The Epidemiology and Clinical Spectrum of Melioidosis: 540 Cases from the 20 Year Darwin Prospective Study

Melioidosis is an occupationally and recreationally acquired infection important in Southeast Asia and northern Australia. Recently cases have been reported from more diverse locations globally. The responsible bacterium, Burkholderia pseudomallei, is considered a potential biothreat agent. Risk factors predisposing to melioidosis are well recognised, most notably diabetes. The Darwin prospective melioidosis study has identified 540 cases of melioidosis over 20 years and analysis of the epidemiology and clinical findings provides important new insights into this disease. Risk factors identified in addition to diabetes, hazardous alcohol use and chronic renal disease include chronic lung disease, malignancies, rheumatic heart disease, cardiac failure and age ≥50 years. Half of patients presented with pneumonia and septic shock was common (21%). The decrease in mortality from 30% in the first 5 years of the study to 9% in the last five years is attributed to earlier diagnosis and improvements in intensive care management. Of the 77 fatal cases (14%), all had known risk factors for melioidosis. This supports the most important conclusion of the study, which is that melioidosis is very unlikely to kill a healthy person, provided the infection is diagnosed early and resources are available to provide appropriate antibiotics and critical care where required

Defining and Implementing Best Available Science for Fisheries and Environmental Science, Policy, and Management American Fisheries SocietyDefining and Implementing Best Available Science for Fisheries and Environmental Science, Policy, and Management

In the United States, many of the laws governing environmental conservation and management stipulate that the best available science be used as the basis for policy and decision making. The Endangered Species Act, for example, requires that decisions on listing a species as threatened or endangered be made on the basis of the best scientific and commercial data available. Similarly, National Standard 2 of the Magnuson-Stevens Fishery Conservation and Management Act states that conservation and management measures shall be based on the best scientific information available. Further, the U.S. Environmental Protection Agency has emphasized the role of best available science in implementing the Clean Water Act (USEPA 1997). Determining what constitutes the best available science, however, is not straightforward, and scientists, policymakers, and stakeholders often have disparate ideas on how the concept should be defined and interpreted. The American Fisheries Society and the Estuarine Research Federation established a committee to consider what determines the best available science and how it might be used to formulate natural resource policies and procedures. This synopsis examines how scientists and nonscientists perceive science, what factors affect the quality and use of science, and how changing technology and societal preferences influence the availability and application of science. Because the issues surrounding the definition of best available science surface when managers and policymakers interpret and use science, we also discuss the interface between science and policy and explore ways in which scientists, policymakers, and managers can more effectively apply science to environmental policy