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PubMed2006

Analyses of the red-dry-rough phenotype of an Escherichia coli O157:H7 strain and its role in biofilm formation and resistance to antibacterial agents.

In a previous study, we identified Congo red-binding and -nonbinding phase variants of Escherichia coli serotype O157:H7 strain ATCC 43895. The Congo red-binding variant, strain 43895OR, produced a dry, aggregative colony that was similar to the red, dry, and rough (rdar) phenotype characteristic of certain strains of Salmonella. In contrast, variant 43895OW produced a smooth and white colony morphology. In this study, we show that, similar to rdar strains of Salmonella enterica serovar Typhimurium, strain 43895OR forms large aggregates in broth cultures, firm pellicles at the air-medium interface on glass, and dense biofilms on glass and polystyrene. However, unlike S. enterica serovar Typhimurium, strain 43895OR does not stain positive for cellulose production. When strain 43895OR was fixed on agar, scanning electron microscopy showed cells expressing extracellular matrix (ECM) containing curli fibers. Strain 43895OW was devoid of any ECM or curli fibers on agar but showed expression of curli fibers during attachment to glass. Strain 43895OR produced >4-fold-larger amounts of biofilm than strain 43895OW on polystyrene, glass, stainless steel, and Teflon; formation was >3-fold higher in rich medium than in nutrient-limited medium. Biofilm-associated cells of both strains showed statistically greater resistance (P < 0.05) to hydrogen peroxide and quaternary ammonium sanitizer than their respective planktonic cells. This study shows that the rdar phenotype of E. coli O157:H7 strain 43895OR is important in multicellular growth, biofilm formation, and resistance to sanitizers. However, the lack of cellulose production by strain 43895OR indicates important differences in the ECM composition compared to that of Salmonella.

Anti-Bacterial Agents↗
PubMed1967

Microbial destruction by low concentrations of hypochlorite and iodophor germicides in alkaline and acidified water.

Hypochlorite and iodophor germicides were evaluated for their ability to destroy a variety of organisms at levels approximating those used for final sanitizing rinse for dairy and food equipment and beverage bottles (3 to 50 ppm). Test organisms included Escherichia coli, Streptococcus lactis, Lactobacillus plantarum, Pediococcus cerevisiae, and Saccharomyces cerevisiae. The hypochlorites and iodophors demonstrated approximate rates of destruction at equivalent concentrations for the bacterial species tested, except where the hypochlorite contained excess alkalinity. The hypochlorite responded more readily to a downward shift to a pH of 5.0 than did the iodophor. Excess alkalinity of the hypochlorite significantly affected its bactericidal activity. The iodophor exhibited a consistently greater rate of destruction of yeast cells than the hypochlorite. Successive treatment with low levels of iodophor (6 ppm) followed by a hypochlorite (12 to 25 ppm) resulted in a high level of destruction of all test organisms. Possibilities for employing these measures in a sanitizing rinse of bottles for maximal destruction of organisms were discussed. Among the test organisms, S. lactis showed a comparatively high resistance and was a useful organism for comparing the halogen preparations.

Chlorine↗
PubMed1967

Bacteriological Survey of the Frozen Prepared Foods Industry: III. Potato Products.

During sanitation-inspections of 29 potato-processing firms, 2,544 finished product units and 1,654 samples were collected and analyzed bacteriologically. The results of the bacteriological examination of finished French fries, fried potato cylinders, and dehydrated potatoes usually did not reveal the conditions of cleanliness under which they were produced. This was most likely due to the lethal effect of the terminal fry to which the French fries and potato cylinders are subjected, and because of the lethal effect of the dehydration temperatures used in processing the dehydrated potato products. However, as in most food-processing firms, line samples collected at each processing step reflect sanitary conditions and provide bacteriological support of inspectional evidence of plant insanitation. Most of the frozen stuffed baked potatoes examined were produced under poor sanitary conditions. But because this product is usually processed while hot, bacteriological examination of the finished product did not usually reveal the conditions of cleanliness under which they were produced. Again, inspectional observations were necessary for a full evaluation of the conditions of production. In contrast, frozen potato patties and frozen hash brown potatoes were more likely to reveal the conditions of sanitation under which they were produced as evidenced by the varying bacterial counts.

Journal Article↗
PubMed2026

Investigating the zoonotic origins of ESBL-producing E. coli in community-acquired urinary tract infections in Ecuador.

