Infectious Etiologies of Acute Febrile Illness among Patients Seeking Health Care in South-Central Cambodia

The agents of human febrile illness can vary by region and country suggesting that diagnosis, treatment, and control programs need to be based on a methodical evaluation of area-specific etiologies. From December 2006 to December 2009, 9,997 individuals presenting with acute febrile illness at nine health care clinics in south-central Cambodia were enrolled in a study to elucidate the etiologies. Upon enrollment, respiratory specimens, whole blood, and serum were collected. Testing was performed for viral, bacterial, and parasitic pathogens. Etiologies were identified in 38.0% of patients. Influenza was the most frequent pathogen, followed by dengue, malaria, and bacterial pathogens isolated from blood culture. In addition, 3.5% of enrolled patients were infected with more than one pathogen. Our data provide the first systematic assessment of the etiologies of acute febrile illness in south-central Cambodia. Data from syndromic-based surveillance studies can help guide public health responses in developing nations

Lawson criterion for ignition exceeded in an inertial fusion experiment

For more than half a century, researchers around the world have been engaged in attempts to achieve fusion ignition as a proof of principle of various fusion concepts. Following the Lawson criterion, an ignited plasma is one where the fusion heating power is high enough to overcome all the physical processes that cool the fusion plasma, creating a positive thermodynamic feedback loop with rapidly increasing temperature. In inertially confined fusion, ignition is a state where the fusion plasma can begin "burn propagation" into surrounding cold fuel, enabling the possibility of high energy gain. While "scientific breakeven" (i.e., unity target gain) has not yet been achieved (here target gain is 0.72, 1.37 MJ of fusion for 1.92 MJ of laser energy), this Letter reports the first controlled fusion experiment, using laser indirect drive, on the National Ignition Facility to produce capsule gain (here 5.8) and reach ignition by nine different formulations of the Lawson criterion

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Determination of biodegradation kinetics of volatile organic compounds through the use of respirometry

Electrolytic respirometry was used to determine the biodegradation kinetic parameters of five volatile aromatic organic compounds: benzene, 1,2‐dichlorobenzene, 1,3‐dichlorobenzene, 1,4‐dichlorobenzene, and 1,2,3‐trichlorobenzene. A protocol developed earlier was modified to accommodate the volatile characteristic of the test compounds. Specifically, the model used in data analysis was modified using Henry's law constant to incorporate the effect of partitioning of a volatile substrate between the gas and liquid phases in a batch reactor. Similar kinetic parameters were obtained for benzene and its four chlorinated analogs. Substrate inhibition was observed in the case of 1,3‐ and 1,4‐dichlorobenzene, and intermediate product inhibition was observed in the case of 1,2‐dichlorobenzene. In addition, all chlorinated benzenes exhibited complete inhibition above certain threshold concentrations

Developments in Bioremediation of Soils and Sediments Polluted with Metals and Radionuclides: 2. Field Research on Bioremediation of Metals and Radionuclides

Bioremediation of metals and radionuclides has had many field tests, demonstrations, and full-scale implementations in recent years. Field research in this area has occurred for many different metals and radionuclides using a wide array of strategies. These strategies can be generally characterized in six major categories: biotransformation, bioaccumulation/bisorption, biodegradation of chelators, volatilization, treatment trains, and natural attenuation. For all field applications there are a number of critical biogeochemical issues that most be addressed for the successful field application. Monitoring and characterization parameters that are enabling to bioremediation of metals and radionuclides are presented here. For each of the strategies a case study is presented to demonstrate a field application that uses this strategy