text:
Climate-related increase in the prevalence of urolithiasis in the United States
Tom H. Brikowski, Yair Lotan, and Margaret S. Pearle
*Geosciences Department, University of Texas at Dallas, Richardson, TX 75080-3021; and
‡Department of Urology, University of Texas Southwestern Medical School, Dallas, TX 75390
PNAS July 15, 2008 105 (28) 9841-9846; https://doi.org/10.1073/pnas.0709652105
Tom H. Brikowski
Yair Lotan
Margaret S. Pearle
Edited by William C. Clark, Harvard University, Cambridge, MA, and approved May 8, 2008 (received for review October 12, 2007)
An unanticipated result of global warming is the likely northward expansion of the present-day southeastern U.S. kidney stone "belt." The fraction of the U.S. population living in high-risk zones for nephrolithiasis will grow from 40% in 2000 to 56% by 2050, and to 70% by 2095. Predictions based on a climate model of intermediate severity warming (SRESa1b) indicate a climate-related increase of 1.6–2.2 million lifetime cases of nephrolithiasis by 2050, representing up to a 30% increase in some climate divisions. Nationwide, the cost increase associated with this rise in nephrolithiasis would be $0.9–1.3 billion annually (year-2000 dollars), representing a 25% increase over current expenditures. The impact of these changes will be geographically concentrated, depending on the precise relationship between temperature and stone risk. Stone risk may abruptly increase at a threshold temperature (nonlinear model) or increase steadily with temperature change (linear model) or some combination thereof. The linear model predicts increases by 2050 that are concentrated in California, Texas, Florida, and the Eastern Seaboard; the nonlinear model predicts concentration in a geographic band stretching from Kansas to Kentucky and Northern California, immediately south of the threshold isotherm.
Nephrolithiasis, or kidney stone disease, is a common human affliction, with a lifetime prevalence of ≈12% in men and 7% in women in the U.S (1). Kidney stones form in response to environmental and/or metabolic risk factors. Low urine volume, an important environmental factor, reflects low fluid intake or excessive fluid loss and directly increases stone risk by increasing urinary saturation of stone-forming salts.
Stone disease in the U.S. shows marked geographic variability; the Southeast has been found in several studies to have as much as a 50% higher prevalence of stone disease than the Northwest (2–4). Because of its influence on fluid status and urine volume, mean annual temperature (MAT) has been estimated to account for 70% or more of this variability (MAT is 8°C higher in the Southeast), whereas other risk factors such as age, gender, race, diuretic use, and sunlight index account for the remainder (3, 4).
In addition to regional variation in stone disease, evidence is mounting that in Western societies the overall prevalence of stone disease is increasing (2, 5, 6). In the U.S., an increase in the prevalence of stone disease from 3.6 to 5.2% between the time periods 1976–1980 and 1988–1994 has been reported (2). Interestingly, between these two time periods, U.S. MAT increased by 0.5°C, suggesting a potential but unproven correlation between the rise in temperature and the increased prevalence of nephrolithiasis.
Transient variations in stone prevalence, such as seen with desert military deployments (7–9) and seasonal cyclicity (10–14), can also be accounted for by temperature changes. The physiologic response time to these climate changes is generally rapid; in one study, the peak time for stone development occurred 90 days after military deployment into a hot, arid climate (15).
Prediction of global warming in this century indicates that MAT will rise significantly in much of the U.S. (16). Consequently, the prevalence of nephrolithiasis is likely to increase as the present-day "kidney stone belt," currently comprising primarily the Southeast, expands north- and westward in response to warming. We hypothesize that predicted climate change will result in an increase in kidney stone disease and stone-related health care costs. This work evaluates the predicted spatial distribution of the increase in prevalence and cost of nephrolithiasis in the U.S. by 2050 by using estimates of the temperature dependence (3) and cost (1) of nephrolithiasis, along with global climate predictions (16). We limited our analysis to upper-tract stones because the formation of kidney stones is responsive to environmental change, whereas lower-urinary tract (bladder) stones are thought to be temperature-independent and instead form as a result of infection, obstruction, and other factors. We also restricted our quantitative predictions to the next 50 years because unpredictable changes in demographics, internal migration, and diet may predominate over climate effects over longer periods.
Given projected warming (e.g., histograms; Fig. 1), the two temperature-response models (lines, top of Fig. 1) clearly indicate that the risk of nephrolithiasis will increase. The predicted distribution of climate-related changes in urolithiasis strongly depends on the form of the temperature-dependence model. In the linear model, stone risk depends on baseline risk and rise in temperature, and therefore risk increase is concentrated in the midcontinent and West (Fig. 2). Arbitrarily defining the stone belt as those areas with a risk ratio ≥1.2 relative to the Northeast, the net effect of warming on stone risk is most easily visualized as a northward expansion of this belt from the Southeast into the Midwest (Fig. 3) This newly expanded stone belt occupies the southeastern half of the nation and all of California by 2050 and significantly beyond that by 2095.
Temperature-dependence models for nephrolithiasis risk relative to the Northeast (Upper) and current and projected MAT for U.S. climate divisions (Lower). Linear model 80% prediction interval and non-linear model 95% confidence interval is shown by shading. Original VA data were grouped by U.S. census region, temperature is the value for nearest corresponding National Oceanic and Atmospheric Administration (NOAA) climate region. Nonlinear risk model [1983 data, age- and gender-corrected (3)] exhibits peaked temperature dependence. Heating will drive many climate divisions to higher risk of urolithiasis, regardless of choice of nephrolithiasis model.
Predicted warming and linear model nephrolithiasis risk change by 2050 for U.S. Strongest warming is in the midcontinent and upper Midwest. Heavy lines show the four U.S. census regions, and light gray lines show NOAA climate divisions.
Predicted growth in high-risk stone area (stone belt; risk ratio ≥1.2) vs. time, for 2000 (yellow), 2050 (orange), and 2095 (red); linear model. At 2000, 41% of the population is within a high-risk zone, 56% at 2050, and 70% at 2095, based on year 2000 population distribution.
In contrast, the nonlinear model theorizes a steeper rate of increase in stone risk between 10 and 15°C (i.e., a threshold value) and a small risk decrease above those temperatures (Fig. 1). Consequently, the nonlinear model predicts little change in stone risk with warming in the traditional Southeastern stone belt where MAT already exceeds 15°C; however, just north of that belt, a significant increase in risk is predicted in areas where 2050 temperatures rise above 13.4°C (i.e., trailing the northward movement of the threshold isotherm, red area, Fig. 4). Likewise, where 2050 temperatures rise above 17.2°C, a narrow zone of decreased risk is predicted, extending from Southern California to South Carolina (green, Fig. 4). The net effect predicted by the nonlinear model is similar to the linear model, where the present southeastern zone of elevated stone risk expands northward to include a band of states from Kansas to Virginia and Northern California, but prevalence increase is sharply concentrated immediately south of the threshold isotherm.
Predicted changes in stone risk by 2050, nonlinear model (3). Peaked risk vs. temperature model (Fig. 1) concentrates risk change at northern edge of the present-day stone belt (yellow, Fig. 3). Trailing that to the south is a zone of reduced risk (green).
The epidemiological and economic impact of climate-related changes in temperature on stone risk depends on the distribution of risk as plotted in Figs. 3 and 4 modified (multiplied) by the distribution of population. Warming in general is moderated by proximity to the oceans in the coastal states. In the linear model, changes in prevalence are solely a function of warming; consequently, inland populations compared with coastal populations of approximately the same size exhibit larger prevalence changes (Fig. 5a). For example, Florida is projected to incur a 7.5% increased risk by 2050 [80% confidence interval (C.I.) 4.4–10.6%], whereas Illinois is anticipated to incur an 11.2% increased risk (C.I. 6.3–16.9%). Other examples of states predicted to have proportionately higher prevalence are Colorado, Michigan, and Wisconsin compared with similar-sized states Alabama, Georgia, and Washington, respectively. In the nonlinear model, the steep increase in risk associated with the temperature range of 10–15°C means that climate divisions warming into this range will incur the maximum climate-related risk increase. In general, population centers lying in the latitude range 37–42°N fit this criterion, including New York, Detroit, Chicago, Salt Lake City, and Sacramento (Fig. 5b). South of this band lies the zone predicted to experience risk reduction by the nonlinear model, and population centers lying in latitudes 32–36°N fit this criterion, including Atlanta, Oklahoma City, Phoenix, and Los Angeles.
Impact of climate-related increase in nephrolithiasis prevalence by 2050 for the linear (a) and nonlinear (b) models. Data are represented as the number of new climate-related cases (predicted 2050 nephrolithiasis prevalence times 2050 estimated population).
In the linear model, the increase in number of cases (prevalence times population) is relatively uniformly distributed between census regions, although slightly smaller in the Northeast because of lesser warming in high-population coastal climate divisions. In the nonlinear model, new cases are strongly concentrated in the Midwest, whereas the number of new cases in the South and West are reduced by the predicted decrease in risk for temperatures >17.2°C. Nationwide, 1.6–2.3 million new lifetime cases are predicted by the models by 2050 (80% C.I. nonlinear model 0.3–3.1 million, linear model 1.3–3.3 million). Annual direct costs related to the treatment of climate-related nephrolithiasis are projected to increase by $1.3 billion by 2050 (year 2000 dollars) for the linear model (C.I. $0.72–1.84 billion). The nonlinear model predicts an annual increase of $900 million (C.I. $0.3–1.6 billion).
The nationwide impact of climate-related increases in stone disease based on these two models of temperature dependence of stone risk is significant (Table 1, right columns). We predict a nationwide increase in prevalence of nephrolithiasis of 10.4% (linear model) and 7% (nonlinear) and an increase in annual cost of nephrolithiasis of 25% [compared with $5.3 billion for 2000 (17)], of which approximately two-thirds is accounted for by the consequences of warming and the remainder from growth in the population exposed to warming, concentrated predominantly in the higher-cost regions of the U.S. (Table 2). These changes in risk are somewhat larger than projected indirect climate-change effects on human health, e.g., the climate-related increase in vector-borne diseases such as malaria in tropical areas (18).
Predicted change in stone prevalence and cost by 2050 attributable to climate change, by census region
Costs of stone-related interventions ($) by region per 100,000 population, based on utilization rates in Table 3
Similar climate-related changes in the prevalence of nephrolithiasis can be expected worldwide given the well established dependence of nephrolithiasis on MAT and predictions of long-term climate warming. This phenomenon will be manifest primarily as expansion of recognized kidney stone belts in the southern portions of the U.S., Europe, and Asia (19, 20). Although a precise understanding of the temperature dependence of stone disease remains to be established, published reports consistent with a nonlinear relationship imply that the upper Midwest of the U.S. would be most heavily impacted. For example Kansas, Missouri, Maryland, and Kentucky are predicted to sustain 25% increases in stone prevalence by 2050 under the nonlinear model. The linear model developed here yields a more uniform distribution of increased prevalence, but the number of cases and increased annual costs will be concentrated in warm, high-population states such as California and Texas, which, by 2050, would each realize an annual cost increase of $110 million in year 2000 dollars.
This work used data primarily developed for other purposes, and as such our results are subject to a number of limitations. Perhaps foremost is that the precise relationship between ambient temperature and stone risk remains unknown, chiefly because it was of little importance to management of stone disease in the past. Clearly with the likelihood of long-term temperature changes, this importance is now greatly enhanced, and the issue warrants careful study. Of the two models discussed here, we favor the linear model because the Veterans Affairs (VA) data on which estimates of stone prevalence are based were derived from actual outpatient visits for stone disease rather than on surveys eliciting a self-reported history of stones (3). It is also consistent with our own observation of seasonal variation despite a high MAT. Although it is possible that individuals might reduce their environmental exposure during "hot" seasons, thereby decreasing stone risk at high temperature as suggested by the nonlinear model, a compensatory increase in stone risk during "cooler" seasons might also be expected. More accurate models will require detailed analysis of spatial and temporal variations in nephrolithiasis by using climate-based, rather than population-based divisions. Given the likely mechanism of nephrolithiasis response to climate change (i.e., fluid balance), derived climate variables such as mean annual heat stress [apparent temperature, akin to heat index (21)] may provide a better correlation. For example, the year 2000 distribution of elevated risk as defined by the linear model (Fig. 3) appears to overestimate present risk in the Southwest (compare with ref. 22). Heat stress falls off from east to west in the U.S., and its distribution more closely mimics the known stone belt.
Considerable uncertainty is present in the underlying climate models obtained from the Fourth Climate Assessment of the Intergovernmental Panel on Climate Change (IPCC4). We considered the intermediate warming scenarios (A1B) as defined in the Special Report on Emissions Scenarios (SRES). For example, a U.S. contribution to this model set is the National Center for Atmospheric Research Parallel Climate Model (NCAR-PCM), which predicts an additional degree of warming, for a total of 4°C in the midcontinent by 2050. More severe warming scenarios, e.g., SRESa2, predict significantly greater warming after 2050. Given this level of warming, the nationwide increase in the prevalence of stone disease would be 15–20% and the annual cost increase up to 40% by 2050. With the nonlinear model, this amount of warming would yield a 40–50% increase in prevalence and cost in some Midwest climate divisions such as Chicago.
We acknowledge additional limitations in this work. The temperature-dependence models presume an accurate understanding of current stone prevalence; however, such data are problematic for a variety of reasons. Unlike some diseases that are readily diagnosed as present or not, such as appendicitis, stone disease occurs intermittently and is not always readily apparent. Many patients harbor undiagnosed, asymptomatic stones, whereas others require repeated hospitalizations for recurrent stone events. Whereas virtually all patients with appendicitis come to medical attention and can be accounted for by hospital discharges and confirmed with pathology reports, patients with stone disease may or may not come to medical attention, and consequently some remain unaccounted for, and others involve repeated use of health care resources for the same or different stone events. Consequently, true stone prevalence is difficult to determine and is likely routinely underestimated but also occasionally overestimated. The baseline prevalence of stone disease assumed here reflects the most current published data (2) but could be as much as 35% higher today, based on trend projection. For the linear model, this would yield a matching percentage increase in nephrolithiasis prevalence and cost.
When using national and regional datasets, a variety of surrogate markers are used to estimate stone prevalence, including hospital discharges, physician office visits, emergency room visits, or procedures related to a primary diagnosis of stone disease, or a self-reported history of stones (17, 23). All of these surrogates are compromised in that they likely underestimate the prevalence of disease either because a patient may pass a stone without requiring any health care resources or because a patient may report a history of stones based on unsubstantiated symptoms or not report a history of stones because a stone was never collected despite classic symptoms of renal colic.
