Effects of stand age, tree species, and climate on water table fluctuations and estimated evapotranspiration in managed peatland forests.

Lowland conifer forests dominated by black spruce (Picea mariana) and tamarack (Larix laricina) typically occur in peatlands in the boreal North American forest with near-surface water tables throughout the year. These forests are ecologically and economically important resources that may be impacted by climate change. However, information characterizing effects of forest disturbance, such as even-aged harvest on water table dynamics is needed to evaluate which forest tree species cover types are most hydrologically susceptible to even-aged harvest and changes in precipitation. We used a chronosequence approach to evaluate water table fluctuations and evapotranspiration across four stand age classes (<10, 15-30, 40-80, and >100-years old) and three distinct forest cover types (productive black spruce, stagnant black spruce, and tamarack) for a period of three years in Minnesota, USA. In general, there is limited evidence for elevated water tables in the younger age classes; the <10-year age class had no significant difference in mean weekly water table depth compared to the older age classes across all cover types. Estimated actual daily evapotranspiration (ET) generally agreed with the water table observations, with the exception of the tamarack cover type where ET was significantly lower in the <10-year age class. Productive black spruce sites that are 40-80-years old had higher evapotranspiration, and lower water table, possibly reflecting increased transpiration associated with the stem exclusion stage of stand development. Tamarack in the 40-80-year age class had higher water tables but no difference in ET compared to all other age classes, indicating that other external factors are driving higher water tables in that age class. To evaluate susceptibility to changing climate, we also assessed the sensitivity and response of water table dynamics to pronounced differences in growing season precipitation that occurred across study years. In general, tamarack forests are more sensitive to changes in precipitation compared to the two black spruce forest cover types. These findings can inform expected responses of site hydrology for a range of precipitation scenarios that may occur under future climate and be used by forest managers to evaluate hydrologic impacts of forest management activities across lowland conifer forest cover types.

Using internet discussion of antimicrobial susceptibility databases for continuous quality improvement of the testing and management of antimicrobial resistance.

Accurate results from the world's microbiology laboratories are essential for care of patients, control of hospital and community infections, and global epidemiology. Yet those laboratories differ greatly in their access to supplies, published literature and standards, training courses, peer interaction, and mandated quality control. Because much of what is needed is information, new information technology should help. In particular, measurements of susceptibility to antimicrobial agents, now increasingly filed in electronic databases, exhibit many kinds of variances due both to test performance and to the diversity of bacteria and of their mechanisms of resistance. In industry, workers' ongoing evaluation of variances in measurements of performance has been the basis of management programs of continuous quality improvement. Examples suggest how collegial evaluation of variances in shared susceptibility test data might similarly improve quality not only of testing but also of other aspects of the management of antimicrobial resistance. Internet access is now making such ongoing evaluation and discussion increasingly possible in most parts of the world.

The complex processes of antimicrobial resistance and the information needed to manage them.

Wide use of a succession of different manufactured antimicrobial agents during the past 60 years has prompted the eventual emergence and progressive spread through the world's interconnecting bacterial populations of a growing variety of genes expressing resistance to those agents. The complex processes that spread and link resistance genes into different distributions at different times and places are driven by antimicrobial selection and by contagion. Management of resistance by reducing selection and contagion in a coordinated way requires better information. Most of the information about the spread of resistance exists in laboratory files of isolates at medical centers, and the information about patient antimicrobial use is found in pharmacy files at the same centers. Putting these in a combined database at each center would give a valuable tool to each center's antimicrobial resistance management team. Merging such databases from multiple centers would provide a public health resource for benchmarking, overview surveillance, and general resistometrics.

Surveillance of antimicrobial resistance: the WHONET program.

Genes expressing resistance to each antimicrobial agent emerged after each agent became widely used. More than a hundred such genes now spread selectively through global networks of populations of bacteria in humans or animals treated with those agents. Information to monitor and manage this spread exists in the susceptibility test results of tens of thousands of laboratories around the world. The comparability of those results is uncertain, however, and their storage in paper files or in computer files with diverse codes and formats has made them inaccessible for analysis. The WHONET program puts each laboratory's data into a common code and file format at that laboratory, either by serving as or by translating from its own computer reporting system. It then enables each medical center to analyze its files in ways that help it monitor and manage resistance locally and to merge them with files of other centers for collaborative national or global surveillance of resistance.

