Michelle Alfa and a team of scientists from Manitoba, Canada investigated the spread of so-called superbugs in hospitals. Hospital patients are thought to catch bugs like vancomycin resistant Enterococci (VRE), methicillin resistant Staphylococcus aureus (MRSA) and C. difficile because they are not eradicated from the hospital environment. These bugs may be transferred between patients through cross-contamination in the bathroom.

“Various studies have looked at the most effective cleaning agents, but none of these studies considered whether housekeeping staff were actually cleaning the toilets properly,” says Alfa. “It is impossible to assess the effectiveness of any action against these bacteria unless you can be sure that cleaners comply with protocols.”

Alfa’s toilet inspectors smeared the UV lotion under the seats of 20 toilets and commodes being used by patients with diarrhoea at a hospital in Winnipeg. Seven of these patients had C. difficile infection, while 13 others did not. The toilets and commodes were tested every weekday for six months and checked using UV light to determine how well they had been cleaned. In addition, samples were taken from toilet surfaces to determine whether C difficile spores were present.

The UV marker revealed that the commodes for the seven patients isolated with C. difficle infections had not been properly cleaned 72% of the time. The toilets fared slightly better, with half of the samples taken showing no residual UV lotion after cleaning. The 13 patients not on isolation had much cleaner toilets, with only 14% glowing brightly under UV light. Further assessments showed that differences in toilet cleaning were “ward dependent” and since specific cleaners work on different wards, the results likely reflect characteristics of the individual cleaning staff.

More worryingly, C. difficle was still detected in 40% of samples taken from the cleanest toilets (i.e. those with no detectable UV marker). “This suggests that both the physical cleaning action as well as the disinfectant/cleaning agent were ineffective for killing and/or removing C. difficile from toilets,” notes Alfa.

“Our data suggest that without an agent with some activity against C. difficile spores the physical action of cleaning alone cannot be relied upon to effectively eradicate this organism from the toilets of patients who are shedding this type of spore. Nevertheless, we would still recommend that monitoring with a UV marker becomes a routine part of a hospital’s housekeeping quality assurance programme.

[Charlotte Webber @ BioMed Central]

Professor Downing found that constructed ponds and lakes on farmland in the United States bury carbon at a much higher rate than expected; as much as 20-50 times the rate at which trees trap carbon. In addition, ponds were found to take up carbon at a higher rate than larger lakes.

“Aquatic ecosystems play a disproportionately large role in the global carbon budget,” Downing said. “Despite being overlooked in the past, it’s small bodies of water that are important because they take up carbon at a high rate and there are more of them than previously thought. The combined effect is that farm ponds could be burying as much carbon as the world’s oceans, each year.”

Ponds capture carbon in two main ways:

The research estimated there are 304 million natural lakes and ponds in the world, covering an area of 4.2 million square kilometers, twice the area previously thought. As many as 90 percent of these water bodies are one hectare (two acres) or less in area.

Downing’s research team published its most recent findings in the Feb. 15 issue of the journal Global Biogeochemical Cycles in a paper titled, “Sediment organic carbon burial in agriculturally eutrophic impoundments over the last century.” The team included members from Europe, the United States and Canada. The work was sponsored by the National Center for Ecological Analysis and Synthesis and the Iowa Department of Natural Resources.

Downing has presented invited seminars on this research to the International Society of Limnology, the American Society of Limnology and Oceanography, and at several major research institutions in North America and Europe. Most recently, he was invited to discuss his research by the Pond Conservation, a charity in the United Kingdom dedicated to creating and protecting ponds and the wildlife they support. He will spoke today at University College London. An upcoming presentation is scheduled for the annual meeting of the European Pond Conservation Network in Valencia, Spain.

Jeremy Biggs, Pond Conservation director of policy and research, said the research has exciting implications. “It may be that ponds will be the modern equivalent of the swamps that formed coal in the past. But before we all rush into making ponds to trap carbon we need to do some basic research here in the UK. If the rate of carbon uptake in ponds in Europe is the same as that found in the USA study, we may well have discovered an important new natural way of trapping carbon,” he said.

Downing’s ongoing research, partnering with the United States Geological Survey, and his contributions to the Iowa Lakes Survey will investigate the role of small Iowa lakes in the absorption of atmospheric carbon dioxide and other important gases such as methane.

[John Downing @ Iowa State University]

The researchers found evidence that fungi can “lock” depleted uranium into a mineral form that may be less likely to find its way into plants, animals, or the water supply.

“This work provides yet another example of the incredible properties of microorganisms in effecting transformations of metals and minerals in the natural environment,” said Geoffrey Gadd of the University of Dundee in Scotland. “Because fungi are perfectly suited as biogeochemical agents, often dominate the biota in polluted soils, and play a major role in the establishment and survival of plants through their association with roots, fungal-based approaches should not be neglected in remediation attempts for metal-polluted soils.”

The testing of depleted-uranium ammunition and its recent use in Iraq and the Balkans has led to contamination of the environment with the unstable metal, Gadd explained. Depleted uranium differs from natural uranium in the balance of isotopes it contains. It is the byproduct of uranium enrichment for use in nuclear reactors or nuclear weapons and is valued for its very high density. Although less radioactive than natural uranium, depleted uranium is just as toxic and poses a threat to people.

In the new study, the researchers found that free-living and plant symbiotic (mycorrhizal) fungi can colonize depleted-uranium surfaces and transform the metal into uranyl phosphate minerals.

