Klebsiella pneumoniae exhibiting a phenotypic hyper-splitting phenomenon including the formation of small colony variants.

In this study, we characterized a Klebsiella pneumoniae strain in a patient with shrapnel hip injury, which resulted in multiple phenotypic changes, including the formation of a small colony variant (SCV) phenotype. Although already described since the 1960s, there is little knowledge about SCV phenotypes in Enterobacteriaceae. The formation of SCVs has been recognized as a bacterial strategy to evade host immune responses and compromise the efficacy of antimicrobial therapies, leading to persistent and recurrent courses of infections. In this case, 14 isolates with different resisto- and morpho-types were distinguished from the patient's urine and tissue samples. Whole genome sequencing revealed that all isolates were clonally identical belonging to the K. pneumoniae high-risk sequence type 147. Subculturing the SCV colonies consistently resulted in the reappearance of the initial SCV phenotype and three stable normal-sized phenotypes with distinct morphological characteristics. Additionally, an increase in resistance was observed over time in isolates that shared the same colony appearance. Our findings highlight the complexity of bacterial behavior by revealing a case of phenotypic "hyper-splitting" in a K. pneumoniae SCV and its potential clinical significance.

Analyzing the nexus between environmental sustainability and clean energy for the USA.

Environmental sustainability is a key target to achieve sustainable development goals (SDGs). However, achieving these targets needs tools to pave the way for achieving SDGs and COP28 targets. Therefore, the primary objective of the present study is to examine the significance of clean energy, research and development spending, technological innovation, income, and human capital in achieving environmental sustainability in the USA from 1990 to 2022. The study employed time series econometric methods to estimate the empirical results. The study confirmed the long-run cointegrating relationship among CO2 emissions, human capital, income, R&D, technological innovation, and clean energy. The results are statistically significant in the short run except for R&D expenditures. In the long run, the study found that income and human capital contribute to further aggravating the environment via increasing CO2 emissions. However, R&D expenditures, technological innovation, and clean energy help to promote environmental sustainability by limiting carbon emissions. The study recommends investment in technological innovation, clean energy, and increasing R&D expenditures to achieve environmental sustainability in the USA.

Case Report: Hip arthroplasty after fracture-related joint infection caused by extensively drug-resistant Klebsiella pneumoniae.

This case-report focuses on a 23-year-old soldier suffering from a fracture-related hip joint infection (FRI) due to extensively drug-resistant Klebsiella pneumoniae and S. epidermidis. The patient underwent multiple septic revision surgeries including the removal of remaining shrapnel accompanied by last-resort antimicrobial therapy with cefiderocol and colistin. Additionally, the surgeries included repeated tissue sampling for microbiological and histopathological analysis. An antibiotic-loaded cemented filler containing cefiderocol was used to improve local antimicrobial therapy. The biopsies prior to and during hip replacement surgery confirmed successful microbe eradication. Hip arthroplasty restored hip joint function and significantly improved patient's quality of life. The utilization of a trabecular metal shell and a meta-diaphyseally anchored cementless hip stem ensured secure implant fixation and early patient mobilisation. An adjusted biofilm active oral antimicrobial therapy after arthroplasty intervention was continued to prevent early periprosthetic joint infection. This case emphasizes the difficulties of managing FRI and multidrug-resistant pathogens. It contributes valuable insight into navigating complex orthopedic cases while ensuring successful hip arthroplasty outcomes. In conclusion, early interdisciplinary collaboration, appropriate antimicrobial therapy along with tailored surgical interventions are crucial for managing such complex cases successfully.

Ecological footprints and sustainable environmental management: A critical view of China's economy.

Global economies have recently been concerned about sustainable environmental management by reducing emissions and tackling ecological footprints. The rapid economic expansion and investment in traditional manufacturing further raises environmental degradation. China surpasses other emerging economies in the economic growth race yet has remained the top pollution-emitting economy for the last few decades, necessitating scholarly attention. This study examines the influencing factors of ecological footprints in China from the perspective of COP27. Using the extended dataset from 1988 to 2021, this study uses several time series diagnostic tests and verifies the existence of the long-run association between the study variables. Consequently, the non-linear scattered data leads to non-parametric (method of moment quantile regression) adoption. The empirical results indicate that only economic growth is a significant factor in environmental quality degradation in China. However, improving renewable energy usage, research and development, and foreign direct investment reduces the country's ecological footprint. Hence, the latter variables substantially lead to environmental sustainability. The robustness of the results is confirmed via a robust non-parametric estimator and causality test. Based on the empirical results, this study recommends increased investment in research and development, renewable production, and foreign direct investment enhancement.

