Making Medical Decisions for Incapacitated Patients Without Proxies: Part I.

To date no one has identified or described the population of incapacitated patients being treated in an inpatient setting who lack proxy decision-makers. Nor, despite repeated calls for protocols to be developed for decision-making, has any institution reported on the utilization of such a protocol. In 2005, our urban tertiary care hospital instituted a protocol utilizing community members of the ethics committee to meet with the medical providers and engage in shared decision-making for patients without proxies (PWPs).

Agricultural contamination impacts antibiotic resistance gene abundances in river bed sediment temporally.

Kewaunee County, Wisconsin is an agricultural area dominated by concentrated animal feeding operations and manure fertilized cropland. The objective of this study was to characterize chemical and antibiotic resistance gene (ARG) profiles of 20 surface water locations in Kewaunee County to better understand relationships between agricultural contamination and ARG abundance over one year. Surface water (n = 101) and bed sediment (n = 93) were collected from 20 sites during five timepoints between July 2016 and May 2017.

Pathogens transmitted in animal feces in low- and middle-income countries.

Animals found in close proximity to humans in low-and middle-income countries (LMICs) harbor many pathogens capable of infecting humans, transmissible via their feces. Contact with animal feces poses a currently unquantified-though likely substantial-risk to human health. In LMIC settings, human exposure to animal feces may explain some of the limited success of recent water, sanitation, and hygiene interventions that have focused on limiting exposure to human excreta, with less attention to containing animal feces.

Exposure to Animal Feces and Human Health: A Systematic Review and Proposed Research Priorities.

Humans can be exposed to pathogens from poorly managed animal feces, particularly in communities where animals live in close proximity to humans. This systematic review of peer-reviewed and gray literature examines the human health impacts of exposure to poorly managed animal feces transmitted via water, sanitation, and hygiene (WASH)-related pathways in low- and middle-income countries, where household livestock, small-scale animal operations, and free-roaming animals are common. We identify routes of contamination by animal feces, control measures to reduce human exposure, and propose research priorities for further inquiry.

Quantitative analysis of the extent of heavy-metal contamination in soils near Picher, Oklahoma, within the Tar Creek Superfund Site.

The Tri-State Mining District of Missouri, Kansas and Oklahoma was the site of large-scale mining operations primarily for lead and zinc until the mid-1950s. Although mining across the area has ceased, high concentrations of heavy metals remain in the region's soil and water systems. The town of Picher, Ottawa County, OK, lies within this district and was included in the Tar Creek Superfund Site by the U.