New insights in bacterial organophosphorus cycling: From human pathogens to environmental bacteria.

In terrestrial and aquatic ecosystems, phosphorus (P) availability controls primary production, with consequences for climate regulation and global food security. Understanding the microbial controls on the global P cycle is a prerequisite for minimising our reliance on non-renewable phosphate rock reserves and reducing pollution associated with excessive P fertiliser use. This recognised importance has reinvigorated research into microbial P cycling, which was pioneered over 75 years ago through the study of human pathogenic bacteria-host interactions. Immobilised organic P represents a significant fraction of the total P pool. Hence, microbes have evolved a plethora of mechanisms to transform this fraction into labile inorganic phosphate, the building block for numerous biological molecules. The 'genomics era' has revealed an extraordinary diversity of organic P cycling genes exist in the environment and studies going 'back to the lab' are determining how this diversity relates to function. Through this integrated approach, many hitherto unknown genes and proteins that are involved in microbial P cycling have been discovered. Not only do these fundamental discoveries push the frontier of our knowledge, but several examples also provide exciting opportunities for biotechnology and present possible solutions for improving the sustainability of how we grow our food, both locally and globally. In this review, we provide a comprehensive overview of bacterial organic P cycling, covering studies on human pathogens and how this knowledge is informing new discoveries in environmental microbiology.

The effectiveness of protocol drive, nurse-initiated discharge in a 23-h post surgical ward: a randomized controlled trial.

BACKGROUND: A 23-h unit was established in June 2005 to relieve pressure on surgical beds. Patients were to be discharged by 0900h without review by a doctor. However, discharge without review remained the exception rather than the rule. OBJECTIVE: The aim of the current trial was to asses the affect of a protocol driven, nurse-initiated discharge process on discharge time, patient satisfaction and adverse events. DESIGN: Randomised controlled trial. SETTING: A large, major metropolitan hospital in Queensland, Australia. PARTICIPANTS: Patients undergoing a surgical procedure and requiring an overnight stay in the 23-h unit were eligible for inclusion. 182 were randomised and 131 patients completed the study. METHODS: Participants were randomly assigned into one of two groups: protocol driven, nurse-initiated or usual care. The primary end-point was the proportion of patients discharged by 0900h. Patients completed a self-report questionnaire two weeks after hospital discharge, to evaluate their satisfaction. RESULTS: Of the 131 patients completing the trial, only 82 (62.6%) were discharged by 0900h. In the Protocol group 45 (78.9%) patients were discharged on time compared with 37 (50.0%) in the usual care group. This difference was statistically significant (OR 3.75; 95% CI-1.74-8.21; p=0.001). The average length of stay in the 23-h unit was 16.5(SD 6.8)h. This did not differ by group (MD 0.29; 95% CI-2.13-2.71; p=0.81). The overall mean satisfaction score was 95.4 (SD 8.8) and results were similar between groups (Protocol group 96.2 versus usual care group 94.6; p=0.40). CONCLUSIONS: A protocol driven, nurse-initiated discharge process in an overnight post surgery unit results in a higher proportion of patients being discharged by 0900h without compromising patient satisfaction.