Secondary Peritonitis and Intra-Abdominal Sepsis: An Increasingly Global Disease in Search of Better Systemic Therapies.

Secondary peritonitis and intra-abdominal sepsis are a global health problem. The life-threatening systemic insult that results from intra-abdominal sepsis has been extensively studied and remains somewhat poorly understood. While local surgical therapy for perforation of the abdominal viscera is an age-old therapy, systemic therapies to control the subsequent systemic inflammatory response are scarce. Advancements in critical care have led to improved outcomes in secondary peritonitis. The understanding of the effect of secondary peritonitis on the human microbiome is an evolving field and has yielded potential therapeutic targets. This review of secondary peritonitis discusses the history, classification, pathophysiology, diagnosis, treatment, and future directions of the management of secondary peritonitis. Ongoing clinical studies in the treatment of secondary peritonitis and the open abdomen are discussed.

Anthropogenic modification of forests means only 40% of remaining forests have high ecosystem integrity.

Many global environmental agendas, including halting biodiversity loss, reversing land degradation, and limiting climate change, depend upon retaining forests with high ecological integrity, yet the scale and degree of forest modification remain poorly quantified and mapped. By integrating data on observed and inferred human pressures and an index of lost connectivity, we generate a globally consistent, continuous index of forest condition as determined by the degree of anthropogenic modification. Globally, only 17.4 million km2 of forest (40.5%) has high landscape-level integrity (mostly found in Canada, Russia, the Amazon, Central Africa, and New Guinea) and only 27% of this area is found in nationally designated protected areas. Of the forest inside protected areas, only 56% has high landscape-level integrity. Ambitious policies that prioritize the retention of forest integrity, especially in the most intact areas, are now urgently needed alongside current efforts aimed at halting deforestation and restoring the integrity of forests globally.

Biosurfactants produced by Serratia species: Classification, biosynthesis, production and application.

Biosurfactants are surface-active molecules that are synthesised non-ribosomally by a wide range of microorganisms including bacteria, yeast and filamentous fungi. The bacterial genus Serratia is gaining international interest, as biosurfactants produced by this genus have emerged as a promising source of antimicrobial, antifouling and antitumour compounds that possess emulsification and surface activity. Various species of Serratia have been identified as biosurfactant producers, including Serratia marcescens, Serratia rubidaea and Serratia surfactantfaciens. Members of the Serratia genus have been reported to principally produce two classes of biosurfactants, namely lipopeptides and glycolipids. Lipopeptides produced by Serratia species include serrawettins and stephensiolides, while identified glycolipids include rubiwettins and rhamnolipids. This review will primarily focus on the classification of biosurfactants produced by Serratia species and the genes and mechanisms involved in the biosynthesis of these biosurfactant compounds. Thereafter, an indication of the primary growth conditions and nutrient composition required for the optimum production of biosurfactants by this genus will be outlined. An overview of the latest advances and potential applications of the biosurfactants produced by Serratia in the medical, pharmaceutical, agricultural and petroleum industries is also provided.

Five challenges to reconcile agricultural land use and forest ecosystem services in Southeast Asia.

Southeast Asia possesses the highest rates of tropical deforestation globally and exceptional levels of species richness and endemism. Many countries in the region are also recognized for their food insecurity and poverty, making the reconciliation of agricultural production and forest conservation a particular priority. This reconciliation requires recognition of the trade-offs between competing land-use values and the subsequent incorporation of this information into policy making. To date, such reconciliation has been relatively unsuccessful across much of Southeast Asia. We propose an ecosystem services (ES) value-internalization framework that identifies the key challenges to such reconciliation. These challenges include lack of accessible ES valuation techniques; limited knowledge of the links between forests, food security, and human well-being; weak demand and political will for the integration of ES in economic activities and environmental regulation; a disconnect between decision makers and ES valuation; and lack of transparent discussion platforms where stakeholders can work toward consensus on negotiated land-use management decisions. Key research priorities to overcome these challenges are developing easy-to-use ES valuation techniques; quantifying links between forests and well-being that go beyond economic values; understanding factors that prevent the incorporation of ES into markets, regulations, and environmental certification schemes; understanding how to integrate ES valuation into policy making processes, and determining how to reduce corruption and power plays in land-use planning processes.

