The significant challenges presented by the April 20, 2010 explosion, sinking, and subsequent oil spill of the Deepwater Horizon drilling platform in Canyon Block 252 about 52 miles southeast of Venice, LA, USA greatly impacted Louisiana's coastal ecosystem including the sea food industry, recreational fishing, and tourism. The short-term and long-term impact of this oil spill are significant, and the Deepwater Horizon spill is potentially both an economic and an ecological disaster. Microbes present in the water column and sediments have the potential to degrade the oil. Oil degradation could be enhanced by biostimulation method. The conventional approach to bioremediation of petroleum hydrocarbon is based on aerobic processes. Anaerobic bioremediation has been tested only in a very few cases and is still considered experimental. The currently practiced conventional in situ biorestoration of petroleum-contaminated soils and ground water relies on the supply of oxygen to the subsurface to enhance natural aerobic processes to remediate the contaminants. However, anaerobic microbial processes can be significant in oxygen-depleted subsurface environments and sediments that are contaminated with petroleum-based compounds such as oil-impacted marshes in Louisiana. The goal of this work was to identify the right conditions for the indigenous anaerobic bacteria present in the contaminated sites to enhance degradation of petroleum hydrocarbons. We evaluated the ability of microorganisms under a variety of electron acceptor conditions to degrade petroleum hydrocarbons. Researched microbial systems include sulfate-, nitrate-reducing bacteria, and fermenting bacteria. The results indicated that anaerobic bacteria are viable candidates for bioremediation. Enhanced biodegradation was attained under mixed electron acceptor conditions, where various electron-accepting anaerobes coexisted and aided in degrading complex petroleum hydrocarbon components of marsh sediments in the coastal Louisiana. Significant degradation of oil also occurred under sulfate-reducing and nitrate-reducing conditions.
Maternity care access in the United States is in crisis. The American Congress of Obstetrics and Gynecology projects that by 2030 there will be a nationwide shortage of 9,000 obstetrician-gynecologists (OB/GYNs). Midwives and OB/GYNs have been called upon to address this crisis, yet in underserved areas, family physicians are often providing a majority of this care. Family medicine maternity care, a natural fit for the discipline, has been on sharp decline in recent years for many reasons including difficulties cultivating interdisciplinary relationships, navigating privileging, developing and maintaining adequate volume/competency, and preventing burnout. In 2016 and 2017, workshops were held among family medicine educators with resultant recommendations for essential strategies to support family physician maternity care providers. This article summarizes these strategies, provides guidance, and highlights the role family physicians have in addressing maternity care access for the underserved as well as presenting innovative ideas to train and retain rural family physician maternity care providers. (Fam Med. 2018;50(9):662-71.)
PREFACE: This “In the Literature” column has a different genesis from previous columns. It emanates from a discussion that began on the Maternity Care Discussion Group (MCDG), an online group of more than 600 family physicians, obstetricians, midwives, nurses, and doulas that has been hosted on the College of Family Physicians of Canada website for 20 years. Although mainly a Canadian list, international participants are welcome to join in the struggle to improve maternity care and support those who provide it. To join the MCDG List, send an e‐mail to mklein@interchange.ubc.ca.
Purpose To address the intravenous (i.v.) opioid shortage, computer-based alerts and modifications were implemented over 2 phases beginning in August 2017 and February 2018, respectively. A study was conducted to assess the impact of these interventions on dispenses of intermittent doses of i.v. opioids during a national shortage. Methods A retrospective, single-center, pre- and postimplementation study was conducted to compare opioid dispenses from September 2017 through December 2017 (phase 1) and March 2018 through May 2018 (phase 2) with dispenses during the same time periods of the previous year (historical control periods). Dispense data for intermittent doses of i.v. fentanyl, hydromorphone, and morphine and select oral opioids were collected from automated dispensing cabinets (ADCs) located in nonprocedural areas. The primary endpoint was the percentage of total intermittent doses of i.v. and oral opioids that were dispensed for i.v. administration. A subanalysis accounting for unit type was conducted. Key secondary endpoints were the numbers of oral and i.v. opioid dispenses by month. Results The final analysis included data from 92 ADCs. The percentage of i.v. opioid dispenses significantly decreased, by 9.8% during phase 1 (P < 0.0001) and by 16.8% during phase 2 (P < 0.0001) compared to dispenses during the historical control periods. These decreases were significant across all unit types except pediatric units during phase 1. Average monthly dispenses of i.v. opioids were 49.9% and 74.2% fewer than dispenses during the historical control periods after the phase 1 and phase 2 implementations, respectively. Conclusion Order entry alerts and modifications significantly decreased dispenses of intermittent doses of i.v. opioids during a national shortage, with demonstrated sustainability of decreases over 7 months.
