Environmental and bioclimatic factors influencing yeasts and molds distribution along European shores.

The present study employed data collected during the Mycosands survey to investigate the environmental factors influencing yeasts and molds distribution along European shores applying a species distribution modelling approach. Occurrence data were compared to climatic datasets (temperature, precipitation, and solar radiation), soil datasets (chemical and physical properties), and water datasets (temperature, salinity, and chlorophyll-a concentration) downloaded from web databases. Analyses were performed by MaxEnt software. Results suggested a different probability of distribution of yeasts and molds along European shores. Yeasts seem to tolerate low temperatures better during winter than molds and this reflects a higher suitability for the Northern European coasts. This difference is more evident considering suitability in waters. Both distributions of molds and yeasts are influenced by basic soil pH, probably because acidic soils are more favorable to bacterial growth. Soils with high nitrogen concentrations are not suitable for fungal growth, which, in contrast, are optimal for plant growth, favored by this environment. Finally, molds show affinity with soil rich in nickel and yeasts with soils rich in cadmium resulting in a distribution mainly at the mouths of European rivers or lagoons, where these metals accumulate in river sediments.

Mycosands: Fungal diversity and abundance in beach sand and recreational waters - Relevance to human health.

The goal of most studies published on sand contaminants is to gather and discuss knowledge to avoid faecal contamination of water by run-offs and tide-retractions. Other life forms in the sand, however, are seldom studied but always pointed out as relevant. The Mycosands initiative was created to generate data on fungi in beach sands and waters, of both coastal and freshwater inland bathing sites. A team of medical mycologists and water quality specialists explored the sand culturable mycobiota of 91 bathing sites, and water of 67 of these, spanning from the Atlantic to the Eastern Mediterranean coasts, including the Italian lakes and the Adriatic, Baltic, and Black Seas. Sydney (Australia) was also included in the study. Thirteen countries took part in the initiative. The present study considered several fungal parameters (all fungi, several species of the genus Aspergillus and Candida and the genera themselves, plus other yeasts, allergenic fungi, dematiaceous fungi and dermatophytes). The study considered four variables that the team expected would influence the results of the analytical parameters, such as coast or inland location, urban and non-urban sites, period of the year, geographical proximity and type of sediment. The genera most frequently found were Aspergillus spp., Candida spp., Fusarium spp. and Cryptococcus spp. both in sand and in water. A site-blind median was found to be 89 Colony-Forming Units (CFU) of fungi per gram of sand in coastal and inland freshwaters, with variability between 0 and 6400 CFU/g. For freshwater sites, that number was 201.7 CFU/g (0, 6400 CFU/g (p = 0.01)) and for coastal sites was 76.7 CFU/g (0, 3497.5 CFU/g). For coastal waters and all waters, the median was 0 CFU/ml (0, 1592 CFU/ml) and for freshwaters 6.7 (0, 310.0) CFU/ml (p < 0.001). The results advocate that beaches should be monitored for fungi for safer use and better management.

The nursing and financial implications of laparoscopic colorectal surgery: data from a randomized controlled trial.

AIM: The issue of cost effectiveness of laparoscopic surgery remains uncertain and its impact on the ward nursing staff is unaddressed. This study investigated these issues using patients from a single centre admitted to a randomized controlled trial. METHOD: All patients recruited into the Australasian Laparoscopic Colon Cancer Study (ALCCaS) from The Queen Elizabeth Hospital between January 1999 and March 2005 were included in this study. Data relating to hospital cost were collated from the Hospital Patient Costing System. Nursing interventions were calculated in minutes per patient, using the excelcare Software database. RESULTS: Data from 97 patients were analysed (laparoscopy, 53; open surgery, 44). The median number of hours of nursing input per patient was 80 (27.5-907) h in the open surgery group and 58.5 (15-684.5) h in the laparoscopy group. This difference was further increased after exclusion of patients converted from laparoscopy to open surgery. The median total cost of the procedure was AUS $9698/£ 5631 (AUS $3862-90,397) in the open surgery group and AUS $10,951/£ 6219 (AUS$2337-66,237) in the laparoscopy group. CONCLUSION: These data suggest that laparoscopic colorectal surgery is equivalent in price to open surgery and there may be added benefits in reduced nursing intensity.

