Community health partnerships (CHPs) are voluntary collaborations of diverse community organizations that have joined forces in order to pursue a shared interest in improving community health. Although these cross‐sectoral collaborations represent a way to address social determinants of health and disease in society, they suffer from governance and management problems associated with interorganizational relationships in general and health care challenges specifically. A typology of effective governance and management characteristics provides a systematic, theoretically based way of addressing dimensions of governance and management and serves as a guide in constructing, maintaining, and measuring successful partnerships. It offers a multidisciplinary perspective for classifying important organizational issues, identifying barriers to successful development and sustainability, and facilitating the attainment of goals.

Perfluorinated compounds, which are environmentally persistent and bioaccumulative contaminants, cannot currently be treated in the subsurface by in situ technologies. Catalyzed H 2 O 2 propagation (CHP) reactions, which generate hydroxyl radical, hydroperoxide anion, and superoxide anion, were investigated for treating perfluorooctanoic acid (PFOA) as a basis for in situ chemical oxidation remediation of groundwater. Using 1 M H 2 O 2 and 0.5 mM iron(III), PFOA was degraded by 89% within 150 min. Hydroxyl radical does not react with PFOA, but systems producing only superoxide promoted 68% PFOA degradation within 150 min. In systems producing only hydroperoxide, the level of PFOA degradation was 80% over 150 min. The generation of near-stoichiometric equivalents of fluoride during PFOA degradation and the lack of detectable degradation products suggest PFOA may be mineralized by CHP. CHP process conditions can be adjusted during treatability studies to increase the flux of superoxide and hydroperoxide to treat PFOA, providing an easily implemented technology.

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Background: Osteopenia and rickets are common among extremely low birth weight infants (ELBW, <1000 g birth weight) despite current practices of vitamin and mineral supplementation. Few data are available evaluating the usual course of markers of mineral status in this population. Our objectives in this study were to determine the relationship between birth weight (BW) and peak serum alkaline phosphatase activity (P-APA) in ELBW infants and evaluate our experience with the diagnosis of rickets in these infants.

Antibiotics and antibiotic-resistant bacteria (ARB) enter the environment through municipal and agricultural waste streams and pose a potential risk to human and livestock health through either direct exposure to antibiotic-resistant pathogens or selective pressure on the soil microbial community. This review summarizes current literature on the fate of antibiotics, ARB, and antibiotic resistance genes (ARGs) during anaerobic digestion and composting of manure and wastewater residuals. Studies have shown that removal of antibiotics varies widely during mesophilic anaerobic digestion, even within the same class of antibiotics. Research on ARB shows a wide range of removal under mesophilic conditions, with nearly complete removal under thermophilic conditions. Research on 16 antibiotics in 11 different studies using both bench-scale and farm-scale composting systems demonstrates that composting significantly reduces levels of extractable antibiotics in livestock manure in nearly all cases. Calculated half-lives ranged from 0.9 to 16 d for most antibiotics. There is more limited evidence that levels of ARB are also reduced by composting. Studies of the fate of ARGs show mixed evidence for removal during both mesophilic and thermophilic anaerobic digestion and during thermophilic composting. Antibiotic resistance genes are DNA structures, so they may persist until the DNA structure is degraded, yet the bacterium may have been rendered nonviable long before the DNA is completely degraded. Additional research would be of value to determine optimum anaerobic digestion and composting conditions for removal of ARB and to increase understanding of the fate of ARGs during anaerobic digestion and composting.

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It is generally assumed that antibiotic residues in soils select for antibiotic-resistant bacteria. This assumption was tested by separately adding 10 different antibiotics (>200 ppm) to three soil-water slurries (silt-loam, sand-loam, and sand; 20% soil [wt/vol]) and incubating mixtures for 24 h at room temperature. The antibiotic activity of the resultant supernatant was assessed by culturing a sensitive Escherichia coli strain in the filter-sterilized supernatant augmented with Luria-Bertani broth. We found striking differences in the abilities of supernatants to suppress growth of the indicator E. coli. Ampicillin, cephalothin, cefoxitin, ceftiofur, and florfenicol supernatants completely inhibited growth while bacterial growth was uninhibited in the presence of neomycin, tetracycline, and ciprofloxacin supernatants. High-performance liquid chromatography (HPLC) analysis demonstrated that cefoxitin and florfenicol were almost completely retained in the supernatants, whereas tetracycline and ciprofloxacin were mostly removed. Antibiotic dissipation in soil, presumably dominated by adsorption mechanisms, was sufficient to neutralize 200 ppm of tetracycline; this concentration is considerably higher than reported contamination levels. Soil pellets from the tetracycline slurries were resuspended in a minimal volume of medium to maximize the interaction between bacteria and soil particles, but sensitive bacteria were still unaffected by tetracycline (P ‫؍‬ 0.6). Thus, residual antibiotics in soil do not necessarily exert a selective pressure, and the degree to which the pharmaceutical remains bioactive depends on the antibiotic. Efforts to control antibiotic contamination would be better directed toward compounds that retain biological activity in soils (e.g., cephalosporins and florfenicol) because these are the antibiotics that could exert a selective pressure in the environment.

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