Length of Stay: An Inappropriate Readout of the Success of Enhanced Recovery Programs

BACKGROUND: Enhanced recovery after surgery (ERAS) programs are designed to reduce hospital length of stay by shortening the postoperative recovery period. The intended effect of an accelerated recovery on the length of stay may be frustrated by a delayed discharge. This study was designed to assess the influence of an ERAS program on the proportion, appropriateness, and extent of delay in discharge. METHODS: Patients who enrolled in the ERAS program (n = 121) between 2003 and 2006 were compared with 52 patients who were managed traditionally in 2001. RESULTS: Ninety percent of the pre-ERAS patients and 87% of the ERAS patients were not discharged on the day that discharge criteria were fulfilled. The additional stay of 59% of the pre-ERAS patients and 69% of the ERAS patients was inappropriate. Wound care (15% in the pre-ERAS and 3% of the ERAS group) and observation of any symptoms pointing to an anastomotic leakage (10% in both groups) were the most important reasons for a medical appropriate delay of discharge. The extent of delay in discharge decreased significantly from a median of two days in the pre-ERAS group to a median of 1 day in the ERAS group (p = 0.004). CONCLUSIONS: Reductions in length of stay up to a median of 2 days after start of an enhanced recovery program may relate to changes in organization of care and not to a shorter recovery period. Recovery statistics should replace or at least be added to the length of stay as outcome of enhanced recovery programs. AD - Department of Surgery, University Hospital Maastricht, PO Box 5800, 6202 AZ, Maastricht, the Netherlands. [email protected]

Proteomic Insights into the Hidden World of Phloem Sap Feeding

The physical interface between a phloem-feeding insect and its host plant is a single cell buried deep within the plant tissue. As such, the molecular interactions between these notorious agricultural pests and the crop plants upon which they feed are diffi cult to study. ‘Omic’ technologies have proved crucial in revealing some of the fascinating detail of the molecular interplay between these partners. Here we review the role of proteomics in identifying putative components of the secreted saliva of phloem-feeding insects, particularly aphids, and discuss the limited knowledge concerning the function of these proteins

Environmental Barcoding Reveals Massive Dinoflagellate Diversity in Marine Environments

Rowena F. Stern is with University of British Columbia, Ales Horak is with University of British Columbia, Rose L. Andrew is with University of British Columbia, Mary-Alice Coffroth is with State University of New York at Buffalo, Robert A. Andersen is with the Bigelow Laboratory for Ocean Sciences, Frithjof C. Küpper is with the Scottish Marine Institute, Ian Jameson is with CSIRO Marine and Atmospheric Research, Mona Hoppenrath is with the German Center for Marine Biodiversity Research, Benoît Véron is with University of Caen Lower Normandy and the National Institute for Environmental Studies, Fumai Kasai is with the National Institute for Environmental Studies, Jerry Brand is with UT Austin, Erick R. James is with University of British Columbia, Patrick J. Keeling is with University of British Columbia.Background -- Dinoflagellates are an ecologically important group of protists with important functions as primary producers, coral symbionts and in toxic red tides. Although widely studied, the natural diversity of dinoflagellates is not well known. DNA barcoding has been utilized successfully for many protist groups. We used this approach to systematically sample known “species”, as a reference to measure the natural diversity in three marine environments. Methodology/Principal Findings -- In this study, we assembled a large cytochrome c oxidase 1 (COI) barcode database from 8 public algal culture collections plus 3 private collections worldwide resulting in 336 individual barcodes linked to specific cultures. We demonstrate that COI can identify to the species level in 15 dinoflagellate genera, generally in agreement with existing species names. Exceptions were found in species belonging to genera that were generally already known to be taxonomically challenging, such as Alexandrium or Symbiodinium. Using this barcode database as a baseline for cultured dinoflagellate diversity, we investigated the natural diversity in three diverse marine environments (Northeast Pacific, Northwest Atlantic, and Caribbean), including an evaluation of single-cell barcoding to identify uncultivated groups. From all three environments, the great majority of barcodes were not represented by any known cultured dinoflagellate, and we also observed an explosion in the diversity of genera that previously contained a modest number of known species, belonging to Kareniaceae. In total, 91.5% of non-identical environmental barcodes represent distinct species, but only 51 out of 603 unique environmental barcodes could be linked to cultured species using a conservative cut-off based on distances between cultured species. Conclusions/Significance -- COI barcoding was successful in identifying species from 70% of cultured genera. When applied to environmental samples, it revealed a massive amount of natural diversity in dinoflagellates. This highlights the extent to which we underestimate microbial diversity in the environment.This project was funded by Genome Canada and the Canadian Barcode of Life Network. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Biological Sciences, School o

Diferenças na infestação de Aphis gossypii em plantas de algodoeiro cultivar 'IAC-RM3' tratadas com reguladores de crescimento

