Broader perspective on ecosystem sustainability: Consequences for decision making

Although the concept of ecosystem sustainability has a long-term focus, it is often viewed from a static system perspective. Because most ecosystems are dynamic, we explore sustainability assessments from three additional perspectives: resilient systems; systems where tipping points occur; and systems subject to episodic resetting. Whereas foundations of ecosystem resilience originated in ecology, recent discussions have focused on geophysical attributes, and it is recognized that dynamic system components may not return to their former state following perturbations. Tipping points emerge when chronic changes (typically anthropogenic, but sometimes natural) push ecosystems to thresholds that cause collapse of process and function and may become permanent. Ecosystem resetting occurs when episodic natural disasters breach thresholds with little or no warning, resulting in long-term changes to environmental attributes or ecosystem function. An example of sustainability assessment of ecosystem goods and services along the Gulf Coast (USA) demonstrates the need to include both the resilient and dynamic nature of biogeomorphic components. Mountain road development in northwest Yunnan, China, makes rivers and related habitat vulnerable to tipping points. Ecosystems reset by natural disasters are also presented, emphasizing the need to understand the magnitude frequency and interrelationships among major disturbances, as shown by (i) the 2011 Great East Japan Earthquake and resulting tsunami, including how unsustainable urban development exacerbates geodisaster propagation, and (ii) repeated major earthquakes and associated geomorphic and vegetation disturbances in Papua New Guinea. Although all of these ecosystem perturbations and shifts are individually recognized, they are not embraced in contemporary sustainable decision making.     

Estimating Alcohol Content of Traditional Brew in Western Kenya Using Culturally Relevant Methods: The Case for Cost Over Volume

Traditional homemade brew is believed to represent the highest proportion of alcohol use in sub-Saharan Africa. In Eldoret, Kenya, two types of brew are common: chang’aa, spirits, and busaa, maize beer. Local residents refer to the amount of brew consumed by the amount of money spent, suggesting a culturally relevant estimation method. The purposes of this study were to analyze ethanol content of chang’aa and busaa; and to compare two methods of alcohol estimation: use by cost, and use by volume, the latter the current international standard. Laboratory results showed mean ethanol content was 34% (SD = 14%) for chang’aa and 4% (SD = 1%) for busaa. Standard drink unit equivalents for chang’aa and busaa, respectively, were 2 and 1.3 (US) and 3.5 and 2.3 (Great Britain). Using a computational approach, both methods demonstrated comparable results. We conclude that cost estimation of alcohol content is more culturally relevant and does not differ in accuracy from the international standard.     

Direct placental effects of cigarette smoke protect women from pre-eclampsia: the specific roles of carbon monoxide and antioxidant systems in the placenta

Pre-eclampsia is a hypertensive disorder of pregnancy characterized by shallow placentation, inadequate placental perfusion, localized placental oxidative stress, a heightened maternal inflammatory response and subsequent maternal endothelial dysfunction. This pathophysiology leads to an increase in maternal blood pressure, edema and proteinurea. Interestingly, women who smoke cigarettes throughout pregnancy are at a 33% reduced risk of developing this disorder. The exact mechanisms through which cigarette smoke reduces the risk of pre-eclampsia are not yet understood. We propose that cigarette smoke reduces the risk of developing pre-eclampsia via direct placental effects. In this review we will address, and provide evidence for, our specific hypotheses that: (a) CO increases trophoblast invasion and spiral arteriole remodeling; (b) CO decreases a localized inflammatory response at the level of the decidua; (c) CO increases utero-placental, intra-placental and feto-placental blood flow; (d) CO decreases hypoxia-induced apoptosis of the syncitiotrophoblast layer; (e) CO activates hemoproteins involved in normal endothelial functioning normally acted upon by NO; (f) compound(s) within cigarette smoke result in upregulation of antioxidant systems within the placenta. These various mechanisms of action must be further examined as they may provide valuable keys to novel therapeutic design in the realm of pre-eclampsia research.     

