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Decompensated cirrhosis predisposes to infectious diseases and acute-on-chronic liver failure (ACLF) in critically ill patients. Infections like spontaneous bacterial peritonitis (SBP) are frequently associated with multi-organ failure and increased mortality. Consequently, reliable predictors of outcome and early diagnostic markers of infection are needed to improve individualized therapy. This study evaluates the prognostic role of ascitic interleukin 6 in 64 patients with cirrhosis admitted to our intensive care unit (ICU). In addition, we analysed the diagnostic ability of ascitic interleukin 6 in a subgroup of 19 patients with SBP. Baseline ascitic interleukin 6 performed well in predicting 3-month mortality in patients with decompensated cirrhosis (area under curve (AUC) = 0.802), as well as in patients fulfilling ACLF-criteria (AUC = 0.807). Ascitic interleukin 6 showed a moderate prognostic advantage compared with common clinical scores and proinflammatory parameters. Moreover, ascitic interleukin 6 had a sufficient diagnostic ability to detect SBP (AUC = 0.901) and was well correlated with ascitic polymorphonuclear neutrophils in SBP (p = 0.002). Interestingly, ascitic interleukin 6 revealed a high predictive value to rule out apparent infections on admission to ICU (AUC = 0.904) and to identify patients with "culture-positive SBP" (AUC = 0.856). Ascitic interleukin 6 is an easily-applicable proinflammatory biomarker with high prognostic and diagnostic relevance in critically ill patients with liver cirrhosis.

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Nature-based tourism has the potential to enhance global biodiversity conservation by providing alternative livelihood strategies for local people, which may alleviate poverty in and around protected areas. Despite the popularity of the concept of nature-based tourism as an integrated conservation and development tool, empirical research on its actual socioeconomic benefits, on the distributional pattern of these benefits, and on its direct driving factors is lacking, because relevant long-term data are rarely available. In a multi-year study in Wolong Nature Reserve, China, we followed a representative sample of 220 local households from 1999 to 2007 to investigate the diverse benefits that these households received from recent development of nature-based tourism in the area. Within eight years, the number of households directly participating in tourism activities increased from nine to sixty. In addition, about two-thirds of the other households received indirect financial benefits from tourism. We constructed an empirical household economic model to identify the factors that led to household-level participation in tourism. The results reveal the effects of local households' livelihood assets (i.e., financial, human, natural, physical, and social capitals) on the likelihood to participate directly in tourism. In general, households with greater financial (e.g., income), physical (e.g., access to key tourism sites), human (e.g., education), and social (e.g., kinship with local government officials) capitals and less natural capital (e.g., cropland) were more likely to participate in tourism activities. We found that residents in households participating in tourism tended to perceive more non-financial benefits in addition to more negative environmental impacts of tourism compared with households not participating in tourism. These findings suggest that socioeconomic impact analysis and change monitoring should be included in nature-based tourism management systems for long-term sustainability of protected areas.

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BACKGROUND: Walking to school has been identified as an activity that contributes to children's daily exercise requirements. The purpose of this study was to better understand factors that influence walking to school by elementary school-aged children. METHODS: A sample of 1,897 elementary school-aged children (84% response rate; 3rd-5th graders) throughout Michigan completed the Michigan Safe Routes to School Student Survey. The survey measures environmental, access, and attitudinal perceptions toward school routes and transportation methods. RESULTS: Using logistic regression, the results indicate that the odds of walking to school increase the older children are (odds ratio (OR) = 1.80, 95% confidence interval (CI) = 1.20-2.70) and if students perceive that walking to school saves time (OR = 3.32, 95% CI = 1.44-7.66) or is safe (OR = 2.60, 95% CI = 1.06-6.39). The odds of a student walking to school decrease the farther a student lives from his or her school (OR = 0.11, 95% CI = 0.04-0.37), if his or her parents have a car (OR = 0.07, 95% CI = 0.02-0.22), and if the student has access to a school bus (OR = 0.07, 95% CI = 0.03-0.18). These factors are significant (p < .05) predictors of walking to school after controlling for other demographic, environmental, access, and attitude factors. CONCLUSIONS: The study results support research indicating that environmental and access factors influence whether elementary school-aged children walk to school. In addition, when children perceive walking to school to be convenient (ie, saves time), their odds of walking to school increase. Future school- and community-based programs promoting walking to school should continue to focus on making walking to school not only safer, but also more convenient.

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BACKGROUND: Jackson, Michigan (population 36,000) started active living interventions to help solve residents' low physical activity levels. Jackson's experience can serve as a case study for beginning similar efforts in smaller communities. METHODS: In 2003, Jackson began a 3-prong community intervention utilizing the 5P model to increase safe physical activity opportunities and encourage walking and biking for short trips. The focus included work on projects at 1) elementary schools, 2) worksites, and 3) city-wide networks. RESULTS: Evaluation results show changes in attitudes toward active transportation (8% increase in children who thought walking to school was "safer" postintervention), intentions to try active transportation (43% of Smart Commute Day participants "would" smart commute more often postevent), and increased physical activity (the percentage of students walking to school more than doubled at 3 of 4 intervention schools). In addition, a community level observational study was conducted at 10 locations in the city in 2005 and 2006. The number of people seen using active transportation increased from 1,028 in 2005 to 1,853 people in 2006 (a 63% increase). CONCLUSIONS: Local community-driven projects to increase walking and biking can be effective by utilizing a variety of interventions, from the individual to the policy level.

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