Analyzing the nexus between energy transition, environment and ICT: A step towards COP26 targets.

In line with the Sustainable Development Goals and the recent COP26 summit, energy transition, low carbon emissions and technology have become extremely important subjects in the agenda of governments and policymakers. The present study thus discusses the nexus between energy transition, economic growth, CO2 emissions and information and communications technology (ICT) in BRICS countries applying the novel GMM-PVAR method proposed on the annual data for the period 2000-2017. This method is strong to the issue of endogeneity which is commonly faced in the context of panel data analysis but mostly ignored in the literature. The findings of this research demonstrate that carbon emissions have a positive and significant effect on energy transition; similarly, raising economic growth augments the consumption of energy transition. Furthermore, ICT is found to be a significant choice in the development of energy transition and the solution of environmental challenges. Overall, technological factors in addition to economic and environmental factors also have great roles in the development of renewable energy and energy transition. Thus, results from this study call for government supports to develop ICT across the BRICS countries.

The impacts of organizational green culture and corporate social responsibility on employees' responsible behaviour towards the society.

Corporate social responsibility (CSR) initiatives and organizational green culture (OGC) play a significant role in developing organizations and society. However, the extent to which these activities encourage organizational employees to act socially responsible outside their workplace is yet to be explored. This study uses the Operant conditioning theory to examine the effect of OGC and CSR activities on employees' responsible behaviour towards the society (ERBS) outside their organizations. To collect data, we focused on employees of public and private manufacturing and services firms and analysed it using the structural equation modelling (SEM) technique). It is found that OGC and CSR activities significantly reshape employees' behaviour, and they tend to behave in a socially responsible manner in society. Moreover, the relationship between OGC and ERBS' is partially mediated by CSR. It is also found that female workers tend to behave more socially responsibly than male workers. This study suggests that firms should adopt a green culture and CSR practices since it promotes socially responsible behaviour (a better citizen) among their employee, which is essential for a sustainable society.

Analyzing the nexus of COVID-19 and natural resources and commodities: Evidence from time-varying causality.

Even though a few studies have focused on natural resources and commodity sectors by considering the pandemic, they have only compared their status in pre-COVID19 to post-COVID19. None of the studies has directly examined the causal relationship between the pandemic, and natural resource index and the primary commodity-related sector indices. This study fills the gap of exploring the dynamic association between them by analyzing the causal relationship between the COVID19, and natural resources index and the primary commodity-related sectors (i.e., agribusiness, energy, and metals & mining) by applying a novel time-varying causality test on daily data from January 23, 2020, to November 12, 2021. The empirical results support the presence of time-varying causality from COVID19 to natural resources, agribusiness, energy and metals & mining. The results obtained from the rolling window algorithm support causal linkages between the variables however at several points it fails to capture the dynamics of linkages between the variables which is captured by the recursive window algorithm. The outcome is robust when the pandemic is proxied by either number of cases or deaths. Similarly, the findings obtained from heteroskedastic-robust specification also validate our findings. Several policy implications are further discussed in the study.

The role of economic policy uncertainty in the energy-environment nexus for China: Evidence from the novel dynamic simulations method.

Even though a great number of researches have explored the determinants of carbon emissions, the impact of economic policy uncertainty (EPU) on the environment has not been fully investigated in the energy-environment literature. Since recent studies show a strong relationship between the external environment and uncertainty, the present study for the first time in the literature aims to explore the function of EPU in the energy-environment nexus for China by using the novel bounds testing with dynamic simulations. The empirical results indicate that increases in the real income and energy intensity contribute to environmental pollution while increases in renewable energy lower the level of emissions. Besides, an increase in EPU causes an increase in the volume of carbon emissions. As EPU increases, the government's attention to implement environmental protection policies decreases, and the execution of the environment-related strategies is likely directed in an expected way. The empirical findings suggest that the government should establish consistency in economic and environmental policies to mitigate environmental pollution and thus to reach environmental sustainability.

