Wellbeing-responsive community: a growth target for intentional mental health promotion

With mental illness remaining a significant burden of disease, there is an ongoing need for community-based health promotion, prevention, and responses (or "mental health promotion activities"). The health promotion, community development, and positive psychology literature identifies significant heterogeneity in the design and delivery of these activities. This variability spans: (1) individual vs. group outcomes, (2) psychological vs. sociological determinants of change, (3) promoting wellbeing vs. reducing mental health symptoms, and (4) the degree activities are contextualized vs. standardized in design and delivery. Mental health promotion activities do not easily accomplish this level of complexity within design and implementation. This has led to the emergence of the complexity-informed health promotion literature and the need for innovative tools, methods, and theories to drive this endeavor. This article directly responds to this call. It introduces "wellbeing-responsive community": a vision and outcome hierarchy (or growth target) for intentionally delivered mental health promotion. The construct enables the design and implementation of interventions that intentionally respond to complexity and contextualization through the drivers of co-creation, intentionality, and local empowerment. It represents a community (support team, programme, agency, network, school, or region) that has the shared language, knowledge, methods, and skills to work together in shared intent. In other words, to integrate best-practice science with their local knowledge systems and existing strengths, and intentionally co-create and deliver contextualized wellbeing solutions at both the individual and community levels that span the "system" (e.g., whole-of-community) to the "moment" (e.g., intentional support and care). Co-creation, as applied through a transdisciplinary lens, is emerging as an evidence-based method to respond to complexity. This article describes the rationale and evidence underpinning the conceptualization of a wellbeing-responsive community through the integration of three key disciplines: (1) positive psychology, (2) ecological or systems approaches, and (3) intentional practice (implementation science). A definitional, contextual, and applied overview of the wellbeing-responsive community is provided, including a hierarchy of outcomes and associated definitions. Its purported application across education, mental health, community service, and organizational settings is discussed, including its potential role in making complexity-informed health promotion practical for all knowledge users.

COVID-19 pandemic in Ireland: Epidemiology, public health restrictions and vaccination uptake

Background: The first wave of COVID-19 pandemic in Ireland was managed by a prolonged national lockdown. The second and third waves were managed by continued non-pharmaceutical interventions (NPIs) and deployment of a national vaccination programme. This paper aims to describe the epidemiological trends, Public Health restrictions and vaccination uptake during the first three waves of the pandemic.   Methods: Data on confirmed cases of COVID-19 from 1 March 2020 to 27 March 2021 were extracted from the national COVID-19 data hub, the Health Protection Surveillance Centre (HPSC) and the National Contact Management Programme. Vaccine uptake and epidemiological data from European Centre for Disease Prevention and Control were reported from four other EU states.  Results: Ireland experienced three distinct waves of COVID-19; first wave occurred March to August 2020, second August to November 2020 and third from November 2020 onwards. The third wave was attributable to emergence of the Alpha variant of concern (B.1.1.7 strain) and relaxation of public health restrictions in December 2020, when weekly mean number of close contacts per case peaked at 5.2. A similar epidemiological trajectory was observed across four other EU states.   Conclusions: Surges of COVID-19 continue to occur despite increasing vaccine coverage in the EU, due to the emergence of novel variants of concern and relaxation of Public Health restrictions. A “vaccine plus policy” is needed.

The largest prison outbreak of TB in Western Europe investigated using whole-genome sequencing

BACKGROUND: In March 2011, the Department of Public Health East in Ireland were notified of two cases of TB in two prisoners sharing a cell. We define the resulting outbreak and highlight the role of public health and laboratory-based molecular epidemiology in mapping and control of a prison outbreak.METHODS: Cases were identified through clinical presentation, contact tracing, case-finding exercise or enhanced laboratory surveillance. Mycobacterium tuberculosis isolates were genotyped and underwent whole-genome sequencing (WGS).RESULTS: Of the 34 cases of TB linked to the outbreak, 27 were prisoners (79%), 4 prison officers (12%) and 3 community cases (9%). M. tuberculosis was isolated from 31 cases (culture positivity: 91%). A maximum of six single-nucleotide polymorphisms separated the isolates, with 22 being identical, suggestive of a highly infectious 'super-spreader´ within the prison. Isolates belonged to the Beijing sub-lineage, and were susceptible to first-line anti-TB agents. A case-finding exercise incidentally detected a prisoner with multidrug-resistant TB. Of the 143 prison officers screened, 52% had latent TB infection. Litigation costs exceeded five million euros.CONCLUSION: This constitutes the largest prison outbreak of TB in Western Europe investigated using WGS. A robust prison entry TB screening and education programme is required to effect better TB control, and prevent future outbreaks and attendant litigation.

Epidemiology of COVID-19 and public health restrictions during the first wave of the pandemic in Ireland in 2020

BACKGROUND

We describe the epidemiological trends and report and review the public health restrictions implemented during the first wave of the COVID-19 pandemic in Ireland.