Extended-spectrum &#x3b2;-lactamase-producing Escherichia coli (ESBL-producing E. coli) pose a growing global health threat. Although Latin America has been identified as a global hotspot of antimicrobial resistance, the zoonotic contribution to drug-resistant infections in the region remains poorly defined. We analyzed 137 clinical ESBL-producing E. coli isolates from urinary tract infections (UTIs) in Quito, Ecuador, applying a Bayesian latent class model informed by host-associated mobile genetic elements to estimate the fraction of infections attributable to food-animal sources. We estimated that 25.5% (35/137) of UTI isolates were putative zoonotic cases. This proportion rose to 42.5% after excluding ST131-H30, a human-associated pandemic lineage. Putative zoonotic isolates were enriched for animal-associated &#x3b2;-lactamase genes (e.g., blaTEM-1B, blaCTX-M-65), lacked human-associated markers such as blaOXA-1, and exhibited diverse antimicrobial resistance gene profiles resembling those observed among food-animal isolates. These isolates were also enriched for ColV-associated virulence genes typically linked to avian pathogenic E. coli. Putative zoonotic strains contributed substantially to third-generation cephalosporin-resistant UTIs in Quito, Ecuador, challenging assumptions derived from high-income settings that such infections are driven predominantly by human-to-human transmission. These findings highlight the importance of integrated One Health surveillance and mitigation, particularly in low- and middle-income countries where gaps in water, sanitation, and hygiene (WASH) may interact with antimicrobial use in food production to amplify antimicrobial resistance transmission.IMPORTANCEESBL-producing E. coli have rapidly emerged as a major global antimicrobial resistance threat. In Latin America, cephalosporins are commonly used in food-animal production, fueling the emergence of ESBL-producing E. coli. In low- and middle-income countries, excessive antimicrobial use driven by poorly regulated over-the-counter sales, combined with inadequate water, sanitation, and hygiene (WASH) infrastructure, can facilitate antimicrobial-resistant pathogen transmission from food animals to humans. Using a novel statistical-genomic approach, we found that over one in four cephalosporin-resistant UTIs in Quito, Ecuador, may be caused by E. coli strains originating from food animals. Our findings highlight the public health risks associated with antimicrobial use in food-animal production and the role of environmental and infrastructure-related vulnerabilities. As global demand for animal protein continues rising in middle-income countries, controlling zoonotic antimicrobial resistance transmission becomes increasingly urgent for protecting human health through integrated One Health strategies.

ESBL-producing E. coli↗
PubMed2001

Response to trisodium phosphate treatment of Salmonella Chester attached to fresh-cut green pepper slices.

A laboratory model using green pepper disks was developed to investigate the attachment of Salmonella Chester on plant tissue and to evaluate the effectiveness of sanitizer agents in inactivating attached bacteria on fruits. Pepper disks (14 mm in diam, and 3-4 mm in thickness) were immersed in a bacterial suspension containing 1.5 x 107 cfu x mL(-1) of S. Chester for 30 s and subsequently air-dried at room temperature for 10 min. Approximately 30% of the bacteria retained on the disk after immersion were firmly attached and could not be removed by two washes and agitation. A positive correlation was observed between the number of bacteria attached and the concentration of bacteria in the suspension. Population studies and scanning electron microscopic examinations revealed that attachment of S. Chester on pepper disks occurred mainly on the surfaces of injured (cut) tissue but rarely on the unbroken skin. When inoculated disks were treated with 3% to 12% (w/v) of trisodium phosphate (TSP) at pH 12.3 for 5 min, the population of bacteria on the disk was reduced by 10- to 100-fold. A small portion (0.7% to 7.1%) of bacteria attached to the disk were either resistant to or protected from the TSP treatment. When the pH of TSP solution was reduced from 12.3 to 4.5, the effectiveness of TSP in inactivating S. Chester on pepper disks was reduced by 26%. This study shows that surfaces of injured fruit tissue are the principal sites for bacterial attachment, and a small portion of the bacteria attached to the tissue are resistant to the sanitizer treatment. Avoiding mechanical injuries to fresh fruits during and after harvest would reduce the chance of pathogen attachment and contamination on green pepper and fruits of similar nature.

Bacterial Adhesion↗
PubMed2005

Principles of plant health management for ornamental plants.