Analysis of CO2 emissions and energy consumption by sources in MENA countries: evidence from quantile regressions.

The development of economies and energy usage can significantly impact the carbon dioxide (CO2) emissions in the Middle East and North Africa (MENA) countries. Therefore, this study aims to analyze the factors that determine CO2 emissions in MENA under the environmental Kuznets curve (EKC) framework by applying novel quantile techniques on data for CO2 emissions, real income, renewable and non-renewable energy consumption, and urbanization over the period from 1990 to 2015. The results from the estimations suggest that renewable energy consumption significantly reduces the level of emissions; furthermore, its impact increases with higher quantiles. In addition, non-renewable energy consumption increases CO2 emissions, while its magnitude decreases with higher quantiles. The empirical results also confirm the validity of EKC hypothesis for the panel of MENA economies. Policymakers in the region should implement policies and regulations to promote the adoption and use of renewable energy to mitigate carbon emissions.

The impacts of different proxies for financialization on carbon emissions in top-ten emitter countries.

The nexus of financialization and carbon emissions has been widely discussed in the literature. A vast body of literature that estimates the impact of financialization on carbon emissions proxies financialization with either domestic credit or market capitalization. However, these representatives do not fully respond to the complicated nature of financial development. To fill the gaps in the existing literature, nine different proxies for financial development are used in the links with carbon emissions in the framework of EKC theory for the years 1980-2014. This study exposes reliable and robust empirical results due to the use of a number of proxies for financialization and second-generation econometric approaches in the empirical analysis. The quantile regression approach deals with unobserved heterogeneity for each cross-section and estimates different slope parameters at varying quantiles. Because non-normality and heterogeneity are detected in dataset, quantile regression provides more robust and reliable estimates than conventional econometric techniques. Results from quantile regression estimator support mixed effects of financial development on carbon emissions over quantiles; in addition, the impact of financial development on carbon emissions is varying not only for each quantile but also for different proxies of financial development. The EKC hypothesis is validated for the top-ten emitter economies. Interpretations and policy suggestions are further discussed in the present study.

The importance of intracellular bacterial biofilm in infectious diseases.

Various bacterial species, previously known as extracellular pathogens, can reside inside different host cells by adapting to intracellular modes by forming microbial aggregates with similar characteristics to bacterial biofilms. Additionally, bacterial invasion of human cells leads to failure in antibiotic therapy, as most conventional anti-bacterial agents cannot reach intracellular biofilm in normal concentrations. Various studies have shown that bacteria such as uropathogenic Escherichia coli, Pseudomonas aeruginosa, Borrelia burgdorferi,Moraxella catarrhalis, non-typeable Haemophilus influenzae, Streptococcus pneumonia, and group A Streptococci produce biofilm-like structures within the host cells. For the first time in this review, we will describe and discuss the new information about intracellular bacterial biofilm formation and its importance in bacterial infectious diseases.

Revisiting the nexus among carbon emissions, energy consumption and total factor productivity in African countries: new evidence from nonparametric quantile causality approach.

This study aims to contribute to the existing thin body of nonlinear causality literature by applying the new hybrid nonparametric quantile causality approach. In this line, we investigate the non-linear nexus among total factor productivity, energy consumption and carbon emissions for seventeen African countries. From the results, it is remarkable that there are generally strong causalities between the variables in the middle lower, middle upper and middle quantiles. Hence, energy consumption, environmental pollution and total factor productivity are closely linked in African countries. In particular, bidirectional linkage is detected between total factor productivity and energy consumption for Angola, Benin, Botswana, Cote d'Ivoire, Kenya, Morocco, Egypt, Nigeria and Tunisia. Studying the relationship between total factor productivity and emissions again at the middle quantile bidirectional causal ordering is documented almost for all the countries. Lastly and regarding the linkage between energy consumption and carbon emissions, a strong bidirectional ordering between the two variables is confirmed for Angola, Benin, Cote d'Ivoire, Cameroon, Kenya, Morocco, Egypt, Mozambique, Nigeria, Senegal and Tunisia. We can notice that an increase in economic development is critical for these countries; a number of regulatory policies for environmental problems and energy consumption are required during this development.

The use of ecological footprint in estimating the Environmental Kuznets Curve hypothesis for BRICST by considering cross-section dependence and heterogeneity.