METHODS

The study reviewed confirmed cases of COVID-19 notified from 1 March to 18 July 2020. Data were obtained from the national COVID-19 Data Hub, the National Health Protection Surveillance Centre, the National Contact Management Programme and the European Centre for Disease Prevention and Control.

RESULTS

A total of 25 617 cases were notified during the study period. Weekly cases and deaths peaked in mid-April 2020 at 5701 and 316, respectively. Mean number of close contacts per case was lowest at 0.7 in April, rising to 6.6 by July. Outbreak settings shifted from travel and workplace in March, to healthcare in April. Restrictions implemented on 12 March extended to full lockdown on 27 March. Phased relaxation of restrictions commenced 18 May. Effective suppression of community transmission of COVID-19 was achieved by June 2020.

CONCLUSION

Lockdown is a crude population-level restriction effective in controlling COVID-19. Phased relaxation of restrictions in Ireland, however, led to an immediate increase in mean number of contacts per case, which facilitates viral transmission unless individual-level restrictions are adhered to. This demonstrates a limitation of lockdown as a long-term mechanism of pandemic control.

Neophobia does not account for motoric self-regulation performance as measured during the detour-reaching cylinder task

The ability to restrain a prepotent response in favor of a more adaptive behavior, or to exert inhibitory control, has been used as a measure of a species' cognitive abilities. Inhibitory control defines a spectrum of behaviors varying in complexity, ranging from self-control to motoric self-regulation. Several factors underlying inhibitory control have been identified, however, the influence of neophobia (i.e., aversion to novelty) on inhibitory control has not received much attention. Neophobia is known to affect complex cognitive abilities, but whether neophobia also influences more basic cognitive abilities, such as motoric self-regulation, has received less attention. Further, it remains unclear whether an individual's response to novelty is consistent across different paradigms purported to assess neophobia. We tested two North American corvid species, black-billed magpies (Pica hudsonia) and California scrub jays (Aphelocoma californica) using two well-established neophobia paradigms to assess response stability between contexts. We then evaluated neophobia scores against the number of trials needed to learn a motoric self-regulation task, as well as subsequent task performance. Neophobia scores did not correlate across paradigms, nor did the responses during either paradigm account for motoric self-regulation performance.

Tendency to overestimate the explicit time interval in relation to aging and cognitive decline

Age-related deficits in explicit time perception has been reported by some studies. However, the findings are inconsistent about the preference of older adults to over/underestimate the observed interval as well as the relationship between the time estimation and the participant's cognitive status. In this study, we used a verbal estimation task for the rotation time of a virtual building (40 seconds) to assess the explicit interval timing of participants. The performance of a cohort of 250 cognitively-healthy adults and 10 Alzheimer's patients was analyzed in relation to their age and cognitive scale, measured by Montreal Cognitive Assessment (MoCA) score. The participants' performances were evaluated based on three measurements: Coefficient of variation (CV) for measuring stability, Absolute Error (AE) for measuring accuracy and Directional Error (DE) for measuring the degree of over/under-estimation. A significant difference was observed between the participants who overestimated the interval and those who underestimated it in terms of age, cognitive status and Absolute Error. We also found a significant effect of time estimation, with underestimation by cognitively healthy participants to mild over-estimation by 70+ year old and low-MoCA (MoCA score <; 26) participants as well as severe overestimation by Alzheimer's disease patients. The result of regression analysis for predicting MoCA score based on the dependent variables (AE, DE and CV) support the superiority of Directional Error to Absolute Error and Coefficient of Variation that are commonly used in the time perception studies.

Testosterone and obesity

Testosterone is a key hormone in the pathology of metabolic diseases such as obesity. Low testosterone levels are associated with increased fat mass (particularly central adiposity) and reduced lean mass in males. These morphological features are linked to metabolic dysfunction, and testosterone deficiency is associated with energy imbalance, impaired glucose control, reduced insulin sensitivity and dyslipidaemia. A bidirectional relationship between testosterone and obesity underpins this association indicated by the hypogonadal-obesity cycle and evidence weight loss can lead to increased testosterone levels. Androgenic effects on enzymatic pathways of fatty acid metabolism, glucose control and energy utilization are apparent and often tissue specific with differential effects noted in different regional fat depots, muscle and liver to potentially explain the mechanisms of testosterone action. Testosterone replacement therapy demonstrates beneficial effects on measures of obesity that are partially explained by both direct metabolic actions on adipose and muscle and also potentially by increasing motivation, vigour and energy allowing obese individuals to engage in more active lifestyles. The degree of these beneficial effects may be dependent on the treatment modality with longer term administration often achieving greater improvements. Testosterone replacement may therefore potentially be an effective adjunctive treatment for weight management in obese men with concomitant hypogonadism.

