on human health.”There is currently very little known about the effects antibiotics and other selective chemicals in the environment may have on evolution of antibiotic resistance,” Murray said. “This research is contributing to filling that knowledge gap.”The study was funded in part by AstraZeneca.See also:Jul 24 mBio study
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JASCO Applied Sciences, under subcontract to Tetra Tech Inc., is providing underwater acoustic measurement and monitoring services to Deepwater Wind during the installation of the Block Island Wind Farm. JASCO is conducting field data acquisition and subsequent analysis and interpretation for short- and long-term studies of noise from pile driving and related construction activities. The work is supported by staff from one of JASCO’s USA offices, located in Silver Spring, Maryland.This engagement is part of a growing body of environmental marine acoustics studies that JASCO is performing off the eastern coast of North America, where the company has deployed recording instruments from the tip of Labrador to Virginia.JASCO’s CEO Scott Carr said: “Being selected for involvement in this project reflects the valuable knowledge, services, and systems JASCO can provide to support offshore wind, tidal, and wave energy projects.”JASCO stated that its acoustic monitoring studies off the Eastern Seaboard, in addition to helping ensure noise from human activities does not harm or interfere with the behaviour of aquatic animals, contribute to the understanding of subsea ambient noise environments and of marine mammal habitats and migration routes in the region.
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The port authority reported that fewer slabs and pipes were handled, whilst the number of coils and crane units increased. “Heavy lift general cargo is increasingly being replaced by general cargo with a greater added value, such as cranes and wind power plants”, says Dr Gernot Tesch, managing director operations/ technics.www.rostock-port.de
Newspapers have won the right to identify a man arrested but never charged following a child sex grooming investigation in a landmark Supreme Court ruling today. In Khuja v Times Newspapers Limited and others, justices ruled that the principle of open justice outweighs any harm done to the individual’s private or family life by reporting the arrest. The case arose from the trial of nine men in the Oxford area after a police investigation into child sex grooming and prostitution. Seven men were convicted in 2013. The appellant, originally identified as PNM, was arrested at the same time, apparently on the basis of his first name, but released after an alleged victim failed to identify him. He was not charged with any offence but his identity emerged in evidence given at the Old Bailey trial. He secured an injunction under section 4(2) of the Contempt of Court Act 1981 preventing newspapers from naming him on the basis coverage might prejudice a future trial.When the threat of proceedings receded, PNM applied for an injunction against The Times and the Oxford Mail that would have preserved his anonymity. It was rejected by the High Court, a decision backed by the Court of Appeal in 2014. Ruling on an appeal by PNM, the seven Supreme Court justices split 5:2. Lord Sumption, backed by Lord Neuberger, Lady Hale, Lord Clarke and Lord Reed, dismissed the appeal, ruling that the appellant be referred to in the title of the proceedings under his real name, Tariq Khuja. ‘It has been recognised for many years that press reporting of legal proceedings is an extension of the concept of open justice, and is inseparable from it,’ Sumption said. ‘In reporting what has been said and done at a public trial, the media serve as the eyes and ears of a wider public which would be absolutely entitled to attend but for purely practical reasons cannot do so.’ Dissenting, Lord Kerr and Lord Wilson said that previous rulings had failed to recognise that, while most most people might understand that an arrested person is not guilty in law, that ‘is distinctly different’ from most people’s assumptions of guilt. Referring to the Leveson Inquiry’s findings on the tendency of arrest to be associated with guilt, they concluded ‘that the scales have descended heavily in favour of PNM’s rights under article 8 [of the European Convention on Human Rights].’ In a leading article, The Times described the ruling as ‘an important victory for open justice’.However Anna Rothwell of criminal firm Corker Binning said: ’This will be an extremely disappointing judgment for privacy campaigners and lawyers, as there has in recent years been a growing recognition that the identity of those suspected of crimes should not generally be released to the public before charge.’Manuel Barca QC and Hannah Ready, instructed by Collyer Bristow, appeared for the appellant. Gavin Millar QC and Adam Wolanski, instructed by Times Newspapers Limited’s legal department and Newsquest Media Group Limited’s legal department, for the respondents.