Economic, environmental, and technological influences complicate the task of achieving disease-free products in the ornamentals industry. Integrated pest management (IPM) is a cornerstone of floriculture and nursery crop production: strategies include sanitation, clean stock, host resistance, and control through biological, cultural, environmental, chemical, and regulatory means. Sanitation measures and cultural controls must keep pace with new production technologies. Clean stock programs are used for many crops that are propagated vegetatively. Breeding, selection, and biotechnology provide crops resistant to pathogens. Offshore production for economic competitiveness can introduce pathogens that make regulatory programs necessary. New biocontrol and chemical products continue to improve control while meeting the requirement for minimal environmental impact. Continual introduction of new crops and new production technologies creates new opportunities for pathogens to exploit, such that new disease management tactics must be discovered and old ones rediscovered to achieve optimum health management for ornamentals.

Agriculture↗
PubMed2004

Characterization of the DialGuard device for endotoxin removal in hemodialysis.

Bacterial pyrogens, capable of penetrating dialyzer membranes, are responsible for a systemic inflammatory reaction in hemodialysis patients. Dialyzer reuse, involving rinsing of the dialyzer with pyrogen-containing water, may exacerbate this situation. Studies of the mechanism of action of endotoxin suggest that it irreversibly damages the vascular endothelium. The novel endotoxin removal method described here, is based on affinity-binding of endotoxin by the adsorbent ClarEtox, a USP Class VI-certified resin that is the active component of the medical device DialGuard. Under standard hemodialysis operating conditions, challenge of DialGuard with Pseudomonas maltophilia supernatant-spiked dialysate, containing 35-193 EU/ml endotoxin, resulted in endotoxin levels below 0.05 EU/ml in the treated dialysate. DialGuard was able to decrease endotoxin concentrations in the dialysate from a range of 2.39-8.49 to <0.005 EU/ml. DialGuard supports high fluid velocities at low back pressures and can be sanitized using the heat sanitization cycle of hemodialysis machines. DialGuard offers a simple, user-friendly way to reduce the concentration of endotoxin in dialysate and water for dialysis at a low cost.

Chromatography, Affinity↗
PubMed2005

The World Summit on Sustainable Development: reaffirming the centrality of health.

The World Summit on Sustainable Development (WSSD) was held in Johannesburg in 2002 to review progress since the Rio conference in 1992, and to agree a new global deal on sustainable development. Unlike its predecessor, it was primarily concerned with implementation rather than with new treaties and targets, although a number of new targets were agreed, for example one on sanitation. Failure to agree a target on renewable energy was regarded as a major disappointment of the conference. While relatively modest in its achievements, and with difficulties in achieving consensus in key areas such as energy, trade, finance and globalisation, WSSD nevertheless succeeded in placing sustainable development back on the political agenda, giving new impetus, in particular to the environment and development needs of Africa, with a strong focus on local issues like household energy, water and sanitation. Health was singled out as one of five priority areas, along with water, energy, agriculture and biodiversity, and was devoted a separate chapter in the resulting Plan of Implementation, which highlighted a range of environmental health issues as well as issues relating to health services, communicable and non-communicable diseases. A number of new partnerships were formed at WSSD, including the Healthy Environments for Children Alliance (HECA) launched by WHO, which will form an important platform for implementation. The Commission on Sustainable Development has been designated main responsibility for monitoring and follow up, with its programme of work reorganised to focus on thematic clusters of issues. From the perspective of health, WSSD must be seen as a reaffirmation of the central place of health on the sustainable development agenda, and in the broader context of a process which began in Rio and was given added impetus with the Monterrey Financing for Development conference and the World Trade Organisation meeting held in Doha. Translating policies into action at all levels- global to local - remains the single biggest challenge in the years that lie ahead.

Journal Article↗
PubMed2002

Diarrheal diseases in children from a water reclamation site in Mexico city.