Split liver transplantation using Hemiliver graft in the MELD era: a single center experience in the United States

Under the "sickest first" Model for End-Stage Liver Disease (MELD) allocation, livers amenable to splitting are most often allocated to patients unsuitable for split liver transplantation (SLT). Our experience with SLT using hemilivers was reviewed. From April 2004 to June 2012, we used 25 lobar grafts (10 left lobes and 15 right lobes) for adult-sized recipients. Twelve recipients were transplanted with primary offers, and 13 were transplanted with leftover grafts. Six grafts were shared with other centers. The data were compared with matched whole liver grafts (n = 121). In 92% of donors, the livers were split in situ. Hemiliver recipients with severe portal hypertension had a greater graft-to-recipient weight ratio than those without severe portal hypertension (1.96% vs. 1.40%, p < 0.05). Hemiliver recipients experienced biliary complications more frequently (32.0% vs. 10.7%, p = 0.01); however, the 5-year graft survival for hemilivers was comparable to whole livers (80.0% vs. 81.5%, p = 0.43). The secondary recipients with leftover grafts did not have increased incidences of graft failure (p = 0.99) or surgical complications (p = 0.43) compared to the primary recipients. In conclusion, while routine application is still controversial due to various challenges, hemiliver SLT can achieve excellent outcomes under the MELD allocation.

The development of a soccer-specific training drill for elite-level players

The use of sports-specific technical practices as a physical training stimulus has increased in recent years in soccer. Such approaches, although effective, can produce different levels of physiological strain in the individual players within the session, thereby limiting the usefulness of the training session for all players. The aim of this study was to develop a high-intensity soccer-specific training (SST) drill that was not only based on the demands of match-play but also would reduce the variability in the physiological response to training compared with other specific drills. To evaluate this approach to training, the SST drill was compared with a "traditional" aerobic interval training (AIT) protocol and a small-sided games (SSG) drill. Each training protocol was carried out across 4 × 4-minute exercise bouts, interspersed by 4 × 3 minutes of active recovery. Mean ± SD heart rates (HRs) for the 4-minute exercise bouts during SST (175 ± 5 b·min) and AIT (174 ± 6 b·min) were significantly higher than that observed during the SSG protocol (170 ± 6 b·min; p < 0.05). Heart rate during the SST drill showed less interparticipant variability (mean ± SD HR ranged from 169 ± 6 to 180 ± 5 b·min) when compared with those during AIT (157 ± 8 to 186 ± 8 b·min) and SSG (143 ± 10 to 179 ± 78 b·min) training conditions. Ratings of perceived exertion (SST, 6 ± 2; AIT, 7 ± 1; SSG, 5 ± 1) across the entire exercise period were similar between the 3 training conditions (p > 0.05). These results indicate that the SST stimulates a more uniform physiological response than other currently adopted specific endurance training protocols used in soccer. This would suggest that it provides a valid alternative to the current approaches used for the aerobic training of players.

Service priorities and unmet service needs among people living with HIV/AIDS: results from a nationwide interview of HIV/AIDS housing organizations

Housing for people living with HIV/AIDS (PLWHA) has been linked to a number of positive physical and mental health outcomes, in addition to decreased sexual and drug-related risk behavior. The current study identified service priorities for PLWHA, services provided by HIV/AIDS housing agencies, and unmet service needs for PLWHA through a nationwide telephone survey of HIV/AIDS housing agencies in the USA. Housing, alcohol/drug treatment, and mental health services were identified as the three highest priorities for PLWHA and assistance finding employment, dental care, vocational assistance, and mental health services were the top needs not being met. Differences by geographical region were also examined. Findings indicate that while housing affords PLWHA access to services, there are still areas (e.g., mental health services) where gaps in linkages to care exist.

Use of tissue plasminogen activator in liver transplantation from donation after cardiac death donors

Ischemic-type biliary stricture (ITBS) occurs in up to 50% after liver transplantation (LT) from donation after cardiac death (DCD) donors. Thrombus formation in the peribiliary microcirculation is a postulated mechanism. The aim was to describe our experience of tissue plasminogen activator (TPA) administration in DCD-LT. TPA was injected into the donor hepatic artery on the backtable (n = 22). Two recipients developed ITBS including one graft failure. Although excessive postreperfusion bleeding was seen in 14 recipients, the amount of TPA was comparable between those with and without excessive bleeding (6.4 ± 2.8 vs. 6.6 ± 2.8 mg, p = 0.78). However, donor age (41 ± 12 vs. 29 ± 9 years, p = 0.02), donor BMI (26.3 ± 5.5 vs. 21.7 ± 3.6 kg/m(2) , p = 0.03), previous laparotomy (50% vs. 0%, p = 0.02) and lactate after portal reperfusion (6.3 ± 4.6 vs. 2.8 ± 0.9 mmol/L, p = 0.005) were significantly greater in recipients with excessive bleeding. In conclusion, the use of TPA may lower the risk of ITBS-related graft failure in DCD-LT. Excessive bleeding may be related to poor graft quality and previous laparotomy rather than the amount of TPA. Further studies are needed in larger population.