Laparoscopically assisted colectomy: a study of risk factors and predictors of open conversion.

BACKGROUND: Conversion to an open procedure during laparoscopically assisted colorectal resection may be necessary because of technical, patient, or pathologic factors. Recent literature has indicated that converted patients may have poorer outcomes than those undergoing open or completed laparoscopically assisted procedure. This study aimed to audit the authors' experience with laparoscopically assisted colectomy and to assess the clinical outcomes of patients undergoing conversion. METHODS: All laparoscopic right hemicolectomies or anterior resections performed at seven South Australian hospitals from 1997 to 2006 were reviewed. Data pertaining to patient sex, age, American Society of Anesthesiology (ASA) score, pathology, operative outcomes including operating time, conversion, reason for conversion, length of hospital stay, and intra- and postoperative complications were analyzed. RESULTS: Laparoscopic anterior resection had a higher rate of open conversion than laparoscopic right hemicolectomy (18.7% vs 10.4%; p = 0.028). In the right hemicolectomy group, none of the investigated risk factors for conversion were statistically significant, and the morbidity rates for the two groups were similar. The median hospital stay was significantly longer in the anterior resection group (p < 0.001), and the wound morbidity rate was higher in the converted group (12.8% vs 3.0%; p = 0.022). Age older than 75 years and a high ASA status were independent risk factors for conversion in anterior resection. CONCLUSIONS: Conversion of laparoscopic anterior resection to open procedure is associated with higher wound morbidity and a longer hospital stay. The authors recommend that surgeons carefully consider the selection of patients 75 years of age or older and high ASA status for laparoscopic anterior resection.

Can targeted intervention in CRC patients' relatives influence screening behaviour? A pilot study.

OBJECTIVE: This study aimed to assess the utility of a standardised risk information tool with respect to the uptake of screening activities administered to an accessible population of first-degree relatives of patients with sporadic colorectal cancer. METHOD: Patients admitted for colorectal cancer resection were invited to enroll their family unit in the study. Families were randomised either to receive standard care or the intervention tool. The intervention group received a structured one page pamphlet outlining the risk associated with a family history of colorectal cancer, and the availability of and potential benefits from screening. Three months after the initial contact with the index patient, family members were invited to participate in a telephone interview. Primary end-points were both intention to screen and uptake of screening activities. RESULTS: Forty-seven families had 156 eligible first degree relatives. Ninety-one consented to participate and were enrolled: 59 received standard care, 32 received the intervention. Age and sex were similar between groups. There was no significant difference in previous screening activities. The intervention tool had no influence on perceived self-risk of developing colorectal cancer or uptake of screening activities within the study period. CONCLUSION: This study suggests that the provision of targeted risk information to first-degree relatives is not likely to positively influence screening behaviour. Health care providers need to find alternative methods of disseminating information to this high-risk group.

Long-term follow-up of patients with a diagnosis of paranoid state and hospitalized, 1913 to 1940.

From a sample of 239 patients diagnosed paranoid state and hospitalized between 1913 and 1940 at the Phipps Clinic, we particularly studied a group of 60 patients without previous hospitalizations, consisting of 57 patients with follow-ups of 5 or more years, and 3 patients who killed themselves (the ultimate follow-up) less than 1 year after discharge. These 60 patients had been retrospectively diagnosed with delusional disorders by DSM-IV criteria. On follow-up, 27% were rated recovered, whereas 52% were rated unimproved. Long-term follow-up was correlated with discharge status. Poor follow-up was significantly correlated with seclusive personality, poor premorbid history, onset 6 months or more before admission, gradual onset, lack of insight, single marital status, and lack of precipitating events. A prognostic scale constructed from the first four of these variables was predictive of long-term outcome. More recent, better treatment results have been contrasted with these findings from an earlier non-drug-treatment era.