Telling a pregnant woman and her family about a fetal demise is one of the greatest challenges for maternity care clinicians. In this essay, the author refl ects on such an encounter in her work as a community health center clinician, maternity care teacher, and mother herself. T he morning begins in celebration, my son brightly leaping awake in joyful anticipation of his eighth birthday unfolding before him. This day will truly be his. Before work, I share the merriment of his breakfast birthday gifts and then kiss him good-bye more wistfully than usual. My happiness at his excitement is tinged both with memory of his newborn self so fl eetingly long ago and with sadness at departing for work. This day should be fully his-and fully mine to be there as I was at the beginning. But he seems unaware and is too busy thinking about his latest Lego and his upcoming party to give me more than a quick airborne hug.At work, I, too, become busy thinking about other things, enveloped in the tumult of my overbooked schedule at a community health center. After a couple of patients do not show, I have a breather to fi nish notes in a chart at the nurses' station. When our obstetric nurse-practitioner approaches me, I expect her usual quick curbside question about a newly pregnant woman' s medication list or yesterday' s telephone messages. But she is somber and succinct as she hands me her Doptone. "I'm seeing a woman at 30 weeks' with no fetal movement for a week and no fetal heart tones now." I put down my pen immediately to follow her. Somehow in her tone and my response, we both wordlessly know that if she cannot fi nd the heartbeat, I probably cannot either.I enter the examination room and introduce myself to the woman sitting on the examination table. She' s Salvadoran, quiet with respect for doctors, neatly dressed, and carefully coiffed. Her prenatal history is unremarkable; her 2-year old daughter is at home while her sister-in-law dropped her off for this visit. She knows this baby is a boy-she paid for a sonogram to know that.I ask a few questions about her history and symptoms as I wash my hands; I query again about when she last felt movement and explain that I will also try to listen for the baby. In these fi rst few moments of meeting each other, I cannot quite read her face. I wonder silently what kept her from calling sooner than this regularly scheduled appointment and what she thinks could be wrong.I put my hands gently on her soft belly, feeling for her uterus and the baby' s position before I reach for the Doptone. Under my hands, her fundus is soft, the baby still. I listen in the usual places, moving the Doptone around, searching for the swift swishing sound of life' s pulse, but hearing only static. The nurse-practitioner knocks on the door to tell me that luckily for us our sonography technician is available immediately. I look this mother in the eye and make a swift decision to be completely honest right 368MOTHERS AND SONS now: I say in my pretty good but not perfect Spanish, "Well, sometim...
If we merge mercy with might, and might with right, then love becomes our legacy and change our children's birthright... For there is always light, if only we're brave enough to see it" 1 T his month's issue begins with a qualitative study conducted by a team of researchers from the University of Rochester's Department of Family Medicine. This team, led by Holly Russell, MD, MS, explored barriers and facilitators to reporting and responding to gender discrimination and sexual harassment within their own department. 2 This was brave, and inspiring, and-as it was done extremely well-also lays out an educational roadmap for those moved to replicate this important work. The women editors of Family Medicine collaborated on this editorial, after recognizing the strength of shared narrative highlighted by this study. The italicized quotes that follow are reflections from this team.The article starts by describing the pervasiveness of gender discrimination and sexual harassment in medicine, citing studies that reveal most women clinician-researchers and almost all women residents have experienced gender discrimination during their careers, with one-third experiencing sexual harassment. 3,4 Discrimination must be ubiquitous to support such statistics, however the frequency uncovered by this work surprised even some members of Dr Russell's research team and department. This is understandable, as it is easiest to believe that "almost all" means everyone else, rather than the more logical truth that it includes us all. But as this research team demonstrated, and what our society is discovering, is that being brave enough to see also suggests one is responsible to challenge the darkness when revealed.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.