Accounting for the impact of conservation on human well-being.

Conservationists are increasingly engaging with the concept of human well-being to improve the design and evaluation of their interventions. Since the convening of the influential Sarkozy Commission in 2009, development researchers have been refining conceptualizations and frameworks to understand and measure human well-being and are starting to converge on a common understanding of how best to do this. In conservation, the term human well-being is in widespread use, but there is a need for guidance on operationalizing it to measure the impacts of conservation interventions on people. We present a framework for understanding human well-being, which could be particularly useful in conservation. The framework includes 3 conditions; meeting needs, pursuing goals, and experiencing a satisfactory quality of life. We outline some of the complexities involved in evaluating the well-being effects of conservation interventions, with the understanding that well-being varies between people and over time and with the priorities of the evaluator. Key challenges for research into the well-being impacts of conservation interventions include the need to build up a collection of case studies so as to draw out generalizable lessons; harness the potential of modern technology to support well-being research; and contextualize evaluations of conservation impacts on well-being spatially and temporally within the wider landscape of social change. Pathways through the smog of confusion around the term well-being exist, and existing frameworks such as the Well-being in Developing Countries approach can help conservationists negotiate the challenges of operationalizing the concept. Conservationists have the opportunity to benefit from the recent flurry of research in the development field so as to carry out more nuanced and locally relevant evaluations of the effects of their interventions on human well-being.

Novel pulsatile cerebrospinal fluid model to assess pressure manometry and fluid sampling through spinal needles of different gauge: support for the use of a 22 G spinal needle with a tapered 27 G pencil-point tip.

BACKGROUND: Parallel-walled spinal needles ≤ 22 G are routinely used for lumbar puncture, despite a reported ≥ 32% incidence of post-dural puncture headache. A tapered spinal needle (22 G shaft, 27 G tip) is in use in our institution. We hypothesized that despite the smaller dural puncture hole, this needle has similar cerebrospinal fluid (CSF) pressure equilibration times and CSF sampling times to a standard 22 G needle and assessed a range of spinal needles using an experimental pulsatile CSF reservoir. METHODS: The pulsatile CSF reservoir had an oscillating pressure varying between 25 and 15 cm H(2)O at a cycle frequency of 80 s(-1). We tested seven parallel-walled spinal needles (18-27 G) and the tapered 22/27 G needle. CSF pressure was measured every 2 s by manometry. The time to collect 1 ml CSF samples was measured. Saline 0.9% and mannitol 20% were tested separately. One-way ANOVA with Bonferroni post-hoc test was used to compare 22G, 27G and 22/27G needles. RESULTS: The mean [standard deviation (sd)] CSF pressure equilibration time (saline) was 40.7 (6.4), 108.7 (6.1), and 51.3 (4.6) s for the 22, 27, and 22/27 G needles (P< 0.0001 for comparisons between 27 G and other needles). The mean (sd) CSF sampling time (saline) was 40.3 (3.1), 225.3 (10.0), and 63.0 (5.2) s for the 22, 27, and 22/27 G needles (P< 0.0001 for comparisons between 27 G and other needles, and P= 0.019 between 22 and 22/27 G needles). Saline was different from mannitol for both measurements and all needles (P< 0.0001). CONCLUSIONS: A 22/27 G tapered spinal needle has similar flow properties to the 22 G needle, despite a 27 G tip.

Rapid discovery and optimization of therapeutic antibodies against emerging infectious diseases.

Using a comprehensive set of discovery and optimization tools, antibodies were produced with the ability to neutralize SARS coronavirus (SARS-CoV) infection in Vero E6 cells and in animal models. These anti-SARS antibodies were discovered using a novel DNA display method, which can identify new antibodies within days. Once neutralizing antibodies were identified, a comprehensive and effective means of converting the mouse sequences to human frameworks was accomplished using HuFR (human framework reassembly) technology. The best variant (61G4) from this screen showed a 3.5-4-fold improvement in neutralization of SARS-CoV infection in vitro. Finally, using a complete site-saturation mutagenesis methodology focused on the CDR (complementarity determining regions), a single point mutation (51E7) was identified that improved the 80% plaque reduction neutralization of the virus by greater than 8-fold. These discovery and evolution strategies can be applied to any emerging pathogen or toxin where a causative agent is known.

Transition state dynamics of the OH + H2O hydrogen exchange reaction studied by dissociative photodetachment of H3O2-.

Dynamics in the transition state region of the bimolecular OH + H2O-->H2O + OH hydrogen exchange reaction have been studied by photoelectron-photofragment coincidence spectroscopy of the H3O2- negative ion and its deuterated analog D3O2-. The data reveal vibrationally resolved product translational energy distributions. The total translational energy distribution shows a vibrational progression indicating excitation of the antisymmetric stretch of the water product. Electronic structure calculations at the QCISD level of theory support this analysis. Examination of the translational energy release between the neutral products reveals a dependence on the product vibrational state. These data should provide a critical test of ab initio potential energy surfaces and dynamics calculations.

Family medicine residents' and community physicians' concerns about patient truthfulness.

PURPOSE: To assess how often family physicians question patient truthfulness, what factors influence them to do so, and how often resident physicians experience such doubts as compared with senior physicians. METHOD: In 1994-95, after half-day patient care sessions, 44 residents from the University of Kansas School of Medicine's three Wichita family practice residency programs and nine community family physicians associated with the programs recorded their impressions of each patient's truthfulness, what issues prompted concern about patient truthfulness, and their feelings about each encounter. RESULTS: The residents doubted patients in 54 of 277 encounters (19.5%); the senior physicians doubted patients in 16 of 183 encounters (8.7%) (p = .003). Both groups had more negative than positive emotions toward such encounters, with no significant difference in feelings. The demographics of the resident and senior physician populations differed greatly. CONCLUSION: Although preliminary, the present study suggests that family physicians question patient truthfulness fairly often, resident physicians more than senior physicians, and that these physicians have some negative feelings toward such situations. Because such feelings may contribute to inadequate patient care, the authors recommend that further research is warranted to understand contributing factors and to guide the development of resident and student education programs in this neglected area of the doctor-patient relationship.

Non-01 Vibrio cholerae gastroenteritis in New Hampshire: a case report.

Non-01 Vibrio cholerae gastroenteritis has been reported in the literature in association with foreign travel, or seafood ingestion, particularly raw shellfish harvested from warm-water climates. Non-01 V. cholerae gastroenteritis has not been reported before from New England. The case presented describes a previously healthy female who developed non-01 V. cholerae gastroenteritis approximately 26 hours after ingestion of raw cherrystone clams.

Neurochemical evidence for tryptaminergic ascending and descending pathways in the spinal cord of the dog.

The brain and spinal cord of the chronic spinal dog contained higher levels of tryptamine than comparable regions of the intact dog. The most significant brain elevations were found in the cerebellum and mesencephalon. Further, tryptamine in the white matter of the spinal cord above the level of transection was higher than below. These findings have been interpreted as indicating that there are tryptaminergic pathways descending in the white matter of the spinal cord from the mesencephalon, cerebellum and rostral spinal cord. The level of tryptamine below the transection was not different from that found in the intact dog, suggesting that there are not only descending but ascending tryptaminergic pathways and that when the axons are transected. tryptamine accumulates proximal to the level of transection.