Cefdinir vs cephalexin for the treatment of urinary tract infections: A retrospective evaluation.

PURPOSE: Cefdinir and cephalexin are cephalosporin antibiotics commonly used in the treatment of urinary tract infections (UTIs). Their efficacy depends on achieving sufficient time with concentrations exceeding the minimum inhibitory concentration (MIC). Despite being frequently prescribed for UTIs, cefdinir has markedly lower urine penetration compared to cephalexin. It is possible that differences in pharmacokinetics could result in dissimilar efficacy between these agents; however, comparative studies of cephalosporins in UTIs are lacking. METHODS: This was a retrospective comparative study of patients discharged from emergency departments within a community health system with a diagnosis of acute cystitis who were prescribed cefdinir or cephalexin. Treatment failure rates at 7 and 14 days were compared between the 2 agents using a χ2 or Fisher's exact test, as appropriate. RESULTS: There were no differences in overall treatment failure between the cefdinir and cephalexin groups. Treatment failure at 7 days occurred in 11.6% (n = 14) of patients in the cefdinir group and 8.3% (n = 10) of patients in the cephalexin group (P = 0.389). Treatment failure at 14 days was higher for cefdinir at 20.7% (n = 25) than for cephalexin at 11.8% (n = 14), but this difference was not statistically significant (P = 0.053). There were no differences in the rate of treatment failure in subgroup analyses of uncomplicated or complicated UTIs. CONCLUSION: The results of this study suggest that cefdinir and cephalexin have comparable efficacy for the treatment of lower UTIs. While there was a numerically higher rate of treatment failure with cefdinir, there were no significant differences in treatment failure between the agents.

Impact of reflex fosfomycin susceptibility testing on the utilization of carbapenems for definitive extended-spectrum ß-lactamase Escherichia coli urinary tract infection treatment.

PURPOSE: A protocol was started within a large health system to automatically test all confirmed extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli urine isolates for susceptibility to fosfomycin, an antibiotic not routinely included in such testing in most institutions. This study assessed the effectiveness of the protocol at reducing carbapenem use for the definitive treatment of ESBL E. coli urinary tract infection (UTI) through several endpoints. METHODS: Eighty and 99 patients were compared pre- and postintervention, respectively. The primary outcome was the proportion of patients who received definitive carbapenem therapy. Key secondary outcomes included median total carbapenem days of therapy (DOT), discharge on intravenous UTI antibiotics, and median total antibiotic DOT. RESULTS: Preprotocol vs postprotocol definitive carbapenem use was seen in 59 of 80 patients (73.8%) and 71 of 99 patients (71.7%) (95% confidence interval [CI] for difference, -11.1% to 15.1%; P = 0.76). The rates of step-down to oral agents pre- and postintervention were 15 of 59 (25.4%) and 35 of 71 (49.3%) (P = 0.004). Median carbapenem DOT in those receiving carbapenems decreased from 8 to 4 days (95% CI, -5 to -1 days; P = 0.001). Median total DOT decreased from 10 to 8 days (95% CI, -3 to -1 days; P = 0.002). CONCLUSION: Implementation of a laboratory policy to automatically test ESBL positive E. coli for fosfomycin susceptibility did not reduce the percentage of patients receiving at least 1 dose of carbapenem treatment. It did result in a larger percentage reduction in step-down use of intravenous antibiotics for UTI prior to discharge, reduction in carbapenem DOT, and reduction in total antibiotic DOT.

Bending the rules: exploitation of allochthonous resources by a top-predator modifies size-abundance scaling in stream food webs.

Body mass-abundance (M-N) allometries provide a key measure of community structure, and deviations from scaling predictions could reveal how cross-ecosystem subsidies alter food webs. For 31 streams across the UK, we tested the hypothesis that linear log-log M-N scaling is shallower than that predicted by allometric scaling theory when top predators have access to allochthonous prey. These streams all contained a common and widespread top predator (brown trout) that regularly feeds on terrestrial prey and, as hypothesised, deviations from predicted scaling increased with its dominance of the fish assemblage. Our study identifies a key beneficiary of cross-ecosystem subsidies at the top of stream food webs and elucidates how these inputs can reshape the size-structure of these 'open' systems.

