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The aim of this discussion paper is to show the way to the outdoors by shedding light on conditions in the physical environment enabling outdoor stays for older adults living in residential care facilities (RCFs). The origin was that outdoor stays is a basic human need and applies to everyone. However, despite extensive research on the health-promoting values of contact with the outdoors, it seems that for older adults in RCFs this is not met because they often have difficulty getting outdoors on their own. Therefore, the access to and the conditions of outdoor environments are discussed and exemplified through two cases based on evidence-based approaches, namely the principal model of four zones of contact with the outdoors, and the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM). An interdisciplinary team, including both researchers and practitioners highlights future directions by showing the way to the outdoors on a national level with six suggested points. As a reader, you will gain increased knowledge about environmental qualities that support outdoor stays as well as initiatives that are needed to achieve equal conditions related to outdoor stays in RCFs.

The bacterium Pseudomonas aeruginosa is involved in chronic infections of cystic fibrosis lungs and chronic wounds. In these infections the bacteria are present as aggregates suspended in host secretions. During the course of the infections there is a selection for mutants that overproduce exopolysaccharides, suggesting that the exopolysaccharides play a role in the persistence and antibiotic tolerance of the aggregated bacteria. Here, we investigated the role of individual P. aeruginosa exopolysaccharides in aggregate-associated antibiotic tolerance. We employed an aggregate-based antibiotic tolerance assay on a set of P. aeruginosa strains that were genetically engineered to over-produce a single, none, or all of the three exopolysaccharides Pel, Psl, and alginate. The antibiotic tolerance assays were conducted with the clinically relevant antibiotics tobramycin, ciprofloxacin and meropenem. Our study suggests that alginate plays a role in the tolerance of P. aeruginosa aggregates toward tobramycin and meropenem, but not ciprofloxacin. However, contrary to previous studies we did not observe a role for Psl or Pel in the tolerance of P. aeruginosa aggregates toward tobramycin, ciprofloxacin, and meropenem.

This article is about Nayib Bukele’s presidency in El Salvador, and to what extent it is a case of populism, and if it has contributed to a negative democratic development between 2019–2021. By using the concepts of democratic backsliding, autocratization, and populism, three main conclusions are made. First, actions taken by Bukele during his presidency has directly contributed to a negative democratic development. Second, both during the electoral campaign and in office, there are also signs of populism, such as anti-pluralism, hijacking the state, mass clientelism, and a feeling of a less democratic civil society and free media. Consequently, Bukele has pushed the country into a process of autocratization, where the future destiny toward less democracy is still uncertain.

Background In patients undergoing neurosurgeries, inflammation and infection are strongly related; however, inflammation can be present without infection. Midregional proadrenomedullin (MR-proADM) is a relatively new sepsis biomarker that is rarely used clinically. Recently, the concept of DiffTemp was introduced, that is, a >1°C rise from individual normal temperature accompanied by malaise, as a more accurate definition of temperature assessed as fever. The aim of the present study was to examine the importance of C-reactive protein (CRP), white blood cells, procalcitonin, and MR-proADM levels and DiffTemp. Methods This prospective, comparative study had a quantitative approach. Forty-two patients, aged >18 years and presenting with severe cerebral trauma were included from a neurosurgical intensive care unit. The outcome variable was infection; group 0, no infection (n=11); group 1, suspected infection (n=15); and, group 2, confirmed infection (n=16). Group assignments were performed using biomarkers, medical records, bacterial cultures, and International Classification of Diseases-10, and by the clinical assessment of criteria for nosocomial infections by a neurosurgeon. Results On comparing groups 1 and 2, MR-proADM and DiffTemp were associated with a higher risk of confirmed infection (odds ratio, 5.41 and 17.14, respectively). Additionally, DiffTemp had a 90.9% specificity in patients with no infection and a 93.8% sensitivity in patients with confirmed infections. CRP and procalcitonin levels were not associated with an increased risk of confirmed infection. Conclusion Increased levels of MR-proADM were associated with a higher risk of confirmed infection. DiffTemp was associated with a higher risk of having a confirmed infection.

