Local County Research Articles

A quarantine process for the resolution of duodenoscope-associated transmission of multidrug-resistant Escherichia coli

Because of their complex design, duodenoscopes have been long recognized to be difficult to fully disinfect and may play a role in transmission of bacteria between patients. Recent reports of duodenoscope-associated carbapenem-resistant enterobacteriaceae transmission have confirmed these suspicions. An outbreak of a multidrug resistant strain of Escherichia coli was recently reported at our institution. Herein we report the results of our investigation and the process improvements that we deployed in an effort to contain the outbreak. A full investigation into the environment, endoscopists, infection control practices, high-level disinfection process as well as endoscopes was undertaken in conjunction with the local county health authority and the Centers for Disease Control and Prevention. Duodenoscopes were cultured and quarantined for 48 hours until negative cultures were obtained. Ergonomic changes were made to the endoscope reprocessing area, duodenoscopes were returned for routine maintenance, and surveillance cultures were obtained from all patients undergoing ERCP. Between November 2012 and August 2013, 32 patients were found to harbor 1 of 2 clonal strains of multidrug-resistant E coli, all of whom had undergone ERCP or duodenoscopy. A total of 1149 ERCPs were performed during this time period. Seven patients died within 31 days of the organism being identified in culture, 16 patients died overall by March 2015. The exact contribution of E coli to death is unclear because most patients had underlying late-stage malignancy or other severe medical comorbidities. No breach in high-level disinfection protocol or infection control practices was identified. The clonal strain of E coli was identified in culture on 4 of 8 duodenoscopes, 3 of which required critical repairs despite lack of obvious malfunction. The defect rate in high-level disinfection of duodenoscopes was 2% over a 1-year period. The implemented quality improvements, subsequent to which 1625 ERCPs have been performed, were successful in halting the outbreak. The existing manufacturer-recommended high-level disinfection protocols for duodenoscopes are inadequate. Although the ultimate solution may be a design change to the instrument, the timeline for such a change appears long and potentially difficult to exact. In the interim, a reliable method to ensure that bacterial pathogens are not present on the duodenoscope after high-level disinfection is needed.

Leveraging E-Commerce Opportunities for Developing Countries

Recent studies have raised a disturbing issue concerning the ability of developing countries to compete in the E-business marketplace. Historically, researchers have been optimistic and anticipated that E-commerce technologies could be leveraged and benefit underdeveloped countries. Aside from a slight improvement in communications, recent studies have shown that businesses in developing countries do not benefit from advances made in E-commerce technologies. While E-commerce technologies help foreign countries access the markets of underdeveloped countries, they do not return the favor and help businesses in underdeveloped countries. The net result of this unfortunate situation is an unfair level of competition imposed on businesses in developing countries caused by an increase in the digital divide. This paper assesses the level of E-commerce support developing countries are currently realizing, investigates potential benefits or opportunities that E-commerce technologies could bring to bear, and then reviews the barriers that are keeping these opportunities from being realized. Coordinating the actions of government and industry to encourage investment in E-commerce technologies by government, businesses, and individuals, is recommended so businesses in underdeveloped countries and reap the same advantages as their counter parts in developed countries. Given businesses in developing countries did not get to influence the design features associated with improvements to information and communication technologies; it is unlikely they will offer businesses in developing countries the same efficiencies they do to their counterparts in developed countries. The application of the social shaping would allow developing countries to leverage public policy decisions to influence how technology evolves in their local market places. The governments of underdeveloped countries can provide some assistance by adopting policies and regulations, or even to implement laws, to facilitate development and control of E-commerce infrastructure within their own territories. From a global perspective, however, this would be a piecemeal solution. Some kind of international regulation would therefore be preferred. Creative legislative solutions are called for, but at the international level. One approach is to mirror how US municipalities encourage private investment for making infrastructure improvements. Due to tight US municipal budgets, many local county governments leverage land zoning approvals to entice real estate developers into making road and utility infrastructure improvements. By making the infrastructure improvements surrounding the land parcel they are developing, the developers become eligible for zoning and building permit approvals. Costs are prorated to customers for each finished lot the developer sells. A similar approach could be adopted where external businesses desiring to participate in the online market place of developing countries are required to make investments to improve the E-commerce infrastructure position in return for authorizations to conduct business. By integrating approvals to enter the market place with requirements to stand up infrastructure components in government regulated e-portals, the improved E-commerce capabilities could also be leveraged by the businesses within the developing countries, and equal access to E-commerce benefits would be provided to all businesses. Before the products and services of networking and telecommunications service providers are approved for use, the service providers should be required to reduce the gaps in technology and human infrastructure contextual enablers, and level the competitive playing field. An international treaty supported by a list of adopting member states would be a good way to ensure adoption of the approach world-wide, and may encourage positive leveraging of E-commerce capabilities that facilitate growth in underdeveloped countries.

