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Ideas as art. Interview by Dane Cutu.

Three years ago, consultants Laurence Prusak and Thomas H. Davenport asked prominent management thinkers to name their gurus and reported the results in HBR. James G. March appeared on more lists than any other person except Peter Drucker. A professor emeritus in management, sociology, political science, and education at Stanford University, March has taught courses in subjects as diverse as organizational psychology, behavioral economics, leadership, rules for killing people, friendship, computer simulation, and statistics. He is perhaps best known for his pioneering contributions to organization and management theory. March's accomplishments in that field, and in many others, have conferred on him an almost unprecedented reputation as a rigorous scholar and a deep source of wisdom. As University of Chicago professor John Padgett wrote in the journal Contemporary Sociology, "March's influence, unlike that of any of his peers, is not limited to any possible subset of the social science disciplines; it is pervasive." March approaches thought aesthetically; he cares that ideas have "some form of elegance or grace or surprise." His poetic sensibility can be felt in the metaphors he has created over the years--the "garbage can theory" of organizational choice, for instance, and the "hot-stove effect" in learning. In this edited interview with HBR senior editor Diane Coutu, March shares his thinking on aesthetics, leadership, the role of folly, and the irrelevance of relevance when it comes to the pursuit of ideas. He also comments on the fundamental differences between academic and experiential knowledge, underscoring the need for both.

Commerce↗

Some epidemiological aspects of intestinal parasites in women workers before going abroad.

A study was conducted in Jakarta on 903 women workers before going abroad through stool examination by Ritchie's technical method. Of the women workers studied, 640 subjects (70.87%) were found to be infected with intestinal parasites either helminthes, protozoa or combination. Out of those infected, 451 (70.47%) subjects were infected with intestinal helminthes, namely Ascaris lumbricoides (38.13%), Trichuris trichiura (28.13%), a combination of Necator americanus and Ancylostoma duodenale (13.59%) and Enterobius vermicularis (4.84%). In addition 319 (49.84%) subjects were infected with intestinal protozoa namely Giardia lamblia (22.03%), Entamoeba histolytica (14.53%), Blastocystis hominis (6.56%) and Entamoeba coli (6.72%). The youngest age to be affected was 14 years old (14.19% of the subjects studied). Majority (72.09%) of the study subjects received junior high school level of education. Home yard (46.51%) and ground under the trees (22.09%) were places favourable for the habits of defaecation, whereas garbage disposal took place in 52.33% home yards and 25.58% creeks. This study revealed that various life style habits and indiscriminate defaecation were the causes of the continuous transmission of intestinal parasitic infections. The different parasites that were found in women workers before going abroad relate to the various epidemiological aspects of intestinal parasites in women workers in Indonesia who came from different islands in the country and possessed different life style patterns, socioeconomic status, geographical condition and cultures.

Adolescent↗

The prevalence and environmental risk factors for moderate and severe trachoma in southern Ethiopia.

Inflammatory eye disease is a leading cause of reported morbidity throughout rural Ethiopia. The purpose of this investigation was to document the prevalence of trachoma at all stages and to identify environmental risk factors for moderate to severe cases among rural inhabitants of Sidamo Region in southern Ethiopia. An ophthalmic examination followed by a blind household interview were completed on 1222 randomly selected subjects. Those with moderate or severe trachoma were compared with normal subjects for rates of exposure to potential environmental risk factors. The results of the eye examinations are as follows; normal 59.5%, trivial 8.4%, mild 10.3%, moderate 8.5%, severe 8.0%, cicatricial 3.0%, and other eye diseases without trachoma 2.3%. Highest prevalence rates for moderate to severe trachoma were found in those under 10 and over 45 years of age. Increased adjusted odds ratios were found for exposure to garbage disposal near home, crowded sleeping arrangements, animals inside the home, cooking in a separate room, and living at lower altitudes. The identification of several modifiable environmental risk factors for trachoma will be of use in the further development of preventive programmes.

Adolescent↗

House-fly distribution in certain general hospital in Cairo.