The effect of pitch dimensions on heart rate responses and technical demands of small-sided soccer games in elite players

The aim of this study was to examine the impact of changes in pitch size on heart rate responses and technical requirements of small-sided soccer games. Eight male soccer players participated in the study (mean+/-S.D.; age 18+/-1 years, height 1.80+/-0.1 m, weight 73.3+/-6.2 kg, estimated VO2peak 50.0+/-3.2 ml kg(-1) min(-1)). All players participated in small-sided games on three different pitch sizes (SSG1, 30 m x 20 m; SSG2, 40 m x 30 m; SSG3, 50 m x 40 m). Games consisted of 4 x 4 min of game play, interspersed by 2 min of active recovery. Heart rate measurements were made using a team-based monitoring system. Each game was also filmed to evaluate the technical actions. These tapes were analysed using a hand notation system. Mean+/-S.D. heart rates for the three games were not significantly different between conditions (SSG1, 175+/-9; SSG2, 173+/-11; SSG3, 169+/-6). The technical actions that changed as a result of changes in pitch size were the number of tackles (SSG1, 45+/-10; SSG2, 15+/-4; P<0.05) and shots (SSG1, 85+/-15; SSG 2, 60+/-18; SSG3, 44+/-9; P<0.05). Comparisons between the four 4 min intervals of game play indicated significant differences for both heart rate responses and the technical demands. These results demonstrate that changes in pitch size do not alter heart rate or the majority of technical requirements observed within small-sided games.

High-Resolution CT Using MDCT: Comparison of Degree of Motion Artifact Between Volumetric and Axial Methods

OBJECTIVE

The purpose of this study was to compare the degree of motion artifact on high-resolution CT images obtained using volumetric and axial (nonvolumetric) CT methods.

CONCLUSION

Volumetric high-resolution CT is associated with significantly greater motion artifact compared with axial noncontiguous high-resolution imaging.

Pigeons encode relative geometry

Pigeons were trained to search for hidden food in a rectangular environment designed to eliminate any external cues. Following training, the authors administered unreinforced test trials in which the geometric properties of the apparatus were manipulated. During tests that preserved the relative geometry but altered the absolute geometry of the environment, the pigeons continued to choose the geometrically correct corners, indicating that they encoded the relative geometry of the enclosure. When tested in a square enclosure, which distorted both the absolute and relative geometry, the pigeons randomly chose among the 4 corners, indicating that their choices were not based on cues external to the apparatus. This study provides new insight into how metric properties of an environment are encoded by pigeons.

Detection of glass patterns by pigeons and humans: implications for differences in higher-level processing

Glass patterns have been used to examine mechanisms underlying form perception. The current investigation compared detection of Glass patterns by pigeons and humans and provides evidence for substantial species differences in global form perception. Subjects were required to discriminate, on a simultaneous display, a random dot pattern from a Glass pattern. Four different randomly presented Glass patterns were used (concentric, radial, parallel-vertical, and parallel-horizontal). Detection thresholds were measured by degrading the Glass patterns through the addition of random noise. For both humans and pigeons, discrimination decreased systematically with the addition of noise. Humans showed detection differences among the four patterns, with lowest thresholds to radial and concentric patterns and highest thresholds to the parallel-horiZontal pattern. Pigeons did not show a detection difference across the four patterns. Implications for differences in neural processing of complex forms are discussed.

Pulmonary lymphangitis carcinomatosa and acute pancreatitis: a rare presentation of choledochal cyst

Pulmonary lymphangitis carcinomatosa is an unusual cause of death in a young adult. This case describes an apparently healthy young woman who presented with severe acute pancreatitis, which is a recognized complication of a choledochal cyst. Autopsy examination revealed advanced malignancy with poorly differentiated adenocarcinoma penetrating the wall of the choledochal cyst and metastatic adenocarcinoma in the lymph nodes, lungs and kidneys. This case emphasises the unusual presentation of a choledochal cyst with acute pancreatitis and the aggressive nature of malignancy associated with this congenital anomaly.

Spontaneous rupture of a malignant rhabdoid tumour of the liver

Malignant rhabdoid tumours (MRT) of the liver are rare. The criteria for pathological diagnosis are clearly defined, but the clinical behaviour of these tumours is still emerging. We report a MRT of the liver with the rare clinical presentation of spontaneous rupture.

Liver transplant recipients are not at increased risk for nonlymphoid solid organ tumors

BACKGROUND

Organ transplant recipients are at higher risk for developing lymphoid tumors, skin carcinomas, and sarcomas. Whether liver transplant recipients are at higher risk for developing more common cancers is unclear.

METHODS

All patients with a history of malignancy prior to liver transplantation and those who developed malignancy, either de novo or recurrent, after transplantation were identified retrospectively. The following parameters were examined: age at diagnosis; indication for transplant; interval from transplant to tumor diagnosis; tumor treatment received; predisposing factors for the development of cancer; immunosuppression regimen, including the use of OKT3; number and treatment of rejection episodes; and survival.

