The distribution, impact and potential management of the introdued vine Passiflora mollissima (Passifloraceae) in Hawai'i

Reports were scanned in black and white at a resolution of 600 dots per inch and were converted to text using Adobe Paper Capture Plug-in.Passiflora mollissima, a weedy vine introduced to Hawai'i, infests significant portions of two of the major islands, Hawai'i and Kaua'i. It grows between 600 and 2200 m elevation in areas where the rainfall does not exceed 5100 mm. The vine is distributed continuously over a total of 190 km² and in more widely scattered populations over an additional 330 km². Man has been the principle agent of introduction for this species. However, intermediate-distance dispersal may be affected by introduced gallincaeous birds and cattle. Locally feral pigs are the major dispersal agent. Passiflora mollissima inhabits many of the major upland vegetation types in Hawaii but is most successful in mesic Acacia koa - Metrosideros polymorpha forests. Although over much of its current range its foliage cover is less than 25%, in some areas it is so dense that it smothers large tracts of native forest. Potential impacts of the infestation on depleted and endangered endemic organisms are also discussed. It is concluded that P. mollissima has become too widespread for successful mechanical or chemical control except in are as of recent local introduction. Prospects for biological control of this species are discussed in the context of current research efforts and practical problems related to a commercially grown congener.U.S. Fish and Wildlife Service; Cooperative National Parks Reseach Studies Unit, Department of Botany, University of Hawai’i; Institute of Pacific Islands Forestry, U.S. Forest Service; Hawaii Volcanoes National Park, Resources Management Division; Hawaii Office of the Nature Conservanc

Practice guidelines for clinical microbiology laboratories: Mycobacteria

Mycobacteria are the causative organisms for diseases such as tuberculosis (TB), leprosy, Buruli ulcer, and pulmonary nontuberculous mycobacterial disease, to name the most important ones. In 2015, globally, almost 10 million people developed TB, and almost half a million patients suffered from its multidrug-resistant form. In 2016, a total of 9,287 new TB cases were reported in the United States. In 2015, there were 174,608 new case of leprosy worldwide. India, Brazil, and Indonesia reported the most leprosy cases. In 2015, the World Health Organization reported 2,037 new cases of Buruli ulcer, with most cases being reported in Africa. Pulmonary nontuberculous mycobacterial disease is an emerging public health challenge. The U.S. National Institutes of Health reported an increase from 20 to 47 cases/100,000 persons (or 8.2% per year) of pulmonary nontuberculous mycobacterial disease among adults aged 65 years or older throughout the United States, with 181,037 national annual cases estimated in 2014. This review describes contemporary methods for the laboratory diagnosis of mycobacterial diseases. Furthermore, the review considers the ever-changing health care delivery system and stresses the laboratory’s need to adjust and embrace molecular technologies to provide shorter turnaround times and a higher quality of care for the patients who we serve

Interpretation of CT studies: single-screen workstation versus film alternator

A prototype single-screen workstation with a 2,048 x 2,560-pixel high-brightness monitor, 0.11-second image display time, and simple ergonomic design was compared to a conventional horizontal film alternator in diagnostic interpretation of chest computed tomography (CT) studies. Four radiologists used either the workstation or film alternator in interpretation of studies obtained in 10 patients. A counterbalanced within-subject repeated measures experimental design was used. Response times were analyzed for both methods of interpretation. Grades of excellent, acceptable, and unacceptable were assigned by a blinded "grader" to reports of the radiologists. The average time needed for an interpretation at the workstation was 5.65 minutes. No interpretations were graded unacceptable. Retrospective power analysis showed that 16 observers rather than four would have been required to show that use of the workstation was faster than the alternator. With this 95% confidence interval, the workstation interpretation time is clinically equivalent to that with the alternator. These data show that this type of workstation has practical application in interpretation of CT, magnetic resonance imaging, and ultrasound studies

Surveillance of Wisconsin Antibacterial Susceptibility Patterns

Background: Antimicrobial resistance presents a threat to quality patient care. Knowledge of local antibacterial susceptibility patterns can guide clinicians in empiric antibacterial administration and assist pharmacists and infectious disease physicians in development of appropriate therapeutic pathways. Methods: To characterize Wisconsin antibacterial susceptibility patterns and elucidate geographic or temporal variation in antibacterial resistance, a retrospective, observational analysis of antibiogram data was performed. Seventy-two members of the Wisconsin Clinical Laboratory Network (WCLN) submitted antibiograms describing clinically significant isolates tested in calendar year 2013 to the WCLN Laboratory Technical Advisory Group. Results: In the context of commonly reported antibacterial agents, data were compiled for approximately 75,800 isolates of Escherichia coli; 13,300 Klebsiella pneumoniae; 6300 Proteus mirabilis; 2800 Enterobacter cloacae; 8400 Pseudomonas aeruginosa; 30,000 S aureus; 11,200 coagulasenegative Staphylococcus spp; and 13,800 Enterococcus spp. P mirabilis isolates from northern Wisconsin were more likely to demonstrate resistance than those in the southern region. In contrast, P aeruginosa isolates from southern Wisconsin had decreased susceptibility to a number of agents when compared to other regions. Temporal trending in decreased E coli and P mirabilis susceptibility to fluoroquinolones and trimethoprim-sulfamethoxazole was observed. Increased methicillin-resistant Staphylococcus aureus (MRSA) rates were observed in northwest and southeast Wisconsin. In general, northeast Wisconsin exhibited less frequency of antibacterial resistance. Conclusions: Geographic variation exists with respect to antibacterial resistance, particularly in areas of Wisconsin adjacent to large population centers of neighboring states. Antibacterial surveillance in Wisconsin is indicated on a regular basis to assess emerging trends in antibacterial resistance. Existing WCLN infrastructure allows for such investigations

ACR Appropriateness Criteria(R) right lower quadrant pain--suspected appendicitis

The diagnostic imaging of patients presenting with right lower quadrant pain and suspected appendicitis may be organized according to age and gender and to the presence or absence of classic signs and symptoms of acute appendicitis. Among adult patients presenting with clinical signs of acute appendicitis, the sensitivity and specificity of CT are greater than those of ultrasound, with improved performance when CT is performed with intravenous contrast. The use of rectal contrast has been associated with decreased time in the emergency department. Computed tomography has also been shown to reduce cost and negative appendectomy rates. Both CT and ultrasound are also effective in the identification of causes of right lower quadrant pain unrelated to appendicitis. Among pediatric patients, the sensitivity and specificity of graded-compression ultrasound can approach those of CT, without the use of ionizing radiation. Performing MRI after inconclusive ultrasound in pregnant patients has been associated with sensitivity and specificity of 80% to 86% and 97% to 99%, respectively. The ACR Appropriateness Criteria((R)) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. rights reserved