In the linear model that we derived using VA data, prevalence was derived from inpatient and outpatient hospital visits, which provide an accurate estimate of health care resource utilization in this population during the specified time; however, because the data were not acquired by using unique identifiers, all encounters, not only unique patients, were captured, thereby likely overestimating prevalence. However, because this dataset relies on resource utilization, individuals who passed stones without accessing the health care system were not captured, potentially leading to an underestimate of prevalence.
When determining regional differences in stone risk, these systematic errors affect the entire population and should not affect the calculated relative regional risks of stone disease. However, error in stone prevalence can have a profound impact on estimates of economic consequences of increased stone prevalence in that the increase in health care dollars depends on a precise estimate of the burden of disease. In the future, we plan to use other national datasets that use population-based estimates of stone prevalence (i.e., self-reported history) or that use claims data for a much greater and more inclusive sampled population, allowing a more accurate estimate of current and future stone prevalence.
Finally, this analysis cannot take into account potential dramatic changes in the care of patients with kidney stones that might result in significant and unexpected changes in the future cost of care of these patients. Although dramatic changes in technology are possible, small changes with minimal impact on cost are more likely. Health care-related costs have been increasing at a rate that surpasses inflation. Most surgical procedures for stone removal (ureteroscopy and shock wave lithotripsy) are minimally invasive and are already performed on an outpatient basis. Furthermore, newer generation shock wave lithotripters are rarely less costly but are less effective than the original lithotripter, the Dornier HM-3, which was introduced >20 years ago (24). Whereas medications have been shown to reduce the risk of stone recurrence, they are not currently in widespread use by patients because of high cost, frequent side effects, and poor patient compliance (25). Furthermore, the cost-effectiveness of medications aimed at stone prevention has been questioned because of low yearly recurrence rates in first-time stone formers and the high cost of current medications (26). Although recurrent stone formers have a greater potential benefit from medication, current medications are still not cost-effective despite their therapeutic effectiveness. It is possible that new medications will be developed that will be more effective or less costly than ones currently available, and this change could impact overall cost, both by increasing medication use and by decreasing utilization of health care resources. Unfortunately, there have been no new medications that have come to market for stone prevention in the last few decades, and therefore this is unlikely to have a significant impact on cost in the near future. Overall, the future estimates of health care costs are limited by our inability to predict future changes in medical care and health care delivery.
Regardless of these limitations, climate-related increases in the prevalence of nephrolithiasis in the U.S. appear likely, and the impact of changes in stone disease will be nonuniformly distributed. The nephrolithiasis-response models used here indicate that the impact will either be concentrated in the southern half of the U.S. (linear model) or the upper Midwest (nonlinear model). These changes are likely to cause notable perturbations in the magnitude of stone interventions, with corresponding stresses in health care delivery and economics. Although less well characterized, stone belts worldwide will be similarly affected, with much greater impact on morbidity in developing nations. This direct link between climate change and human health adds yet another challenge to the task of adapting to climate change this century.
Dependence of Stone Risk on Temperature.
Although evidence strongly supports a positive correlation between temperature and stone risk, the precise relationship between these factors has not been elucidated. One possibility is that stone risk rises with increasing temperature, perhaps abruptly at some threshold value, until a point at which it plateaus or even declines (nonlinear model). Alternatively, stone risk may continue to rise with increasing temperature (e.g., a linear model).
The nonlinear model is based primarily on data derived from the Second Cancer Prevention Survey of 1982, in which a history of stone disease was elicited from >1 million subjects (3). This cross-sectional study revealed a peaked (nonlinear) distribution of stone risk with a maximum raw odds ratio of 1.9 (or 1.4 when adjusted for gender, age, and personal risk factors; Fig. 1) for persons living in areas with a MAT of 13.4–17.2°C. For reasons that are unclear, the risk of nephrolithiasis declined slightly for those living in areas with MAT exceeding 17.2°C, perhaps because at higher temperatures individuals are more likely to avoid outdoor activities, thereby limiting their environmental exposure and reducing their stone risk. The most prominent feature of this model is the indication of a threshold value of MAT at which stone risk rises rapidly (13.4°C; Fig. 1).
An alternative linear model describing the temperature dependence of stone prevalence is supported by evidence that even in high-MAT locales increases in temperature continue to raise stone risk, i.e., there is still a "stone season" [e.g., Saudi Arabia (10), Taiwan (14), with monthly temperatures ranging from 24 to 34°C]. Indeed, a study of spinal cord injury patients in the U.S. revealed a linear 10% increase in stone risk per 1°C increase in MAT (4). We derived a linear model of temperature dependence of stone disease by using a VA dataset from the Urologic Diseases in America project (UDA; ref. 1). Stone prevalence, estimated from physician office visits for a diagnosis of upper-tract urolithiasis, was correlated with MAT for the four U.S. census regions. A strong linear relationship was found between the two (points and linear fit; Fig. 1) with a 4.2% increase in stone risk per degree Celsius temperature increase.
This work considers both models of temperature dependence of nephrolithiasis, the nonlinear distribution (3) and the linear model fit to the VA dataset.
Projected Temperature Change.
Over the last 30 years, global temperature increases have been steadily accelerating, and increases in MAT of nearly 1°C have been recorded in the U.S. Projections of future climate are best represented in the results of global circulation models (GCMs). The most comprehensive of these are coordinated by the IPCC4 (16). From these results, predicted temperature increases resulting from CO2 already added to the atmosphere ("committed") will add another 1–2°C rise in the U.S. MAT by 2100. Future emissions are predicted to cause a 3–5°C rise in MAT in midcontinent regions by 2100 (16), depending on greenhouse gas emissions scenario (27). The global mean of all IPCC4 scenario models is quite similar to the mean of the intermediate scenario models (SRESa1b), and therefore the latter was chosen for this work to predict U.S. temperature changes. In simplest terms, the degree of modeled warming correlates primarily with atmospheric CO2, and predicted CO2 for all scenarios by 2100 ranges from 600 to 1,500 ppm (27); current levels are ≈380 ppm. Atmospheric CO2 concentration for the SRESa1b scenario by 2100 is 850 ppm, thereby constituting the closest specific scenario to the mean value for all scenarios modeled in IPCC4. Current rates of emission (2.5% increase per year in atmospheric CO2 since 2000) (28) are consistent with the SRESa1b scenario, although they would exceed SRESa1b-envisioned emissions if continued beyond 2025.
The predicted change in annual MAT across the U.S. was determined from the mean of 19 IPCC4 SRESa1b scenario GCM results. Mean monthly surface air temperatures (TAS) were computed for each model and regridded to a 0.5 × 0.5° mesh over North America. To minimize GCM bias, monthly model increments of TAS (model departure from the mean of 20th-century model, 20c3m, results) were determined, and the annual average increment was calculated for each model. These were downscaled to U.S. climate divisions (1–10 of these per state) by using intersection–area weighting, and future TAS values were computed by adding the increment to observed temperature normals (1895–2006) for each division. The climate normals represent an instrumental record that is effectively population weighted within each division (weather stations are near people) and therefore most closely indicate the temperature experienced by the population. This can be important in areas with significant topographic relief. For example, Las Vegas, NV, has an observed divisional normal TAS of 17.4°C. A direct average of SRESa1b TAS for that division at 2050 predicts an unreasonably low 15.4°C, which reflects an average of mountain and desert temperatures. The 2050 mean TAS increment of 2.8°C added to the normal gives a predicted MAT of 20.2°C, more consistent with expected temperatures in the populated desert valleys in that climate division. Mean, 90th- and 10th-percentile values over the 19 models were computed for each division for each year and were the basis for the central projection and uncertainty ranges described below.
Current Costs of Urolithiasis.
There are two factors that influence the overall financial burden of stone disease: cost of service and rate of utilization. The direct cost of stone disease comprises emergency room visits, outpatient physician and hospital visits, inpatient hospital care, and procedure costs for both inpatient and outpatient care. The indirect costs include primarily loss of work and are less objectively defined, although the UDA project estimated these costs at $775 million per year currently (17).
The UDA project obtained information from a variety of national datasets, including the Healthcare Cost and Utilization Project (HCUP), Centers for Medicare and Medicaid Services (CMS), National Hospital Ambulatory Medical Care Survey (NHAMCS), National Ambulatory Medical Care Survey (NAMCS), and Center for Health Care Policy and Evaluation (CHCPE), to identify regional rates of stone-related interventions (Table 3), and these data were used to determine rates of utilization.
Rates of stone-related interventions by region per 100,000 population
Specific health care costs related to patients with stone disease were obtained from two large metropolitan hospitals in Dallas, Texas. We used cost rather than charge data to capture relative resource utilization more accurately because charge data include profit margins that are variable for different cost centers within an institution and among institutions. These individual costs were aggregated into costs per population for the four U.S. census regions (Table 2).
Emergency room visits.
Data for emergency room visits were obtained from the NHAMCS dataset and were estimated at 226 per 100,000 population (Table 3). The cost of an emergency room visit was estimated by the cumulative cost of nursing, medication (i.v. fluids, pain medication, and antiemetics), radiology (computed tomography of the abdomen), and laboratory along with physician fees for a level III visit based on 2007 Texas Medicare reimbursement fees; it averaged $461.
Inpatient hospitalization.
By using the HCUP dataset for the year 2000, the mean inpatient hospital length of stay was determined to be 2.2 days, and rates of utilization varied by region from 44 to 97 per 100,000 population (Table 3). The cost of an average hospital stay, based on the cumulative cost of room and board, nursing, medication (i.v. fluids, pain medication and antiemetics), radiology and laboratory and physician fees, was estimated at $1062.
Outpatient hospital visits.
Outpatient hospitalization rates were obtained from NHAMCS for the year 2000. No regional data were available for this dataset, but the overall rate was 110 visits per 100,000 population (Table 3). The cost of an outpatient hospital visit was assumed to be the same as an emergency room visit (see above) at $461.
Physician office visits.
Outpatient office visit rates were obtained from NAMCS and CMS and ranged from 1262 to 1482 per 100,000 population (Table 3). Physician fees for a level III visit based on 2007 Texas Medicare reimbursement fees for new and established patients averaged $77.50 per visit.
Procedure costs.
The number and distribution of procedures, including both inpatient- and ambulatory-based procedures, were obtained from the CHCPE and CMS datasets. The distribution of procedures for stones was comparable for CMS and CHCPE: shock wave lithotripsy (SWL) 54% for both; ureteroscopy (URS) 41% and 42% for CMS and CHCPE, respectively, and percutaneous nephrostolithotomy (PCNL) 4% and 6% for CMS and CHCPE, respectively. For our model, we used procedure rates from CMS. The estimated cost of each procedure was obtained from the mean cost of >100 cases performed at a large, metropolitan county hospital. The mean costs of SWL, URS, and PCNL were $6,620, $4,773, and $11,530, respectively. Cost centers included the operating room, operating room supplies, day surgery, recovery room, laboratory costs, and anesthesia along with professional fees. Professional fees were obtained from 2007 Medicare reimbursement rates in Texas rather than from charge data. SWL and URS were assumed to be outpatient procedures, whereas PCNL was considered an inpatient procedure.
Total direct costs.
Table 2 summarizes the total costs for each geographic region taking into account procedure/intervention costs and rates of utilization. Costs are highest in the Southeast, primarily reflecting the elevated incidence of nephrolithiasis in the stone belt. Indirect costs such as those associated with lost work time were not considered but would add an additional 15–20% to the computed cost (17).
Projecting Climate Change Impact on Nephrolithiasis.
Prevalence.
To project the likely changes in the expected prevalence of stone disease and associated health care cost, we combine the predicted temperature changes and the quantitative relationship between ambient temperature and stone risk. Warming-related change in stone risk was calculated by using the predicted TAS (nonlinear model) or TAS increments (linear model). These risk changes multiplied by a base risk of 5.2% [representing age- and gender-corrected stone prevalence for the Northeast between 1988 and 1994 (2)] and by the estimated population in 2050 [assuming uniform 48% growth (29)] yield the climate-related change in number of lifetime stone cases incurred by 2050.
The change in annual cost associated with the warming-related change in stone disease for each climate division was computed by using current regional cost rates (Table 2, converted to per capita) multiplied by risk change and estimated 2050 population. Stated C.I. values for the nonlinear model and computed prediction interval for the linear model regression were combined with the temperature C.I. to compute an 80% C.I. for the number of cases and costs (Fig. 1 and Table 1).
We thank Dr. D. M. Smith, DVM, for bringing the idea of a climate–urolithiasis link to our attention and J. Terrell for help in the initial evaluation of that idea. Dr. R. Mitterrer and Dr. Brian Berry and two anonymous reviewers provided helpful reviews of the manuscript. IPCC4 datasets were made available to us via the Earth System Grid webserver.
†To whom correspondence should be addressed at:
University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080-3021.
E-mail: brikowi{at}utdallas.edu
Author contributions: T.H.B. designed research; T.H.B. and Y.L. performed research; T.H.B., Y.L., and M.S.P. analyzed data; and T.H.B., Y.L., and M.S.P. wrote the paper.
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(2004) in Urologic Diseases in America, eds Litwin MS, Saigal CS (Natl Inst Health, Bethesda, MD), pp 3–42.
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(2002) Management of ureteral calculi: A cost comparison and decision making analysis. J Urol 164:1621–1629.
Pak CY
(1999) Meta-analysis of randomized trials for medical prevention of calcium oxalate nephrolithiasis. J Endourol 13:679–685.
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(2000) Special Report on Emission Scenarios: Technical Report (UN Intergovernmental Panel on Climate Change, Geneva).
Canadell JG,
(2007) Contributions to accelerating atmospheric CO2 growth from economic activity, carbon intensity, and efficiency of natural sinks. Proc Nat Acad Sci USA 104:18866–18870.
(2004) US Interim Projections by Age, Sex, Race, and Hispanic Origin. Technical Report (US Census Bureau, Washington, DC).
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Tom H. Brikowski, Yair Lotan, Margaret S. Pearle
Proceedings of the National Academy of Sciences Jul 2008, 105 (28) 9841-9846; DOI: 10.1073/pnas.0709652105


