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]

Identification of novel aphid-killing bacteria to protect plants

Aphids, including the peach-potato aphid, Myzus persicae, are major insect pests of agriculture and horticulture, and aphid control measures are limited. There is therefore an urgent need to develop alternative and more sustainable means of control. Recent studies have shown that environmental microbes have varying abilities to kill insects. We screened a range of environmental bacteria isolates for their abilities to kill target aphid species. Tests demonstrated the killing aptitude of these bacteria against six aphid genera (including Myzus persicae). No single bacterial strain was identified that was consistently toxic to insecticide-resistant aphid clones than susceptible clones, suggesting resistance to chemicals is not strongly correlated with bacterial challenge. Pseudomonas fluorescens PpR24 proved the most toxic to almost all aphid clones whilst exhibiting the ability to survive for over three weeks on three plant species at populations of 5-6 log CFU cm-2 leaf. Application of PpR24 to plants immediately prior to introducing aphids onto the plants led to a 68%, 57% and 69% reduction in aphid populations, after 21 days, on Capsicum annuum, Arabidopsis thaliana and Beta vulgaris respectively. Together, these findings provide new insights into aphid susceptibility to bacterial infection with the aim of utilizing bacteria as effective biocontrol agents

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

First report of field evolved resistance to agrochemicals in dengue mosquito, Aedes albopictus (Diptera: Culicidae), from Pakistan

<p>Abstract</p> <p>Background</p> <p>Agrochemicals have been widely used in Pakistan for several years. This exposes mosquito populations, particularly those present around agricultural settings, to an intense selection pressure for insecticide resistance. The aim of the present study was to investigate the toxicity of representative agrochemicals against various populations of <it>Aedes albopictus </it>(Skuse) collected from three different regions from 2008-2010.</p> <p>Results</p> <p>For organophosphates and pyrethroids, the resistance ratios compared with susceptible Lab-PK were in the range of 157-266 fold for chlorpyrifos, 24-52 fold for profenofos, 41-71 fold for triazofos, and 15-26 fold for cypermethrin, 15-53 fold for deltamethrin and 21-58 fold for lambdacyhalothrin. The resistance ratios for carbamates and new insecticides were in the range of 13-22 fold for methomyl, 24-30 fold for thiodicarb, and 41-101 fold for indoxacarb, 14-27 fold for emamectin benzoate and 23-50 fold for spinosad. Pair wise comparisons of the log LC_50sof insecticides revealed correlation among several insecticides, suggesting a possible cross resistance mechanism. Moreover, resistance remained stable across 3 years, suggesting field selection for general fitness had also taken place for various populations of <it>Ae. albopictus</it>.</p> <p>Conclusion</p> <p>Moderate to high level of resistance to agrochemicals in Pakistani field populations of <it>Ae. albopictus </it>is reported here first time. The geographic extent of resistance is unknown but, if widespread, may lead to problems in future vector control.</p

Within-plant variation in concentrations of amino acids, sugar, and sinigrin in phloem sap of black mustard, Brassica nigra (L.) Koch (Cruciferae)

Although within-plant variation in the nutrient and allelochemical composition of phloem sap has been invoked to explain patterns of host use by phloem-feeding insects, little is known about within-plant variation in phloem chemistry. Here I describe a new technique in which I use the green peach aphid, Myzus persicae Sulz., to investigate within-plant variation in the concentrations of chemicals in the phloem sap of black mustard, Brassica nigra (L.) Koch (Cruciferae). Relationships between the concentrations of chemicals in aphid diets and honeydew were established using honeydew from aphids fed on artificial diets with known concentrations of amino acids, sucrose, and sinigrin. These relationships were applied to honeydew from aphids fed on different aged leaves of black mustard to estimate the concentrations of the chemicals in phloem sap. Sinigrin concentration was estimated to be high (>10 mM) in phloem sap in young leaves, calling into question the prevailing opinion that phloem sap contains only low concentrations of allelochemicals. High concentrations may function as defenses against sap-feeding herbivores. Within-plant variation in phloem sap composition was high: (1) young leaves had high concentrations of nutrients (216 mM amino acids, 26% sugar) and sinigrin (>10 mM); (2) mature and presenescent leaves had lower concentrations of nutrients (77–83 mM amino acids, 19–20% sugar) and low concentrations of sinigrin (1–2 mM); and (3) senescing leaves had high concentrations of nutrients (199 mM amino acids, 25% sugar) and low concentrations of sinigrin (3 mM).Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44893/1/10886_2005_Article_BF02027950.pd

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

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

Rapid transcriptional plasticity of duplicated gene clusters enables a clonally reproducing aphid to colonise diverse plant species

Background: The prevailing paradigm of host-parasite evolution is that arms races lead to increasing specialisation via genetic adaptation. Insect herbivores are no exception and the majority have evolved to colonise a small number of closely related host species. Remarkably, the green peach aphid, Myzus persicae, colonises plant species across 40 families and single M. persicae clonal lineages can colonise distantly related plants. This remarkable ability makes M. persicae a highly destructive pest of many important crop species. Results: To investigate the exceptional phenotypic plasticity of M. persicae, we sequenced the M. persicae genome and assessed how one clonal lineage responds to host plant species of different families. We show that genetically identical individuals are able to colonise distantly related host species through the differential regulation of genes belonging to aphid-expanded gene families. Multigene clusters collectively upregulate in single aphids within two days upon host switch. Furthermore, we demonstrate the functional significance of this rapid transcriptional change using RNA interference (RNAi)-mediated knock-down of genes belonging to the cathepsin B gene family. Knock-down of cathepsin B genes reduced aphid fitness, but only on the host that induced upregulation of these genes. Conclusions: Previous research has focused on the role of genetic adaptation of parasites to their hosts. Here we show that the generalist aphid pest M. persicae is able to colonise diverse host plant species in the absence of genetic specialisation. This is achieved through rapid transcriptional plasticity of genes that have duplicated during aphid evolution