DyeTiO2 interfacial structure of dye-sensitised solar cell working electrodes buried under a solution of I-/I3- redox electrolyte.

Dye-sensitised solar cells (DSCs) have niche prospects for electricity-generating windows that could equip buildings for energy-sustainable future cities. However, this 'smart window' technology is being held back by a lack of understanding in how the dye interacts with its device environment at the molecular level. A better appreciation of the dyeTiO2 interfacial structure of the DSC working electrodes would be particularly valuable since associated structure-function relationships could be established; these rules would provide a 'toolkit' for the molecular engineering of more suitable DSC dyes via rational design. Previous materials characterisation efforts have been limited to determining this interfacial structure within an environment exposed to air or situated in a solvent medium. This study is the first to reveal the structure of this buried interface within the functional device environment, and represents the first application of in situ neutron reflectometry to DSC research. By incorporating the electrolyte into the structural model of this buried interface, we reveal how lithium cations from the electrolyte constituents influence the dyeTiO2 binding configuration of an organic sensitiser, MK-44, via Li+ complexation to the cyanoacrylate group. This dye is the molecular congener of the high-performance MK-2 DSC dye, whose hexa-alkyl chains appear to stabilise it from Li+ complexation. Our in situ neutron reflectometry findings are built up from auxiliary structural models derived from ex situ X-ray reflectometry and corroborated via density functional theory and UV/vis absorption spectroscopy. Significant differences between the in situ and ex situ dyeTiO2 interfacial structures are found, highlighting the need to characterise the molecular structure of DSC working electrodes while in a fully assembled device.

Terrestrial support of lake food webs: Synthesis reveals controls over cross-ecosystem resource use.

Widespread evidence that organic matter exported from terrestrial into aquatic ecosystems supports recipient food webs remains controversial. A pressing question is not only whether high terrestrial support is possible but also what the general conditions are under which it arises. We assemble the largest data set, to date, of the isotopic composition (δ2H, δ13C, and δ15N) of lake zooplankton and the resources at the base of their associated food webs. In total, our data set spans 559 observations across 147 lakes from the boreal to subtropics. By predicting terrestrial resource support from within-lake and catchment-level characteristics, we found that half of all consumer observations that is, the median were composed of at least 42% terrestrially derived material. In general, terrestrial support of zooplankton was greatest in lakes with large physical and hydrological connections to catchments that were rich in aboveground and belowground organic matter. However, some consumers responded less strongly to terrestrial resources where within-lake production was elevated. Our study shows that multiple mechanisms drive widespread cross-ecosystem support of aquatic consumers across Northern Hemisphere lakes and suggests that changes in terrestrial landscapes will influence ecosystem processes well beyond their boundaries.

Invasive crayfish impacts on native fish diet and growth vary with fish life stage.

Assessing the impacts of invasive organisms is a major challenge in ecology. Some widespread invasive species such as crayfish are potential competitors and reciprocal predators of ecologically and recreationally important native fish species. Here, we examine the effects of signal crayfish (Pacifastacus leniusculus) on the growth, diet, and trophic position of the chub (Squalius cephalus) in four rivers in Britain. Growth rates of 0+ chub were typically lower in sympatric populations with signal crayfish compared with allopatric populations, and this effect could be traced through to 2+ chub in one river. However, growth rates of older chub (5+ to 6+) were typically higher in the presence of crayfish. Sympatry with crayfish resulted in lower chub length-at-age and mass-at-age in half of the rivers sampled, with no change detected in the other rivers. Stable isotope analyses (δ13C and δ15N) revealed that both chub and crayfish were omnivorous, feeding at multiple trophic levels and occupying similar trophic positions. We found some evidence that chub trophic position was greater at invaded sites on one river, with no difference detected on a second river. Mixing models suggested crayfish were important food items for both small and large chub at invaded sites. This study provides evidence that invasive species can have both positive and negative effects on different life stages of a native species, with the net impact likely to depend on responses at the population level.

Dietary niche constriction when invaders meet natives: evidence from freshwater decapods.