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Source: Ex-girlfriend behind Philadelphia Airport threat hoax
September 6, 2012 (PHILADELPHIA )
It was approximately 7:30 a.m. Thursday when a call was received at Philadelphia police airport headquarters from a person stating that a specific individual would attempt to get past TSA and board a flight to somewhere in Texas with a dangerous and hazardous substance.
PHOTOS of threat response at Philly Int'l Airport
Police say that information was immediately given to the FBI and TSA. It was then confirmed that the individual implicated on the tip call was on US Airways flight 1267 that had already departed at 7:39 a.m. to Dallas.
The decision was made jointly by police, FBI and US Airways to order the Airbus A-319 to return to the airport.
The flight arrived back in Philadelphia where officials boarded the plane and secured the man in question.
Philadelphia Police Inspector Joe Sullivan explained at a press briefing Thursday morning that, "At that time we checked him and his carry-on luggage, and determined that he was not in possession of anything dangerous, hazardous or illegal."
The male was then transferred into FBI custody and removed from the scene for further questioning. Several passengers sitting near the man in question were briefly re-interviewed at the scene.
Bomb technicians and bomb sniffing dogs conducted a very thorough search of the plane and around 9:30 a.m. the all clear was given. By that time, however, some of the flight's 69 passengers chose to book other flights.
"There was no emergency. There was a threat, but that threat was unfounded," said Inspector Sullivan. "That flight was never in any danger. And I just want to stress right now that the male that was briefly taken in for investigation has committed no crime. It would appear at this time, this is an ongoing investigation, but at this time all indications are that this was a hoax."
The target of the hoax was released from custody and will not be facing any charges. Authorities would not comment on who they think may have been behind the threat, but did say that if caught that person will face federal charges.
"They're going to be very serious charges," explained Sullivan. "They're interfering with aviation. And you're causing a plane to return to do another landing - an unnecessary landing. You're requiring armed law enforcement to go onto a plane, which this plane appeared to be full to me. There's always an opportunity for mistakes to happen. So this is no joke. Not to mention the fact that all of these passengers are now late on their arrival to Dallas, Texas. Many of them will have to make connecting flights, which they are going to miss. Most of these people today were traveling on business, they have people waiting for them at their point of arrival. It's just an incredibly foolish and irresponsible thing to do, and the bottom line is it's criminal."
Sources tell WPVI that it was a former girlfriend of the man behind the prank call.
The FBI is now leading the investigation.
CPD release picture of car wanted in hit-and-run that killed woman, 93
CTA Red Line trains standing at Howard after empty train derails
Chicago Weather: Snow showers and windy Friday
Annual Corned Beef and Cabbage Dinner held at Plumbers Hall