Recommendations have been passed to make way for third party funding of arbitration proceedings in Hong Kong – though a code of practice to manage the system is yet to formally come into effect.Clarification that third-party funding is now permissible appears in the Hong Kong International Arbitration Centre Administered Arbitration Rules 2018, published earlier this year and which come into force today.A consultation period seeking views on a draft code of practice for third party funding closed yesterday. The code, intended to protect against potential abuse, is expected to be finalised shortly.Under the rules, a funded party is required to disclose promptly the existence of a funding agreement, the identity of the funder, and any subsequent changes to the arrangement. A funded party will be permitted to disclose arbitration-related information to the funder.The rules on third party funding bring Hong Kong into line with Singapore, Asia’s other main dispute resolution venue, and other common law jurisdictions.Ing Loong Yang, partner in the Hong Kong office of international firm Latham & Watkins, told the Gazette that the provisions would help increase access to justice for parties who would otherwise not be able to afford proceedings but will also help weed out ‘unmeritorious claims’. The idea is that a funder would not back a claim where they do not see a return.Today’s new rules mark the first time since 2013 that procedures for arbitration in Hong Kong have been changed. Other measures introduced in the 2018 rules include a procedure for an early determination of points of law or fact (enabling an unmeritorious point of law to be thrown out earlier).Separately, a panel session on international arbitration discussed the possibility of appointing ‘non-lawyer experts’ to arbitration proceedings ahead of legally qualified arbitrators.Alexis Mourre, president of the International Court of Arbitration, said experts are appointed from time to time but that usually if one side appoints a lawyer the other side will also want a lawyer. Lucy Reed, vice president at the International Council for Commercial Arbitration, said experience would be the key factor in most cases if opting for an expert over a lawyer.
YET ANOTHER official report has recommended major reform of Indian Railways. This time it originated with the Parliamentary Standing Committee on Railways, which last month published a document in response to IR’s requests for grants in 2000-01. The report went much further than commenting on the grants, making strong criticism of the status quo and even suggesting that the Indian Railways Board should be abolished. The committee felt that the Board could be replaced by ’a more state-of-the-art structure’. One option would be to ’corporatise’ the railway by setting up a joint stock company as a holding organisation, with the zonal railways trading as separate operating subsidiaries. The committee has promised to come up with detailed recommendations at a later date.The broad policy recommendations are in line with the views expressed by the Rakesh Monan committee (RG 3.01 p141), in that ’nothing short of major restructuring will be required to achieve the objective of commercialising IR and making its management autonomous’. The Rakesh Monan committee favours establishing an Indian Railway Corp to manage railway assets under rules set by an Indian Rail Regulatory Authority; we understand that IRRA would be responsible for regulating fares, which when used as an instrument of social policy are inevitably going to be the subject of controversy. At the head of IRC would be the Indian Railways Executive Board, charged specifically with implementing a restructuring programme.The Standing Committee was harshly critical of IR’s financial policies, warning that borrowing money on the market through Indian Railway Finance Corp to pay for uneconomic services was ’a sure recipe for disaster’. The opportunity to generate funds from property and land ownership was not being handled well, while the programme to convert another 11000 route-km of narrow gauge lines to broad gauge, in addition to 8000 route-km already converted, would require 13 to 14 years to complete at present spending levels. The programme should be reassessed and priority allocated to schemes that would generate traffic, and hence extra revenue.Further, the committee suggested that there should be a moratorium on new projects, with the emphasis switched to improving the current network, notably through raising capacity on high-density routes and on reducing surplus facilities elsewhere.To be fair, outgoing Railway Minister Mamata Banerjee did not recommend new construction in her controversial budget in February (RG 4.01 p218). But her tenure was not marked by any serious attempt to come to terms with the need for reform, leaving a tough legacy to her replacement, Nitish Kumar.