Michigan Local Leaders Have Positive Views on Relationships with County Road Agencies, Despite Some Concerns

This report presents the opinions of Michigan local government leaders and officials from the state’s county road agencies regarding the relationships between local governments and county road agencies, as well as local officials’ ratings of road agency performance and related issues. The findings in this report are based on a statewide survey of local government leaders and county road commissions and departments in the Fall 2014 wave of the Michigan Public Policy Survey (MPPS).

Consider when information may be disclosed under FERPA's health and safety emergency provision

In 1992, a University of Iowa graduate student killed several UI faculty and staff members and a student. As a result of that action, from 1993–2013, UI officials disclosed nondirectory information without the students' written consent to the local county sheriff's office whenever a UI student applied for a gun permit.

English Law, Irish Trials and Cromwellian State Building in the 1650s

Everywhere there is one principle of justice, which is the interest of the stronger. Plato, The Republic In his 1975 Whigs and Hunters , E. P. Thompson reflected upon the fabled English common law. His long-held Marxist perspective, he acknowledged, and its simple conclusion that law ‘is clearly an instrument of the de facto ruling class’, had begun to crumble in the face of a more complex and contradictory realization. ‘If the law’, Thompson wrote, ‘is evidently partial and unjust, then it will mask nothing, legitimize nothing, contribute nothing to any class’s hegemony’. Achieving such objectives instead depended upon the law appearing impartial and independent from ‘gross manipulation’. Calculated moments of government retreat in law courts ‘served, paradoxically, to consolidate power [and] to enhance legitimacy’ while simultaneously bringing ‘power even further within constitutional controls’. Law, regulation and procedure thus amounted to ‘a great deal more than a sham’. 1 Thompson’s assertion applied specifically to the Black Act of the eighteenth century, yet the phenomenon he captured remains fundamental to understanding the consolidation of power in both state and empire building more generally. State formation has received much attention from scholars of early modern England in recent years. Social historians have emphasized the domestic functions of the state, executed by local parish and county officials whose vested social interests ensured that the state remained deeply local and lacked ‘modern’ central institutions and legitimating languages. 2 Political historians, meanwhile, have considered the rise of the bureaucratic state, whose fiscal–military apparatus necessitated modern concepts of political legitimation. 3 Because social and political historians rarely find themselves in conversation with one another, the role of law as a legitimating language and its use by contemporary actors has been marginalized. 4 Moreover, studies of state formation assess only the situation in England and do not extend their analyses to consider the process in Wales, Scotland and Ireland, which, together with England, constituted the ‘British’ composite monarchy by the mid seventeenth century. 5 Examining how the English used law to incorporate the Scots and Irish into a composite state yields valuable results not just for national and archipelagic histories, but also for British imperial history. As David Armitage has noted, the structures of European empires depended upon the constitutional arrangements of their parent states, while J. H. Elliott’s realization that early modern Europe was a world of composite monarchies helps to clarify the connection between early modern state formation and empire building. 6

The Impact of Gender and Early Delinquency on Reoffending: A Life History Perspective

In New Jersey, conversations within a statewide antiviolence initiative stimulated the idea to begin interviewing local repeat offenders to uncover the root of their criminal trajectories. Capturing the life histories of recidivists provides a rich understanding of how these individuals entered and remained in a criminal lifestyle. Employing qualitative methods, 20 men and women were interviewed in a local county jail and asked to describe numerous aspects of their lives that may have contributed to their criminal outcome. Similarities and differences are described between and among the men and women.