RESULTS

Of 888 patients, 29 (3.2%) had 31 previous malignancies; of these 29 patients, 4 developed a recurrence in the posttransplant period. Thirty-nine patients (4.3%) developed 43 de novo nonlymphoid malignancies. Alcoholic cirrhotic patients had a significantly higher incidence of de novo carcinomas. Except for skin carcinomas, tumors did not occur with greater frequency than in the general population, and recurrent tumors were not more aggressive than reported for that disease. One patient had an unrecognized renal cell carcinoma at the time of transplant that progressed rapidly; this patient died 64 days after transplantation.

CONCLUSIONS

With current immunosuppressive regimens, liver transplant patients do not appear to be at an increased risk for developing nonlymphoid solid organ tumors. However, longer follow-up will be necessary to confirm these results.

Effect of off-site transportation on detection of Neisseria gonorrhoeae in endocervical specimens

OBJECTIVES

To evaluate both the effect of off-site transportation on detection of Neisseria gonorrhoeae in cultured endocervical specimens and the impact of transportation on viability of N. gonorrhoeae by comparison of culture with a nucleic acid probe assay.

DESIGN

Three endocervical swabs were randomly collected; one was tested on-site using a nucleic acid-based assay (PACE 2NG System, Gen-Probe, Inc, San Diego, Calif), one was tested off-site following inoculation to modified Thayer-Martin agar (Remel, Lenexa, Kan), and a third swab was tested on-site by culture isolation. A nucleic acid amplification assay of the original swab for PACE 2NG testing was used to resolve discrepancies.

SETTING

The emergency department of a university medical center.

PATIENTS

Four hundred two patients were evaluated. The test population consisted of both asymptomatic and symptomatic patients.

MAIN OUTCOME MEASURE

Positivity for N. gonorrhoeae by one or more of the test procedures, with discrepancy analysis when warranted.

RESULTS

Of 402 specimens evaluated, the sensitivities for on-site and off-site testing using culture isolation for N. gonorrhoeae were 88.9% and 77.8%, respectively, in a population prevalence of 6.7%. However, the sensitivity for on-site PACE 2NG testing for N. gonorrhoeae was 96.3%.

CONCLUSIONS

A decrease in sensitivity between on-site and off-site culture was found, which suggested transportation may have an adverse effect on the detection of N gonorrhoeae. However, with the limited population and prevalence, the difference was not found to be statistically significant. Further studies indicated that the nucleic acid probe assay was significantly more sensitive (P = .05) when compared with off-site testing using a culture isolation method, demonstrating that viability is an important consideration. These results suggested that a molecular probe assay should be considered in testing specimens for N. gonorrhoeae, especially when the specimen is to be transported off-site.

Safe use of hepatic allografts from donors older than 70 years

Between March 1991 and August 1995, 36 livers from donors >/=70 years old were transplanted. In donors, we recorded the following risk factors: alanine aminotransferase > 120 and rising, dopamine dose > 15 microg/kg/min, hypotension (systolic blood pressure <80) >1 hr, stay in the intensive care unit >5 days and body mass index >/=27. In 35 recipients, we recorded pretransplant United Network for Organ Sharing (UNOS) status, cold/warm ischemia time, intraoperative blood loss, and occurrence of poor early graft function or primary nonfunction. Mean recipient age was 55 years (range, 25-75 years). Four recipients were UNOS status 1, 19 were UNOS 2, and 12 were UNOS 3. Two livers were used as second grafts for primary graft nonfunction. Mean donor age was 73 years (range, 70-84 years). Intracranial bleeding was the cause of death in the majority of donors. The 36 donors had 40 risk factors; 10 donors had >1 risk factor. Mean cold and warm ischemia times were 9:08 +/- 2:57 hr and 51 +/- 9 min. Mean total operative time was 7.5 hr. Posttransplant mean peak alanine aminotransferase and aspartate aminotransferase levels were 937.3 +/- 703.1 IU/L and 923.3 +/- 708.5 IU/L, respectively. Mean prothrombin time on postoperative day 2 was 14.9 +/- 1.6 sec. Average total bilirubin on postoperative day 5 was 4.9 mg/dl. Median length of stay in the intensive care unit was 4 days. One recipient had poor early graft function; two recipients had primary nonfunction. Mean follow-up was 503 days (range, 110-1714 days). Three-month actual graft and patient survival rates were 85% and 91%, respectively. One-year actuarial graft and patient survival rates were also 85% and 91%, respectively. We conclude that older livers can be used safely. Advanced donor age should not be a contraindication to liver procurement.