This study was conducted to assess the risk of enteric diseases among children living in a water reclamation area in Mexico City. A geographic information system was used to define eligible wells and surrounding homesteads. Sixty-five water samples from five wells were tested for fecal coliform bacteria per 100 mL (FC/100 mL) during visits to 750 eligible households; caretakers only in those dwellings with children under 5 years old were interviewed throughout repeated cross-sectional surveys, conducted during 1999-2000. Data on diarrheal diseases were obtained from 761 children during the rainy season and 732 children during the dry season; their guardians also provided information on drinking water supply, sanitation, and socioeconomic variables. The presence of indicator organisms in groundwater samples pointed to fecal pollution; bacterial indicators, however, did not predict the health risk. The rates of diarrhea were 10.7% in the dry season and 11.8% in the rainy season. Children 1 year old showed the highest rate of diarrhea during the dry season [odds ratio (OR) = 2.1 with 95% confidence interval (CI), 0.99-4.71], particularly those from households perceiving unpleasant taste of tap water (OR, 1.7; 95% CI, 0.97-2.92) and consuming vegetables washed only with water (OR, 2.2; 95% CI, 1.10-4.39). Lower risk was observed in individuals enjoying full-day water supply (OR, 0.5; 95% CI, 0.27-0.86) and a flushing toilet (OR, 0.3; 95% CI, 0.16-0.67), as well as those storing water in covered receptacles (OR, 0.3; 95% CI, 0.15-0.80). Rainy season data suggested that children from households perceiving a color to their water had a higher rate of diarrhea than did those without such complaint (OR, 1.8; 95% CI, 0.93-3.67); recent consumption of food sold by street vendors was also a significant risk factor (OR, 1.6; 95% CI, 0.98-2.87). Groundwater is at risk of contamination, as indicated by the presence of FC/100 mL. The endemic pattern of diarrhea, however, reflects mostly inadequate housing, sanitation, and water-related practices. Health protection policy must be discussed.

Child Welfare↗
PubMed1997

Exposure assessment for workers applying DDT to control malaria in Veracruz, Mexico.

DDT has systematically been used in sanitation campaigns against malaria in Mexico. To assess chronic occupational exposure, we studied a group of workers dedicated to spraying houses to control malaria vectors in the state of Veracruz. Exposure was directly estimated for a subgroup of 40 workers by measuring DDT metabolites in adipose tissue samples and indirectly estimated for 331 workers by using a questionnaire to determine their occupational history. Participants ranged in age from 20 to 70 years, and 80% of the workers had been employed in the sanitation campaign for at least 20 years. The mean concentrations of extractable lipids found in adipose tissue samples were as follows: total DDT, 104.48 micrograms/g; p,p'-DDE, 60.98 micrograms/g; p,p'-DDT, 31.0 micrograms/g; o,p'-DDT, 2.10 micrograms/g; and p,p'-DDD, 0.95 microgram/g. The DDT metabolite p,p'-DDE was selected as the indicator of chronic exposure. An index of chronic occupational exposure was constructed according to worker position and based on the historical duration and intensity of DDT application. A linear model including this index, the use of protective gear, and recent weight loss explained 55% of the variation of p,p'-DDE concentrations in adipose tissue. By this model, the predicted values of p,p'-DDE concentration in adipose tissue for the 331 workers are between 9.56 micrograms/g and 298.4 micrograms/g of fat, with a geometric mean of 67.41 micrograms/g. These high levels of DDT in adipose tissue call for exposure prevention programs and the promotion of more secure application measures and hygiene. We also discuss the use of indirect measures of DDT exposure in epidemiological studies of health effects.

Adipose Tissue↗
PubMed2004

Chemotherapy for major food-borne trematodes: a review.

Food-borne trematode infections, caused by liver flukes (Clonorchis, Fasciola, Opisthorchis), lung flukes (Paragonimus) and intestinal flukes (Echinostoma, Fasciolopsis, heterophyids), are significant public health problems, most notably in Southeast Asia and the Western Pacific. Globally, it is estimated that > 40 million people are infected among the 750 million people who live in endemic areas. The epidemiology of food-borne trematodiasis has changed over the past few decades, and now presents a dual picture. On the one hand, increasing numbers of infections are reported from non-endemic areas, and endemic areas are expanding due to larger areas utilised for aquaculture, domestic migration, declining socioeconomic conditions, lack of improved sanitation, and increasing availability of aquatic foods through wider distribution networks often without proper food inspections. On the other hand, social and economic advances in many Asian countries, going hand-in-hand with urbanisation, use of chemical fertilisers and, above all, the administration of safe, efficacious and inexpensive drugs, have significantly reduced the prevalence of food-borne trematode infections. In this review, the taxonomy, life cycle, and geographical distribution of the major food-borne trematodes, including issues of diagnosis and clinical disease manifestations, is summarised. The discovery, chemistry, pharmacological properties, safety, therapeutic efficacy and adverse effects of the current drugs of choice, namely praziquantel and triclabendazole, is then discussed. Recent advances on other drugs and contemporary investigations on novel compounds that might become important players in chemotherapy are highlighted. Finally, the need for research and development of new trematocidal drugs that - employed in concert with health education, improved sanitation and enhanced food safety - are key factors for sustainable control of food-borne trematodiasis, is highlighted.