Invasive species are a key driver of global environmental change, with frequently strong negative consequences for native biodiversity and ecosystem processes. Understanding competitive interactions between invaders and functionally similar native species provides an important benchmark for predicting the consequences of invasion. However, even though having a broad dietary niche is widely considered a key factor determining invasion success, little is known about the effects of competition with functionally similar native competitors on the dietary niche breadths of invasive species. We used a combination of field experiments and field surveys to examine the impacts of competition with a functionally similar native crab species on the population densities, growth rates and diet of the globally widespread invasive red swamp crayfish in an African river ecosystem. The presence of native crabs triggered significant dietary niche constriction within the invasive crayfish population. Further, growth rates of both species were reduced significantly, and by a similar extent, in the presence of one another. In spite of this, crayfish maintained positive growth rates in the presence of crabs, whereas crabs lost mass in the presence of crayfish. Consequently, over the 3-year duration of the study, crab abundance declined at those sites invaded by the crayfish, becoming locally extinct at one. The invasive crayfish had a dramatic effect on ecosystem structure and functioning, halving benthic invertebrate densities and increasing decomposition rates fourfold compared to the crabs. This indicates that replacement of native crabs by invasive crayfish likely alters the structure and functioning of African river ecosystems significantly. This study provides a novel example of the constriction of the dietary niche of a successful invasive population in the presence of competition from a functionally similar native species. This finding highlights the importance of considering both environmental and ecological contexts in order to predict and manage the impacts of invasive species on ecosystems.

Preferred Molecular Orientation of Coumarin 343 on TiO2 Surfaces: Application to Dye-Sensitized Solar Cells.

The dye···TiO2 interfacial structure in working electrodes of dye-sensitized solar cells (DSCs) is known to influence its photovoltaic device performance. Despite this, direct and quantitative reports of such structure remain sparse. This case study presents the application of X-ray reflectometry to determine the preferred structural orientation and molecular packing of the organic dye, Coumarin 343, adsorbed onto amorphous TiO2. Results show that the dye molecules are, on average, tilted by 61.1° relative to the TiO2 surface, and are separated from each other by 8.2 Å. These findings emulate the molecular packing arrangement of a monolayer of Coumarin 343 within its crystal structure. This suggests that the dye adsorbs onto TiO2 in one of its lowest energy configurations; that is, dye···TiO2 self-assembly is driven more by thermodynamic rather than kinetic means. Complementary DSC device tests illustrate that this interfacial structure compromises photovoltaic performance, unless a suitably sized coadsorbant is interdispersed between the Coumarin 343 chromophores on the TiO2 surface.

Riverbed methanotrophy sustained by high carbon conversion efficiency.

Our understanding of the role of freshwaters in the global carbon cycle is being revised, but there is still a lack of data, especially for the cycling of methane, in rivers and streams. Unravelling the role of methanotrophy is key to determining the fate of methane in rivers. Here we focus on the carbon conversion efficiency (CCE) of methanotrophy, that is, how much organic carbon is produced per mole of CH4 oxidised, and how this is influenced by variation in methanotroph communities. First, we show that the CCE of riverbed methanotrophs is consistently high (~50%) across a wide range of methane concentrations (~10-7000 nM) and despite a 10-fold span in the rate of methane oxidation. Then, we show that this high conversion efficiency is largely conserved (50%± confidence interval 44-56%) across pronounced variation in the key functional gene (70 operational taxonomic units (OTUs)), particulate methane monooxygenase (pmoA), and marked shifts in the abundance of Type I and Type II methanotrophs in eight replicate chalk streams. These data may suggest a degree of functional redundancy within the variable methanotroph community inhabiting these streams and that some of the variation in pmoA may reflect a suite of enzymes of different methane affinities which enables such a large range of methane concentrations to be oxidised. The latter, coupled to their high CCE, enables the methanotrophs to sustain net production throughout the year, regardless of the marked temporal and spatial changes that occur in methane.

A program using pharmacy technicians to collect medication histories in the emergency department.