Understanding Place Attachment to the County in the American Great Plains

The American Great Plains is a region dominated by a flat, treeless, semiarid environment that has challenged population settlement for over 140 years. As railroad companies successfully attracted pioneers to settle the land, state governments established hundreds of counties. Following Jeffersonian ideals, many of the counties were small in area so they could better serve the local agricultural‐based population. When states established these counties, they envisioned that the population would continue to grow and the Great Plains would become the breadbasket of North America. Unfortunately that did not materialize. A succession of hardships combined with serious environmental constraints has discouraged large‐scale settlement in the region. Many counties reached their maximum population in the early 1900s and their totals have decreased ever since (in some counties by as much as 60 percent to 80 percent). This has led a number of government officials to consider consolidating counties much like school districts have been combined. Using Logan and Gove counties in western Kansas as a case study, our purpose is to understand how attached people are to the county in which they live. Employing multiple methods, we gathered information about how different segments of the population regard their local county. We learned that changing computer technology and the Internet has the biggest impact on peoples' attachment to the county seat.

An Evaluation of Early Education Based on Physical Environmental Guidelines

The integration of environmental policies with political support for action on these policies is of prime significance for mobilization and progression of improving indoor environments. However, state licensing agencies and local county ordinances for child care centers do not universally follow these policies and standards. As a result, most early childhood educational programs operate without proper indoor environments. Indoor air quality, temperature, ventilation, daylighting, and acoustics are crucial factors for educational settings in early childhood education. This study documents the physical environment in early childhood education centers in three counties in Maryland. Results indicate that building performance and indoor air quality standards vary according to the socioeconomic status of children who attend early childhood programs, and environmental factors correlate with educational achievement (as measured by kindergarten readiness scores).

Effects of preventive home visits by district nurses on self-reported health of 75-year-olds.

The aim of this study was to analyse the effects of preventive home visits (PHVs) by district nurses (DNs) on the self-reported health of 75-year-olds, including changes in self-reported health after the visits. The study also investigated whether or not the participants believed the visit was useful. There is a need for methods that promote health among older persons so that they can remain healthy as long as possible. One such method is PHVs. In Sweden, the Stockholm County Council decided to implement such visits to 75-year-olds. The study was a cluster-controlled trial carried out in Stockholm. Sixteen healthcare centres (HCCs) were randomly selected from five geographic medical areas in the county. Eight were assigned to the study group (SG) and eight to the control group (CG). The 75-year-olds registered at these centres (SG n=176, CG n=262) filled in a questionnaire before and after the intervention. Each SG member received a PHV from a DN, and the CG was treated as usual. At follow-up, both the groups reported decreased health and well-being. However, the SG reported a significant reduction in pain as an effect of the PHV. Participants in the SG reported increased knowledge of local community and county council services, more contacts with their HCCs and increased use of medication. The PHV had no effect on health behaviour. The CG reported significantly more problems in the categories of activities of daily living (ADL) and breathing/circulation. Eighty-four per cent of the participants reported that the PHV was somewhat useful, useful or very useful.

ECONOMIC CRISIS AND FOREIGN DIRECT INVESTMENTS IN ROMANIA

Foreign direct investments represent an essential factor of economic development and growth at all levels: national, regional and local (county). The authors analyse the evolution of foreign direct investments in Romania over the last decade, taking into consideration the influence of the economic and financial crisis, different territorial levels, types of foreign investments, the economic activities and also the main countries of origin. The aim of the paper is to explain some of the reasons for the illustrated evolution of FDI and to reveal some policy implications for the future period.

Prevalence of Inherited Ichthyosis in Romania

Abstract Inherited ichthyosis in Romania constitutes a health problem of unknown dimension. Over a period of nine months we collected information about inherited ichthyosis patients from three different sources. We found 124 of individuals in 32 counties and Bucharest, the majority of cases being reported by the social assistance services. We characterized our population by gender, age and domicile area and we compared the number of the identified inherited ichthyosis cases to the local stable population data from 2011 Romanian census in each domicile area. The prevalence of inherited ichthyosis cases was calculated for each source of information and in addition we calculated the cumulated prevalence of medical and social source and total prevalence of all three sources, always reporting to the stable population of the domicile county of reported patients. Statistical analyses and interpretation of data for comparing these values of prevalence were used to determine if the prevalence is different in these sources. We realized first a study to evaluate the existence of significant statistic difference between mean values of prevalence in each source type and subsequently we compared how addition of new data to the main source modified its prevalence. We found that the information collected from local counties official organisms for social assistance and protection is the most significant for the final results and this information is different from that of medical sources and other nonconventional sources.

International primary care snapshots: Sweden and Lebanon.

