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South Africa has embarked on major health policy reform to deliver universal health coverage through the establishment of National Health Insurance (NHI). The aim is to improve access, remove financial barriers to care, and enhance care quality. Health technology assessment (HTA) is explicitly identified in the proposed NHI legislation and will have a prominent role in informing decisions about adoption and access to health interventions and technologies. The specific arrangements and approach to HTA in support of this legislation are yet to be determined. Although there is currently no formal national HTA institution in South Africa, there are several processes in both the public and private healthcare sectors that use elements of HTA to varying extents to inform access and resource allocation decisions. Institutions performing HTAs or related activities in South Africa include the National and Provincial Departments of Health, National Treasury, National Health Laboratory Service, Council for Medical Schemes, medical scheme administrators, managed care organizations, academic or research institutions, clinical societies and associations, pharmaceutical and devices companies, private consultancies, and private sector hospital groups. Existing fragmented HTA processes should coordinate and conform to a standardized, fit-for-purpose process and structure that can usefully inform priority setting under NHI and for other decision makers. This transformation will require comprehensive and inclusive planning with dedicated funding and regulation, and provision of strong oversight mechanisms and leadership.
Extensive shale gas development is expected throughout the Appalachian Basin, and implementing effective avoidance and mitigation techniques to reduce ecosystem impacts is essential. Adoption of best management practices (BMPs) is an important approach for standardizing these techniques. For BMPs to be credible and effective, they need to be strongly supported by science. We focused on 28 BMPs related to surface impacts to habitat and wildlife and tested whether each practice was supported in the scientific literature. Our quantitative assessment produced four general conclusions: (1) the vast majority of BMPs are broad in nature, which provides flexibility in implementation, but the lack of site-specific details may hamper effectiveness and potential for successful conservation outcomes; (2) relatively low support scores were calculated for a number of BMPs, most notably those relating to noise and light pollution, due to existing research documenting effects on behavior rather than directly on species' survival and fitness—an indication that more research is needed; (3) the most commonly and strongly supported BMPs include landscape-level planning and shared infrastructure; avoidance of sensitive areas, aquatic habitats, and core forest areas; and road design, location, and maintenance; and (4) actions to enhance the development and implementation of BMPs should include public education, increased communication among scientists, improved data sharing, development of site-specific BMPs that focus on achieving ecological outcomes, and more industry collaboration.
Environmental Practice 14:308–319 (2012)
The anterior nares are the most sensitive single site for detecting methicillin-resistant Staphylococcus aureus (MRSA) colonization. Colonization patterns of USA300 MRSA colonization are unknown.
To assess whether residents of extended care facilities who are colonized with USA300 MRSA have different nares or skin colonization findings, compared with residents who are colonized with non-USA300 MRSA strains.
The study population included residents of 5 extended care units in 3 separate facilities who had a recent history of MRSA colonization. Specimens were obtained weekly for surveillance cultures from the anterior nares, perineum, axilla, and skin breakdown (if present) for 3 weeks. MRSA isolates were categorized as USA300 MRSA or non-USA300 MRSA.
Of the 193 residents who tested positive for MRSA, 165 were colonized in the anterior nares, and 119 were colonized on their skin. Eighty-four percent of USA300 MRSA-colonized residents had anterior nares colonization, compared with 86% of residents colonized with non-USA300 MRSA (P = .80). Sixty-six percent of USA300 MRSA–colonized residents were colonized on the skin, compared with 59% of residents colonized with non-USA300 MRSA (P = .30).
Colonization patterns of USA300 MRSA and non-USA300 MRSA are similar in residents of extended care facilities. Anterior nares cultures will detect most—but not all—people who are colonized with MRSA, regardless of whether it is USA300 or non-USA300 MRSA.
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