Animals↗
PubMedDate not supplied

[A control program for an outbreak of the scorpion Tityus serrulatus, Lutz and Mello 1922 in the town of Aparecida, São Paulo state (Scorpiones, Buthidae)].

A scorpion control program was proposed for the town of Aparecida (SP), an endemic region of Tityus serrulatus. Clusters of scorpions in urban and rural areas, environmental degradation of the town's outskirts and new scorpion procreation and dispersal habitats were studied. In addition, infrastructure problems such as the disposal and collection of residential and municipal refuse, sanitation (sewage and storm sewer), condition of vacant lots and constructions in the urban area were evaluated. After an epidemiological study, educational measures such as the distribution of pamphlets, cleaning group work, visits to residences and cooperation from High School teachers and students were also suggested. Chemical control was indicated in high-risk sites, especially those of near-school buildings. Furthermore, the use of natural predators was also mentioned within the present sanitation regulations for urban areas. The authors assert that these procedures must be integrated and continued uninterruptedly for several years. They also suggest a collaborative work with those responsible for the dengue eradication program, as well as the institution of the "scorpion study week", which would greatly contribute to the education of the population, to preventive programs and to scorpion control.

Animals↗
PubMed1992

[Control of schistosomiasis mansoni in an area of low transmission].

The schistosomiasis is transmitted by Biomphalaria tenagophila in our study area (Pedro de Toledo, São Paulo, Brazil). From 1980 to 1990 epidemiological surveys in a population of 4,000 inhabitants, has shown that: prevalences by Kato-Katz (KKT), immunofluorescence (FT) and intradermal (IDT) techniques were 22.8%, 55.5% and 51.8%, respectively; intensity of infection was low, 58.5 eggs per gram of faeces (epg); there were no symptomatic cases; prevalences were higher in mates, children and rural zone; index of potential contamination was 57.5% in the age group 5 to 20 years; 2/3 of patients were autochthonous; cases were no-randomly aggregated; transmission was focal and only 0.4% of snails were infected; water contacts through recreation showed the most important odds ratio; knowledge, attitudes and practices were satisfactory. From the epidemiological findings a control programme was carried out: yearly faeces exams, chemotherapy, molluscocide, health education and sanitation. Thus, the prevalence decreased sharply to 3.3% and intensity of infection to 30.3 epg; the incidence rates ranged between 0.4% and 2.5% annually; the sanitation became better and the youngsters were the main target in prophylaxis. To improve control, immunodiagnosis has to be conducted and the involvement of the population should be increase. However, we cannot forget that re-infection, therapeutic failure, etc, could play a major role in the maintenance this residual prevalence.

Adolescent↗
PubMed2006

Epidemiological pattern and mortality rates for hepatitis A in Brazil, 1980-2002--a review.

The prevalence of hepatitis A virus (HAV) infection is high in developing countries, in which low standards of sanitation promote the transmission of the virus. In Latin America, which is considered an area of high HAV endemicity, most HAV-positive individuals are infected in early childhood However recent studies have shown that prevalence rates are decreasing. Herein, we review the data on HAV prevalence and outbreaks available in scientific databases. We also use official government data in order to evaluate mortality rates in Brazil over the last two decades. Studies conducted in the northernmost regions of Brazil have indicated that, although improved hygiene has led to a reduction in childhood exposure to HAV, the greatest exposure still occurs early in life. In the Southeastern region, the persistence of circulating HAV has generated outbreaks among individuals of low socioeconomic status, despite adequate sanitation. Nationwide, hepatitis A mortality rates declined progressively from 1980 to 2002. During that period, mortality rates in the Northern region consistently exceeded the mean national rate and those for other regions. Excluding the North, the rates in all regions were comparable. Nevertheless, the trend toward decline observed in the South was paralleled by a similar trend in the North.