redpajama_set_name: RedPajamaCommonCrawl


14th follow up their impressive debut 'Hide Yourself' EP with 'Take Me There'.
This is another great track that showcases 14th's ability to channel multiple music genre's, creating their own hybrid sound.
'Take Me There' is released Monday 6th February 2012.


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UK gives Pfizer world's first over-the-counter Viagra approval
By Reuters News Service November 30, 2017 1588
Viagra is so far the only erectile dysfunction medicine to be reclassified from "prescription only medicine" to "pharmacy" status in Britain
Pfizer's big-selling erectile dysfunction drug Viagra has been given a green light for sale without a prescription in Britain, the first country to grant it over-the-counter status.
The U.S. drugmaker said on Tuesday it was working on plans to launch the non-prescription version of the medicine, known as Viagra Connect, in the United Kingdom in the spring of 2018.
The drug will only be available in pharmacies and its supply will depend on pharmacists' assessment of its suitability for each individual.
Viagra has been one of the pharmaceutical industry's most successful prescription products since its launch in 1998, following a serendipitous discovery of its effects by researchers who had been studying it as a heart medicine.
It achieved peak worldwide sales of more than $2 billion in 2012 but sales have since declined as patents have expired, prompting Pfizer to explore extending its brand value as a non-prescription drug.
Viagra is so far the only erectile dysfunction medicine to be reclassified from "prescription only medicine" to "pharmacy" status in Britain. The change follows a lengthy review by the Medicines and Healthcare products Regulatory Agency (MHRA).
Pfizer will continue to make Viagra available as a prescription drug but the option of also buying it over-the-counter is likely to reduce demand for potentially ineffective and dangerous fakes.
"It's important men feel they have fast access to quality and legitimate care, and do not feel they need to turn to counterfeit online supplies which could have potentially serious side effects," said Mick Foy, the MHRA's group manager in vigilance and risk management of medicines.
Teenage son stabs father, flees say police
And so the Christmas season begins all over the world
Reuters News Service
Nikolaos Prakas January 25, 2023 January 25, 2023
Staff Reporter January 25, 2023
Nick Theodoulou January 25, 2023 January 25, 2023
WHO urges 'immediate action' after deaths from cough syrup
WHO investigating links between cough syrup deaths, considers advice for parents


