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Introduction Learning and development in the context of organizational development is having an essential role in achieving strategic human resourcing outcome.
From attraction and retention, to development and utilisation of human capital, Human Resource Development (HRD) is the centre of strategic focus in HRM.
A common topic for debate is the issue of nature versus nurture, wherein some groups support the idea that language and cognitive development is as natural as breathing while other groups contend that external factors influence these characteristics of human progress....
Dose–response relationships. To properly characterize human risks, it is typical to select hazards for which there are dose–response health data described either deterministically or stochastically, as available for the reference enteric pathogens (e.g., Campylobacter jejuni, Salmonella enterica, E. coli) (), but these dose–response health data have yet to be quantified for the skin/wound reference pathogens (; ). However, as noted above for processes 1–5, (), an important difference for ARB is the need to account for the phenomena associated with selective environmental pressures for the development of ARB, and ultimately that form the human infective dose of either eARB or pARB. The exact mechanisms and dose–response relationships have yet to be elucidated, and may be different depending on the bacterial species and resistance mechanisms involved. Nevertheless, it seems reasonable for the noncompromised human exposed to a pARB to fit the published dose–response/infection relationship (e.g., derived from “feeding” trials with healthy adults or from information collected during outbreak investigations) for strains of the same pathogen without antibiotic resistance. What appears more limiting are dose–response models that describe the probability of illness based on the conditional probability of infection and including people who are already compromised, such as those undergoing antibiotic therapy. Although there is definitive data on pARB being more pathogenic or causing more severe illness than their antimicrobial-susceptible equivalents (; , ; ), that may not always be the case (; ). Clear examples of excess mortality include associated blood stream infections for methicillin-resistant Staphylococcus aureus (MRSA) and from third generation cephalosporin-resistant E. coli (G3CREC). In 2007 in participating European countries, 27,711 cases of MRSA were associated with 5,503 excess deaths and 255,683 excess hospital days, and 15,183 episodes of G3CREC blood stream infections were responsible for 2,712 excess deaths and 120,065 extra hospital days (). The authors predicted that the combined burden of resistance of MRSA and G3CREC will likely lead to a predicted incidence of 3.3 associated deaths per 100,000 inhabitants in 2015. Yet for many regions of the world, such predictions are less well understood.
In addition to a huge diversity of eARB hazards, there are several pathogens that could be evaluated in microbial risk assessments: a) foodborne and waterborne fecal pathogens represented by Campylobacter jejuni, Salmonella enterica, or various pathogenic E. coli; and b) environmental pathogens, such as respiratory, skin, or wound pathogens represented by Legionella pneumophila, Staphylococcus aureus, and Pseudomonas aeruginosa. Each of these fecal and environmental pathogens is well known to be able to acquire ARG; thus, given further data on environmental HGT rates, they could be used as reference pathogens in microbial risk assessments. However, what is much more problematic for risk assessment—and a current limiting factor—is the rate at which the indigenous bacteria transfer resistance to these pathogens within each environmental compartment and within the human/animal host (, processes 3–5). Methods to model and experimentally derive relevant information on these environmental issues are discussed below in “Environmental Exposure Assessment.” Data on HGT within the human gastrointestinal tract have been summarized by .
- Schachter’s Two Factor Theory of Emotion Research Paper examines an integral part of human behavior, and how it applies in clinical practices.
Based on our conceptualization of the processes important to undertake HHRA of ARB (), most elements related to ARB development in environmental media (processes 1, 2, and 4) have been addressed above in “Hazard identification and hazard characterization.” Here we focus on describing important environmental compartments for and human exposure to ARB (, processes 3 and 6). Concentrations of environmental factors (such as antibiotics) and ARB, along with their fate and transport to points of human uptake, are critical to exposure assessment. For a particular human health risk assessment of ARB, it would be important to select/expand on individual pathway scenarios (identifying critical environmental compartments to human contact) relevant to the antibiotic/resistance determinants identified in the problem formulation and hazard characterization stages.
Hazard identification and hazard characterization. Unfortunately, we are unaware of data that quantitatively link ARG uptake and human health effects (, processes 3 and 6). What data do exist and are rapidly improving in quality, however, are on the presence of ARGs within various environmental compartments (; ; ), specifically on clinically relevant resistance genes within soils () (, process 1). Precursors that lead to the development of ARB hazards include ARG and mechanisms to mobilize these genes, antibiotics, and coselecting agents (; ) along with gene mutations (). Depending on the presence of recipient bacteria, these processes generate either eARB or pARB (, processes 1 and 2).
Compartments of potential concern include soil environments receiving animal manure or biosolids, compost, and lagoons, rivers, and their sediments receiving wastewaters (). More traditional routes of human exposures to contaminants that could include eARB and pARB are drinking water, recreational and irrigation waters impacted by sewage and/or antibiotic production wastewaters, food, and air affected by farm buildings and exposure to farm animal manures, as discussed by . What is emerging as an important research gap is the in situ development of ARB within biofilms () and their associated free-living protozoa that may protect and transport ARB () to and within drinking water systems (; ). This latter route could be particularly problematic for hospital drinking water systems where an already vulnerable population is exposed. In addition, with the increasing use and exposure to domestically collected rainwater, atmospheric fallout of ARB may “seed” household systems ().