PURPOSE: To evaluate the percentage, frequency, and types of medication history errors made by pharmacy technicians compared with nurses in the emergency department (ED) to determine if patient safety and care can be improved while reducing nurses' workloads. METHODS: Medication history errors were evaluated in a pre-post study comparing a historical control group (nurses) prior to the implementation of a pharmacy technician program in the ED to a prospective cohort group (pharmacy technicians). Two certified pharmacy technicians were trained by the post-graduate year one (PGY1) pharmacy practice resident to conduct medication history interviews in a systematic fashion, with outside resources (i.e., assisted living facility, pharmacy, physician's office, or family members) being consulted if any portion of the medication history was unclear or lacking information. The primary outcome compared the percentage of patients with accurate medication histories in each group. Secondary outcomes included differences between groups regarding total medication errors, types of errors, documentation of patient allergies and drug reactions, and documentation of last administration times for high-risk anticoagulant/antiplatelet medications. Accuracy was determined by reviewing each documented medication history for identifiable errors, including review of electronic generated prescriptions within the hospital system as well as physician notes or histories documented on the same day (for potential discrepancies). This review was performed by the pharmacy resident. The categories of errors included a drug omission, a drug commission, an incorrect or missing drug, an incorrect or missing dose, or an incorrect or missing frequency. Anonymous surveys were distributed to ED nurses to assess their feedback on the new medication reconciliation program using pharmacy technicians. RESULTS: A total of 300 medication histories from the ED were evaluated (150 in each group). Medication histories conducted by pharmacy technicians were accurate 88% of the time compared with 57% of those conducted by nurses (P < 0.0001). Nineteen errors (1.1%) were made by pharmacy technicians versus 117 (8.3%) by nurses (relative risk [RR], 7.5; P < 0.0001). The most common type of error was an incorrect or missing dose (10 versus 59, P < 0.001), followed by an incorrect or missing frequency (0 versus 30, P < 0.0001), and a drug commission (5 versus 23, P = 0.004). There were no differences between groups regarding the documentation of patient allergies. Documentation rates of high-risk anticoagulant and antiplatelet administration times were greater for pharmacy technicians than for nurses (76% versus 13%, P < 0.001). CONCLUSION: This study demonstrates that trained pharmacy technicians can assist prescribers and nurses by improving the accuracy of medication histories obtained in the ED.

Widespread methanotrophic primary production in lowland chalk rivers.

Methane is oversaturated relative to the atmosphere in many rivers, yet its cycling and fate is poorly understood. While photosynthesis is the dominant source of autotrophic carbon to rivers, chemosynthesis and particularly methane oxidation could provide alternative sources of primary production where the riverbed is heavily shaded or at depth beneath the sediment surface. Here, we highlight geographically widespread methanotrophic carbon fixation within the gravel riverbeds of over 30 chalk rivers. In 15 of these, the potential for methane oxidation (methanotrophy) was also compared with photosynthesis. In addition, we performed detailed concurrent measurements of photosynthesis and methanotrophy in one large chalk river over a complete annual cycle, where we found methanotrophy to be active to at least 15 cm into the riverbed and to be strongly substrate limited. The seasonal trend in methanotrophic activity reflected that of the riverine methane concentrations, and thus the highest rates were measured in mid-summer. At the sediment surface, photosynthesis was limited by light for most of the year with heavy shading induced by dense beds of aquatic macrophytes. Across 15 rivers, in late summer, we conservatively calculated that net methanotrophy was equivalent to between 1% and 46% of benthic net photosynthetic production within the gravel riverbed, with a median value of 4%. Hence, riverbed chemosynthesis, coupled to the oxidation of methane, is widespread and significant in English chalk rivers.

'Leaves and eats shoots': direct terrestrial feeding can supplement invasive red swamp crayfish in times of need.

We used stable isotope analyses to characterise the feeding dynamics of a population of red swamp crayfish in Lake Naivasha, Kenya, after the crash of submerged macrophytes and associated macroinvertebrates, and during a natural draw-down of the lake water level. We expected a heavy reliance upon a diet of detrital matter to sustain the population as a consequence, and indeed, for the majority of the crayfish population caught from the lake, we saw a concomitant shift in isotopic values reflecting a dietary change. However, we also caught individual crayfish that had occupied the footprints of hippopotamus and effectively extended their range beyond the lake up to 40 m into the riparian zone. Isotopic analysis confirmed limited nocturnal observations that these individuals were consuming living terrestrial plants in the vicinity of the footprints. These are the first empirical data to demonstrate direct use of terrestrial resources by an aquatic crayfish species and further highlight the traits that make red swamp crayfish such opportunistic and successful invaders.