AMPATH: Living Proof that No One Has to Die from HIV

Background and Objective The HIV/AIDS epidemic in sub-Saharan Africa is decimating populations, deteriorating economies, deepening poverty, and destabilizing traditional social orders. The advent of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) made significant supplemental resources available to sub-Saharan national programs for the prevention and treatment of HIV/AIDS, but few programs have demonstrated the capacity to use these resources to increase rapidly in size. In this context, AMPATH, a collaboration of Indiana University School of Medicine, the Moi University School of Medicine, and the Moi Teaching and Referral Hospital in Eldoret, Kenya, is a stunning exception. This report summarizes findings from an assessment of AMPATH staff perceptions of how and why this has happened. Participants and Approach Semistructured, in-depth, individual interviews of 26 AMPATH workers were conducted and recorded. Field notes from these interviews were generated by independent reviewers and subjected to close-reading qualitative analysis for themes. Results The themes identified were as follows: creating effectively, connecting with others, making a difference, serving those in great need, providing comprehensive care to restore healthy lives, and growing as a person and a professional. Conclusion Inspired personnel are among the critical assets of an effective program. Among the reasons for success of this HIV/AIDS program are a set of work values and motivations that would be helpful in any setting, but perhaps nowhere more critical than in the grueling work of making a complex program work spectacularly well in the challenging setting of a resource-poor country. Sometimes, even in the face of long odds, the human spirit prevails. This work was presented as a poster at the SGIM national meeting in Toronto, CA, April 26, 2007.     

Determination of shear strength of periosteum attached to bone with BioGlue Surgical Adhesive

OBJECTIVE: To determine the shear strength of BioGlue Surgical Adhesive (Cryolife Inc, Kennesaw, Georgia) for use in periosteal fixation in endoscopic browplasty. METHODS: In a controlled design, the shear strength of periosteal attachment to native bone and that of dissected periosteum affixed to bone with BioGlue surgical adhesive was physiologically determined. Twenty-one periosteum and bone samples were harvested from 3 human cadavers. These samples were tested for maximum shear strength using an Instron Model 5500 universal materials testing machine. Native samples consisted of periosteum still attached to the bone surface, while BioGlue samples consisted of dissected periosteum reattached to the bone surface using BioGlue surgical adhesive. The maximum shear strength attained for each sample was recorded and used to determine if native samples differed from those using BioGlue surgical adhesive. RESULTS: The mean (SD) maximum shear strength values obtained during testing were 57.8 (31.7) kPa and 45.9 (27.4) kPa (589.4 [323.3] gram force [gf]/cm(2) and 468.0 [279.4] gf/cm(2)) for native (n = 8) and BioGlue (n = 9) samples, respectively. There was no statistical difference between the native and BioGlue samples (P > .05) using analysis of variance. CONCLUSION: This study demonstrates that the adhesive properties of BioGlue are similar to the strength of attachment of native periosteum to bone and supports the use of BioGlue as an alternative method of fixation for use in endoscopic brow-lifting.     

手术治疗部分性癫痫患儿的远期疗效研究

目的：探讨手术治疗部分性癫痫患儿的远期疗效。方法回顾性分析2005年6月至2008年6月在斯坦伦布什大学泰格堡儿童医院该院接受外科手术治疗的158例部分性癫痫患儿的临床资料,观察患儿术后生活质量、智商改善及癫痫控制情况,并对影响手术远期疗效的相关因素进行分析。结果术后对患儿随访5年,158例患儿术后1、3、5年癫痫控制率分别为100．00％、94．85％、94．35％,其中MRI结果及病程是影响癫痫控制率的独立危险因素。智商1、3、5年改善率分别为89．87％、89．71％、88．71％,其中病程、手术年龄是影响患儿智商改善效果的独立危险因素。术后1、3、5年生活质量改善率分别为93．04％、91．18％、90．32％,其中术前智商、手术方式是影响患儿术后生活质量的独立危险因素。结论尽早对患儿实施手术,改善患儿病灶范围,能有效控制癫痫发作,改善患儿智商水平,提高患儿术后生活质量。     

Keloids: prevention and management

Keloids result from an abnormal wound-healing process in which the normal regulatory pathways during tissue regeneration and scar remodeling are disrupted. While the pathogenesis of keloids continues to be investigated, numerous treatment options exist. Although prevention of keloid formation is the best management, early recognition of keloid formation is integral in treatment and prevention of recurrence. Surgical resection with adjuvant silicone gel sheeting or triamcinolone injection is common, but can still result in recurrence. New treatments include chemotherapeutics such as 5-fluorouracil, bleomycin, and mitomycin C. Although further clinical investigation is required for newer treatments, initial results are promising.