Adolescent↗
PubMed1997

[Risk profile: multivariate cluster analysis of urban small areas based on socioeconomic indicators - census tracts from the Greater Rio de Janeiro Metropolitan Area]

A method based on small area data analysis was developed to build a health risk classification for the Greater Rio de Janeiro Metropolitan Area. The approach uses 1991 census data and studies data pertaining to sanitation, ownership and type of housing, size and occupancy of the household, demography, schooling, and income. Principal component analysis applied over each dimension allowed for the choice of 15 variables, which summarized most of the observed variances. Additional analysis with these variables suggested that just six variables are sufficient for the construction of a classification using k-means method of multivariate cluster analysis. Five classes were obtained: (A) high income; (B) lower income; (C) poor; (D) low schooling and income; (E) low-level access to sanitation. The existing inequality in each of the geopolitical established areas was clearly identified. The proposed method allowed for the construction of compound indices to evaluate quality of life, based on widespread and easily obtained data (the census). Moreover, the method contributed to the detection of socioeconomic inequality, identifying, not only the larger poor regions but also the small excluded areas.

Journal Article↗
PubMed2004

[Social inequalities and other determinants of height in children: a multi-level analysis].

A cross-sectional household survey of height among children under five years of age (n = 2,632) was conducted in the city of Porto Alegre, Rio Grande do Sul State, Brazil. Multi-level linear regression was applied to investigate the effect of socioeconomic and demographic factors, physical and social environment, and health conditions on children s height, measured by the height-for-age z-scores of the National Center for Health Statistics standards. Area of residence (census tract) was classified as good versus poor in terms of housing and sanitation standards. On average, children s height was -0.18 z-score. Average height increased with maternal and paternal schooling, parents work skills, per capita family income, improved housing, maternal age, birth intervals, and birth weight. Height decreased with hospitalization in the first two years of life, number of under-five children in the household, and preterm birth. In the poor residential areas, the effect of maternal schooling was twice as great as in the better-off areas. The effect of parental work skills was only evident in the more deprived areas. Area of residence modified the effects of socioeconomic conditions on children s growth. Housing and sanitation programs are potentially beneficial to offset the negative effect of social disadvantage on children's growth.

Body Height↗
PubMedDate not supplied

[The "Instituto de Salud Carlos III" and the public health in Spain. Origin of laboratory medicine and of the central laboratories and research in public health].

The "Instituto de Salud Carlos III" is the Central Public Health Laboratory in Spain with an important component of scientific research in health related areas, such as cancer, cardiovascular diseases, infectious diseases and environmental health. The article describes the development of the Public Health Institutes. arising from the introduction and development of scientific and laboratory based medicine and the introduction of vaccination and sanitation with the control of water and food. At about the same time, the discoveries in microbiology and immunology were produced, being the research activities incardinated with the practical advances in the control of products. To cope with the practical needs, Institutions were created with the responsibility of providing smallpox vaccine but incorporating very soon production of sera and other vaccines and water and sanitation control and foods control. At the same time. colonization of countries specially in Africa, South East Asia and explorations in Central America confront the Europeans with new diseases and the need of laboratories where to study them. These circumstances gave rise to the birth of the Central Public Health Laboratories and the National institutes of Health at the beginning of the XX century in many countries. In Spain, the Spanish Civil War was a breaking point in the development of such an institution that finally was reinvented with the creation of the Instituto de Salud Carlos III, in 1986, incorporating research and epidemiological surveillance and control of diseases and also the responsibilities of the Food and Drug Control, lately separated from it.

Academies and Institutes↗
PubMed1977

Evaluating municipal policy: an analysis of a refuse packaging program.

The effect of a municipal enforcement program to improve residents' packaging of refuse was analyzed in a multiple-baseline design across two areas of a city. The enforcement program involved instruction concerning refuse-packaging regulations, collection only of appropriately packaged refuse, and feedback notices to residents concerning the reasons for noncollection of their inadequately packaged refuse. Both the number of violations and the percentage of residences violating each day were markedly reduced during the enforcement program. Furthermore, sanitation workers considered that the packaging of refuse and the safety and efficiency of refuse collection had improved. This study served as a pilot evaluation of a policy change in the city sanitation department, and was functional in determining the direction of that policy.

Journal Article↗