We have studied the effect of application of growth regulators, (2-chloroethyl) trimethylammonium chloride (CCC), N,N-dimethylaminosuccinamic acid (SADH), gibberellic acid (GA3) and 3-indoleacetic acid (IAA) on cotton, Gossypium hirsutum L. cv. 'IAC-RM3', in relation to atack of Aphis gossypii Glover, 1876, under greenhouse conditions. Two determinations of infestation levels of the aphids showed differences in degree of infestation among treatments. CCC treated plants showed increasing in aphid colonization in relation to GA3 at 100 ppm treated plants. The application of SADH at 4000 ppm also showed a tendency of increasing aphid colonization in relation to treated plants with GA3 at 100 ppm. Probably growth retardants promote differences in the water status of hostplant; and the aphids preferences to that plants suggest that the increase in the osmotic potential promotes better rates of aphid feeding than GA3 treated plants. In treated plants with GA3 at 100 ppm the infestation decreased, there was water stress during the warmer time of the day and a probable decreasing in the osmotic potential.Estudou-se a influência da aplicação de reguladores de crescimento (CCC, SADH, GA3 e IAA) em algodoeiro, Gossypium hirsutum L. cv. 'IAC-RM3', na infestação de Aphis gossypii Glover, 1876; em condições de casa de vegetação. A realização de duas determinações no nível de infestação dos afídios, evidenciou que plantas tratadas com CCC mostram níveis superiores de infestação com relação às tratadas com GA3 a 100 ppm; sendo que a aplicação de SADH a 4000 ppm também promoveu uma tendência de maior infestação com relação ao GA3 a 100 ppm. Estes resultados parecem revelar que os retardadores de crescimento promovem um equilíbrio hídrico interno nas plantas mais favorável, mantendo o potencial osmótico mais elevado e possibilitando uma melhor alimentação do afídio. Plantas tratadas com GAg a 100 ppm parecem sofrer maiores déficits hídricos, não favorecendo o estabelecimento das colônias, nas condições estudadas

Mirid feeding preference as influenced by light and temperature mediated changes in plant nutrient concentration in cocoa

Cocoa mirids are the most important insect pests of cocoa in West Africa. This study investigated the effect of environmental parameters that are modulated by overhead shade, i.e. light intensity and temperature, on nutrient and phenolic concentrations in cocoa and their subsequent effect on mirid feeding. Eight-month-old cocoa seedlings were maintained for 50 days in two growth chambers set to day temperatures of 25oC or 30oC. Each chamber had sections with different light intensities (541, 365 and 181 µmolm-2s-1 PAR). For the field studies at Akim-Tafo in Ghana, eight-month-old plants of three cocoa clones were subjected to shaded (PAR= 180 µmol m-² s-1, between 11:00 and 12:00) and unshaded (PAR= 1767 µmol m-² s-1 between 11:00 and 12:00) treatments for 50 days after which nutrient measurements and mirid choice tests were carried out. No significant effect of environment was observed on the phenolic concentration of stems under controlled environment chamber conditions. However, in the field, the phenolic concentration of stems was significantly greater for unshaded compared with shaded plants (P=0.04). Under controlled conditions, the leaf nitrogen concentration increased slightly with light intensity (P=0.003). The same trend was seen in stems but only at 30oC. In the field, the impact of overhead shade on nitrogen varied between cocoa clones. The concentration of carbohydrates in both leaves and stems in the field was higher under unshaded conditions. When subjected to feeding tests, stems from unshaded cocoa had significantly more mirid feeding lesions (P=0.003) after 24 hours exposure to mirids compared to shaded cocoa. Mirid feeding therefore appears not to be deterred by the higher phenolic levels but rather there was a preference for cocoa tissue grown under unshaded conditions. These findings highlight the need to consider the growing environment of cocoa clones when screening for varieties with resistance to mirids

Phylogenetic Relationships of Tribes Within Harpalinae (Coleoptera: Carabidae) as Inferred from 28S Ribosomal DNA and the Wingless Gene

Harpalinae is a large, monophyletic subfamily of carabid ground beetles containing more than 19,000 species in approximately 40 tribes. The higher level phylogenetic relationships within harpalines were investigated based on nucleotide data from two nuclear genes, wingless and 28S rDNA. Phylogenetic analyses of combined data indicate that many harpaline tribes are monophyletic, however the reconstructed trees showed little support for deeper nodes. In addition, our results suggest that the Lebiomorph Assemblage (tribes Lebiini, Cyclosomini, Graphipterini, Perigonini, Odacanthini, Lachnophorini, Pentagonicini, Catapiesini and Calophaenini), which is united by a morphological synapomorphy, is not monophyletic, and the tribe Lebiini is paraphyletic with respect to members of Cyclosomini. Two unexpected clades of tribes were supported: the Zuphiitae, comprised of Anthiini, Zuphiini, Helluonini, Dryptini, Galeritini, and Physocrotaphini; and a clade comprised of Orthogoniini, Pseudomorphini, and Graphipterini. The data presented in this study represent a dense sample of taxa to examine the molecular phylogeny of Harpalinae and provide a useful framework to examine the origin and evolution of morphological and ecological diversity in this group