Abstract Microbial biofilms are involved in a number of infections that cannot be cured, as microbes in biofilms resist host immune defenses and antibiotic therapies. With no strict biofilm-antibiotic in the current pipelines, there is an unmet need for drug candidates that enable the current antibiotics to eradicate bacteria in biofilms. We used high-throughput screening to identify chemical compounds that reduce the intracellular c-di-GMP content in Pseudomonas aeruginosa. This led to the identification of a small molecule that efficiently depletes P. aeruginosa for c-di-GMP, inhibits biofilm formation, and disperses established biofilm. A combination of our lead compound with standard of care antibiotics showed improved eradication of an implant-associated infection established in mice. Genetic analyses provided evidence that the anti-biofilm compound stimulates the activity of the c-di-GMP phosphodiesterase BifA in P. aeruginosa. Our work constitutes a proof of concept for c-di-GMP phosphodiesterase-activating drugs administered in combination with antibiotics as a viable treatment strategy for otherwise recalcitrant infections.

Abstract Our planet hosts a variety of highly diverse ecosystems. The persistence of high diversity is generally attributed to factors such as the structure of interactions among species and the dispersal of species in metacommunities. Here, we show that large contiguous landscapes—that are characterized by high dispersal—facilitate high species richness due to the spatial heterogeneity in interspecies interactions. We base our analysis on metacommunities under high dispersal where species densities become equal across habitats (spatially coherent). We find that the spatially coherent metacommunity can be represented by an effective species interaction‐web that has a significantly lower complexity than the constituent habitats. Our framework also explains how spatial heterogeneity eliminates differences in the effective interaction‐web, providing a basis for deviations from the area‐heterogeneity tradeoff. These results highlight the often‐overlooked case of high dispersal where spatial coherence provides a novel mechanism for supporting high diversity in large heterogeneous landscapes.

Introduction: Cranioplasty (CP) after decompressive craniectomy (DC) is a common neurosurgical procedure. Implementation of European Union (EU) directives recommending bacterial cultures before cryopreservation, lead to increased number of autologous bone flaps being discarded due to positive cultures. A new method for handling bone flaps prior to cryopreservation, including the use of pulsed lavage, was developed. Research question: The aim was to evaluate the effect of a new method on proportion of positive bacterial cultures and surgical site infection (SSI) following CP surgery. Material and methods: Sixty-one bone flaps from 53 consecutive DC surgery patients were retrospectively included and the study period was divided into before and after method implementation. Patient demographics, laboratory and culture results, type of CP and occurrence of SSI were analyzed. Results: Twenty-six and 18 bone flaps were available for analysis during the first and second period, respectively. The proportion of positive bacterial cultures was higher in the first period compared to the second (n ​= ​9(35%) vs 0(0%); p ​= ​0.001), and thus the use of custom made implants was considerably higher in the first study period (p ​= ​0.001). There was no difference in the frequency of post-cranioplasty SSI between the first and second study period (n ​= ​3 (11.5%) vs 1 (4.8%), p ​= ​0.408). Discussion and conclusion: The new method for handling bone flaps resulted in a lower frequency of positive bacterial cultures, without increased frequency of post-cranioplasty SSI, thus demonstrating it is safe to use, allows compliance with the EU-directives, and may reduce unnecessary discarding of bone flaps.

Understanding ecosystem stability and functioning is a long-standing goal in theoretical ecology, with one of the main tools being dynamical modelling of species abundances. With the help of spatially unresolved (well-mixed) population models and equilibrium dynamics, limits to stability and regions of various ecosystem robustness have been extensively mapped in terms of diversity (number of species), types of interactions, interaction strengths, varying interaction networks (for example plant-pollinator, food-web) and varying structures of these networks. Although many insights have been gained, the impact of spatial extension is not included in this body of knowledge. Recent studies of spatially explicit modelling on the other hand have shown that stability limits can be crossed and diversity increased for systems with spatial heterogeneity in species interactions and/or chaotic dynamics. Here we show that such crossing and diversity increase can appear under less strict conditions. We find that the mere possibility of varying species abundances at different spatial locations make possible the preservation or increase in diversity across previous boundaries thought to mark catastrophic transitions. In addition, we introduce and make explicit a multitude of different dynamics a spatially extended complex system can use to stabilise. This expanded stabilising repertoire of dynamics is largest at intermediate levels of dispersal. Thus we find that spatially extended systems with intermediate dispersal are more robust, in general have higher diversity and can stabilise beyond previous stability boundaries, in contrast to well-mixed systems. Author summary One of the major challenges facing humanity is the fragmentation of wildlife habitats and decline in biodiversity due to human land-use practices and need for resources. We need to find ways to combine human prosperity with biodiversity conservation. To achieve this a solid understanding of ecosystem stability and functioning is paramount. One way to gain such insight is to find limits when we expect species to go extinct or ecosystems to collapse by simulations of interacting species populations. Many such stability limits have been found theoretically the last decades, but for simplification of modelling, studies often exclude that ecosystems are spread out in space. Here, we explicitly include space and thus allow for dispersal and spatial heterogeneity (local differences) in species abundances. We find that for an ecosystem with the possibility of local spatial heterogeneity, the repertoire of the system’s dynamical behaviour increases dramatically. This increase in possibilities increases system robustness, enables limits previously marking extinction or collapse to be crossed without any remarkable change in global species abundances, and increases biodiversity. Thus we elucidate an additional mechanism pointing to spatial heterogeneity as crucial for ecosystem stability. We find intermediate dispersal as the most favourable for robustness and diversity of ecosystems since they display the largest repertoire of dynamical behaviour.