Suicide in patients hospitalized for schizophrenia: 1913-1940.

From a sample of 1357 schizophrenic patients hospitalized between 1913 and 1940 at the Phipps Clinic, we have follow-up data on 1212 (89%) cases, with a mean length of follow-up of 11 years. Of these 1212 patients, 28 (2%) are known to have committed suicide. Suicide was significantly correlated with 1) previous suicide attempts, 2) depressive symptoms, 3) preoccupation with suicide, 4) affective illness in close relatives, 5) poor premorbid social and work history, 6) sexual worries, and 7) psychomotor agitation. Marital status, gender, age at onset, age at admission, number of previous admissions, condition at discharge from Phipps, length of hospitalization, the presence of any type of delusions or hallucinations, alcohol problems, paranoid or catatonic features, and utilization of shock therapies were not significantly correlated with subsequent suicide. The seven variables significantly correlated with suicide enumerated above were chosen to construct a scale suggesting which patients were at high risk for suicide.

Long-term follow-up of patients hospitalized for schizophrenia, 1913 to 1940.

From a sample of 1357 schizophrenic patients hospitalized between 1913 and 1940 at the Phipps Clinic, we particularly studied 484 patients with follow-ups of 5 or more years. Of the sample of 1357 patients, 28 (10%) committed suicide. None of the suicides were included in the sample of 484, which also eliminated all patients with any previous psychiatric admissions or episodes of mental illness, even without hospitalization. On follow-up, only 13% of the 484 were rated recovered, whereas 58% were rated unimproved. Long-term global follow-up was highly correlated with discharge status. Subgroups retrospectively diagnosed by DSM-IV criteria were significantly related to long-term follow-up in the sample of 484 patients, there being a continuum of poor outcome ranging from the diagnoses schizophrenia through schizophreniform to schizoaffective. Poor follow-up was significantly correlated with poor premorbid history, gradual onset, lack of depressive symptoms and heredity, seclusive personality, lack of precipitating events, lack of confusion, single status, onset before age 21, delusions of control, onset 6 months or more before admission, and emotional blunting. These variables were used to construct a validated prognostic scale. More recent treatment results have been contrasted with these findings from an earlier non-drug treatment era.

The interaction of RNA polymerase II with the adenovirus-2 major late promoter is precluded by phosphorylation of the C-terminal domain of subunit IIa.

Mammalian RNA polymerase II contains at the C terminus of its largest subunit an unusual domain consisting of 52 tandem repeats of the consensus sequence Tyr-Ser-Pro-Thr-Ser-Pro-Ser. The phosphorylation of this domain is thought to play an important role in the transition of RNA polymerase II from a preinitiation complex to an elongating complex. The unphosphorylated form of RNA polymerase II is designated IIA, whereas the phosphorylated form is designated IIO. In an effort to determine the consequence of C-terminal domain phosphorylation on complex formation, 32P-labeled RNA polymerases IIA and IIO were prepared and examined for their ability to form a stable preinitiation complex on the adenovirus-2 major late promoter in the presence of a reconstituted HeLa cell transcription extract. Preinitiation complexes were formed in the absence of ATP and purified from free RNA polymerase II by chromatography on Sepharose CL-4B. The state of phosphorylation of the largest subunit was monitored by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and the transcriptional activity was determined by assaying specific transcript formation upon the addition of nucleotides and a competing DNA template. RNA polymerase IIA was recovered in transcriptionally active complexes in reactions in which the input enzyme was RNA polymerase IIA. In reactions with RNA polymerase IIO as the input enzyme, no IIO was recovered in excluded fractions that normally contain preinitiation complex. In reactions with equimolar amounts of RNA polymerases IIO and IIA, purified preinitiation complexes contained almost exclusively RNA polymerase HA. These results support the idea that RNA polymerase II containing an unphosphorylated C-terminal domain preferentially associates with the adenovirus-2 major late promoter. The state of phosphorylation of the C-terminal domain can, therefore, directly influence preinitiation complex formation. We also report here the presence of an activity in HeLa cell extracts that catalyzes dephosphorylation of the C-terminal domain, thereby converting RNA polymerase IIO to IIA. This C-terminal domain phosphatase is specific in that it does not catalyze the dephosphorylation of a serine residue phosphorylated by casein kinase II. The presence of a C-terminal domain phosphatase in in vitro transcription reactions containing RNA polymerase IIO results in the formation of RNA polymerase IIA. This RNA polymerase IIA associates preferentially with preinitiation complexes.

