Voluntary sustainability standards could significantly reduce detrimental impacts of global agriculture.

Voluntary sustainability standards (VSS) are stakeholder-derived principles with measurable and enforceable criteria to promote sustainable production outcomes. While institutional commitments to use VSS to meet sustainable procurement policies have grown rapidly over the past decade, we still have relatively little understanding of the (i) direct environmental benefits of large-scale VSS adoption; (ii) potential perverse indirect impacts of adoption; and (iii) implementation pathways. Here, we illustrate and address these knowledge gaps using an ecosystem service modeling and scenario analysis of Bonsucro, the leading VSS for sugarcane. We find that global compliance with the Bonsucro environmental standards would reduce current sugarcane production area (-24%), net tonnage (-11%), irrigation water use (-65%), nutrient loading (-34%), and greenhouse gas emissions from cultivation (-51%). Under a scenario of doubled global sugarcane production, Bonsucro adoption would further limit water use and greenhouse gas emissions by preventing sugarcane expansion into water-stressed and high-carbon stock ecosystems. This outcome was achieved via expansion largely on existing agricultural lands. However, displacement of other crops could drive detrimental impacts from indirect land use. We find that over half of the potential direct environmental benefits of Bonsucro standards under the doubling scenario could be achieved by targeting adoption in just 10% of global sugarcane production areas. However, designing policy that generates the most environmentally beneficial Bonsucro adoption pathway requires a better understanding of the economic and social costs of VSS adoption. Finally, we suggest research directions to advance sustainable consumption and production.

Consistent fractionation of 13C in nature and in the laboratory: growth-rate effects in some haptophyte algae.

The carbon isotopic fractionation accompanying formation of biomass by alkenone-producing algae in natural marine environments varies systematically with the concentration of dissolved phosphate. Specifically, if the fractionation is expressed by epsilon p approximately delta e - delta p, where delta e and delta p are the delta 13C values for dissolved CO2 and for algal biomass (determined by isotopic analysis of C37 alkadienones), respectively, and if Ce is the concentration of dissolved CO2, micromole kg-1, then b = 38 + 160*[PO4], where [PO4] is the concentration of dissolved phosphate, microM, and b = (25 - epsilon p)Ce. The correlation found between b and [PO4] is due to effects linking nutrient levels to growth rates and cellular carbon budgets for alkenone-containing algae, most likely by trace-metal limitations on algal growth. The relationship reported here is characteristic of 39 samples (r2 = 0.95) from the Santa Monica Basin (six different times during the annual cycle), the equatorial Pacific (boreal spring and fall cruises as well as during an iron-enrichment experiment), and the Peru upwelling zone. Points representative of samples from the Sargasso Sea ([PO4] < or = 0.1 microM) fall above the b = f[PO4] line. Analysis of correlations expected between mu (growth rate), epsilon p, and Ce shows that, for our entire data set, most variations in epsilon p result from variations in mu rather than Ce. Accordingly, before concentrations of dissolved CO2 can be estimated from isotopic fractionations, some means of accounting for variations in growth rate must be found, perhaps by drawing on relationships between [PO4] and Cd/Ca ratios in shells of planktonic foraminifera.

Active macrophage-associated TGF-beta co-localizes with type I procollagen gene expression in atherosclerotic human pulmonary arteries.