Implementation of an e-participation system in a low-income region with poor infrastructure, limited access to ICT and low awareness of civic rights and responsibilities, is challenging and requires thorough understanding of the contextual conditions and requirements. Present study provides a qualitative analysis of the implementation phase of an e-participation platform mapping the specific factors that play key roles in defining the access to and the use of the system by the citizens. Social and political context as well as the design and management of the platform are found to be the two crucial dimensions defining successful use of a platform.

Microbial biofilms are the cause of persistent infections associated with various medical implants and distinct body sites such as the urinary tract, lungs, and wounds. Compared with their free living counterparts, bacteria in biofilms display a highly increased resistance to immune system activities and antibiotic treatment. Therefore, biofilm infections are difficult or impossible to treat with our current armory of antibiotics. The challenges associated with biofilm infections have urged researchers to pursue a better understanding of the molecular mechanisms that are involved in the formation and dispersal of biofilms, and this has led to the identification of several steps that could be targeted in order to eradicate these challenging infections. Here we describe mechanisms that are involved in the regulation of biofilm development in Pseudomonas aeruginosa, Escherichia coli, and Acinetobacter baumannii, and provide examples of chemical compounds that have been developed to specifically inhibit these processes. These compounds include (i) pilicides and curlicides which inhibit the initial steps of biofilm formation by E. coli; (ii) compounds that interfere with c-di-GMP signaling in P. aeruginosa and E. coli; and (iii) compounds that inhibit quorum-sensing in P. aeruginosa and A. baumannii. In cases where compound series have a defined molecular target, we focus on elucidating structure activity relationship (SAR) trends within the particular compound series.

Screening of a Streptococcus mutans mutant library indicated that pgmA mutants displayed a reduced biofilm-associated tolerance toward gentamicin. The biofilms formed by the S. mutans pgmA mutant also displayed decreased tolerance towards linezolid and vancomycin compared to wild-type biofilms. On the contrary, the resistance of planktonic S. mutans pgmA cells to gentamycin, linezolid, and vancomycin was more similar to wild-type levels. Investigations of biofilms grown in microtiter trays and on submerged glass slides showed that pgmA mutants formed roughly the same amount of biofilm as the wild type, indicating that the reduced antimicrobial tolerance of these mutants is not due to diminished biofilm formation. The pgmA gene product is known to be involved in the synthesis of precursors for cell wall components such as teichoic acids and membrane glycolipids. Accordingly, the S. mutans pgmA mutant showed increased sensitivity to Congo Red, indicating that it has impaired cell wall integrity. A changed cell wall composition of the S. mutans pgmA mutant may play a role in the increased sensitivity of S. mutans pgmA biofilms toward antibiotics.

This article explores the development in Bolivia under president Evo Morales, through a critical postcolonial approach. From a traditional liberal perspective, this article concludes that the liberal democratic system under Morales has not been deepening, though certain new participatory aspects of democracy, including socio-economic reforms have been carried out. In contrast, this article analyses to what extent the presidency of Evo Morales may be seen as the end of the postcolonialism, and the beginning of a new era in which Bolivia’s indigenous people finally have been incorporated into the forward development of a multi-ethnic society. By analysing issues such as time, nation, land, space, globalization and language, the conclusion is that the new constitution marks a fresh beginning, one beyond the colonial and postcolonial eras, for indigenous groups, but it will not bring back the old indigenous societies as was dominating the territory of today’s modern state.