Fly sampling was evaluated under laboratory conditions before starting the field surveys. Three different fly traps were tested, of which the Spiralettes (a commercial one) proved to be the most efficient. Sampling conditions were also considered in this laboratory evaluation, light, air current, swinging, height and temperature were tested, all of them have affected fly trapping except height. Fly density and distribution in two general hospitals and two specialized ones, were estimated in order to evaluate them epidemiologically in relation to hospital bacterial contamination. Results of these surveys revealed the followings: (1) The location of the hospital has no impact on the fly density. (2) Flies are attracted more to swinging hanged ribbon traps than to fixed ones. (3) Fly densities were relatively high in the main kitchens and the main garbages followed by toilets (common ones), patient wards, outpatients investigating rooms, surgical theaters and plasterrooms of the hospitals. (4) Fly density is higher during warm seasons than in cold ones.

Animals↗

Trichinosis surveillance, United States, 1987-1990.

Since the Public Health Service began recording statistics on trichinosis in 1947, the number of cases reported by state health departments each year has declined. In the late 1940s, health departments reported an average of 400 cases and 10-15 deaths each year; from 1982 through 1986, the number declined to an average of 57 cases per year and a total of three deaths for the period. From 1987 through 1990, 206 cases of trichinosis from 22 states, including 14 multiple-case outbreaks, were reported to CDC. In 1990, two large outbreaks associated with commercial pork accounted for 106 cases. In the 192 instances in which a suspect food item was identified, pork was implicated in 144 (75%) cases, walrus meat in 34 (18%), and bear meat in 14 (7%). Sausage, the most frequently implicated pork product, was associated with 128 of the 139 cases for which a form of ingested pork was specified. Before 1990, the proportion of cases of trichinosis attributable to consumption of commercial pork had declined steadily. This decline was probably due to a combination of factors, including laws prohibiting the feeding of garbage to hogs, the increased use of home freezers, and the practice of thoroughly cooking pork. Although the incidence of trichinosis has decreased substantially since national reporting was initiated in 1947, a dramatic increase in 1990, resulting from two large outbreaks, emphasizes the need for further education and control measures.

Adolescent↗

[Intestinal parasitosis in pre-school children from Tarapoto].

We examined stool specimens from 110 children (Pre Scholar) from the suburb "9 de Abril" Tarapoto (Perú). The diagnostic techniques were: direct smear, Faust floaty concentration, Willis floating and Graham's tape. 98 percent had intestinal parasitosis, without sexual differences. The most common parasites were: Ascaris lumbricoides 68%, Trichuris trichiura 44%, Enterobius vermicularis 28%, Hymenolepis nana 21% and Strongyloides stercoralis 16%. Monoparasitosis was present in 44% and biparasitosis 42%. The most frequent association was Ascaris-Trichuris. The clinical findings were hyporexia, borborygms, bruxismo, abdominal pain and diarrhea. 60% received irregular treatment and without laboratory stool tests. In this suburb there's not garbage dump, drainage and the drinkable water is very contaminated; the deficient hygiene worsen the soul contamination. We consider that the elimination of these situations and health education are better than the medicine use.

Child, Preschool↗

[Changes in prevention of infection: a historic retrospect].

The discovery of pathogenic microorganisms in the mid 19th century made possible an effective prophylaxis on a scientific basis. During many centuries, sequestration of leprous in specific dwellings was the custom; in the hindsight it proved to be instrumental for the almost complete disappearance of leprosy in Europe. This was also the case with the epidemics of plague, which, since the late Middle Ages, were stopped by measures of quarantine in ports and at frontier passages (e.g. Austrian plague-cordon). The beginning of internationally coordinated health measures was equally decisive. With smallpox, the variolation (since 1730) gave first relief, until Sir Edward Jenner discovered in 1798 the highly successful cross-immunity through vaccination. The development of sanitary conditions through better drinking-water supply, canalization and garbage disposal since the mid 19th century contributed much to the betterment of health, especially concerning cholera epidemics in cities. The reinforcement of the individual hygiene (body care, extermination of lice, antiseptic treatment of wounds, etc.) helped to achieve an adequate prevention and, together with intensified health education, a decline of infectious diseases in general.

Communicable Disease Control↗

From the Big Bang to sustainable societies.