Vascular remodeling in adult atherosclerotic pulmonary arteries is characterized by discrete areas of neointimal smooth muscle cell extracellular matrix gene expression in close proximity to non-foamy macrophages, suggesting regulation by local macrophage-associated factors. The purpose of these studies was to begin addressing the role of putative macrophage-associated factors such as transforming growth factor-beta (TGF-beta), by determining the spatial relationship between TGF-beta and neointimal matrix gene expression in human atherosclerotic pulmonary arteries. For example, the participation of TGF-beta in vascular remodeling could be inferred by its colocalization with non-foamy macrophages in areas of active matrix synthesis. In situ hybridization and immunohistochemistry demonstrated focal neointimal procollagen gene expression in close association with non-foamy but not foamy macrophages. Immunohistochemistry with isoform-specific anti-TGF-beta antibodies demonstrated all three isoforms of TGF-beta associated with non-foamy macrophages, but foamy macrophages were not immunoreactive. Neointimal and medial smooth muscle cells stained lightly. In contrast, intense TGF-beta immunoreactivity was also associated with medial smooth muscle cells in normal nonremodeling vessels. Immunohistochemistry with antibodies specific for latent TGF-beta was similar to immunohistochemistry for mature TGF-beta in both remodeling and nonremodeling vessels. Finally, using an antibody specific for active TGF-beta 1, immunoreactivity was only seen in non-foamy neointimal macrophages but not in foamy macrophages or medial smooth muscle cells from hypertensive or normal vessels. These observations suggest non-foamy macrophages may participate in modulating matrix gene expression in atherosclerotic remodeling via a TGF-beta-dependent mechanism.

Multiple myeloma presenting with Hemophilus influenzae septic arthritis: case report and review of the literature.

This article reports a case of pyogenic arthritis with Hemophilus influenzae in a previously healthy woman. This infection was the initial manifestation of an underlying serious systemic illness, multiple myeloma. Certain laboratory parameters as well as the causative organism suggested the underlying disease. Although infections are common in patients with known multiple myeloma, certain infections can provide a hint to concomitant serious systemic diseases and thus facilitate their early diagnosis.

Clinical, social and ethical aspects of HIV-1 infections in an Arab Gulf State.

Clinical, social and ethical aspects of HIV-1 infection as occurring in the Arab Gulf State of Qatar are presented. Up until November 1989, 50 patients were reported with HIV infection. In more than 75% of cases, the disease was acquired via transfusion of imported blood; 52% have developed AIDS and 65% of these have died. In response to the problem, the Ministry of Health has established a National AIDS Committee whose major function has been to educate both the medical profession and lay public about the disease and on ways to prevent its spread. Furthermore, the Committee has also taken on the role of patient advocate and has been instrumental in resolving many HIV-related difficulties in the community at large. Specialized HIV clinics have also been set up, with both Qatari and expatriate patients being enrolled in treatment programmes. No expatriate patient has been deported due to infection with HIV. Although many social and ethical issues remain unresolved, it appears that a rational and humane public health policy has been adopted in Qatar with respect to the AIDS threat.

PIP: Described is how the National AIDS Committee of the Arab Gulf State of Qatar has managed medical and public education, screening of immigrant workers, and treatment of HIV-infected persons and AIDS cases. Qatar is unusual for being a rapidly emerging Bedouin Muslim culture with a majority of guest workers, and comprehensive, free, state-of-the-art health care. There were 50 HIV+ patients as of 1989, of whom 52% developed AIDS, and 65% of these have died. After an 18-year old girl with no risk factors except having been transfused with imported blood got AIDS in 1984, all transfused persons were screened. The 50 (26 native Qatari) with HIV included 28 males and 22 females, 31 adults and 19 children under 15. 38 were infected by transfusion, 6 were children of infected mothers, 2 were infected abroad, and the source of infection in 2 men was unknown. 17 have dies, and 3 left Qatar. The Qatar National AIDS Committee is educating the medical profession and the public with press releases, news and television interviews, a brochure, and teaching conferences. Weekly HIV clinics, called "Immunocompromised Host Clinics" are conducted by Board Certified Infectious Disease Physicians, trained nurses, and a dedicated social worker. The AIDS Committee has acted as patient advocate for delicate situations such as school attendance, a divorce, a prison inmate, and objections of health care workers. All patients receive azidothymidine and several are receiving pentamidine. There are special cultural issues, such as difficulty in getting informed consent from illiterate nationals, getting compliance from fatalistic fundamentalist Muslims on contraception. While struggling to design the most humane AIDS policy for natives and expatriate workers, Qatar has opposed the WHO recommendations by screening and refusing entry of infected immigrants.