Primary care in Sweden is delivered through around 1200 primary healthcare centres (PHCs), almost all of which are group surgeries containing more than one doctor. The largest one, situated in a suburb of Stockholm, has more than 30 GPs plus registrars. The surgeries also have nurses, secretaries and laboratory staff. Where I have worked for 33 years there are 4 senior doctors sharing 3 positions, a registrar, 2.5 surgery nurses, 1.5 district nurses, a lab nurse, and one secretary. We have contracts with physiotherapists, occupational therapists, a psychologist, social worker, and a dietician. The government owns about half of the PHCs; the other half being private practices. The latter are more common in the cities and the former more ubiquitous in rural settings. The economic conditions are the same for both type of ownership through contracts with the local county council. The average Swede sees the doctor three times per year, and 50–70% of this constitutes visits to GPs. The rest of the visits are to secondary care doctors, at hospitals or outside. However, Sweden does not have a common system for reimbursement. All GPs (in practice surgeries) have lists of citizens who have actively chosen their doctor. Sweden has 22 counties and each decides on its payment. The reimbursement (payment) amount per visit is highest (‘pay per visit’) in Stockholm but the payment per visit consists not only of what the patient pays but is also a payment per visit from the …

Learn when you may disclose information under health and safety emergency provision

In 1992, a University of Iowa graduate student killed several UI faculty and staff members and a student. As a result of that action, from 1993–2013, UI officials disclosed nondirectory information without students' written consent to the local county sheriff's office whenever a UI student applied for a gun permit.

Sustainability and the local emergency manager.

The objective of this study was to explore how local county emergency managers conceptualize sustainability and apply the concept within their jobs. Qualitative, semistructured telephone and face-to-face interviews were used to collect data from a purposive and convenience sample of local county emergency managers. Interviews were conducted with Florida and North Dakota emergency managers. Twenty-five local county emergency managers participated in this study. The study demonstrated that there is a lack of definitional clarity in emergency manager conceptualizations of sustainability. Nevertheless, emergency managers apply the concept to their jobs in important ways. Emergency management has the opportunity to further define its role vis-à-vis sustainability and how it does so will have implications for the communities it serves, the professionals who will be tasked with it, and the educators who will support the development of future generations of emergency management professionals.

Duty Bound? Court Possession Schemes and Clinical Education

<p>The opportunity to take part in the local County Court hearings of repossession cases arose around 3 years ago, the same time as I joined the University of Northumbria as a solicitor/ tutor working in the Student Law Office. I wanted to keep up my own hands-on skills as a solicitor, and so grasped this opportunity with enthusiasm. It has been an invaluable teaching tool as part of student’s experiences within the student law office, but only recently have I stopped to take stock of the nature and value of this experience, and to consider more carefully the aims and objectives, from the Student Law Office point of view, in taking part in this.</p><p>This paper looks at experiences with students at court repossession days, and the messages we are giving students when we expose them to this type of work – are we moving closer towards clinical legal education with a social justice agenda? And what do we get out of these court days as a student learning experience. </p>

The Relationship Between Local Public Health Agency Administrative Variables and County Health Status Rankings in Kentucky

The purpose of this research study was to determine whether specific local public health agency (LPHA) characteristics were associated with favorable county health status. Specifically, financial and administrative comparisons were made to determine whether variables such as budget size or number of employees, among others, were associated with community health status among the 120 counties in Kentucky. Other financial and administrative variables collected from LPHA data were also investigated in this study. Administrative and financial data were collected for each local public health agency in Kentucky. This was matched with data on the health status of Kentucky counties from the 2010 University of Wisconsin MATCH (Mobilizing Action Towards Community Health Assessment) counties in select measures of health. MATCH data used included measures of health outcomes, specifically socioeconomic status (SES), mortality, and morbidity. Logistic regressions were used to determine the relationship, if any, between variations in the health agency data variables, SES, and health status. Analysis suggests that SES is the strongest link to county health status. Several other variables that appear to have statistically significant association with health status include the education level of the director, whether the LPHA employees received a raise, whether the LPHA had an associated Home Health agency, and the amount of money used from their reserve account to balance the LPHA budget. For many years, public health in Kentucky has measured the number of clinical visits and other LPHA services but failed to determine specific characteristics and variables that influence community health status. This study suggests that LPHAs in Kentucky can advance public health practice by having well-educated directors, giving annual incremental raises, and utilizing the agency reserve funds to meet budget shortfalls in the short run. Furthermore, LPHAs with an associated home health agency may need to reassess their impact and need in their community, considering the negative effect it may have on county health status.