Chronic infection is associated with an increased risk of atherothrombotic disease and direct bacterial infection of arteries has been suggested to contribute to the development of unstable atherosclerotic plaques. In this study, we examined coronary thrombi obtained in vivo from patients with ST-segment elevation myocardial infarction (STEMI) for the presence of bacterial DNA and bacteria. Aspirated coronary thrombi from 22 patients with STEMI were collected during primary percutaneous coronary intervention and arterial blood control samples were drawn from radial or femoral artery sheaths. Analyses were performed using 16S polymerase chain reaction and with next-generation sequencing to determine bacterial taxonomic classification. In selected thrombi with the highest relative abundance of Pseudomonas aeruginosa DNA, peptide nucleic acid fluorescence in situ hybridization (PNA-FISH) with universal and species specific probes was performed to visualize bacteria within thrombi. From the taxonomic analysis we identified a total of 55 different bacterial species. DNA from Pseudomonas aeruginosa represented the only species that was significantly associated with either thrombi or blood and was >30 times more abundant in thrombi than in arterial blood (p

ObjectivesInfection remains a leading cause of post-transfusion mortality and morbidity. Bacterial contamination is, however, detected in less than 0.1% of blood units tested. The aim of the study was to identify viable bacteria in standard blood-pack units, with particular focus on bacteria from the oral cavity, and to determine the distribution of bacteria revealed in plasma and in the red blood cell (RBC)-fraction.DesignCross-sectional study. Blood were separated into plasma and RBC-suspensions, which were incubated anaerobically or aerobically for 7 days on trypticase soy blood agar (TSA) or blue lactose plates. For identification colony PCR was performed using primers targeting 16S rDNA.SettingBlood donors attending Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Hvidovre, Denmark, October 29th to December 10th 2013.Participants60 donors (≥50 years old), self-reported medically healthy.ResultsBacterial growth was observed on plates inoculated with plasma or RBCs from 62% of the blood donations. Growth was evident in 21 (35%) of 60 RBC-fractions and in 32 (53%) of 60 plasma-fractions versus 8 of 60 negative controls (p = 0.005 and p = 2.6x10-6, respectively). Propionibacterium acnes was found in 23% of the donations, and Staphylococcus epidermidis in 38%. The majority of bacteria identified in the present study were either facultative anaerobic (59.5%) or anaerobic (27.8%) species, which are not likely to be detected during current routine screening.ConclusionsViable bacteria are present in blood from donors self-reported as medically healthy, indicating that conventional test systems employed by blood banks insufficiently detect bacteria in plasma. Further investigation is needed to determine whether routine testing for anaerobic bacteria and testing of RBC-fractions for adherent bacteria should be recommended.

Periodontitis is a chronic, bacterially-induced inflammatory disease of the tooth-supporting tissues, which may result in transient bacteremia and a systemic inflammatory response. Periodontitis is associated with coronary artery disease independently of established cardiovascular risk factors, and translocation of bacteria from the oral cavity to the coronary arteries may play a role in the development of coronary artery disease. Very few studies have used angioplasty balloons for in vivo sampling from diseased coronary arteries, and with varying results. Therefore, the aim of this study was to assess if bacterial DNA from primarily oral bacteria could be detected on coronary angioplasty balloons by use of an optimized sampling process combined with an internally validated sensitive polymerase chain reaction (PCR) assay. Coronary angioplasty balloons and control samples from a total of 45 unselected patients with stable angina, unstable angina/non-ST elevation myocardial infarction, and ST-elevation myocardial infarction (n = 15 in each group) were collected and analyzed using a PCR assay with high sensitivity and specificity for 16S rRNA genes of the oral microbiome. Despite elimination of extraction and purification steps, and demonstration of sensitivity levels of 25-125 colony forming units (CFU), we did not detect bacterial DNA from any of the coronary angioplasty balloons. A subsequent questionnaire indicated that the prevalence of periodontitis in the study cohort was at least 39.5%. Although coronary angioplasty balloons are unlikely to be useful for detection of bacteria with current PCR techniques in unselected patients with coronary artery disease, more studies are warranted to determine the extent to which bacteria contribute to atherosclerosis and its clinical manifestations and whether the presence of bacteria in the arteries is a transient phenomenon.

We present a lattice gas technique for simulating molecular self-assembly of amphiphilic polymers in aqueous environments. Water molecules, hydrocarbons tail-groups and amphiphilic head-groups are explicitly represented on a three dimensional discrete lattice. Molecules move on the lattice proportional to their continuous momentum. Collision rules preserve momentum and kinetic energy. Potential energy from molecular interactions are also included explicitly. Non-trivial thermodynamics of large scale and long time dynamics are studied. In this paper we specifically demonstrate how, from a random initial distribution, micelles are formed, and grow until they destabilize and divide. Eventually a steady state of growing and dividing micelles is formed.