High prevalence of human immunodeficiency virus infection in children with thalassemia exposed to blood imported from the United States.

PIP: 38.5% or 10 of 26 children with thalassemia who had received blood transfusion have tested positive for HIV at the Hamad General Hospital, Doha, Qatar. Blood for transfusion was obtained from commercial suppliers in Miami, Florida, since late 1970. Since December 1985 all blood for transfusion has been tested for HIV for ELISA kits from Abbott Laboratories, Chicago, Ill, and confirmed by Western Blot. These children ranged from 3-13 years old, mean 7.7, and had received an average of 63.5 transfusions. All had been given at least 30 transfusions. Children testing negative for HIV averaged 35.0 lifetime transfusions. 4 of the affected children had persistent generalized lymphadenopathy, but no other symptoms were recorded.^ieng

Legionella micdadei (Pittsburgh pneumonia agent). Two infections with unusual clinical features.

We describe herein the clinical features, diagnosis, and successful treatment of two patients with Legionella micdadei pneumonia, the Pittsburgh pneumonia agent. The rapid pulmonary cavitation and relapse of symptoms after a course of therapy in a renal transplant recipient, and the prolonged illness with hemorrhagic pleural fluid, splenomegaly, and multiple-organ dysfunction in a nonimmunocompromised host, illustrate the clinical spectrum of infections with this organism.

Concurrent legionnaires' disease and active pulmonary tuberculosis.

A 68-yr-old man was admitted to the hospital with severe Legionnaires' disease, which was serologically confirmed by a 6-fold increase in antibody titers to Legionella pneumophila, serogroup 1. The patient improved dramatically with intravenously administered erythromycin therapy but was discharged from the hospital with residual debility and pulmonary complaints later recognized as being caused by active pulmonary tuberculosis. The diagnostic and therapeutic confusion engendered by the concurrence of these pulmonary infections is discussed.

Epidemiologic features of Strongyloides stercoralis infection in an endemic area of the United States.

The epidemiologic features of Strongyloides stercoralis infection in Kentucky were studied by an analysis of clinical cases at the University of Kentucky Medical Center (UKMC); by an analysis of parasitologic records of the Kentucky Bureau for Health Services (KBHS); and by a prospective stool survey of school children in Clay County, located in southeastern Kentucky, an area of the state previously found to be highly endemic for intestinal parasites. S. stercoralis was the most common parasitic infection diagnosed at UKMC. The patients were predominantly white male adults who were over 50 years old, had an associated chronic or debilitating medical illness, were of low socioeconomic background, and resided in southeastern Kentucky. S. stercoralis was a common parasitic infection at KBHS ad the patients showed a similar geographic distribution. Of 561 Clay County children surveyed, 23.7% harbored one or more intestinal parasite pathogens and 3.0% had S. stercoralis. Thus, S. stercoralis remains highly endemic in Kentucky and may cause disease even in geriatric patients.

Clinical features of Strongyloides stercoralis infection in an endemic area of the United States.

Infection with Strongyloides stercoralis, the most common intestinal parasite at our hospital, was encountered in 56 patients over a 3-yr period. The majority of the patients were male adults over 50 years old who had a chronic debilitating associated illness; about half the patients were immunocompromised. Strongyloidiasis was usually a chronic relapsing illness of mild to moderate severity characterized by gastrointestinal complaints (diarrhea, pain, tenderness, nausea, vomiting) and peripheral eosinophilia. Hypoalbuminemia also occurred. Stool examination for larvae was an effective method of diagnosing the parasite, and treatment with thiabendazole was usually successful. The frequent occurrence of S. stercoralis in geriatric patients with other medical problems and the delays in making the diagnosis suggest that the clinical spectrum of strongyloidiasis is greater than generally appreciated by the medical profession. Increased awareness of S. stercoralis is important to prevent the hyperinfection syndrome, which was estimated to occur in 1.5-2.5% of our patients.

Comparison of histological and immunological techniques for detection of Pneumocystis carinii in rat bronchial lavage fluid.