Contrasting effects of different cannabinoid receptor ligands on mouse ingestive behaviour.

This study characterized the effects of seven diverse cannabinoid receptor agonists (and one antagonist) on ingestive behaviour in nondeprived adult, male CD1 mice. Microstructural analysis of licking for a range of concentrations of condensed milk (10, 15 and 20%) was carried out following administration of vehicle or: Δ9-tetrahydrocannabinol (Δ9-THC) at 1, 3 or 6 mg/kg; CP55,940 at 10, 30 or 50 µg/kg; Win 55,212-2 at 0.5, 1 or 3 mg/kg; HU-210 at 0.01, 0.03 or 0.1 mg/kg; methanandamide at 1, 3 or 6 mg/kg; arachidonyl-2'-chloroethylamide at 1, 3 or 6 mg/kg and JWH133 at 1, 3 or 6 mg/kg. The cannabinoid receptor antagonist/inverse agonist rimonabant was also tested at 0.3, 1 or 3 mg/kg. Test sessions comprised three 30 s presentations of the milk concentrations separated by 10 s interpresentation intervals. The nonselective CB1 receptor agonists Δ9-THC, CP55,940 and Win 55,212-2 increased the number of licks for condensed milk, primarily by a significant increase in bout number. The potent and nonselective CB1 receptor agonist HU-210 and the selective CB1 receptor agonists methanandamide and arachidonyl-2'-chloroethylamide did not significantly affect licking behaviour but did significantly increase the latency to start licking. The CB1 receptor antagonist rimonabant produced effects that were opposite in direction to those produced by Δ9-THC, CP55,940 and Win 55,212-2. Finally, the selective CB2 receptor agonist JWH133 had no significant effects on behaviour. These data add to reports that cannabinoid agonists can enhance the appetitive aspects of feeding, but they also demonstrate that not all CB1 receptor agonists do this, and therefore the relationship between action at CB1 receptors and appetitive feeding effects is not straightforward.

River bed carbon and nitrogen cycling: state of play and some new directions.

The significance of freshwaters as key players in the global budget of both carbon dioxide and methane has recently been highlighted. In particular, rivers clearly do not act simply as inert conduits merely piping carbon from catchment to coast, but, on the whole, their metabolic activity transforms a considerable fraction of the carbon that they convey. In addition, nitrogen is cycled, sometimes in tight unison with carbon, with appreciable amounts being 'denitrified' between catchment and coast. However, shortfalls in our knowledge about the significance of exchange and interaction between rivers and their catchments, particularly the significance of interactions mediated through hyporheic sediments, are still apparent. From humble beginnings of quantifying the consumption of oxygen by small samples of gravel, to an integrated measurement of reach scale transformations of carbon and nitrogen, our understanding of the cycling of these two macro elements in rivers has improved markedly in the past few decades. However, recent discoveries of novel metabolic pathways in both the nitrogen and carbon cycle across a spectrum of aquatic ecosystems, highlights the need for new directions and a truly multidisciplinary approach to quantifying the flux of carbon and nitrogen through rivers.

Warming alters community size structure and ecosystem functioning.

Global warming can affect all levels of biological complexity, though we currently understand least about its potential impact on communities and ecosystems. At the ecosystem level, warming has the capacity to alter the structure of communities and the rates of key ecosystem processes they mediate. Here we assessed the effects of a 4°C rise in temperature on the size structure and taxonomic composition of benthic communities in aquatic mesocosms, and the rates of detrital decomposition they mediated. Warming had no effect on biodiversity, but altered community size structure in two ways. In spring, warmer systems exhibited steeper size spectra driven by declines in total community biomass and the proportion of large organisms. By contrast, in autumn, warmer systems had shallower size spectra driven by elevated total community biomass and a greater proportion of large organisms. Community-level shifts were mirrored by changes in decomposition rates. Temperature-corrected microbial and macrofaunal decomposition rates reflected the shifts in community structure and were strongly correlated with biomass across mesocosms. Our study demonstrates that the 4°C rise in temperature expected by the end of the century has the potential to alter the structure and functioning of aquatic ecosystems profoundly, as well as the intimate linkages between these levels of ecological organization.