Characteristics and long-term follow-up of patients hospitalized for mood disorders in the Phipps Clinic, 1913-1940.

From a sample of 2809 mood disorder patients hospitalized between 1913 and 1940, we selected for detailed study 914 patients with at least a 5 year follow-up and 103 patients who committed suicide within 5 years of discharge. Patients with clearly mood incongruent delusions or an onset associated with a physical illness were excluded. Based on the presence or absence of manic symptoms, this cohort of 1017 cases was divided into 297 bipolar and 945 unipolar patients. Bipolar patients had an earlier age of onset and admission and were more likely to be delusional and hallucinated. They also had more sudden onsets, more previous admissions, worse premorbid characteristics, and more problems with alcohol, but more patients were discharged as recovered. Unipolar patients were more often female and married, more likely to have made previous suicidal attempts, and more likely to have experienced a precipitating event. On a mean follow-up of 13.5 years, only 11% of the bipolar and 22% of the unipolar patients experienced no further episodes of mania or depression. Of the bipolar group, 77% had to be rehospitalized, as did 56% of the unipolars. Only 2% of the sample had manic episodes with no lifetime depressions; this small group had the best outcome. One third of all the patients were rated unimproved on follow-up. Thirteen percent committed suicide, usually within 1 year of discharge. Bipolar patients had the worst outcome, with 43% rated unimproved. The sample was split by odd or even case number and one half was used to construct a prognostic scale significantly correlated with long-term outcome. It was cross-validated on the other half of the sample with little shrinkage. Patients with non-drug-treated affective disorders hospitalized half a century ago were found to have polyepisodic illnesses with a frequently chronic course.

Tunga penetrans.

We describe a patient who acquired tungiasis while traveling in an area where the condition is endemic. The pathogenesis, diagnosis, and treatment of this tropical disease are presented.

Inpatient diagnoses during Adolf Meyer's tenure as director of the Henry Phipps Psychiatric Clinic, 1913-1940.

Between 1936 and 1950, detailed abstracts were prepared on all patients admitted to The Phipps Psychiatric Clinic from its opening in 1913 through 1950. Of these abstracts, 74% contained follow-up reports. Except for four papers on schizophrenia and affective disorders published between 1939 and 1943, none of this material has ever been analyzed. The present paper, the first of a series, examines the 8172 first admissions from 1913 through 1940, the period of Adolf Meyer's tenure as Clinic Director. Based on discharge diagnoses, we have sorted the patients into eight diagnostic groups with the following frequencies; schizophrenia, 17%; paranoid state, 3%; manic-depressive, 7%; depression, 27%; organic, 20%; neuroses, 15%; substance abuse, 6%; psychopath, 5%. Our manic-depressive group contains cases discharged primarily as hyperthymergasia, mania, or manic depressive insanity (MDI). Of the 349 cases diagnosed MDI at discharge, 10 had neither a history of nor present symptoms of mania, and these were put in the depression group. Frequencies for most of the diagnoses remained remarkably stable over the 28-year period. Only 9% were discharged recovered, whereas 43% were rated unimproved. Mean length of hospitalization was 76 days, with 10% of the patients readmitted. The mean length of follow-up was 9 years. Correlations of diagnoses, year of admission, length of stay, condition at discharge, age, sex, readmissions, change of diagnoses, somatic treatment, length of follow-up, and deaths in the clinic are presented. Meyer's influence on diagnostic practice is discussed.

Perceptual span in schizophrenia and affective disorders.