We compared histological and immunological techniques in the early diagnosis of Pneumocystis carinii pneumonia in bronchial lavage fluid of steroid-treated rats. The rats were sacrificed weekly and lavage fluids were: (i) examined with cresyl echt violet and Giemsa stains; (ii) examined for P. carinii antigens by indirect fluorescent-antibody, counterimmunoelectrophoresis, and double-diffusion techniques, using high-titer spectific antisera to P. carinii raised in rabbits. P. carinii was detected in lavage fluid by cresyl echt violet at 2 weeks of steroids and persisted even with steroid tapering; the intensity of the infection in lavage fluid closely paralleled that in the lungs. P. carinii was not detected in lavage by Giemsa stain until 4 weeks and disappeared from the fluids with steroid tapering. P. carinii was detected by indirect fluorescent antibody as early as 1 week of steroids, and the results correlated well with those of cresyl echt violet. P. carinii antigens were not detected in lavage fluids or serum by counterimmunoelectrophoresis or double-diffusion techniques. Although precipitin lines sometimes occurred, they were nonspecific. In this model, cresyl echt violet and indirect fluorescent antibody were the preferred techniques for the early diagnosis of P. carinii infection in bronchial lavage fluid.

Growth characteristics and pathogenesis of experimental Pneumocystis carinii pneumonia.

Pneumocystis carinii pneumonia was produced in two groups of rats by the administration of corticosteroids, a low-protein (8%) diet, and tetracycline in the drinking water. A third group not on corticosteroids or a low-protein diet served as controls. Members of the first group were sacrificed weekly for 8 weeks, and lungs were examined. A highly significant correlation was found between the histopathological assessment of the intensity of P. carinii infection and the number of cysts counted in enzyme-digested lungs. P. carinii progressively filled alveoli, and cyst counts increased from less than or equal to 10(4) to 10(9) cysts/g of lung at peak intensity of infection at 7 to 8 weeks. The second group of rats was placed on a regular diet and tapering doses of corticosteroids after week 4, and they were sacrificed at varying intervals for up to 21 weeks. P. carinii was not cleared from the lungs until after week 13 (more than 6 weeks after discontinuation of all steroids). Histologically, there was an increased prominence of alveolar macrophages and the progressive development of interstitial mononuclear cell infiltrate and fibrosis. Thus, P. carinii grows grows slowly in vivo and interacts with specific host cells. The resulting changes may be important in the pathogenesis of the infection and in the clearance of the organism from the lung after immunocompetence has been restored.

Treatment of Pneumocystis carinii pneumonia with trimethoprim-sulfamethoxazole and pentamidine: efficacy and toxicity.

A 39-year-old man with Pneumocystis carinii pneumonia responded poorly to oral trimethoprim-sulfamethoxazole (TMP-SMX) therapy, despite excellent serum concentrations of the drug. He developed severe thrombocytopenia when pentamidine was added to the regimen. This case illustrates problems of drug efficacy and toxicity in the treatment of P carinii pneumonia and suggests caution in the use of TMP-SMX and pentamidine in combination.

Presumed respiratory syncytial virus pneumonia in an adolescent compromised host.

A 15-year-old boy with nephrotic syndrome, renal insufficiency, and cutaneous anergy had severe pneumonia with pleural effusion. There was serologic evidence of respiratory syncytial virus infection, and extensive microbiologic, histologic, and serologic studies failed to identify any other etiologic agent. Respiratory syncytial virus as a possible cause of severe pneumonia in immunocompromised hosts has not been previously reported.

Pasteurella multocida pneumonia and bacteremia.

A 76-year-old man with chronic obstructive pulmonary disease who developed P multocida pneumonia and bacteremia has been described. The infection was treated with antibiotics, and the patient recovered. Pasteurella multocida is known to infect many species of animals. The instances of human infection due to this organism are frequently associated with exposure to animals. Pulmonary infection occurs principally in patients with underlying chronic bronchopulmonary disease.