Treatment failure in pneumonia: Impact of antibiotic treatment and cost analysis

The aim of this study was to investigate treatment failure (TF) in hospitalised community-acquired pneumonia (CAP) patients with regard to initial antibiotic treatment and economic impact. CAP patients were included in two open, prospective multicentre studies assessing the direct costs for in-patient treatment. Patients received treatment either with moxifloxacin (MFX) or a nonstandardised antibiotic therapy. Any change in antibiotic therapy after >72 h of treatment to a broadened antibiotic spectrum was considered as TF. Overall, 1,236 patients (mean ± SD age 69.6 ± 16.8 yrs, 691 (55.9%) male) were included. TF occurred in 197 (15.9%) subjects and led to longer hospital stay (15.4 ± 7.3 days versus 9.8 ± 4.2 days; p < 0.001) and increased median treatment costs (€2,206 versus €1,284; p<0.001). 596 (48.2%) patients received MFX and witnessed less TF (10.9% versus 20.6%; p < 0.001). After controlling for confounders in multivariate analysis, adjusted risk of TF was clearly reduced in MFX as compared with β-lactam monotherapy (adjusted OR for MFX 0.43, 95% CI 0.27-0.68) and was more comparable with a β-lactam plus macrolide combination (BLM) (OR 0.68, 95% CI 0.38-1.21). In hospitalised CAP, TF is frequent and leads to prolonged hospital stay and increased treatment costs. Initial treatment with MFX or BLM is a possible strategy to prevent TF, and may thus reduce treatment costs.

Mainstreaming a Decade's Experiences in Watershed Management to Meet the Challenges of Environmental Change in the Hindu Kush-Himalayas

Like other mountain areas in the world, the Hindu Kush-Himalayan (HKH) region is particularly vulnerable to climate change. Ongoing climate change processes are projected to have a high impact on the HKH region, and accelerated warming has been reported in the Himalayas. These climate change impacts will be superimposed on a variety of other environmental and social stresses, adding to the complexity of the issues. The sustainable use of natural resources is crucial to the long-term stability of the fragile mountain ecosystems in the HKH and to sustain the socio-ecological resilience that forms the basis of sustainable livelihoods in the region. In order to be prepared for these challenges, it is important to take stock of previous research. The ‘People and Resource Dynamics Project’ (PARDYP), implemented by International Centre for Integrated Mountain Development (ICIMOD), provides a variety of participatory options for sustainable land management in the HKH region. The PARDYD project was a research for development project that operated in five middle mountain watersheds across the HKH – two in Nepal and one each in China, India, and Pakistan. The project ran from 1996 to 2006 and focused on addressing the marginalisation of mountain farmers, the use and availability of water, issues relating to land and forest degradation and declining soil fertility, the speed of regeneration of degraded land, and the ability of the natural environment to support the growing needs of the region’s increasing population. A key learning from the project was that the opinion of land users is crucial to the acceptance (and, therefore, successful application) of new technologies and approaches. A major challenge at the end of every project is to promote knowledge sharing and encourage the cross-fertilization of ideas (e.g., in the case of PARDYP, with other middle mountain inhabitants and practitioners in the region) and to share lessons learned with a wider audience. This paper will highlight how the PARDYP findings, including ways of addressing soil fertility and water scarcity, have been mainstreamed in the HKH region through capacity building (international, regional, and national training courses), networking, and the provision of backstopping services. In addition, in view of the challenges in watershed management in the HKH connected to environmental change, the lessons learned from the PARDYP are now being used by ICMOD to define and package climate change proof technology options to address climate change adaptation.

Acid and alkali etching of grit blasted zirconia: Impact on adhesion and osteogenic differentiation of MG63 cells in vitro

There is a need for evaluating zirconia surface modifications and their potential impact on the biological response of osteogenic cells. Grit blasted zirconia discs were either left untreated or underwent acid or alkaline etching. Adhesion and osteogenic differentiation of MG63 cells was determined after one week of culture. The macro-scaled roughness of the grit blasted zirconia discs, independent of the surface treatment, was within a narrow range and only slightly smoother than titanium discs. However, the alkaline- and acid-etching led to an increase of the micro-roughness of the surface. The surface modifications had no effect on cell spreading and did not cause significant change in the expression of differentiation markers. Thus, in this respective setting, morphologic changes observed upon treatment of grit blasted zirconia discs with acid or alkaline do not translate into changes in MG63 cell adhesion or differentiation and are comparable to findings with anodized titanium discs.

