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Five cases of nosocomial Legionnaires' disease which occurred over a five-month period were retrospectively investigated. Chart review showed that during the two- to 10-day incubation period before the onset of illness, all of the patients inhaled aerosolized tap water from jet nebulizers (four patients) or from a portable room humidifier (one patient), and all received high dosages of corticosteroids or adrenocorticotropic hormone. Exposure to both factors was highly significant (P less than 0.000001) when compared with the rate of exposure in 69 control patients. Environmental cultures yielded Legionella pneumophila from tap water and from reservoirs of tap water-filled respiratory devices. The yield was highest from hot tap water, in which the free chlorine level was less than 0.05 parts per million. Thus, Legionnaires' disease may be caused by contaminated aerosols from respiratory devices, and the use of contaminated tap water in such devices represents a previously unrecognized hazard to which corticosteroid-treated patients should not be exposed.

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We compared how management approaches affected shade tree diversity, soil properties, and provisioning and carbon sequestration ecosystem services in three shade coffee cooperatives. Collectively managed cooperatives utilized less diverse shade, and pruned coffee and shade trees more intensively, than individual farms. Soil properties showed significant differences among the cooperatives, with the following properties contributing to differentiation: N, pH, P, K, and Ca. Higher tree richness was associated with higher soil pH, CEC, Ca, and Mg, and lower K. Higher tree densities were associated with lower N, K, and organic matter. Although we found differences in the incidence of provisioning services (e.g., fruit), all plantations generated products other than coffee. No differences were observed between C-stocks. The history and institutional arrangements of cooperatives can influence management approaches, which affect ecosystem properties and services. Our study corroborates that interdisciplinary investigations are essential to understand the socioecological context of tropical shade coffee landscapes.