WHONET: removing obstacles to the full use of information about antimicrobial resistance.

A rich store of detailed information about antimicrobial resistance is at each medical center in paper files inaccessible to analysis or in electronic files too diverse to support a common analytical software. WHONET puts that information on a personal computer at each center in a file code and format that is the same at all centers, so that one software can then fully analyze the files at any center or those merged from many centers. The software monitors the complex matrix of interrelationships between all the measurements of resistance to antimicrobials of tested isolates of each species and of control strains. Differences at a center over time or between centers reflect differences in test performance or in the prevalence of specific resistant strains, which may be tracked. The software helps workers who are knowledgeable about resistance, infection control and clinical use of antimicrobials at any center to control test quality and integrate the management of resistance there. Their ongoing monitoring and experience locally also builds the quality and interpretation of the files merged from many centers.

Resistance to fluid flow in veins.

We evaluated the resistance to fluid infusion in the veins of 118 adult patients after intravenous catheter insertion prior to elective surgery. Hydraulic resistance in veins was defined as the slope of the pressure-flow relationship obtained by measuring venous pressure at several fluid flow rates. A resistance unit (RU) was defined as 1 mmHg/L/hr. Resistance in veins ranged from -12.1 to 732 RU, with 50th and 95th percentiles being 22 and 198 RU, respectively. Venous resistance was not significantly affected by site of catheter insertion, tissue characteristics at the insertion site, age, sex, patient anxiety, American Society of Anesthesiologists physical status, or catheter size. This report provides a distribution of resistance to fluid infusion in arm veins of adult patients.

Detection of intravenous fluid extravasation using resistance measurements.

Resistance to fluid infusion can be derived from measurements of pressure at two or more flow rates. We measured resistance in 31 patients using a pressure-monitoring infusion pump (Model 560, IVAC) by recording pressure at five flow rates (0, 50, 100, 200, and 300 mL/hr), and computing resistance as the slope of the pressure versus flow curve. Resistance was measured subcutaneously (Rtissue) and intravenously (Rvein) immediately after unsuccessful or successful IV catheter placement. In all patients, Rtissue was always greater than Rvein. The difference ranged from 23 resistance units (RU) to 4166 RU, with a mean difference of 1147 RU (p < 0.0001, Student's t-test). Unpaired analysis of the data was performed to assess the ability of resistance to indicate extravasation in the absence of prior Rvein measurement. The median value for Rvein was 62 RU (range -13.6 to 420 RU), and for Rtissue, 544 RU (range 65.7 to 4170 RU). Receiver operating characteristic (ROC) analysis revealed that a 200-RU threshold detected infiltration with 0.90 sensitivity and 0.91 specificity. We conclude that elevated resistance during fluid infusion is an important early and easily measurable finding in fluid extravasation.

The lack of value of repeated Clostridium difficile cytotoxicity assays.

OBJECTIVE: To determine the value of repeated Clostridium difficile cytotoxicity assays (CA). DESIGN: All CAs performed during 1993 were retrospectively reviewed and correlated with clinical data. Assays were grouped into episodes, which were defined as one or more successive tests performed on a single patient within 7 days or less of each other. SETTING: A 751-bed tertiary care facility. PATIENTS: All patients with Clostridium difficile CAs submitted to the microbiology laboratory. RESULTS: There were 947 episodes with two or more CAs. In 15 of these episodes, a negative CA result was followed by a positive result, and in 25 cases, a positive result was followed by a negative one. We reviewed the clinical data for these cases. Of the 947 episodes with two or more CAs, the repeated assays provided new information that was used in patient care in fewer than nine cases. Repeated testing within 7 days of an initial CA accounted for 36% of all assays performed, but provided clinically useful information in only about 1% of cases. CONCLUSIONS: Clostridium difficile CAs should not be repeated within a 7-day period.