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Jundishapur Journal of Microbiology The Official Journal of School of Medicine, Ahvaz Jundishapur University of Medical Sciences
IF, JCR 2019 : 0.593
CiteScore 2019 : 2.2
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Detection and Genetic Characterization of Metallo-β-Lactamase IMP-1 and VIM-2 in Pseudomonas aeruginosa Strains From Different Hospitals in Kermanshah, Iran
Ramin Abiri 1 , * , Pantea Mohammadi 2 , Navid Shavani 1 , Mansour Rezaei 3
1 Department of Microbiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
2 Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
3 Department of Biostatics and Epidemiology, School of Hygiene, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
* Corresponding author: Ramin Abiri, Department of Microbiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, IR Iran. Tel: +98-9122773648, Fax: +98-8314276471, E-mail: [email protected]
How to Cite: Abiri R, Mohammadi P, Shavani N, Rezaei M. Detection and Genetic Characterization of Metallo-β-Lactamase IMP-1 and VIM-2 in Pseudomonas aeruginosa Strains From Different Hospitals in Kermanshah, Iran, Jundishapur J Microbiol. 2015 ; 8(9):e22582. doi: 10.5812/jjm.22582.
Jundishapur Journal of Microbiology: 8 (9); e22582
Article Type: Research Article
Received: August 6, 2014
Revised: November 26, 2014
DOI : 10.5812/jjm.22582
Background: Pseudomonas aeruginosais a frequent nosocomial pathogen that causes severe diseases in many settings. Carbapenems, including meropenem and imipenem, are effective antibiotics against this organism. However, the use of carbapenems has been hampered by the emergence of strains resistant to carbapenemsvia different mechanisms such as the production of metallo-β-lactamases (MBLs), which hydrolyze all carbapenems. Several kinds of MBLs have been reported, among them VIM and IMP types being the most clinically significant carbapenemases.
Objectives: We aimed to determine the distribution of blaVIM-2 and blaIMP-1 transferable genes encoding MBLs in P. aeruginosa isolated from three academic hospitals in Kermanshah.
Patients and Methods: From 22nd June to 22nd September 2012, 225 isolates of P. aeruginosa were collected. These isolates were tested for antibiotic susceptibility with the Kirby-Bauer disk-diffusion method, and the MBLs were assessed using the imipenem-EDTA double-disk synergy test. The isolates were investigated for blaVIM-2 and blaIMP-1 genes using polymerase chain reaction.
Results: Among the 225 isolates, 33.7% (76/225) and 18.1% (41/225) were resistant to imipenem and meropenem, respectively. Of the 76 imipenem-resistant P. aeruginosa strains, 45 (59.2%) were positive for MBLs, 34 (75%) strains carried the blaIMP-1 gene, and 1 (2.2%) strain carried the blaVIM-2 gene.
Conclusions: Our results showed that there was a high frequency of IMP-1 positive P. aeruginosa in the different wards of the hospitals.
Polymerase Chain Reaction Pseudomonas aeruginosa Carbapenems β-Lactamases
Pseudomonas aeruginosais a frequent nosocomial pathogen that causes severe diseases in many settings, particularly in immune-compromised patients such as those with cancer, burns, and cystic fibrosis. Infections are frequently severe, and two recent studies have indicated that the rate of mortality attributable to P. aeruginosa bacteremia is approximately 34% (1, 2). This organism is clinically important since it possesses several virulence factors and is intrinsically resistant to many antimicrobial and disinfectant agents (3). Carbapenems such as meropenem and imipenem are effective antibiotics against this organism since they present a good spectrum of activity and are stable to hydrolysis by most β-lactamases, including the extended spectrum β-lactamases (3, 4). However, the use of carbapenems has been hampered by the emergence of strains resistant to carbapenems via different mechanisms such as impermeability to the drug due to loss of OprD porin, upregulation of the active efflux pump systems, and production of metallo-β-lactamases (MBLs), which hydrolyze all carbapenems (5-7).
MBLs are divided into two categories: chromosomally mediated enzymes and those encoded by movable genetic elements such as plasmids and transposons (8-10). Several kinds of MBLs have been reported, including IMP, VIM, SPM, GIM, and SIM-1 (11). The VIM and IMP types are the most clinically significant carbapenemases coded by blaVIM and blaIMP genes. At least 14 different VIM and 23 different IMP MBLs have been identified so far (7, 8). There are many reports which indicate an increase in the prevalence of carbapenem-resistance mediated by acquired MBLs; however, the prevalence of the MBL-producing isolates of P. aeruginosa varies in Asian countries (8, 12, 13). In Iran, the first isolation of blaIMP-1 was reported in 2011 by Peymani et al. (14), who collected Acinetobacter baumannii isolates from several hospitals in Tabriz (Northwest of Iran).
The growing rate of resistance against the traditional antibiotics has rendered the treatment of patients with infections caused by MBL-producing P. aeruginosa critical. Previous studies have shown a high prevalence rate of multidrug-resistant P. aeruginosa isolated from different clinical specimens, especially in burn wards in Iran (15, 16); nevertheless, little information is available on the distribution of MBL-producing isolates in the country. For example, in Markazi province, 37% of the P. aeruginosa isolates obtained from the hospitalized patients were shown to be resistant to imipenem, and 50% of these strains were detected to have blaVIM-1, 56.6% blaVIM-2, and 6.6% blaIMP-1 (17). In another study, from 240 P. aeruginosa isolates, 34.16% were imipenem-resistant, and 23.3% were screened as MBL-positive strains using the double-disk synergy test. Additionally, a specific polymerase chain reaction (PCR) test confirmed the presence of 8 (9.75%) and 10 (12.19%) IMP-1 and VIM-2 types, respectively (18).
2. Objectives
The current study was performed to examine the prevalence of MBL-producing P. aeruginosa isolates obtained from clinical specimens at different hospitals in Kermanshah (Imam Khomeini, Imam Reza, and Taleghani hospitals) and also the prevalence of those harboring the blaVIM-2 and blaIMP-1 genes, which are the most clinically significant carbapenemases.
3.1. Samples
From 22nd June to 22nd September 2012, 225 isolates of P. aeruginosa were collected from three hospitals in Kermanshah. The isolates were taken from urine (n = 79, 35%), blood (n = 14, 6.2%), wound (n = 29, 12.8%), respiratory tract (n = 81, 36%), burned tissue (n = 17, 7.5%), and eye (n = 5, 2.2%). The isolates were collected from different wards, including ICU, CCU, urology, emergency, burn, respiratory, and surgery. P. aeruginosa was identified by Gram staining, ability to produce oxidase and catalase, oxidative-fermentative test, resistance to cetrimide, and growth at 42°C (19).
3.2. Antimicrobial Susceptibility Testing
The disk diffusion test was conducted in accordance with the clinical and laboratory standards institute (CLSI) methodology. The antimicrobial agents included comprised aztreonam (10 µg), cefepime (10 µg), ceftazidime (30 µg), ciprofloxacin (5 µg), gentamicin (10 µg), imipenem (10 µg), and piperacillin/tazobactam (10 µg, 100 µg) (MAST, U.K.). P. aeruginosa ATCC 27853 was used as quality control in each run of antimicrobial susceptibility testing.
3.3. Identification of Metallo-β-Lactamases
Among β-lactamases, MBLs are unique in requiring the presence of zinc ion in the active site of the enzyme, and are, thus, inhibited by chelating agents such as ethylenediaminetetraacetic acid (EDTA) (20). The imipenem-EDTA double-disk synergy test was used in order to identify the P. aeruginosa producing MBLs. Therefore, a 0.50-M EDTA (Merck, Germany) solution was prepared by dissolving 186.1 g of EDTA in 1000 mL of distilled water, and the pH was adjusted to 8 by adding NaOH (21). Then, 4 μL of the prepared solution was added to the imipenem disk and dried in an incubator. The prepared EDTA/imipenem disk and the imipenem disk itself were placed in a plate containing the Müller-Hinton agar (Merck, Germany) with cultured P. aeruginosa. After 16 - 18 hours of incubation at 37°C, an increase of ≥ 7 mm in the inhibition zone diameter in the presence of EDTA compared to imipenem tested alone was considered to be a positive test for the presence of an MBL (4, 18, 22).
PCR was performed to detect the blaVIM-2 and blaIMP-1 genes. The DNA templates from all the isolates were extracted by boiling (10 minutes in 95°C), and PCR was carried out in a thermal cycler (Bio Rad, USA) using 25-µL volumes containing 12.5 µL of PCR Master Mix (500 mM of Tris-HCl pH 8.55, 1.5 mM of MgCl2, 0.2 mM of dNTPs, and 0.04 units/uL of Taq DNA polymerase) (SinaClon Inc., Tehran, Iran) and 0.5 µM of each of the primers (SinaClon Inc., Iran). The primers and the cycling condition are listed in Table 1 (23, 24).
Table 1. Primers and Cycling Condition
Oligonucleotide Sequence (5' - 3)
Polymerase Chain Reaction Condition
No. of Cycles
Fragment Size, bp
blaIMP-1 94°C, 30 s 25 448 (23)
CATGGTTTGGTGGTTCTTGT 57°C, 45 s
ATAATTTGGCGGACTTTGGC 72°C, 60 s
blaVIM-2 94°C, 30 s 25 801 (24)
ATGTTCAAACTTTTGAGTAAG 57°C, 45 s
CTACTCAACGACTGAGCG 72°C, 60 s
Following amplification, 10 µL of each sample was analyzed with 1.5% agarose gel electrophoresis for the detection of positive samples. For all the amplification reactions, the mixture was heated at 96°C for 4 minutes prior to thermocycling. The mixture was held at 72°C for 7 minutes after the final cycle before cooling at 4°C. The agarose gel electrophoresis of blaVIM-2 and blaIMP-1 PCR products is depicted in Figure 1. The positive controls (clinical P. aeruginosa isolates with sequenced blaIMP-1 and blaVIM-2 genes) were kindly dedicated by Dr. Najjar Pirayeh (Tarbiat Modarres University), and the negative control contained water in place of DNA.
Lane 1: Positive control (clinical P. aeruginosa with the sequenced blaIMP-1 gene). Lane M: 100 bp DNA ladder. Lanes 2, 3, and 4: Isolates with the blaIMP-1 gene. Lane 5: Negative control (distilled water).
Figure 1. Electrophoresis Results of the blaIMP-1 Gene Polymerase Chain Reaction
Lane M: 100 bp DNA ladder. Lane 1: Isolate with the blaVIM-2 gene. Lane 2: Negative control (distilled water). Lane 3: Positive control (clinical P. aeruginosa with the sequenced blaVIM-2 gene).
Figure 2. Electrophoresis Results of the blaVIM-2 Gene Polymerase Chain Reaction
Totally, 225 confirmed isolates of P. aeruginosa recovered from different clinical specimens were tested for antibiogram. The findings showed that 137 (61%) isolates were resistant to ceftazidime, 131 (58.5%) to gentamicin, 130 (57.7%) to piperacillin/tazobactam, 101 (44.7%) to ciprofloxacin, 96 (42.8%) to cefepime, 92 (40.9%) to aztreonam, 76 (33.7%) to imipenem, and 41 (18.1%) to meropenem. According to these percentages, imipenem and meropenem were the most effective drugs. The imipenem-EDTA double-disk synergy test showed that 45 out of the 76 (59.2%) imipenem-resistant strains were MBL positive. The isolates were collected from different wards, including ICU (n = 22), urology (n = 2), emergency (n = 4), burn (n = 11), respiratory (n = 3), and surgery (n = 3).
Furthermore, our molecular studies showed that only the MBL-positive strains were positive in PCR. Moreover, 75% (n = 34) of the MBL-positive strains were detected to have blaIMP-1 and 2.2% blaVIM-2 (n = 1). blaIMP-1 was taken from burned tissue (n = 10, 29.4 %), respiratory tract (n = 10, 29.4 %), urine (n = 8, 23.5%), blood (n = 2, 5.8%), eye (n = 3, 8.8%), and vagina (n = 1, 2.9%). blaVIM-2 (n = 1) was recovered from burned tissue. Antibiogram showed that the strains resistant to imipenem possessed high-level resistance to gentamicin (100%), cefepime (94.7%), and ceftazidime (94.7%). Among the imipenem-resistant strains, 30.3% (n = 23) were resistant to meropenem and the rest (n = 53) were sensitive to it. On the other hand, there were 18 meropenem-resistant strains sensitive to both imipenem and cefepime.
Microbial resistance has increased drastically in recent years in both developed and developing countries and it has rapidly become a leading public health concern. The prevalence of antimicrobial resistance varies greatly between and within countries and between different pathogens. Resistance to antibiotics among organisms is increased either by mutations or by acquiring new genetic material via horizontal gene transfer. Several factors favor the development of bacterial resistance to antibiotics in developing countries such as the less potent activity of the drugs, i.e. some of the antibiotics provided in developing countries have decreased potency due to the degradation or adulteration of the drug or because of the presence of a lower concentration of active substances, lack of well-equipped diagnostic laboratories, and excessive use of antimicrobials in domestic animals (8-10).
Antimicrobial agents suitable for use in pediatric clinics are mainly limited to β-lactam antibiotics, especially carbapenems. However, the problem of drug resistance to carbapenems is gradually worsening owing to their increasing clinical use. The present study analyzed the patterns of resistance to several antibiotics such as carbapenems. The results showed that 33.7% of the isolates were resistant to imipenem. In a previous study in the Iranian city of Kermanshah in 2004, Mohajeri et al. (25) reported a lower rate of resistance (10%). However, another investigation conducted in the Iranian city of Shiraz in 2012 reported that 127 (59.16%) of the 240 isolates were resistant to this antibiotic (18). The reported rates of resistance to imipenem in Japan, Russia, France, Canada, and Spain were 8.3%, 13.4%, 18.5%, 12%, and 14%, respectively (26-30). As was mentioned, numerous factors contribute to these variations. In addition, the increased rate of resistance to imipenem in Kermanshah is in line with the increase throughout the world. Resistance to carbapenems in P. aeruginosa may be due to MBLs, which hydrolyze all carbapenems (5-7). Since MBLs are placed in movable elements, they are horizontally transmitted between organisms easily (8-10, 31). Large outbreaks by MBL-producing P. aeruginosa strains have been described in hospitals in Italy, Greece, and Korea (32-37). IMP and VIM-producing P. aeruginosa strains have been reported worldwide (10, 38-42).
In our study, the majority of the MBL producers carried the blaIMP gene (75%); however, the presence of this gene has been previously proved to be variable in different regions (17, 18). In a previous report from the Iranian province of Markazi, 37% (40 out of 108) of the P. aeruginosa isolates obtained from the hospitalized patients were demonstrated to be resistant to imipenem. The EDTA/imipenem test showed that 50% of the imipenem-resistant strains were MBL positive, and PCR revealed that 50% of the imipenem-resistant strains had blaVIM-1, 56.6% blaVIM-2, and 6.6% blaIMP-1 (17). In another study in Iran, from 240 P. aeruginosa isolates mainly recovered from wound, urine, and sputum, 82 (34.16%) isolates were imipenem-resistant (minimum inhibitory concentration [MIC] ≥ 4 μg/mL). Among these imipenem-resistant isolates, 19 (23.3%) MBL-producing P. aeruginosa isolates were screened using the double-disk synergy test. A specific PCR test confirmed the presence of 8 (9.75%) and 10 (12.19%) IMP-1 and VIM-2 types, respectively (18). In contrast, Khosravi and Mihani (2008) reported that none of the 8 MBL-producing P. aeruginosa strains in their study were positive for the blaIMP gene (40).
The most and also the sole frequent reported MBL-producing P. aeruginosa in Iran is VIM-1, previously cited by several researchers in different cities of Iran (4, 17, 22, 40, 43, 44). Nonetheless, there are only a few investigations reporting the presence of the VIM-2 type of P. aeruginosa in Iran. For the first time in 2012, Sadeghi et al. (17) detected this genotype in the Iranian city of Arak. Subsequently, in 2013, among the 82 imipenem-resistant isolates tested for MBLs, 10 isolates were positive for this gene (18). According to our findings, it seems that the MBL-producing isolates of P. aeruginosa are the main cause of IPM resistance among this species. We suggest that molecular typing via standard methods such as pulsed-field gel electrophoresis be conducted to define the clonality of the isolates.
This study was conducted in the microbiology department of Kermanshah university of medical sciences. The authors are grateful to Dr. Najjar Pirayeh for providing the positive controls.
Authors' Contributions: Ramin Abiri: study concept and design, interpretation of data and final revision of the manuscript; Pantea Mohammadi: research and technical advisor, drafting of the manuscript; Navid Shavani: contribution in all laboratory experiments; Mansour Rezaei: Statistical analysis.
Funding/Support: The financial costs of the study were provided by Kermanshah university of medical sciences.
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Ryoo NH, Ha JS, Jeon DS, Kim JR. Prevalence of Metallo-β-lactamases in Imipenem-non-susceptiblePseudomonas aeruginosaandAcinetobacter baumannii. Korean J Clinic Microbiol. 2010; 13(4) : 169 [DOI]
Hsueh PR, Teng LJ, Yang PC, Chen YC, Ho SW, Luh KT. Persistence of a multidrug-resistant Pseudomonas aeruginosa clone in an intensive care burn unit. J Clin Microbiol. 1998; 36(5) : 1347 -51 [PubMed]
Cornaglia G, Riccio ML, Mazzariol A, Lauretti L, Fontana R, Rossolini GM. Appearance of IMP-1 metallo-beta-lactamase in Europe. Lancet. 1999; 353(9156) : 899 -900 [PubMed]
Hirakata Y, Yamaguchi T, Nakano M, Izumikawa K, Mine M, Aoki S, et al. Clinical and bacteriological characteristics of IMP-type metallo-beta-lactamase-producing Pseudomonas aeruginosa. Clin Infect Dis. 2003; 37(1) : 26 -32 [DOI][PubMed]
Lee K, Lim JB, Yum JH, Yong D, Chong Y, Kim JM, et al. bla(VIM-2) cassette-containing novel integrons in metallo-beta-lactamase-producing Pseudomonas aeruginosa and Pseudomonas putida isolates disseminated in a Korean hospital. Antimicrob Agents Chemother. 2002; 46(4) : 1053 -8 [PubMed]
Mavroidi A, Tsakris A, Tzelepi E, Pournaras S, Loukova V, Tzouvelekis LS. Carbapenem-hydrolysing VIM-2 metallo- beta-lactamase in Pseudomonas aeruginosa from Greece. J Antimicrob Chemother. 2000; 46(6) : 1041 -2 [PubMed]
Senda K, Arakawa Y, Nakashima K, Ito H, Ichiyama S, Shimokata K, et al. Multifocal outbreaks of metallo-ß-lactamase- producing Pseudomonas aeruginosa resistant to broad-spectrum -lactams, including carbapenems. Antimicrob Agents Chemother. 1996; 40 : 349 -53
Dong F, Xu XW, Song WQ, Lu P, Yu SJ, Yang YH, et al. Characterization of multidrug-resistant and metallo-beta-lactamase-producing Pseudomonas aeruginosa isolates from a paediatric clinic in China. Chin Med J (Engl). 2008; 121(17) : 1611 -6 [PubMed]
Yatsuyanagi J, Saito S, Harata S, Suzuki N, Ito Y, Amano K, et al. Class 1 integron containing metallo-beta-lactamase gene blaVIM-2 in Pseudomonas aeruginosa clinical strains isolated in Japan. Antimicrob Agents Chemother. 2004; 48(2) : 626 -8 [PubMed]
Khosravi AD, Mihani F. Detection of metallo-beta-lactamase-producing Pseudomonas aeruginosa strains isolated from burn patients in Ahwaz, Iran. Diagn Microbiol Infect Dis. 2008; 60(1) : 125 -8 [DOI][PubMed]
Corvec S, Poirel L, Espaze E, Giraudeau C, Drugeon H, Nordmann P. Long-term evolution of a nosocomial outbreak of Pseudomonas aeruginosa producing VIM-2 metallo-enzyme. J Hosp Infect. 2008; 68(1) : 73 -82 [DOI][PubMed]
Perez IA, Garcia CP, Poggi MH, Braun JS, Castillo VC, Roman JC, et al. [Presence of metallo beta-lactamases in imipenem-resistant Pseudomonas aeruginosa]. Rev Med Chil. 2008; 136(4) : 423 -32 [PubMed]
Saderi H, Lotfalipour H, Owlia P, Salimi H. Detection of Metallo- -Lactamase Producing Pseudomonas aeruginosa Isolated From Burn Patients in Tehran, Iran. Lab Med. 2010; 41(10) : 609 -12 [DOI]
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Copyright © 2015, Ahvaz Jundishapur University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
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The Movie Poster »Along Came Jones« for the Movie »Along Came Jones« from Director Stuart Heisler on CAFMP – Central Archive for Movie Posters.
He dared to shoot it out with the toughest killer in the west!
Poster »Along Came Jones« from movie »Along Came Jones« on CAFMP - Central Archive for Movie Posters with the star Gary Cooper and Loretta Young on it.
Please note: You are about to vote for the poster art, not the movie »Along Came Jones«. This way we can publish highlights of a particular year and also present your all-time-favorites.
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Marquee up - starting with full text view?
is it possible to show a region filled with text (fit from start) and then starting to marquee up the rest of the text? When using "marquee up" the whole region is empty on start and the text starts showing up from bottom.
But this looks strange with a large region. Thanks.
It isn't possible no at the moment.
I've moved your question in to the Features section so it is considered for inclusion at a later date.
Any idea how I can achieve kind of displaying text like this by a workaround?
Which time I have to set for the text being shown one time completely? Does the marquee not show one loop automatically?
-800px has to be altered to the position, where the text at start should be placed. It has to be a negative value. Works fine.
Thank you for your feedback on this issue - we're looking at replacing the marquee module in 1.8.8 with another one that might support this feature out of the box.
Of course it would have to be an option as some users might not want the new behaviour.
This one is hardware accelerated.