Revised approach for identification and detection of ampicillin and vancomycin resistance in Enterococcus species by using MicroScan panels

The frequency of antimicrobial agent-resistant enterococci is increasing, making accurate identification and screening for susceptibility essential. We evaluated the ability of MicroScan Positive Breakpoint Combo Type 6 panels (Dade MicroScan Inc., West Sacramento, Calif.) to identify Enterococcus species and to detect ampicillin and vancomycin resistance. A total of 398 well-characterized Enterococcus isolates from two institutions were inoculated into MicroScan panels, into conventional biochemical assays, and into ampicillin and vancomycin agar dilution media. Resistance was verified by the broth macrodilution method. MicroScan panels accurately detected resistance to ampicillin in 132 of 132 enterococcal isolates, while three isolates for which the MICs were < 16 micrograms/ml were classified incorrectly by MicroScan panels as resistant. No beta-lactamase-producing enterococci were detected. All 64 isolates showing resistance to vancomycin (MICs > or = 32 micrograms/ml) were correctly classified by MicroScan panels. Seven isolates for which the vancomycin MICs were 8 and 16 micrograms/ml were incorrectly classified as susceptible by MicroScan panels, while eight isolates for which the MICs were 4 micrograms/ml were incorrectly labeled as intermediate. Fourteen of these 15 isolates were subsequently identified as motile enterococci. Overall, there were three major errors in susceptibility testing for ampicillin and 15 minor errors for vancomycin. Conventional testing confirmed the identity of 181 Enterococcus faecalis isolates, 157 E. faecium isolates, and 60 isolates of other species; however, 56 of these 60 isolates were misidentified by the MicroScan panels. After recognition of this problem, a revised approach which included tests for pigment, motility, and sucrose fermentation was devised. In combination with these additional assays, the conventional MicroScan panels accurately identified the 56 originally misidentified isolates. In summary, the ability of MicroScan panels to detect vancomycin and ampicillin resistance in enterococci was confirmed. Our study found that the inability of MicroScan panels to identify enterococci other than E. faecalis and E. faecium can be compensated for by the addition of standard assays.

Stigma stories: four discourses about teen mothers, welfare, and poverty

Teen mothers are often depicted as the cause and consequence of poverty and welfare dependency. The author analyzes recent media accounts of teen mothers, identifying four interpretive frames associated with the discourses of bureaucratic experts (the wrong girl), conservations (the wrong family), oppositional movements (the wrong society), and teen mothers themselves (the stigma is wrong). The dominant discourse is that of the bureaucratic experts, who are most often portrayed by the media as advocates of teen mothers. Yet in reinterpreting the meaning of teen motherhood, these advocates have incentives to tell their own stigma stories about teen mothers.

Evaluation of nucleic acid-based test (PACE 2C) for simultaneous detection of Chlamydia trachomatis and Neisseria gonorrhoeae in endocervical specimens

A nucleic acid-based test (Gen-Probe PACE 2C System) was evaluated for the ability to detect Chlamydia trachomatis and Neisseria gonorrhoeae from endocervical specimens in a single assay. Three swab samples, randomized for collection order, were obtained from each patient and tested by N. gonorrhoeae and C. trachomatis culture and by the PACE 2C probe assay. Fifty of 395 specimens were culture positive for N. gonorrhoeae (17 specimens), C. trachomatis (26 specimens), or both (7 specimens), of which PACE 2C testing detected 48 specimens. The PACE 2C assay was positive for 56 specimens, including 8 specimens not positive by culture. Of the total of 10 discrepancies between culture and PACE 2C results, resolution testing yielded four false-negative culture, four false-positive PACE 2C, and two false-negative PACE 2C results. The sensitivity, specificity, and positive and negative predictive values for PACE 2C after reevaluation were 96.3, 98.8, 92.9 and 99.4%, respectively. The overall sensitivities for C. trachomatis and N. gonorrhoeae culture were 89.2 and 88.9%, respectively. The prevalence rate for C. trachomatis was 9.4%, and that for N. gonorrhoeae was 6.8%. The Gen-Probe PACE 2C System is a reliable alternative for screening endocervical specimens for both C. trachomatis and N. gonorrhoeae in a single assay.

Glomerular epithelial and mesangial cells differentially modulate the binding specificities of VLA-1 and VLA-2

BACKGROUND

Maintenance of glomerular cell interaction with the complex basement membrane is crucial for the normal functioning of the kidney. Because little is known about the receptors utilized by glomerular cells, we examined the attachment of cultured glomerular cells to extracellular matrix proteins.

EXPERIMENTAL DESIGN

We produced monoclonal antibodies that inhibited the function of rat VLA-1 and VLA-2 and used these antibodies alone and in combination to explore the attachment of glomerular epithelial cells (GEC) and mesangial cells to extracellular matrix proteins in vitro.

RESULTS

Cultured GEC utilize only VLA-2 for attachment to collagen but use it together with VLA-1 for adhesion to laminin. In contrast, mesangial cells use both receptors for their attachment to collagen but utilize only VLA-1 in their interaction with laminin. The use of VLA-1 by GEC and of VLA-2 by mesangial cells was unexpected because the expression of these receptors was barely detectable in an enzyme-linked immunosorbent assay and by immunocytochemistry.