Population-level metrics of trophic structure based on stable isotopes and their application to invasion ecology.

Biological invasions are a significant driver of human-induced global change and many ecosystems sustain sympatric invaders. Interactions occurring among these invaders have important implications for ecosystem structure and functioning, yet they are poorly understood. Here we apply newly developed metrics derived from stable isotope data to provide quantitative measures of trophic diversity within populations or species. We then use these to test the hypothesis that sympatric invaders belonging to the same functional feeding group occupy a smaller isotopic niche than their allopatric counterparts. Two introduced, globally important, benthic omnivores, Louisiana swamp crayfish (Procambarus clarkii) and carp (Cyprinus carpio), are sympatric in Lake Naivasha, Kenya. We applied our metrics to an 8-year data set encompassing the establishment of carp in the lake. We found a strong asymmetric interaction between the two invasive populations, as indicated by inverse correlations between carp abundance and measures of crayfish trophic diversity. Lack of isotopic niche overlap between carp and crayfish in the majority of years indicated a predominantly indirect interaction. We suggest that carp-induced habitat alteration reduced the diversity of crayfish prey, resulting in a reduction in the dietary niche of crayfish. Stable isotopes provide an integrated signal of diet over space and time, offering an appropriate scale for the study of population niches, but few isotope studies have retained the often insightful information revealed by variability among individuals in isotope values. Our population metrics incorporate such variation, are robust to the vagaries of sample size and are a useful additional tool to reveal subtle dietary interactions among species. Although we have demonstrated their applicability specifically using a detailed temporal dataset of species invasion in a lake, they have a wide array of potential ecological applications.

High site fidelity and low site connectivity in temperate salt marsh fish populations: a stable isotope approach.

Adult and juvenile fish utilise salt marshes for food and shelter at high tide, moving into adjacent sublittoral regions during low tide. Understanding whether there are high levels of site fidelity for different species of coastal fish has important implications for habitat conservation and the design of marine protected areas. We hypothesised that common salt marsh fish species would demonstrate a high site fidelity, resulting in minimal inter-marsh connectivity. Carbon ((13)C) and nitrogen ((15)N) stable isotope ratios of larvae and juveniles of five common salt marsh fish (Atherina presbyter, Chelon labrosus, Clupea harengus, Dicentrarchus labrax, Pomatoschistus microps), seven types of primary producer and seven secondary consumer food sources were sampled in five salt marshes within two estuary complexes along the coast of south-east England. Significant differences in (13)C and (15)N signatures between salt marshes indicated distinct sub-populations utilising the area of estuary around each salt marsh, and limited connectivity, even within the same estuary complex. (15)N ratios were responsible for the majority of inter-marsh differences for each species and showed similar site-specific patterns in ratios in primary producers, secondary consumers and fish. Fish diets (derived from isotope mixing models) varied between species but were mostly consistent between marsh sites, indicating that dietary shifts were not the source of variability of the inter-marsh isotopic signatures within species. These results demonstrate that for some common coastal fish species, high levels of site fidelity result in individual salt marshes operating as discrete habitats for fish assemblages.

Biological influences on inter- and intraspecific isotopic variability among paired chondrostome fishes.

This study aimed at examining resource partitioning both at the inter- and intraspecific levels between paired chondrostome fishes: Chondrostoma nasus, the nase, C. toxostoma, the sofie, and their hybrid. The study was performed in the south of France and concerned a main river (the Durance River) and a tributary (the Buech River). In these rivers, C. nasus was an introduced species, originating in central Europe, and C. toxostoma was an endemic congener, in the south of France. Stable isotope analysis was used to analyse trophic and spatial niches. Isotopic differences indicated that individuals from the three taxa (C. nasus, C. toxostoma and their hybrid) have different spatial origins. At the interspecific level, the different chondrostomes originating from the Buech River showed a high level of trophic niche overlap. At the intraspecific level, nase individuals originating from the different spatial origins showed a resource polymorphism; differences in morphology were associated with variation in behaviour and life history traits. Their coexistence was a likely outcome of resource polymorphism. This study provides an example of the importance of considering the link between intra- and interspecific interactions to gain an understanding of the mechanisms driving the coexistence of species-pairs.