text:
Posts Tagged 'contest'
Chinese fiction contest '95
Last week's Shanghai Review of Books featured a fascinating essay by Qu Muyang on the beginnings of modern Chinese fiction sparked by the publication of A Collection of New Novels from the Late Qing (清末时新小说集), which reproduces manuscripts submitted to a 1895 fiction contest.
The contest was run by John Fryer, an Englishman who headed the translation department of the Jiangnan Arsenal and established the Chinese Scientific Book Depot in Shanghai. Patrick Hanan's essay, "The New Novel Before the New Novel — John Fryer's Fiction Contest,"[1] is an engaging account of Fryer's activities in China, the contest itself, and the effect that it had on the development of fiction in China.
Social criticism was the explicit aim of the contest, as Hanan explains:
It was as owner of the bookstore that he briefly involved himself in the development of Chinese fiction. In May 1895, seven years before the publication of Liang Qichao's Xin xiaoshuo, he announced a public contest for new fiction and advertised it in the press. The seven leading contestants were to receive prizes, and their work was to be considered for publication. Fryer also held out to prizewinners the possibility of long-term employment as writers. What he was seeking was fiction with a social purpose; it had to attack, as well as suggest remedies for, what he saw as the three great afflictions of Chinese society: opium, the examination essay, and foot-binding.[125]
Fryer ran advertisements in two languages, the Chinese versions emphasizing patriotism, the English, Christian ethics. He received 162 entries, the vast majority of which he called "rubbish." In the SRB, Qu Muyang concurs: "The vast majority of these 'new novels' exhibit little technique, flat characters, bland plots, and many of them are hardly even novels at all."
In his essay, Hanan argues that Fryer's contest pushes back the generally-accepted date for the beginnings of new fiction in China (Xin xiaoshuo in 1902), and speculates on how the stories may have influenced other late-Qing writers. Perhaps those influences can be tracked down, now that the stories themselves are available. Qu notes that vast majority of submissions were from writers with backgrounds in missionary schools, and thus whatever their literary merit, the stories may be a valuable source of information about institutional Christianity in China in the 1890s.
Hanan wrote his essay relying on news reports, Fryer's advertisements, and two novels directly inspired by the contest, but the entries themselves were thought to be lost forever. However, in 2006, as UC-Berkeley's East Asian Library was preparing to move to a new facility, they were rediscovered, more than a century after they were written. They have now been reprinted in a 14-volume collection which can be yours for just 1,680 RMB.
[1]This essay is included in Chinese fiction of the nineteenth and early twentieth centuries: essays (2004), which is available on Google books.↩
Tags:contest, Oriental Morning Post, Qing fiction, Shanghai Review of Books


