The Paleozoic origin of enzymatic lignin decomposition reconstructed from 31 fungal genomes

Wood is a major pool of organic carbon that is highly resistant to decay, owing largely to the presence of lignin. The only organisms capable of substantial lignin decay are white rot fungi in the Agaricomycetes, which also contains non-lignin-degrading brown rot and ectomycorrhizal species. Comparative analyses of 31 fungal genomes (12 generated for this study) suggest that lignin-degrading peroxidases expanded in the lineage leading to the ancestor of the Agaricomycetes, which is reconstructed as a white rot species, and then contracted in parallel lineages leading to brown rot and mycorrhizal species. Molecular clock analyses suggest that the origin of lignin degradation might have coincided with the sharp decrease in the rate of organic carbon burial around the end of the Carboniferous period.

Childhood injuries: issues for the family physician

Injuries are the most frequent cause of death during childhood. Nonfatal injuries occur at least 1,300 times more frequently than fatal injuries, and in any given year about one in every five children sustains an injury that requires medical attention. The injuries for which a child is at risk are influenced by age, cognitive and motor skills, and environment. Childhood injury prevention counseling by physicians can be effective in altering both the parent's and the child's behavior and in modifying the environment to reduce the risk of injury. Family physicians provide a large portion of the preventive and injury-related health care of children and should make office-based safety education a prominent part of their practices.

Prior approval in the pediatric emergency room

Managed-care plans for low-income Americans are widely promoted to improve the quality and control the cost of medical care by reducing unnecessary specialty and emergency room (ER) care through the use of primary care physicians as case managers/gatekeepers. The purpose of this study was to evaluate one element of managed care, gatekeeping prior approval, for children who use the pediatric ER of one urban public hospital. Over a 6-month period, 518 children and adolescents insured under managed-care plans that required authorization from the primary care physician to receive treatment presented to the ER. Of the 385 records reviewed for this study, the majority (87%) received their primary care at community health centers or the hospital's own outpatient clinics. Most ER visits (72%) were made when primary care sites were closed. According to nursing triage assessment, 57% presented with urgent or emergent conditions, and 26% had a history of chronic illness. Nine percent required hospitalization. Although an elaborate system for gatekeeping was established, only 13 (3%) patients' requests for ER care were denied. Of these, 3 were seen in the ER without authorization, 6 received the recommended follow-up, and 4 were not seen in follow-up. Twenty-nine participating primary care physicians (74%) and 19 ER staff (63%) responded to a survey of their experience with and attitudes toward prior approval. For a variety of reasons, the majority of primary care physicians and ER staff found the gatekeeping policies for after-hours visits burdensome and inappropriate.(ABSTRACT TRUNCATED AT 250 WORDS)

Unsuspected cocaine exposure in young children

OBJECTIVE

To determine the prevalence of cocaine exposure among preschool children with clinically unsuspected signs and/or symptoms.

DESIGN

Prevalence study.

SETTING

Pediatric emergency department in an inner-city hospital.

PARTICIPANTS

250 children aged 2 weeks to 5 years who underwent urine assays for cocaine prior to discharge from the emergency department.

INTERVENTIONS

None.

MEASUREMENTS/MAIN RESULTS

Six (2.4%) of the 250 urine assays (95% confidence interval, 0.5% to 4.3%) were positive for benzoylecgonine, the major urinary cocaine metabolite. Four of the positive urine assays were from children younger than 1 year and all children with positive urine assays were younger than 24 months. None of these children presented with a complaint or was identified as having clinical problems currently associated with childhood exposure to cocaine. Possible exposure routes include breastfeeding, intentional administration, accidental ingestion of cocaine or cocaine-contaminated household dust via normal hand-to-mouth activity, and passive inhalation of "crack" vapors.

CONCLUSION

Among the inner-city children served by this hospital, significant numbers of infants and young children are being exposed to cocaine, and this exposure occurs in a clinically unsuspected population.