A vast body of literature estimates the impact of economic growth on environmental degradation in the framework of EKC model. Typical empirical studies proxy environmental degradation with CO2 emissions; however, this indicator does not consider the complex nature of environmental degradation. To fulfill this omission, ecological footprint that tracks the use of multiple categories of productive surface areas is used as proxy for the environment. Moreover, studies that do not consider issues of heterogeneity and cross-sectional dependence may not produce reliable outcomes. Hence, the present study re-investigates the validity of the EKC hypothesis for BRICST (Brazil, Russia, India, China, South Africa, Turkey) by using ecological footprint and considering the mentioned issues in the estimation process. Based on the annual data covering the period of 1980-2014, excluding Russia due to data unavailability, empirical results show that the EKC hypothesis is not valid, and energy intensity and energy structure are important determinants of environmental degradation. In line with the empirical outputs, possible policy suggestions are discussed in the present study.

The impact of economic structure to the environmental Kuznets curve (EKC) hypothesis: evidence from European countries.

The purpose of this study is to examine the role of economic structure of European countries into testing the Environmental Kuznets Curve (EKC) hypothesis for European countries for the period 1980 to 2014. This study is inspired by the work of Lin et al. (J Clean Prod 133:712-724, 2016), which made the first effort to investigate the phenomenon looking only at African countries. The main finding of the study is that the overall economic growth is the factor with which CO2 emissions exhibit an inverted U-shaped relationship in the studied country group. On the contrary, when using their industrial share as a proxy to capture the countries' economic structure, the EKC hypothesis is not confirmed - but a U-shaped relationship is confirmed. The industrial share decreases emissions through the development and absorption of technologies that are energy efficient and environmental friendly. The EKC hypothesis is confirmed when the aggregate GDP growth is considered, taking into account the improvement of the overall economic conditions of the countries regardless of the economic structure and role of industrialization.

Re-estimating the interconnectedness between the demand of energy consumption, income, and sustainability indices.

In this study, we analyze the time-varying causality linkages between energy consumption, economic growth, and environmental degradation in 33 Organization for Economic Co-operation and Development countries, spanning the period 2000 to 2013. The curve causality approach provides evidence of a significant environmental Kuznets curve in 25 countries in the case of the ecological footprint and in 23 countries in the case of the Environmental Performance Index. However, out of them, only Italy, Slovakia, and South Korea have traditional environmental Kuznets curve, in the form of an inverted U-shaped curve. For the remaining countries, different forms of curves are valid. In particular, an N-shaped curve appears to be valid between income and environmental degradation for nearly half of the sample, i.e., for Austria, Belgium, Chile, Estonia, Finland, France, Germany, Hungary, Luxembourg, Netherlands, Sweden, Switzerland, New Zealand, Turkey, and the USA. Additionally, bidirectional causality relationships are confirmed among all covariates in most countries. In view of the results, some crucial policy implications would be suggested, such as sustainable development that aims to make a balance between economic growth and environmental protection.

Analyzing the environmental Kuznets curve for the EU countries: the role of ecological footprint.

A great majority of the environmental Kuznets curve (EKC) literature use CO2 emissions to proxy for environmental degradation. However, this is an important shortage in application of the EKC concept because environmental degradation cannot be captured by CO2 emissions only. By using a broader proxy, ecological footprint, this study aims to investigate the presence of environmental Kuznets curve hypothesis for the EU countries. The annual data from 1980 to 2013 is examined with second generation panel data methodologies which take into account the cross-sectional dependence among countries. The results show that there is U-shaped relationship between the real income and ecological footprint. In addition, non-renewable energy increases the environmental degradation while renewable energy and trade openness decrease the environmental degradation in the EU countries. Policy implications are further discussed.

Evaluation of a novel oxiconazole nitrate formulation: The thermosensitive gel.