Celebrate the creative spirit of our members who submitted recent original works of art in a range of media for this annual exhibition. Because of the renovations to The Galleries at the center, this year's show is being presented in the conference rooms at Hudson Hospital & Clinic as part of our partnership Healing Arts Program. At this venue, the exhibit will be enjoyed by a broad audience–hospital staff, patients, and visitors, as well as the general public–and will be exhibited for an extended period of time, encouraging even more viewers.
Hudson Hospital and Clinic is located at 405 Stageline Road, Hudson. The Members Exhibition is on view Monday through Friday, from 6:00 a.m. – 8:00 p.m. and Saturday, from 7:00 a.m. – 1:00 p.m., when meetings or classes are not scheduled in the conference rooms. Call ahead for viewing availability, 715-531-6059.


text:
Mar 22, 2017 10:19 AM EDT By Anne Collins, UniversityHerald Reporter
Why Sometimes Having A Career Plan Can Do More Harm Than Good [VIDEO]
Career planning or thinking about what one would do 10 years from is a deeply unhealthy way to think said Mike O'Connor, director of career discovery and the education career community at Williams College. O'Connor said that it is neither important nor realistic to have a five or ten year plan and that having once can do more harm than good.
According to data from the US Department of Labor, an average person holds 10 jobs before the age of 40. The 10-year career planning is a thing of the past with today's business climate of corporate restructuring, outsourcing, and rapidly advancing automation.
Training one's self to spot opportunities, thinking creatively and strategically growing network will do more for one's career compared to a 10-year career planning. O'Connor pointed out to break the mindset of obsessing over the future and to mindset and pay attention to the present moment to avoid unnecessary emotional turbulence.
He stressed that the most important thing for a young person to do is develop the ability to think creatively and spot potential opportunities before they arise. Knowing when to leap on an opening helps hone awareness of the present. A mindfulness practice can be incorporated to daily routine or any practice that prioritized focus can increase present state awareness.
Quartz reported that Jennifer Earls, an expert in the intersections of career counseling and mindfulness, said mindfulness exercises will allow one step outside the rational mind and examine what one really wants. In a book called Choose Yourself, James Altucher suggests building the idea muscle by writing down 10 new ideas a day. The more one is able to come up with good ideas on the spot, the more valuable one becomes in every situation. It would help shape a career to fit one's specific strengths and interests.
After getting the idea muscle in shape search for potential organizations that align with strengths and interests. Make a list of best ideas and send it to seniors. If able to make a connection with even one out of six professionals, find a mentor in a target industry to position for the next step.
Tags Career Planning, Mike O'Connor, Williams College, US Department of Labor, spot opportunities, 10-year career planning, emotional turbulence, mindfulness, Jennifer Earls, Choose Yourself, James Altucher, idea muscle
Students Named To National Youth Orchestra 2017 [VIDEO]
How Art Education Can Open A World Of Opportunity [VIDEO]
Jennifer Garner Advocates Early Childhood Education For 'Save The Children' In DC [VIDEO]
Trump's New Budget Blueprint For 2018 Includes Cuts Of Some NASA's Projects [VIDEO]
Celine Dion Shares Advice From Late Husband On The Voice [VIDEO]
Why Women Select College Majors With Lower Earnings Potential


One of my favorite places on the planet is Galveston, Texas. I love it so very much, especially during the summer, and it holds a very special piece of my heart. There's so much history, beauty, and entertainment in Galveston. My high school sweetheart-turned-husband and I used to go to the island to go to the beach all the time when we were dating in high school, so it's also very nostalgic to me. And now that we're grown with our own cars and incomes and lives, we can hit up LaKing's and Big Daddy's Gumbo Bar any old time we want. Seriously, if you haven't had the pleasure of supporting these local eateries, I highly recommend you pay them a visit next time you're in Galveston.
You can imagine how excited I was when Carlee mentioned that she lived in Galveston and wanted to shoot her engagement session there. Some of my favorite places to shoot on the island are on The Strand, the seawall, and obviously the actual beach.
Carlee & I have known each other for a little over 12 years. We actually used to play volleyball together in junior high and high school, and she has since become a labor and delivery nurse. Oh, and obviously gotten engaged to Thomas, too! It's funny because I knew him before this shoot, as well, through a mutual friend, so my time spent with Carlee and Thomas was so fun. There was much catching up to do! And I'm fairly certain I laughed more with them than I have any other time this year. They're friggin' hilarious. Sessions usually last an hour, but this one probably went over by half an hour because we couldn't actually stop laughing.
And just like any amazing engagement session, we ended up at Big Daddy's Gumbo Bar for gumbo and beer. Just another fun memory to add to the Galveston files.


IGFRI has invited application for the posts of Technical Assistant on its official website http://www.igfri.res.in for B.Tech, diploma . Candidates who want to get a job in IGFRI can apply for this notification. If you clear the recruitment process your job location will be Uttar Pradesh. Candidates must submit his or her application on or before 30 Days From Date Of Publication.. For more details like eligibility criteria,age limit and salary read further.
Fee :- The Examination fee for this recruitment is Rs. 200/-, through demand draft in favour of ICAR Unit IGFRI payable at SBI Karari Jhansi.
Application Procedure :-One who wants to apply should download the application form from www.igfri.res.in and print it and fill all his credentials in the given form affixing his passport size photographs and required attachments and send it before 30-01-2016.


text:
package org.guvnor.structure.repositories.impl;

import org.guvnor.structure.repositories.PublicURI;
import org.jboss.errai.common.client.api.annotations.Portable;

@Portable
public class DefaultPublicURI implements PublicURI {

    private String protocol;
    private String uri;

    public DefaultPublicURI() {
    }

    public DefaultPublicURI(final String uri) {
        this("",
             uri);
    }

    public DefaultPublicURI(final String protocol,
                            final String uri) {
        this.protocol = protocol;
        this.uri = uri;
    }

    @Override
    public String getProtocol() {
        return protocol;
    }

    public void setProtocol(String protocol) {
        this.protocol = protocol;
    }

    @Override
    public String getURI() {
        return uri;
    }

    public void setURI(final String uri) {
        this.uri = uri;
    }

    @Override
    public boolean equals(Object o) {
        if (this == o) {
            return true;
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        if (!(o instanceof DefaultPublicURI)) {
            return false;
        }

        DefaultPublicURI publicURI = (DefaultPublicURI) o;

        if (uri != null ? !uri.equals(publicURI.uri) : publicURI.uri != null) {
            return false;
        }
        if (protocol != null ? !protocol.equals(publicURI.protocol) : publicURI.protocol != null) {
            return false;
        }

        return true;
    }

    @Override
    public int hashCode() {
        int result = protocol != null ? protocol.hashCode() : 0;
        result = ~~result;
        result = 31 * result + (uri != null ? uri.hashCode() : 0);
        result = ~~result;
        return result;
    }

    @Override
    public String toString() {
        return "DefaultPublicURI{" +
                "protocol='" + protocol + '\'' +
                ", uri='" + uri + '\'' +
                '}';
    }
}