CONCLUSIONS

VLA-1, VLA-2, and VLA-3 are integrin receptors with overlapping specificities in that all have the potential to interact with collagen and laminin. Our studies demonstrate that cultured GEC use VLA-1 and VLA-2 almost exclusively for their adhesion to these ligands, and thus VLA-3 appears to play a negligible role in such attachment. Interestingly, GEC and mesangial cells differentially modulate the ligand binding specificities of VLA-1 and VLA-2. In situ, VLA-1 has been localized within the mesangium, whereas VLA-2 has not been detected within the glomerulus leading to the conclusion that GEC do not use VLA-1 or VLA-2 and that mesangial cells fail to utilize VLA-2. However, our studies have shown that, even when such receptors are barely detectable on the surface of cultured cells by sensitive techniques, they can play a functional role. These results suggest either that the levels of expression in situ are too low for the relatively insensitive immunohistochemical techniques employed, and thus the importance of these receptors to glomerular cell attachment in vivo is under appreciated or that such receptors are the result of de novo expression by glomerular cells when they are subjected to in vitro culture conditions. Because it is known that such conditions may mimic pathologic stress, we are presently examining the expression of these receptors by glomerular cells in various disease models.

Invasive infection due to Candida krusei in immunocompromised patients not treated with fluconazole

Candida krusei is a cause of invasive candidiasis (IC), with numerous cases reported among leukemia patients after bone marrow transplantation and treatment with fluconazole. The relation between fluconazole therapy and IC remains controversial. In a retrospective review covering 5 years, we identified 203 cases of IC, 71 (35%) of which were due to non-albicans species. Eight cases were caused by C. krusei: four of the patients involved had leukemia, two had breast cancer, one had end-stage liver disease, and one had undergone abdominal trauma. None of these patients received fluconazole. Surveillance cultures detected colonization with C. krusei before the onset of symptoms in seven cases. The median time from colonization to IC diagnosis was 10 days. Of six patients with neutropenia, five were neutropenic at IC diagnosis. Concomitant infections were common; four patients had both bacteremia and invasive aspergillosis. C. krusei was considered the immediate cause of five of the seven deaths among this group of patients. These eight cases extend the range of immunocompromised conditions in which IC caused by C. krusei develops in the absence of fluconazole therapy.

Pancreatic carcinoma

The management of patients with pancreatic carcinoma poses many problems. The diagnosis is usually made late, generally because the patients present late, but it is not unusual to find patients who have had many negative investigations for vague upper abdominal symptoms only to be diagnosed as having pancreatic carcinoma many months later. Staging the disease is equally difficult and often inaccurate. The results of treatment are to date discouraging even in those patients diagnosed early. But the outlook is not totally dismal; in recent years the results for surgical resection of pancreatic lesions have improved; adjuvant treatment may finally be having an effect, although small, on this relentless disease. The most notable inroad made in the management of pancreatic cancer in the last 10 years is the improvement in palliation due to the use of the endoprosthesis. In spite of the poor results we must continue to search actively for more accurate methods of diagnosis and better methods of treatment.

Temporal expression of VLA-2 and modulation of its ligand specificity by rat glomerular epithelial cells in vitro

BACKGROUND

The interaction of glomerular epithelial cells (GEC) with their underlying basement membrane is of critical importance in maintaining normal glomerular function. Little is known regarding their expression and use of extracellular matrix adhesion receptors in normal conditions and during pathogenic states.

EXPERIMENTAL DESIGN

To examine the use of such receptors, we have produced monoclonal antibodies that inhibit the function of the rat alpha 2 beta 1 integrin receptor (VLA-2) and the common beta 1 subunit. The monoclonal antibodies have been used to examine the expression and functional use of these receptors by rat glomerular cells cultured in vitro.

RESULTS

Rat glomerular visceral epithelial cells are unusual in that, unlike many of the epithelium seen in vivo, these cells do not express VLA-2, an integrin receptor with affinity for laminin and collagen. Our results demonstrate that differentiated GEC, newly isolated from glomeruli, do not use VLA-2 for attachment to collagen and laminin-coated surfaces. However, after 3 days of in vitro growth, approximately 50% of these cells express this receptor and, upon their first in vitro passage, selectively utilize VLA-2 for attachment to collagen but not to laminin-coated surfaces. After long-term maintenance in culture, all GEC express VLA-2, and utilize this receptor for binding to collagen and in their interaction with laminin. In contrast, VLA-2 plays only a partial role in the adherence of mesangial cells to collagen and is not involved in their attachment to laminin-coated surfaces.

CONCLUSIONS

These results show that, as GEC become adapted to in vitro growth, they begin to synthesize and use the VLA-2 integrin receptor suggesting a simultaneous downregulation or inactivation of other beta 1 type integrin receptors. This ability to modulate their receptor repertoire may allow GEC to respond to pathologic conditions in vivo.