While they probably still pose some threat, he said, “The fungal-produced minerals are capable of long-term uranium retention, so this may help prevent uptake of uranium by plants, animals, and microbes. It might also prevent the spent uranium from leaching out from the soil.”

Gadd said that a combination of environmental and biological factors is involved in the process. First, the unstable uranium metal gets coated with a layer of oxides. Moisture in the environment also “corrodes” the depleted uranium, encouraging fungal colonization and growth. While the fungi grow, they produce acidic substances, which corrode the depleted uranium even further. Some of the substances produced include organic acids that convert the uranium into a form that the fungi can take up or that can interact with other compounds. Ultimately, he said, the interaction of soluble forms of uranium with phosphate leads to the formation of the new uranium minerals that get deposited around the fungal biomass.

“We have shown for the first time that fungi can transform metallic uranium into minerals, which are capable of long-term uranium retention,” the researchers concluded. “This phenomenon could be relevant to the future development of various remediation and revegetation techniques for uranium-polluted soils.”

[Cathleen Genova @ Cell Press]

Approximately 20 percent of ACP members who are involved in direct patient care are in solo physician practices. And, about 50 percent are in practices of five or fewer physicians.

On July 1, physicians face a 10.6 percent cut in Medicare reimbursements. Another 5 percent cut is anticipated on January 1, 2009. The Sustainable Growth Rate (SGR) formula that is used to calculate Medicare payments to physicians was created in 1997 and ties physician payments to growth in the overall economy. When growth in physician expenditures exceeds growth in the economy, the difference is subtracted from physician payments. The SGR formula has led to scheduled annual cuts for six consecutive years.

Earlier this year, ACP surveyed its members to measure the impact of pending Medicare payment cuts on their practices and on their patients. The questionnaire asked internists to report on the changes they would be forced to make if Congress does not act. Although the survey was not designed as a scientific sample, almost 2,000 internists responded, providing ACP with first-hand accounts of how the SGR cuts are affecting millions of Medicare beneficiaries.

Dr Dale cited the story of one respondent, a Texas internist, who said:

“The practice of medicine is a calling and as such, my colleagues and I have endured more unfair revenue cuts than most businesses would have endured. Yet, a medical practice is also a small business, and there are limits to how much we can endure. We are now at the point where further cuts are not survivable. Just like any small business, our revenue has to exceed costs in order to survive. Despite everything that I have been able to do to cut costs, the margin of profit is now thin, and the proposed greater than 10 percent cut will put us out of business. The only option will be to downsize the practice and stop seeing all Medicare patients. I would hate this, but it will be the only option I have if Congress does not reverse the proposed cuts.”

ACP is asking Congress to avert the immediate SGR cut, but also go a step beyond. The College is asking Congress to set a timeline for completely eliminating the use of the SGR formula. ACP also wants Congress to direct Medicare, as part of replacing the SGR formula, to change payment policies to support patient-centered, physician-guided care management based on the patient-centered medical home model of care.

“Medicare patients deserve the best possible care,” concluded Dr. Dale. They also deserve a physician payment system that will help physicians deliver the best care possible, his testimony said.

[David Kinsman @ American College of Physicians]

The Socratic dialogue is a particular way of developing children’s, as well as adults’, thinking skills through cooperative dialogue where significant human ideas and values are discussed. By participating in Socratic seminars regularly every other week, preschool children and older students develop their thinking skills. The seminars address literature and art work, with questions such as these: is Pippi Longstocking a good friend, is Jack stupid or smart when he sells his mother’s cow for some beans, or are we born good or evil? In the beginning the students have difficulty expressing their thoughts, but with time their ability to express themselves and to examine ideas critically and logically develops.

The study included seven groups of children, five to sixteen years old. The groups were filmed during three years of philosophizing in the classroom and the films were analyzed. The interaction in the classroom was positively influenced, according to Ann S Pihlgren. The teacher dominated less, more students spoke and the students gradually took over the responsibilities of the teacher to promote exploration in the dialogue. The ability to use the Socratic seminar is learned by students and teachers through practice and by testing the rules of the seminar. The students construct a supportive group culture through their silent interaction, where gestures, glances, and body language are used to show not only support or sympathy for each other, but also cooperation with each other when someone attempts to disturb or to provoke the dialogue. The teacher role changes to one of support, ensuring that the analysis is fruitful and that the dialogue is respectful.

Socratic methods have developed independently in various countries. They all describe a set of methodological steps to attain similar objectives. An opening question is answered by all participants and followed by cooperative, critical analysis. Finally, the new ideas are connected to the everyday life experience of the participants.

It seems as if this ritualized structure and the nurturing culture of the seminar provide a safe circle, helping the participants to try new, bold ideas that they might otherwise not have tested, Ann S. Pihlgren says. By cooperating when examining the ideas they also seem to learn a way to address problems on their own without teacher intervention.

To work with methods connected to the ancient philosopher Socrates may seem out-of-date in a modern school, but that is absolutely not the case, Ann S. Pihlgren states.

The Socratic seminars have been seen as a complement to traditional classroom teaching for hundreds of years. But it is not easy to learn how to stage them to get positive effects. It is especially hard for teachers, who often fall back to their traditional, controlling “teacher” roles. The dissertation offers excellent tools for teachers who want to develop students’ thinking and to foster cooperative group dialogue.

The name of the dissertation: Socrates in the Classroom. Rationales and Effects of Philosophizing with Children. The dissertation can be downloaded as a pdf here.

[Jonas Ablad @ Swedish Research Council]