Concurrent Clostridium septicum bacteremia and colorectal adenocarcinoma with metastasis to the brain - A Case Report.

There is a known relationship between Clostridium septicum bacteremia and colorectal malignancies. C. septicum is a gram-positive, anaerobic, spore-forming bacterium that can survive the acidic colorectal tumor microenvironment, where it is thought to enter the blood by tumor-mediated epithelial tissue damage. While in circulation, C. septicum can release exotoxins which may lead to life-threatening sepsis. The patient in this case presented with a mild fever, abdominal pain, and left hand weakness. Imaging of the head and abdomen revealed a right frontal lucency and wall thickening of the ascending colon. Two colonic adenocarcinomas were found and removed via an exploratory laparotomy and right hemicolectomy. The blood culture was positive for C. septicum. Brain MRI confirmed a right frontal mass concerning for metastasis. Here, we discuss the relationship between colonic cancers and Clostridium septicum bacteremia.

A 10-Year Analysis of 3693 Craniotomies during a Transition to Multidisciplinary Teams, Protocols, and Pathways.

INTRODUCTION: A Cochrane review of teams, protocols, and pathways demonstrated improved care efficiency and outcomes over a traditional model. Little is known about this approach for craniotomy. METHODS: This observational study involved sequential implementation of a multidisciplinary team, protocols, and a craniotomy pathway. Data on 3693 admissions were retrospectively reviewed at a tertiary care neurosurgery center from 2008 to 2017 for the top 6 diagnosis-related group codes. In June 2016, a searchable discharge summary template in the electronic medical record was implemented to capture data regarding quality, efficiency, and outcomes. RESULTS: Staffing transitioned to a team of neurosurgeons, neurointensivists, neurohospitalists, and midlevel practitioners. Order sets, protocols, and pathways were developed. Quality improvements were observed for craniotomy and cranioplasty surgical site infections, ventriculitis, coagulopathy reversal, and decompressive hemicraniectomy rates for stroke. Case volume increased 73%, yet craniotomy hospital days decreased from 2768 in 2008 to 2599 in 2017 because of reduced length of stay. We accommodated service line growth without hospital expansion or case backlogs. With an average California hospital day rate of $3341, the improved length of stay decreased costs by $14,666,990/y. We also present outcomes data, including craniotomy indications, operative timing, complications, functional outcomes, delays in discharge, and discharge destinations using the craniotomy discharge summary. CONCLUSION: Multidisciplinary teams, protocols, and pathways reduced craniotomy complication rates, improved hospital length of stay by 63%, reduced costs, and increased professional collegiality and satisfaction. A searchable craniotomy discharge summary is an important tool for continuous monitoring of quality and efficiency of care.

Ciguatera fish poisoning in la Habana, Cuba: a study of local social-ecological resilience.

Following the collapse of the Cuban economy in the early 1990s, epidemiologists in the Cuban Ministry of Health noticed dramatic increases in reported outbreaks of ciguatera fish poisoning (CFP) in some coastal communities. This article summarizes the results of a comparative case study which applied an ecosystem approach to human health to investigate this issue. Situated learning and complexity theories were used to interpret the results of the investigation. CFP outbreaks are influenced by a complex set of interactions between ecological and socioeconomic processes. This study found that the level of organization of the local sports fishing community and the degree of degradation of the local nearshore marine ecosystem appear to be key factors influencing the diverging levels of CFP outbreaks recorded in the 1990s in the communities studied.

Effect of smoke inhalation on viscoelastic properties and ventilation distribution in sheep.

Smoke inhalation injuries are the leading cause of mortality from burn injury. Airway obstruction due to mucus plugging and bronchoconstriction can cause severe ventilation inhomogeneity and worsen hypoxia. Studies describing changes of viscoelastic characteristics of the lung after smoke inhalation are missing. We present results of a new smoke inhalation device in sheep and describe pathophysiological changes after smoke exposure. Fifteen female Merino ewes were anesthetized and intubated. Baseline data using electrical impedance tomography and multiple-breath inert-gas washout were obtained by measuring ventilation distribution, functional residual capacity, lung clearance index, dynamic compliance, and stress index. Ten sheep were exposed to standardized cotton smoke insufflations and five sheep to sham smoke insufflations. Measured carboxyhemoglobin before inhalation was 3.87 +/- 0.28% and 5 min after smoke was 61.5 +/- 2.1%, range 50-69.4% (P < 0.001). Two hours after smoke functional residual capacity decreased from 1,773 +/- 226 to 1,006 +/- 129 ml and lung clearance index increased from 10.4 +/- 0.4 to 14.2 +/- 0.9. Dynamic compliance decreased from 56.6 +/- 5.5 to 32.8 +/- 3.2 ml/cmH(2)O. Stress index increased from 0.994 +/- 0.009 to 1.081 +/- 0.011 (P < 0.01) (all means +/- SE, P < 0.05). Electrical impedance tomography showed a shift of ventilation from the dependent to the independent lung after smoke exposure. No significant change was seen in the sham group. Smoke inhalation caused immediate onset in pulmonary dysfunction and significant ventilation inhomogeneity. The smoke inhalation device as presented may be useful for interventional studies.

Co-management of natural resources: a proposed framework.

Co-management acknowledges pragmatic developments and progression of institutional choice theories in natural resource management. This innovative concept embraces a pluralistic management approach based on the principle of subsidiarity and creates opportunities for the reconciliation of competitive property claims. This article reviews definitions of co-management, distinguishes it from other property rights regimes, and develops an organizational structure of the major elements involved. Synthesis of both experiences and literature leads to the development of a conceptual framework. Co-management is structured in terms of context, components, and linking mechanisms. In concert, these elements offer insight into the practice of co-management, address the shortcomings of institutional theories, and respond to critical issues raised in related literature. The framework contributes to natural resource management by acting as a means of identification and evaluation for such arrangements, as well as a systematic guide for future inquiries.

Some observations on the terminology in co-operative environmental management.

The notion of managing resources in partnership flourishes in natural resources literature. The terms partnership, collaboration, and co-management are associated with co-operative environmental management. Examining issues of definition reveals similarities, differences and, at times, imprecise use of the three terms. The potential for clarity prompts the proposal of a multi-dimensional model of co-operative environmental management. The model consists of three key dimensions. The first dimension reflects the extent power is shared among the actors and agencies involved in the agreement. The second dimension delineates who is involved in the management regime. Process, the final dimension, reflects the variety of ways in which co-management may function or proceed. The presented model highlights dimensions requiring attention by those working within co-operative environmental management. The model is valuable as it reflects the complexity and range of such arrangements in practice.