Temporal relationship of acinar and microvascular changes in caerulein-induced pancreatitis

A study in rats investigated the temporal relationship between acinar cell changes and alterations in the local microvasculature in oedematous pancreatitis produced by administration of caerulein 5 micrograms kg-1 h-1. Samples were taken from experimental and control animals after 15 min, 30 min, 1 h and 2 h of caerulein infusion. Transmission electron microscopy showed ultrastructural acinar cell changes after 15 min whereas the earliest microvascular changes were seen after 30 min. Ultrastructural alterations in the acinar cells thus preceded local microvascular changes. Microvascular distortion appears to be a consequence and not a cause of pancreatitis in the caerulein model.

Microvasculature of the pancreas, liver, and kidney in cerulein-induced pancreatitis

Edematous pancreatitis was induced in 12 male Sprague-Dawley rats using supramaximal doses of the cholecystokinin analogue cerulein (5 micrograms/kg per hour). The microvasculature of the pancreas, liver, and kidney was examined using scanning electron microscopy of microvascular corrosion casts in 12 test animals and four controls at intervals of 30 minutes, 1 hour, 2 hours, and 4 hours. Distortion of the pancreatic and hepatic microvasculature was seen as early as 30 minutes and progressed during the study period. The renal vasculature remained normal throughout. Light microscopic analysis revealed no morphologic abnormalities in the walls of the pancreatic, hepatic, or renal microvasculature. This study demonstrates that cerulein-induced pancreatitis is associated with marked distortion of the pancreatic and hepatic microvasculature; the abnormalities start early in the disease and progress during the study period.

Long-term and short-term fluctuation in pattern discrimination perimetry

We studied threshold fluctuation with the pattern discrimination perimeter in 24 healthy subjects at 56 locations within the central 30 degrees. This perimeter evaluates a subject's ability to discriminate a patterned stimulus measured by a percentage scale. We found an intraindividual fluctuation of 10.52% and an interindividual fluctuation of 8.78%. A statistically increased intraindividual, but not interindividual fluctuation was noted with increasing eccentricity from fixation (P less than .05, Bartlett's test). However, no correlation in fluctuation was noted with advancing age or increasing false-positive errors (P greater than .05, correlation coefficient). Also, no difference in fluctuation between superior or inferior hemifields was observed (P greater than .05, Student's t-test). The average threshold across all subjects was 54.3%, which provided an upper limit of normal, two standard deviations from the mean, of less than 80% for most locations. This study indicates that fluctuation should be considered when interpreting pattern discrimination fields, but that the extent of fluctuation generally allows for an adequate separation between normal and abnormal measurements.

Pattern discrimination perimetry in patients with glaucoma and ocular hypertension

We compared the results of the pattern discrimination perimeter to the program 30-2 on the Humphrey Field Analyzer (Humphrey, Inc., San Leandro, California) in 93 consecutive patients with ocular hypertension and glaucoma and 30 control patients. In 20 patients with ocular hypertension, a significantly greater number of glaucomatous defects were noted on pattern discrimination perimetry (ten patients) than on the program 30-2 (two patients) (P less than .05, Wilcoxon signed rank test). The diversity in diagnoses found on pattern discrimination testing was not explained by age, intraocular pressure, refraction, number of glaucoma medicines, race, presence of vascular disease, optic disk status, or pupil size. In contrast, in 73 patients with glaucoma no statistical difference in the severity of diagnoses was noted between perimeters (P greater than .05, Wilcoxon signed rank test). These results suggest the potential value of pattern discrimination perimetry as a visual function test in patients with glaucoma and in defining subsets of patients with ocular hypertension not found with conventional automated perimetry.

Pulmonary microvasculature in experimental acute haemorrhagic and oedematous pancreatitis

The pulmonary microvasculature was examined in two experimental models of acute pancreatitis by scanning electron microscopy of microvascular corrosion casts. Haemorrhagic pancreatitis was induced in eight male Sprague-Dawley rats using an intraductal injection of 5 per cent sodium taurocholate. Oedematous pancreatitis was induced in seven male Sprague-Dawley rats using an intravenous infusion of supramaximal doses of caerulein (5 micrograms/kg per hour). The pulmonary vessels were cast using a polymer resin and the cast studied by scanning electron microscopy at 3 and 12 h in those with haemorrhagic and at 1 and 4 h in those with oedematous pancreatitis. Vascular abnormalities were present in both models at the initial study time with abruptly terminating vessels being more prominent in the caerulein model. At the later times, however, the abnormalities in the sodium taurocholate model were much more severe, with a substantial loss of vascular density, tortuosity and abrupt terminations of those vessels present. Microvascular abnormalities may be responsible for some of the pulmonary changes seen in oedematous and haemorrhagic pancreatitis.