The socio-cultural impact of the introduction of motorbike taxis in the rural community of Tombel, South West region, Cameroon

“The socio-cultural impact of the introduction of motorbike taxis in the rural community of Tombel, South West region, Cameroon” seeks to bring out the impact of commercial motorbike taxis on the lifestyle of the Bakossi. The principal objective of this research is to show how the introduction of motorbike taxis has modified the lifestyle of the Tombel population. This anthropological research defines the profile of a motorbike taxi rider, his role in society, the perception of the population towards this activity and the impact of this activity on the lifestyle of the rural population of Tombel. This study reveals that motorbike taxi riders are essentially made up of youths from all works of life who earn a living by riding a motorbike taxi on a daily bases for commercial purposes. The revenue earn here goes a long way to sustain the livelihood of the rider and his entourage, becoming an ascension tool into the social ladder. The activity is very dangerous not only for the riders buts also for the passengers because of the risks involved in riding for most of the riders do not have the basic knowledge of the road code. This research also reveals that motorbike taxi has become the preferred means of public transport of most inhabitants of Tombel to the point of monopolising certain destinations. The population of Tombel perceives this activity as an instrument of change that has brought development and progress. But this activity also constitutes a social ill because of the prevalent sexual promiscuity encouraged by the riders. This activity has also gotten a cultural impact on the society, changing perceptions and being involve in rituals. Motorbike taxis have become a force to reckon with in the organisation of the community. They are a “response from below” to the transport crises in Cameroon.

Double Take Project: Using Applied Theatre For Campus Climate Change

Despite research gathered in the Campus Climate Report, I believe that it underrepresented the student experience of the social scene. The document primarily served as an identification tool for four major problems on campus: binge drinking, sexual assault, diversity, and disengagement in the classroom. Double Take Project also identifies similar issues however, this project uses theatrical techniques to gather the anecdotal reality of the student perspective. Double Take Project expands beyond the Campus Climate Report to inspire dialogue in a variety of student-to-student interactions and, more importantly, the project seeks action and solution plans. The social scene dominates our culture and its many issues result in concern for the safety, self-identity, and development of Bucknell students into thriving adults. Double Take Project is rooted in the belief that theatre is a palpable tool for social change. Over the course of many events, Double Take Project has utilized facets of theatre to provide opportunities to voice discontent, widen perception of normalcy on campus, and inspire confidence to act on personal beliefs. The Double Take Project uses many Applied Theatre methods to impact the social scene. For example, I conducted 36 student interviews and transformed the stories into a one-woman show, Rage Behind Curtains, which I performed at multiple venues across campus. I also used interviews to create a radio show airing one story per day. I conducted ten workshops with student groups, Fraternities and Sororities, and in the classroom utilizing Augusto Boal’s Theatre of the Oppressed (TO) techniques. I also created a “social scene confessional” where I stood outside the Elaine Langone Center with a sign that read, “Tell me a story about the social scene” from a wide variety of Bucknell students. Finally, I have assembled a Forum Theatre Company based on Augusto Boal’s method of the spect-actor, utilizing participants as both actors and spectators in the theatre piece. All of the names indicated in this paper have been altered to protect the identity of the participants. While planning events and conducting various theatrical experiences, I learned that there are a series of internal and external issues contributing to our social environment. Internally, students are conflicted with personal beliefs while battling outward social pressure. Whether they are on the outskirts or center of the social scene determines their response to this conflict. For example, I have discovered that students on the borders of the social culture respond with criticism because they feel excluded, whereas the student’s centrally involved critique the culture in private and while their persona appears to not want change. Externally, there are many structural issues that contribute to the current social climate such as without Fraternity meal plans, Cafeteria space is not sufficient to feed all of the students, exclusive party culture, and gendered housing. Through meetings with Deans and staff, I have learned there are also problems between administration and students, resulting in resentment and blame. Although addressing structural issues would instigate immediate change, in my opinion, internal student conflicts are the primary cause for the current negative social atmosphere. I believe that pressure to conform is rooted in lack of personal identity. Because students simply do not know themselves, they form strong social groups that become the definition of themselves. Without confident self-awareness, large and powerful groups coerce students to accept social norms resulting in the individual’s outward distaste for change, yet internal discomfort.

Maternal mental health in the first 3-week postpartum: the impact of caregiver support and the subjective experience of childbirth - a longitudinal path model

Acute stress reactions (ASR) and postpartum depressive symptoms (PDS) are frequent after childbirth. The present study addresses the change and overlap of ASR and PDS from the 1- to 3-week postpartum and examines the interplay of caregiver support and subjective birth experience with regard to the development of ASR/PDS within a longitudinal path model.

Impact of Holocene climate changes on alpine and treeline vegetation at Sanetsch Pass, Bernese Alps, Switzerland