Superficial fungal infections caused by Candida species are common skin diseases. Therefore, this study aimed to develop a new formulation containing oxiconazole nitrate, which is an azole group derivative for antifungal treatment, as a thermosensitive gel since there has been no literature study until now. MIC value of the novel thermosensitive formulation against three Candida species was calculated and time-dependent antifungal activity analysis was performed. Viscosity, transition temperature Tsol-gel (°C) and gelation time of the thermosensitive gel formulation were also determined in the viscometer. The measurements performed on the tensilometer device were analyzed for adhesion hardness and elongation percentages of the formulation. In the FT-IR spectrometer, the spectrum of solution and gel state was compared between 650 and 4000 cm-1 and it was found that there is no difference between them. It was found that the temperature is reversible on the formulation and did not cause any disruption of its components. Characterization parameters of the thermosensitive gel formulation containing oxiconazole nitrate and time-dependent activity against Candida species was observed to be the same as those of the solution containing only oxiconazole nitrate. MIC, MFC and time-dependent antifungal analysis did not show any particular difference between formulation and oxiconazole nitrate itself. Thermosensitive gel formulation containing oxiconazole nitrate was found to be effective on superficial fungal infections. We believe it is also appropriate for in vivo usage, but it is necessary to perform animal and human research. It is also needed to evaluate the formulation against other etiologic agents of superficial fungal infections.

The significance of renewable energy use for economic output and environmental protection: evidence from the Next 11 developing economies.

Increasing economic activities in developing economies raise demand for energy mainly sourced from conventional sources. The consumption of more conventional energy will have a significant negative impact on the environment. Therefore, attention of policy makers has recently shifted towards the promotion of renewable energy generation and uses across economic activities to ensure low carbon economy. Given the recent scenario, in this paper, we aim to examine the role of renewable energy consumption on the economic output and CO2 emissions of the next fastest developing economies of the world. The study employs several robust panel econometric models by using annual data from 1990 to 2012. Empirical findings confirm the significant long-run association among the variables. Similarly, results show that renewable energy consumption positively contributes to economic output and has an adverse effect on CO2 emissions. Given our findings, we suggest policy makers of those economies to initiate further effective policies to promote more renewable energy generation and uses across economic activities to ensure sustainable economic development.

The influence of renewable and non-renewable energy consumption and real income on CO2 emissions in the USA: evidence from structural break tests.

The objective of this study is to explore the influence of the real income (GDP), renewable energy consumption and non-renewable energy consumption on carbon dioxide (CO2) emissions for the United States of America (USA) in the environmental Kuznets curve (EKC) model for the period 1980-2014. The Zivot-Andrews unit root test with a structural break and the Clemente-Montanes-Reyes unit root test with a structural break report that the analyzed variables become stationary at first-differences. The Gregory-Hansen cointegration test with a structural break and the bounds testing for cointegration in the presence of a structural break show CO2 emissions, the real income, the quadratic real income, renewable and non-renewable energy consumption are cointegrated. The long-run estimates obtained from the ARDL model indicate that increases in renewable energy consumption mitigate environmental degradation whereas increases in non-renewable energy consumption contribute to CO2 emissions. In addition, the EKC hypothesis is not valid for the USA. Since we use time-series econometric approaches that account for structural break in the data, findings of this study are robust, reliable and accurate. The US government is advised to put more weights on renewable sources in energy mix, to support and encourage the use and adoption of renewable energy and clean technologies, and to increase the public awareness of renewable energy for lower levels of emissions.

Removal of Tenon fortified by conjunctival-limbal autograft in treatment of pterygium.

PURPOSE: To describe a simple and effective technique for the prevention of pterygium recurrence. METHODS: This is a retrospective consecutive single-center case series with recurrence rate as the main outcome measure. Dissection of the conjunctiva, the Tenon's layer, and the sclera was continued up to the insertion of medial rectus. The exposed Tenon's layer was excised for 2 to 3 mm. The entire free edges of the conjunctiva was tacked firmly to the sclera. The conjunctival-limbal graft was sutured firmly to the sclera, recipient limbus, and to the conjunctiva incorporating the reciprocal edges. RESULTS: We report findings in a total of 36 patients, with 20 (%55.5) males and 16 (%44.4) females. Median age of the patients was 44.5 years (range 16-80). The mean follow-up period was 23.1 ± 6.5 months. The mean size of pterygium in mm length was 3.8 ± 0.7. Recurrence did not occur in any patient. Diplopia was not reported by any patients. CONCLUSIONS: Conjunctival-limbal autograft combining with selective exicison of Tenon's layer but without damage to any essential tissue such as the semilunar fold or Tenon's capsule pulley is a relatively simple and effective procedure.