redpajama_set_name: RedPajamaGithub


text:
Specific Environments: The Landscape as Metaphor
leannegoebel / December 28, 2011
Specific Environments: The Landscape as Metaphor was conceived as the dynamism of visual forces, unearthing art that is actionable, and objects that ask the viewer to step away from the obvious and move toward the enigmatic, yet not arcane. The goal was to bring together artists whose works are not merely handmade copies of nature, but who use landscape, nature, and the land to enter into a discourse of contemporary issues of our time: environmental degradation, consumption, myth, memory, and perception, and the intersection of technology and terrain, both internal and external. When put together in one gallery setting, the additional aim is to invite the viewer to enter through something familiar, but to emerge knowing something beyond the evidentiary.
This exhibition began by selecting six invited artists with differing approaches to nature, landscape, the environment, and place: Kevin Bell, Chris Coleman, Gregory Euclide, Jenny Gummersall, Laleh Mehran, and Kate Petley. Artists then submitted works and 40 were selected for inclusion based upon the framework presented by the invited artists. However, the seed of the concept began with Kate Petley, an artist I have known professionally and personally for several years. Petley once lived in the small town in Southwestern Colorado where I currently reside. It's a gorgeous place, surrounded by the craggy San Juan Mountains, and a vast wilderness. The area is thinly populated and has no big box stores or urban conveniences. It was here that Petley created her largest public artwork Air Drops for the Bush Intercontinental Airport in Houston, Texas. Her juicy abstract resin panels explore the edges where the urban world bumps up against nature and that tension comes from her relocation to the Front Range. While living in Southwest Colorado, her works were about light, time, and the glimpses of nature caught from the corner of one's eye. It is inevitable that we came to know one another, living in such a small town, and we remain in a network of artists, writers, and curators who share ideas over soy latte's and Facebook. Petley shared her concept for Glint: Time and Light with me via email. She then posted it on her website. I kept returning to the work, which seizes on the moment that sunlight reflects off the surface of the water, but is created using industrial film, unfinished wood, and theatrical lighting, for its perception about place and its pretense of nature.
Petley's work kept bumping up in my mind against the ideas explored by Gregory Euclide,an artist I have written about for Art Ltd magazine, and as an essayist for the David B. Smith Gallery in Denver. His approach to landscape is one that challenges viewers to see small realities and visual misconceptions. His painted, crumbled, mixed media artworks and installations cogitate between the artifice of making an object, the Duchampian tradition of finding an object and making it art, and the actual land. In Capture #3 the sculpture is formed by pouring a glue-like substance on the ground and literally lifting the earth beneath to create the object. He uses lake water, melted snow, and pigments created from dirt combined with found objects and items from nature to create his works that explore the representation of the landscape in art, as in Produced within the layers of viewing's making. Euclide is critical of Hudson River School painters like Thomas Cole, who attempted to convey on a flat rectangle the dynamic experience of nature over time. Euclide wants the viewer to go into the flat spaces not only with their mind, but to enter the 3-D spaces with their physical body.
Both Petley and Euclide ask viewers to enter into a landscape, if not physically, then perhaps figuratively. Imagining the dimensionality of reality. Exploring the relationship between inner and outer topography. They are aware of the traditions of landscape art and have no interest in repeating what many still consider to be the ideal form of creative expression—depicting Nature as
is, as seen, as perceived.
Therefore, it was important that a "landscape painter" be in included in Specific Environments. Kevin Bell is the kind of painter I wanted for this exhibition— one that handles paint masterfully, minimally, and realistically, yet incorporates complex concepts onto the canvas. Bell also helps viewers see what is not readily visible, while challenging perceptions and beliefs. His works deliberate on the man-made and natural environments, but are particularly focused on the tension between the two, which often results in ambivalence. In Sinkhole, unseen erosion results in collapse and introversion, while in Dam an invisible man-made structure is suggested not only by the title, but the depiction of the land. Bell works in the negative spaces highlighting the importance of editing, paring down, and suggestion in our society.
Photographer Jenny Gummersall envisions innuendo as well in her abstract equine landscape photographs. The playful, yet serious aesthetic quality of her work was something I also wanted to explore in this exhibition. It is not necessary for art to be academic and cryptic. It can be accessible, yet rich in beauty and meaning. One of the things I admire most about Gummersall's work is how she makes the ordinary look extraordinary. In With Clouds and Mane Landscape Square the viewer does a double take. The physical landscape becomes an otherworldly landscape. It seems at once simple, but upon closer examination, the viewer realizes what they are seeing, challenging their initial myths and memories.
When considering the otherworldly, my perceptions jump to technology, which infiltrates and influences our lives in dramatic ways. It is technology that impacts our environment and landscapes. Everything we use to make our lives "easier" involves the use of materials extracted from the land. So it was imperative that Specific Environments include new media animation and HD video. Ivar Zeile, the director of Plus Gallery in Denver suggested I contact Chris Coleman and when I perused his website I knew I had found what I was looking to include in this exhibition. Coleman then introduced me to his wife Laleh Mehran. Coleman and Mehran are instructors in new media and digital art at the University of Denver. His award-winning HD animation The Magnitude of the Continental Divides takes viewers on a journey between many locations in various states of withdrawal and aggression, but more importantly for this exhibition is the notion that the individual is caught in the midst of this chaos, unable to define their identity without place. Place is paramount. "It is the stuff of fiction, as close to our living lives as the earth we can pick up and rub between our fingers, something we can feel and smell," Eudora Welty wrote.
It is not so much place as point of view that is questioned in Mehran's projected video Xerces Society, Installment VII: From London to Marrakech. The projection utilizes apertures that are at once windows and eyes suggesting travel by train. A parade of level images raise questions in the viewer's mind and create the tension of point of view. Mehran blurs art, science, and politics together while exploring the complexities of fanaticism and ideolog—critical notions in a world experiencing upheaval and questioning borders.
Every artwork is a metaphor. But how do we understand and interpret metaphor?
The human brain functions by using a structured set of generic knowledge called schema by cognitive psychologists. When we approach the idea of metaphor, we are employing use of schema. The artist uses their own personal schema to elaborate their visual metaphor. If the viewer doesn't have a similar schema, they cannot receive the information. They may interpret the metaphor based on their own schemata or perceptions and not that of the artist. However, decoding a map, whether spatial or thematic, seems to be quite natural for most humans. Many theorist's posit that this is because the landscape metaphor and the way we view our spatial environment requires a knowledge of terrain and our corporeal presence in space. Something we all have. This is why when we look at a painting and see three horizontal bands of color, we automatically presume it to be landscape—terroir, horizon, and sky.
Each of the artists juried into this exhibition relates, reacts, riffs and rubs up against these invited artists works and ideas. An individual artwork represents its own distinct habitat, and these habitats combine to create a composite of our world, our society, and our culture. Viewed together, I hope that Specific Environments adds up to something more than the sum of its parts. That beyond this moment of viewing something is revealed that was unknown and that together these objects originate a new place as tangible as those we can pick up and rub through our fingers.
AICA-USA
Curator and Juror
On view through January 14, 2012 at the LINCOLN center gallery in Fort Collins, CO.
Take a YouTube video tour of the exhibition by watching the video below:
Participating Artists
Kevin Bell, WY
Chris Coleman, CO
Jenny Gummersall, CO
Gregory Euclide, MN
Laleh Mehran, CO
Kate Petley, CO
Monique Janssen-Belitz, NM
Thomas Brunet, CO
Cynthia Camlin, WA
Beau Carey, CO
Stephen Cartwright, IL
Kevin Curry, CO
Elvira Dayel-Kogan, CA
Betsy Duzan, CO
Jeremy Dyer, NY
Susan Field, CA
Jef Gunn, OR
Sabina Haque, OR
Jodi Hays, TN
Cecil Howell, CA
Andrea Jensen, UT
Tomiko Jones, CO
David Jones, WY
Anna Landa, NY
Armin Muhsam, MO
Hilary Norcliffe, CA
Stephanie Ognar, IL
Woody Packard, NY
Karina Rocco, FL
Dawn Roe, FL
Pam Rogers, MD
Katherine Rondina, NM
Georgia Rowswell, WY
Adrien Segal, CA
Amanda Small, NC
Anthony Teneralli, CO
Cheryl Gail Toh, MO
Andrew Wapinski, PA
Jordi Williams, VA
Catalog available:
December 28, 2011 in ART, Denver. Tags: Amanda Small, Christopher Coleman, Gregory Euclide, Jenny Gummersall, Kate Petley, Kevin Bell, Laleh Mehran, Leanne Goebel, Lincoln Center Gallery, Stephanie Ognar, Stephen Cartwright, Tomiko Jones
Exhibition Essay for Gregory Euclide at David B Smith Gallery
Gregory Euclide Limited Edition Book, 2011
Best of 2012: Colorado Art in Review from adobeairstream.com
← Clyfford Still: Part Menace and Yes, Part Majesty from adobeairstream.com
Ricky Allman at David B. Smith Gallery Exhibition Essay →
One thought on "Specific Environments: The Landscape as Metaphor"
Have you read anything about Gerald Pollack's work with Structured Water?


text:
Have reusable cups been trashed?
By Sophie Hurst
Posted in 50th Anniversary, Climate
Before the pandemic began, it was very rare that a day went by when I didn't leave the house without my trusty reusable cup. Apart from feeding my borderline obsessive desire to drink tea all day long, it meant that whilst I was out and about and felt the need to have another brew, I could drink it knowing I wasn't adding another 'throw-away' plastic cup to the ever-growing piles of landfill.
But now, with some of the only COVID rules remaining being those relating to how we consume drinks without sharing any germs, I often find myself tipping my drink out of one plastic cup into my reusable one… a huge contradiction, I know!
In 2020, the government announced that 'it is up to the individual business to decide whether they allow the use of reusable cups or containers during this period'. However, with onslaughts of headlines and reports advising us to 'stop the spread', it was understandable that many businesses stopped accepting the use of reusable cups. Most notably, in March 2020, Starbucks decided that the pandemic was a 'greater priority' than the environment. Consequently, they decided to ban the use of reusable cups. Whilst, at this time, Starbucks were not following health advice, and instead took this decision internally within the business, it is unquestionable that this move set a trend for other businesses, both large and local, to follow.
However, before the pandemic, the rise in the use of reusable cups was spreading rapidly as it seemed more and more people were becoming conscious of how they produced waste. Towns across the UK started to launch successful 'cup' schemes. The Shrewsbury Cup in particular, built a network of 20 cafés across the town in which people can pay a £1 deposit to have their drink in a reusable cup. Once they are finished, they can then return the cup to another participating café, where their initial deposit is returned. This scheme alone saw huge success in the town before the pandemic. It saved 3000 plastic cups from being thrown away within the first 10 months of its launch, and is now back working again after the lockdowns.
Starbucks decided that the pandemic was a greater priority than the environment
Whilst some have questioned the real impact reusable cups can have, it is undeniable that saving thousands of cups worth of plastic waste per year can only be a step in the right direction. And what's more, it shows that people were becoming more and more aware of the impact their actions were having on the planet. But the pandemic means we are facing a new wave of throw away materials. We are now inundated with single use masks, gloves, and food containers, and of course the single use plastic cup!
It has been suggested that the 'best-case scenario estimation is that the plastic waste associated with COVID-19 increased by some 10 million tons'. Of course, this statistic does include masks and medical equipment, but it does show that previously changing habits and attitudes to recycling could be reversed due to the pandemic. Like one Microplastics expert at the University of Bangor has said: "While we need to be very conscious of the health implications, we cannot allow ourselves to be distracted… Covid will eventually go away, plastic waste won't, it's here forever."
As we are now turning back to a society where some single use plastics could be reduced again, will the reusable cup take its former place of glory? The WWF has predicted that by 2030 the UK will use 33% more cups than it does now'. But is this 33% enough when we have just faced such a spike in our usage of throw away plastics?
For me, the reusable cup will always have a space in my rucksack. But with time, there is huge potential for their re-integration across society. With U-turns from major companies and more local recycling schemes popping up around the UK, the reusable cup could take its place as an everyday essential for people around the country – a position it came so close to holding before the pandemic.