In order to infer reactions of treeline and alpine vegetation to climatic change, past vegetation changes are reconstructed on the basis of pollen, macrofossil and charcoal analysis. The sampled sediment cores originate from the small pond Emines, located at the Sanetsch Pass (connecting the Valais and Bern, Switzerland) at an altitude of 2288 m a.s.l. Today's treeline is at ca. 2200 m a.s.l. in the area, though due to special pass (saddle) conditions it is locally depressed to ca. 2060 m a.s.l. Our results reveal that the area around Emines was covered by treeless alpine vegetation during most of the past 12,000 years. Single individuals of Betula, Larix decidua and possibly Pinus cembra occurred during the Holocene. Major centennial to millennial-scale responses of treeline vegetation to climatic changes are evident. However, alpine vegetation composition remained rather stable between 11,500 and 6000 cal. BP, showing that Holocene climatic changes of +/− 1 °C hardly influenced the local vegetation at Emines. The rapid warming of 3–4 °C at the Late Glacial/Holocene transition (11,600 cal. BP) caused significant altitudinal displacements of alpine species that were additionally affected by the rapid upward movement of trees and shrubs. Since the beginning of the Neolithic, vegetation changes at Sanetsch Pass resulted from a combination of climate change and human impact. Anthropogenic fire increase and land-use change combined with a natural change from subcontinental to more oceanic climate during the second half of the Holocene led to the disappearance of P. cembra in the study area, but favoured the occurrence of Picea abies and Alnus viridis. The mid- to late-Holocene decline of Abies alba was primarily a consequence of human impact, since this mesic species should have benefitted from a shift to more oceanic conditions. Future alpine vegetation changes will be a function of the amplitude and rapidity of global warming as well as human land use. Our results imply that alpine vegetation at our treeline pass site was never replaced by forests since the last ice-age. This may change in the future if anticipated climate change will induce upslope migration of trees. The results of this study emphasise the necessity of climate change mitigation in order to prevent biodiversity losses as a consequence of unprecedented community and species displacement in response to climatic change.

Global Change and the World's Mountain. Where are we coming from, and where are we going to?

The history of mountain research is most fascinating. Three names for 3 centuries may give an idea of the growing knowledge about the world's mountains: Horace Bénédict de Saussure, who climbed and studied the Mont Blanc in 1787; Alexander von Humboldt, ever investigating the environment during his attempt to ascend the Chimborazo in 1802; and Carl Troll, who founded the International Geographical Union's Commission on High-altitude Geoecology in 1968. Awareness of the growing impact of human activities on the environment led to scientific and political initiatives at the global level, beginning in the 1970s. The Perth conference in 2010 has offered an opportunity to both look back on these developments and explore the future of the world's mountains in a time of rapidly growing “global change” problems and processes.

Impact of suborbital climate changes in the North Atlantic on ice sheet dynamics at the Mid-Pleistocene Transition

[1] Early and Mid-Pleistocene climate, ocean hydrography and ice sheet dynamics have been reconstructed using a high-resolution data set (planktonic and benthicδ18O time series, faunal-based sea surface temperature (SST) reconstructions and ice-rafted debris (IRD)) record from a high-deposition-rate sedimentary succession recovered at the Gardar Drift formation in the subpolar North Atlantic (Integrated Ocean Drilling Program Leg 306, Site U1314). Our sedimentary record spans from late in Marine Isotope Stage (MIS) 31 to MIS 19 (1069–779 ka). Different trends of the benthic and planktonic oxygen isotopes, SST and IRD records before and after MIS 25 (∼940 ka) evidence the large increase in Northern Hemisphere ice-volume, linked to the cyclicity change from the 41-kyr to the 100-kyr that occurred during the Mid-Pleistocene Transition (MPT). Beside longer glacial-interglacial (G-IG) variability, millennial-scale fluctuations were a pervasive feature across our study. Negative excursions in the benthicδ18O time series observed at the times of IRD events may be related to glacio-eustatic changes due to ice sheets retreats and/or to changes in deep hydrography. Time series analysis on surface water proxies (IRD, SST and planktonicδ18O) of the interval between MIS 31 to MIS 26 shows that the timing of these millennial-scale climate changes are related to half-precessional (10 kyr) components of the insolation forcing, which are interpreted as cross-equatorial heat transport toward high latitudes during both equinox insolation maxima at the equator.

Analyzing, Capturing and Taming Software Change

Software systems need to continuously change to remain useful. Change appears in several forms and needs to be accommodated at different levels. We propose ChangeBoxes as a mechanism to encapsulate, manage, analyze and exploit changes to software systems. Our thesis is that only by making change explicit and manipulable can we enable the software developer to manage software change more effectively than is currently possible. Furthermore we argue that we need new insights into assessing the impact of changes and we need to provide new tools and techniques to manage them. We report on the results of some initial prototyping efforts, and we outline a series of research activities that we have started to explore the potential of ChangeBoxes.

[Impact of tobacco use on the periodontium--an update (I)--Part 1: Epidemiologic und pathogenetic aspects of tobacco-related periodontal diseases]

This literature review represents the second in a series of articles from the Swiss task force "Smoking--Intervention in the private dental office" on the topic "tobacco use and dental medicine". In this article, the epidemiological background as well as some pathogenetic processes are described and discussed critically for tobacco-related periodontal diseases. Earlier publications confirmed tobacco consumption as a risk factor for periodontal diseases. Over the last few years, oral health research has significantly contributed to the understanding of the mechanisms leading to the deterioration of the hard and soft tissues supporting the teeth. With the recording of the number of cigarettes smoked per day and the amount of years tobacco was used, a dose response relationship was established. Various, potentially significant pathogenic effects of tobacco-related substances may exist on the periodontal tissues, the immune response system or the composition of the oral flora. Moreover, there is reference that tobacco consumption may change the genetically determined susceptibility for periodontal diseases.