Perceptual span was assessed in schizophrenic, bipolar affective disorder-manic, bipolar affective disorder-depressed, and nonpsychotic inpatients. Both schizophrenics and manics processed less information than depressives, and did not differ from each other. This suggests that reduced span may be a concomitant of psychoses characterized by distractibility and thought disorder, rather than a trait specific to schizophrenia.

Reactive psychoses.

Scandinavian psychiatrists have been pre-eminent in elucidating the concept of reactive psychoses. This diagnosis has never found much acceptance except in Scandinavia, and the new Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition category of brief reactive psychosis is quite different from reactive psychosis as described by most Scandinavian clinicians and researchers. The concept of psychogenic psychoses is, however, not new. Indeed, many psychiatrists of the early 20th century stressed the psychogenic factors in psychotic mental disturbances. Reactive psychoses have generally been considered illnesses distinct not only from schizophrenia but also from manic-depressive psychosis with a distinctive genetic component. Of 283 hospitalized patients at Johns Hopkins for whom long-term follow-ups were available and of whom all were first admissions, Astrup retrospectively diagnosed 91 as reactive psychoses. A contrasting group of 78 "systematic schizophrenics" by Leonhardt's criteria were identified. Stephens found that these two groups differed significantly in that the reactive patients had a) a more acute onset, b) more precipitating stress, c) more affective symptoms, d) more confusion, e) less affective blunting, f) a better premorbid adjustment, g) less premorbid schizoid traits, h) fewer schizophrenic relatives, and i) a much more favorable long term outcome.

Prognosis as the critical variable in classification of the functional psychoses.

Kraepelin used a disease entity concept to define the two major functional psychoses (i.e., distinctive patterns of onset, symptoms, and course of illness). There have been many subsequent studies using patient outcome or distribution of illness among relatives to test the validity of these nosological classes. Differences between chronic schizophrenia and (predominantly nonchronic) affective disorders are often reported, but it is difficult to discern whether these differences are associated with diagnostic symptomatology rather than premorbid prognostic status. The evidence suggesting a genetic link between good prognosis schizophrenia and affective disorders may be misinterpreted if premorbid prognostic processes are the distinguishing heritable components between chronic schizophrenia and nonchronic illnesses. Which components of severe psychiatric disorders are heritable is not yet clear. The developmental, psychological and neurological processes associated with premorbid and early morbid characteristics of illness appear good candidates. Considering such variables as prognostic (early morbid or premorbid) rather than diagnostic would permit examination of class assignment (e.g., schizophrenia, bipolar affective disorder) and premorbid development. The literature now suggests that chronicity in psychiatric illness breeds true and that symptom constellations breed true. Both of these views may be corrects, and the taxing study design required to simultaneously study these two attributes of disease entities is warranted. This may establish good prognosis schizophrenia as a "third psychosis," or may affirm its standing within traditional nosology.

A comparison of nine systems to diagnose schizophrenia.

The files of 283 hospitalized patients discharged with a diagnosis of schizophrenia, schizoaffective schizophrenia, or paranoid state were examined without knowledge of the patient's subsequent history. These patients, most of whom had originally been diagnosed by DSM-I criteria, were retrospectively diagnosed by New York Research Diagnostic Criteria (RDC), the New Have Schizophrenia Index (NHSI), the St. Louis criteria, Taylor-Abrams 1978 criteria, Schneider's first-rank symptoms (FRS), the Washington IPSS 12-Point Flexible System, Astrup's process/nonprocess distinction, and DSM-III. Kappa values measuring pairwise diagnostic agreement amont the nine systems were typically low except among RDC, DSM-III, and St. Louis criteria. Long-term followup status was not significantly predicted by the FRS, NHSI, or Taylor-Abrams criteria. Diagnosis by means of the other systems, especially the Astrup process/nonprocess distinction, was significantly correlated with followup. However, Astrup's "process" schizophrenia is not operationally defined and could not be expected to be used with the degree of interrater reliability desired by researchers. On the other hand, of the operationally defined systems, DSM-III schizophrenia has the highest correlation with followup and is thus suggested for use by researchers desiring a highly homogeneous, although narrowly defined, population. