Comparison of outcomes of permanently closed and periodically harvested coral reef reserves.

In many areas of the developing world, the establishment of permanent marine reserves is inhibited by cultural norms or socioeconomic pressures. Community conserved areas that are periodically harvested are increasingly being implemented as fisheries management tools, but few researchers have empirically compared them with permanently closed reserves. We used a hierarchical control-impact experimental design to compare the abundance and biomass of reef fishes, invertebrates, and substrate composition in periodically harvested and permanent reserves and in openly fished (control sites) of the South Pacific island country of Vanuatu. Fished species had significantly higher biomass in periodically harvested reserves than in adjacent openly fished areas. We did not detect differences in substratum composition between permanent reserves and openly fished areas or between permanent reserves and periodically harvested reserves. Giant clams (tridacnids) and top shells (Trochus niloticus) were vulnerable to periodic harvest, and we suggest that for adequate management of these species, periodically harvested community conservation areas be used in conjunction with other management strategies. Periodic harvest within reserves is an example of adaptive and flexible management that may meet conservation goals and that is suited to the social, economic, and cultural contexts of many coastal communities in the developing world.

Retrospective study of teicoplanin as home continuation of hospital-initiated therapy.

Data were collected retrospectively on 69 cases of infection in 57 patients who had received teicoplanin on a non-inpatient basis for at least part of a course of therapy. A total of 52 records related to patients who were undergoing treatment for a hematological malignancy, most of whom had central venous catheter infection or catheter-related septicemia. Eleven cases were related to the treatment of bone and/or joint infection, two were concerned with the treatment of endocarditis and two were linked to soft tissue infections. In most cases in which bacteriological identification was made, coagulase-negative staphylococci were the causative organisms. Other pathogens included Staphylococcus aureus, streptococci, enterococci and diphtheroids. In most cases, the dose of teicoplanin used corresponded to the recommended dose for serious infections. All patients received teicoplanin intravenously and some patients administered the drug themselves. Clinical success (cure plus improvement) was achieved in 94% of evaluable cases and bacteriological success in 83%. Two adverse events were reported, but neither related to problems of antibiotic administration in a non-inpatient setting.

Impact of glycopeptide therapy after hospital discharge on inpatient costs: a comparison of teicoplanin and vancomycin.

Data were collected prospectively from 59 patients receiving vancomycin and 20 patients receiving teicoplanin. The mean daily drug cost was 52.40 pounds for teicoplanin and 31.13 pounds for vancomycin; the 95% Confidence Intervals (CI) for the difference in mean drug costs varied between 14.40 pounds and 28.10 pounds in favour of vancomycin. Use of a loading dose of teicoplanin significantly increased mean daily drug costs if the duration of treatment was less than 10 days. Costs of preparation, administration and monitoring were consistently higher for vancomycin than for teicoplanin and inclusion of these costs reduced the difference in mean daily costs to 13.01 pounds (95% CI 6.10 to 19.90 pounds). In Dundee 11 of 20 patients who received teicoplanin had received some of their treatment after discharge from the hospital and a survey of UK hospitals confirmed that teicoplanin treatment after discharge is being used in a wide range of conditions. The median proportion of teicoplanin treatment in Dundee given after discharge was 28.4% for each patient who received the drug: the median proportion of non-inpatient therapy was 50% per patient of those who received any teicoplanin treatment after discharge. Assuming that teicoplanin costs 20 pounds per day more than vancomycin, use of teicoplanin implies an investment of 70.42 pounds to gain one hospital day through earlier discharge of patients receiving teicoplanin.

Comparison of peak expiratory flow rate and forced expiratory volume in one second in histamine challenge studies in children.

The difficulty in performing FEV1 in young children prompted us to assess whether PEFR could be used to measure the response to inhaled histamine. In 123 children with recurrent respiratory symptoms we found a highly significant correlation (r = 0.83, P less than 0.001) between the percentage fall from base-line of FEV1 and PEFR. We also performed histamine challenge tests using PEFR alone on 56 children too young to manage spirometry and found our procedure reliable. PEFR is an adequate measurement in histamine provocation studies and can be used interchangeably with FEV1. The criterion for a positive test is a 20% fall in either PEFR or FEV1.

Bronchial reactivity in cystic fibrosis with normal pulmonary function.

We studied 20 children with cystic fibrosis who had relatively normal pulmonary function (forced expiratory volume greater than or equal to 70% of predicted) to determine whether demonstration of heightened bronchial reactivity in this group reflects coexistent asthma. Using a standardized histamine provocation, we found that eight (40%) had a positive response. These responders were significantly younger than the nonresponders, had a greater incidence of clinical asthma, and all were atopic on skin testing. However, they had a significantly higher ratio of residual volume to total lung capacity than the nonresponders. Although as a group they were less sensitive to histamine than children with asthma, four of the responders with cystic fibrosis had histamine sensitivity similar to a group of asthmatic patients. We concluded that, in the presence of mild lung disease, the demonstration of heightened bronchial reactivity in children with cystic fibrosis may provide confirmatory evidence of coexistent asthma, particularly if the children are highly sensitive to histamine.

Value of combining B2 sympathomimetic metered aerosol and oral theophylline in children with asthma.

We report the results of a double blind controlled trial on 12 children with clinical asthma. Each child received three different treatment regimens; terbutaline sulphate 0.5 mg (Bricanyl) via a metered aerosol; orally administered theophylline 5 mg/kg (Somophyllin); or a combination of both. As expected, the metered aerosol therapy produced significantly greater early bronchodilatation than therapy with theophylline alone. In addition, the combined therapy produced a significantly greater bronchodilatation after three hours than the metered aerosol alone (P less than 0.05). This trend was also observed after one and two hours, but did not reach significance (0.1 greater than P greater than 0.05). We conclude that there is value in combining a B2 sympathomimetic metered aerosol and oral theophylline in children with asthma.

Allergen skin-prick testing in asthmatic children.

Allergen skin-prick tests to the common airborne allergens were performed on 534 children with asthma. A positive reaction to one or more allergens was observed in 81%, and the prevalence increased with age. The specific allergen reactions were characteristic with a high prevalence of reactions to house-dust mite (Dermatophagoides pteronyssinus) (88%), house dust (79%, and cat fur (62%), and a low prevalence of grass-pollen reactions (12% to 25%). We found that the diagnosis of atopy could be made in virtually all (96%) of these children by using only three allergens: D. pteronyssinus, cat fur, and rye grass.

A longitudinal epidemiological study on dental plaque and the development of dental caries--interim results after two years.

1. During the two-year period, caries developed at 20% of the target premolar sites. The attack rate for these surfaces was similar in the plaque panel and the other subjects in the study. 2. The microbial composition of plaque samples from caries-free sites and from carious sites before and after radiographic detection of lesions was broadly similar. 3. Numerical domination of particular sites by S mutans before detection of caries can occur, but has only been observed so far in 2 of 15 sites. 4. Pooled date from sites which have developed lesions indicate a rise in the isolation frequency and mean numbers of S. mutans after detection of caries. This trend was particularly obvious in the one subject who developed bilateral lesions by the second examination and in three of four sites where caries was detected at the fourth examination. Similar observations have been made with lactobacilli. 5. In two of 15 instances no isolations of S mutans were made from sites which developed caries. 6. To date, no single species appears to be uniquely associated with the onset of dental caries.