Entrepreneurs have been characterized according to recognizable types according to attendant concerns and motivations. Within the small business sector of ecotourism, entrepreneurs must balance competing goals pertaining to business objectives, lifestyle aspirations and, most importantly, sustainable environmental practices. This study reports how ecotourism eco-entrepreneurs perceive and manage these goals, consistent with concerns and motivations, based on semi-structured interviews of small business operators. The findings show that eco-entrepreneurs’ social and sustainable characteristics are critical to overcome financially challenging and complex operating environments whilst also delivering a desired lifestyle. As a business strategy, eco-entrepreneurs were found to deliberately maintain small, low-impact ecotourism operations consistent with identified eco-values. Looking forward, eco-entrepreneurs forecast imminent threats to the ecotourism sector through uncontrolled development and mass-tourism business access to sensitive natural areas. If unresolved, this process will replace eco-entrepreneurs in small ecotourism operators with traditional profit-oriented entrepreneurs delivering undifferentiated and high-impact nature-based tourism experiences.

We report a case of pulmonary infection complicated by empyema in a 79-year-old man with diffuse large B-cell lymphoma treated with R-CHOP and ibrutinib. A literature review identified 25 cases of cryptococcal pleural disease published since 1980. Most cases were caused by the species in immunocompromised hosts with an exudative pleural effusion and lymphocyte-predominant infiltrate. The cryptococcal antigen test was often positive when pleural fluid and serum were tested. The outcome was favourable in most cases with antifungal therapy and either thoracocentesis or surgical resection. We also identified 40 cases of opportunistic infections, most commonly aspergillosis, cryptococcosis and pneumonia, in patients treated with ibrutinib. studies indicate Bruton tyrosine kinase inhibition impairs phagocyte function and offer a mechanism for the apparent association between ibrutinib and invasive fungal infections.

Background The microbiology of pancreatoduodenectomy is challenging and published guidelines regarding perioperative antimicrobial prophylaxis are variable with poor adherence. Methods A retrospective analysis of the microbiological results of 294 consecutive patients who underwent pancreatoduodenectomy was performed. Intraoperative specimen culture results were available for 50 patients and their medical records were reviewed to determine the following demographics and factors; age; sex; tumour location, histopathology, grade and stage; neoadjuvant chemotherapy and radiotherapy; preoperative biliary stenting; surgeon; surgery type and antimicrobial prophylaxis coverage. Outcomes assessed included; post‐operative infections, mortality (all and 90‐day), and intensive care unit and hospital admission durations. Univariate analysis with chi‐squared testing was performed. Results Intraoperative specimen cultures were positive in 48 (96%) patients and polymicrobial in 45 (90%) patients with a predominance of Enterobacteriaceae (38/76%), Enterococcus species (27/54%), and Candida species (25/50%). Isolates were potentially susceptible to the current perioperative antimicrobial prophylaxis regimen of ceftriaxone with or without metronidazole in only six patients. However, only neoadjuvant radiotherapy was associated with statistically significant increased intensive care unit and hospital admission durations. Conclusion Although this study was probably underpowered to detect any statistically significant associations, perioperative antimicrobial prophylaxis coverage of the operative field microbiological milieu of pancreatoduodenectomy is logical and current guidelines may be inadequate.

Candida osteoarticular infections are being reported with increasing frequency, possibly due to an expanding population at risk. However, Candida costochondritis is uncommon. We report two cases of Candida costochondritis in patients who presented with subacute-onset chest wall swelling and whose only identifiable risk factor was a history of recent intravenous drug use.

HighlightsThree patients receiving bortezomib therapy for multiple myeloma presented with clinical and radiological features consistent with PCP.The patients deteriorated whilst receiving broad-spectrum antibiotics but responded to sulfamethoxazole + trimethoprim.The negative sputum PCR results in two patients may be due to the prior initiation of sulfamethoxazole + trimethoprim and absence of BAL specimens.The three patients were receiving dexamethasone at doses and durations at the threshold expected to cause PCP.26S proteosome inhibitor therapy may be a risk factor for PCP and may necessitate concomitant PCP prophylaxis.