Rhetorical Education and Student Activism

On February 8, 2010, eleven student activists at the University of California–Irvine protested a speech by Michael Oren, Israel’s ambassador to the United States. The disruptive nature of the protest by these students—advocates of Palestinian de-occupation and members of the Muslim Student Union—led to disciplinary action against their student organization and criminal prosecution in the local county court for disturbing the peace. This essay offers the results of an interview-based study exploring the rhetorical education of five of these college activists. The interviews reveal the powerful influence of family histories of activism and thoughtful reflections on the rhetorical dynamics of the Middle East conflict within local, national, and international publics. They also show student awareness of the limitations of the liberal-deliberative rhetorics that underpin most college writing courses. That students reported only a tenuous sense of connection between college courses and self-sponsored activist education suggests that teachers and scholars of rhetoric and composition may need to give cocurricular activism more consideration in the next phase of the “social turn.”

Southern Highbush Blueberry Cultivars from the University of Florida

Many improved southern highbush cultivars have been developed by the University of Florida breeding program since the initial releases of ‘Sharpblue’, ‘Floridablue’, and ‘Avonblue’ in the mid-1970s. Today there are more blueberry cultivar choices available for Florida growers than ever before, but in every case, cultivar selection involves weighing the advantages and disadvantages of a cultivar relative to the grower’s needs. Unfortunately, there are no perfect cultivars suited for every location and management system. This 10-page fact sheet categorizes southern highbush cultivars into four groups: major cultivars, secondary cultivars, new options, and historical cultivars. Proper cultivar selection is critical to a successful blueberry enterprise, and growers should seek information from multiple sources, including their local county Extension office. Written by J.G. Williamson, J.W. Olmstead, G.K. England, and P.M. Lyrene, and published by the UF Department of Horticultural Sciences, April 2014.
 HS1245/HS1245: Southern Highbush Blueberry Cultivars from the University of Florida (ufl.edu)

Do forest producers benefit from the forest disaster insurance program? Empirical evidence in Fujian Province of China

Disaster insurance programs have been recognized as an effective strategy to reduce agricultural production risk. Although a considerable body of literature has focused on natural disaster insurance programs for agricultural producers, not much is known about forest disaster insurance. This paper contributes to this knowledge gap by looking at the Fujian Forest Disaster Insurance (FFDI) program in China. In particular, we examine the extent to which the socio-demographic characteristics and production practice of forest producers, along with other factors, are associated with their participation decision to the program. Moreover, we assess the impact of the FFDI program on household income. Using a household survey of 950 forest producers in Fujian Province in China, it is evident that the education of forest producers, participation in producers' organizations in the local area, and the incidence of forest fires in the local counties are significant determinants of participation in the FFDI program. With respect to the welfare effect, we found that the FFDI program significantly increased household income by approximately 10%.

Unemployment and substance outcomes in the United States 2002–2010

BackgroundThe economic shock of 2008–2009 provided an opportunity to study the robustness of observed statistical associations between unemployment and problematic substance use. MethodsData from 405,000 non-institutionalized adult participants in the 2002 to 2010 U.S. National Survey on Drug Use and Health were used to compare substance outcomes among unemployed and employed persons. Association of unemployment with substance outcomes was examined for the years 2002–2004, 2005–2007, 2008, and 2009–2010, corresponding to periods prior to and after the economic downturn of 2008. Multivariate logistic regression models adjusted for age, sex, race/ethnicity, education, urban/rural residence, current DSM-IV Major Depression, and local county unemployment rates. ResultsHigher rates of past month tobacco and illicit drug use, heavy alcohol use, and past-year drug or alcohol abuse/dependence were found among the unemployed. Markedly increased unemployment in 2009–2010 did not moderate the association between substance outcomes and employment. This association was not confounded by sex, age group, or race/ethnicity for tobacco and illicit drugs, although it varied for alcohol outcomes among 18–25 year-olds. Results based on retrospective data regarding marijuana use in the period prior to unemployment suggest its use was associated with future job loss. ConclusionsEmployment status was strongly and robustly associated with problematic use of substances. Prevention and treatment interventions are warranted for a group whose employment and resulting insurance status may impair access to much needed health care.