A series of events in the history of cosmos has created the prerequisites for life on Earth. With respect to matter, the earth is a closed system. However, it receives light from the sun and emits infrared radiation into space. The difference in thermodynamic potential between these two flows has provided the physical conditions for self-organization. The transformation of lifeless matter into modern life forms, with their high degree of order and complexity, has occurred in the context of the earth's natural cycles, including the water cycle and the biochemical cycles between plants and animals. Primary production units, the cells of green plants, can use the thermodynamic potential of the energy balance in a very direct way, i.e. in photosynthesis. Plant cells are unique in their ability to synthesize more structure than is broken down elsewhere in the biosphere. The perpetuation of this process requires the recycling of wastes. However, modern industrial societies are obsessed with the supply side, ignoring the principle of matter's conservation and neglecting to plan for the entire material flow. As a result there has been an accumulation of both visible and invisible garbage (pollution), which disturbs the biosphere and reduces stocks of natural resources. Furthermore, due to complexity and delay mechanisms, we usually cannot predict time parameters for the resulting socio-economic consequences or the development of disease. To continue along this path of folly is not compatible with the maintenance of wealth, nor with the health of humans or the biosphere. Rather than address the millions of environmental problems one at a time, we need to approach them at the systemic level. It is essential to convert to human life-styles and forms of societal organization that are based on cyclic processes compatible with the earth's natural cycles. The challenge to the developed countries is not only to decrease their own emissions of pollutants but to develop the cyclic technology and life styles needed by the entire human community.

Animals↗

[The occurrence of Campylobacter spp. and Salmonella spp. in gulls in northern Germany].

Out of a total of 207 gulls--20 Black headed gulls, 185 Herring gulls and 2 Common gulls--128 (62%) and 23 (11%) birds, respectively, were infected with Campylobacter spp. (C.) and Salmonella spp. C. jejuni was predominant in gulls less than two years old (89%) and C. coli in older birds (75%). Furthermore, the infection rate with Campylobacters was depending on the habitats of the birds. The rate for C. jejuni and C. coli, respectively, was in gulls from regional garbage dumps 78% and 4%, from the coast 58% and 21%, and from islands 47% and 47% of the isolations in the corresponding area. Salmonellae were mainly isolated in the period from September to February from gulls less than one year old and from birds from the coast.

Animals↗

Health and nutrition survey in a group of urban homeless adults.

Homeless persons eat foods from municipal and privately run shelters, fast-food restaurants, delicatessens, and garbage bins. Data on the adequacy of the diets and the nutritional status of homeless persons are sparse. Therefore, we surveyed the nutritional adequacy of the dietary intake, the quality of shelter meals, and objective clinical parameters indicative of nutritional status in a heterogeneous group of urban homeless persons. The group comprised mentally ill persons, alcohol and illicit drug users, and temporarily unemployed persons. Although 86 of the 96 subjects (90%) in our survey reported that they obtained enough to eat, a low dietary adequacy score, which was based on the basic four food groups, of 10.7 (norm = 16) indicated that the quality of their diets was inadequate. Shelter meals and diet records showed a high level of saturated fat and cholesterol. Serum cholesterol levels above the desirable limit of 5.17 mmol/L (200 mg) were observed in 79 subjects (82%). In addition to a prevalence of hypertension and obesity (observed in 37 subjects [39%], these homeless persons were at high risk for development of or worsening of cardiovascular disease. We conclude that homeless persons who obtain meals at shelters are getting enough to eat. However, the shelter meals should be modified to meet the nutritional needs and dietary prescriptions of the large number of clients who suffer from various health disorders.

Adult↗

Improper office disposal of needles and other sharps: an occupational hazard outside of health care institutions.

An employee of a private disposal company suffered a finger needlestick injury while collecting waste at curbside from a building containing medical offices. Subsequent inspection of the contents of the garbage bags revealed the presence of used syringes and unsheathed needles. The Ministry of the Environment has developed a regulation and guidelines for the handling and disposal of biomedical waste including needles and other sharps. These specify that approved carriers and receivers are required for disposal; properly decontaminated waste is considered non-hazardous solid waste and can go to landfills. However, responsibility for curbside pickup of waste lies with municipalities; some municipalities have enacted by-laws which prohibit collection of this waste at the curbside. This incident illustrates that improper disposal of biomedical waste (including that from private practitioners' offices) may occur despite efforts to control its handling, and that needlestick injuries can occur outside of health care facilities among personnel who are not health care workers. Efforts are needed to increase the level of awareness among health professionals regarding their responsibility to ensure proper biomedical waste disposal from private offices. In addition, efforts should be made to bridge the gap between all levels of government regarding the disposal of biomedical waste.

Accidents, Occupational↗

Trichinella spiralis in an agricultural ecosystem: transmission in the rat population.

Four hundred forty-three Norway rats (Rattus norvegicus) were examined to determine their role in the transmission and maintenance of Trichinella spiralis on a pig farm. Rats, classified by sex and weight, were examined for trichinellosis by peptic digestion of muscle samples. Over a 25-mo period, 188 (42.4%) rats were found to be infected with T. spiralis. The mean intensity of infection was 293.2 larvae per gram (LPG) of muscle; 65 (34.6%) infected rats had intensities of infection greater than 100 LPG. Even in the absence of a known source of infected meat (garbage containing meat scraps or dead animals), the rat population maintained the infection, probably through cannibalism. Population reduction was an effective method for reducing the prevalence of infection within the rat population. Therefore, to reduce the likelihood of transmission of T. spiralis between rats and swine, it is essential that rat populations in a farmyard environment be controlled.

Animals↗

Assessment of the nutritional status of urban homeless adults.

Homeless people eat foods at municipal and charity run shelters, fast-food restaurants, delicatessens, and from garbage bins. Data on the adequacy of the diets and the nutritional status of homeless persons are sparse. Therefore, nutritional indicators of 55 urban homeless subjects were assessed, and a high prevalence of risk factors was identified. Although 93 percent of subjects reported that they obtained enough to eat, a low dietary adequacy score of 10.1 (norm = 16) indicated that the quality of the diet was inadequate. Diet records showed a high intake of sodium, saturated fat, and cholesterol. Serum cholesterol levels above the desirable limit of 200 mg per dl were prevalent. Anthropometric measurements were significantly different from percentile distributions of the U.S. population (P less than .001). Triceps skinfold measurement was above the 95th percentile in 25 percent of subjects. Upper arm muscle area, which reflects lean body mass, was below the 5th percentile in 23.3 percent of women and 44 percent of the men. These decreased levels of lean body mass and increased levels of body fat, together with the elevated serum cholesterol levels and the shortages of essential nutrients in the diet, may place the homeless at risk of developing nutrition-related disorders.

Adult↗

Incidence of Q fever in two inadequately investigated occupational groups.

In 1973 the authors investigated the incidence of Q fever serologically by means of the reaction of complement fixation (RCF) and the method of immunofluorescent titration (MIFT) in two inadequately investigated occupational groups--communal workers from the town of Russe and medical workers in obstetric departments of several towns in North Bulgaria. In addition, they carried out comparative studies in order to characterize the incidence and the degree of affection from the same disease in other persons exposed and not exposed at work in the same area--transport workers and blood donors. Out of 198 communal workers, 91 (45.95 +/- 3.54%) had positive titres for Q fever (1:8--1:512). A high incidence of Q fever was established in dustmen (61.40%), sweepers (46.55%) and drivers of dust cars (38.00%), i.e. persons collecting and rendering harmless the garbage of big town. Out of 174 medical workers in obstetric departments 65 (37.36% +/- 3.78%) were positive in titres 1:8--1:512. A high incidence of Q fever was established in obstetricians (57.14%), midwives (38.11%) and hospital attendants (34.38%), i.e. persons providing medical care for pregnant women or women in childbirth. In both groups the occupational hazard increases with the length of service. Out of 244 transport workers 82 (33.60% +/- 3.02%) were positive for Q fever, and out of 237 blood donors 19 (8.01 +/- 2.54%) were serologically positive for Q fever. The authors suggest continued investigation of these two occupational groups.

Bulgaria↗

Trichinella spiralis in an agricultural ecosystem: transmission under natural and experimentally modified on-farm conditions.

A hog found infected with Trichinella spiralis at slaughter was traced to its farm of origin, where an epidemiological investigation found the infection prevalent in swine and rats. Garbage-feeding was not responsible for maintaining the high prevalence of infection on this farm, although it may have been responsible historically for the introduction of the infection. Poor husbandry, malnutrition, and intercurrent disease resulted in frequent death and the availability of porcine carcasses for cannibalism. Tissue samples from partly devoured carcasses contained T. spiralis larvae, implicating cannibalism as a major vehicle for the spread of T. spiralis in the herd. Rats also fed on these carcasses, and their rate of infection increased markedly during the first 5 mo of observation. Experimental investigation indicated that rats could also be important in maintaining a high prevalence of infection in swine. For the purpose of our investigation, the farm was depopulated of swine and restocked with parasite-free, sentinel pigs confined in 3 groups exposed to increasing degrees of contact with rats. Pigs exposed to large numbers of rats acquired infections rapidly, whereas pigs with strongly limited rat exposure failed to acquire infection during a 12-mo period. These results indicate that, when rats are available to swine and the prevalence of T. spiralis infection in the former is high, predation (or scavenging) on rats may be as effective as cannibalism in maintaining a high prevalence of porcine T. spiralis infection.

Animals↗

Use of repellents and attractants in filariasis control.

The ways in which repellents and attractants could be used to interrupt the transmission of bancroftian filariasis, especially by Culex pipiens fatigans, are assessed. Dimethyl phthalate (DMP) is an effective repellent against C. p. fatigans. It is also very toxic to all larval stages of Wuchereria bancrofti. The median lethal time to microfilariae of a solution of about 0.2% in normal saline is about 10 minutes. Other stages are similarly sensitive. Contact with DMP in very thin films is almost immediately lethal. It is highly unlikely that infection could take place under ordinary conditions through skin treated with DMP for at least many hours afterwards. This toxicity made it impossible to evaluate repellency in vitro. An in vivo test of the effect of skin applications of DMP on microfilaria counts gave anomalous results. A schedule for filariasis control, involving education, garbage disposal, rodent control, sewage disposal, and mosquito control, is proposed, and the research needed to allow repellents and attractants to play a full role in such a schedule is delineated.

Animals↗

Leptospirosis in the city of Salvador, Bahia, Brazil: a case-control seroepidemiologic study.

From January 1 to December 31 of 1975, all patients admitted to Salvador's Infectious Disease Hospital were serologically tested for leptospirosis if their clinical and laboratory findings were compatible with this diagnosis. Of the 888 patients tested, 133 were positive. Among patients with an initial clinical impression of leptospirosis, the diagnosis was confirmed serologically in 36% and for the 133 leptospirosis patients, only 67 (50.4%) were initially suspected. Epidemiological aspects investigated covered: age, sex, place of residence and occupation for all cases and for fatal cases; distribution of cases by month of occurrence and by rainfall in that month; distribution of serotypes by month; and probable source of infection with emphasis of the occurrence and type of contact with dogs. For each case residing in Salvador, a control of the same age and sex was interviewed in the immediate neighborhood. Sewage, rats, water, dogs, mud and garbage were identified as the most likely source of infection in that order. Marked seasonal fluctuations were apparent with peak incidence during the months of maximum precipitation. In two-thirds of cases reporting contact with a dog, tests on the animal revealed the same serotype. The most frequent serotypes were: icterohemorrhagiae, autumnalis, castellonis, grippotyphosa, hebdomadis and bataviae.

Adolescent↗

Sanitation norms in rural areas: a cross-cultural comparison.

Mortality rates have sharply decreased throughout the world in the twentieth century. While the communicable diseases that had been the principal killers of mankind have been largely brought under control, the enteric and other diseases, which are directly related to sanitation practices, have not been affected. Improvement in health status in the developing nations, especially in isolated rural areas, will hinge on changes in sanitation norms. Modification of these norms must be based on an awareness of what they are and of the values that are associated with them. Sanitation norms in rural areas of three countries--in the southeastern United States, Puerto Rico, and the Dominican Republic--are reviewed on the basis of a study in which essentially the same survey instrument was used in the three samples. Sanitation norms relating to the source of water and storage for household use are compared, as are personal hygiene practices and patterns for the disposal of liquid wastes, garbage, and other solid wastes. Selected attitudinal values are also examined.

Attitude↗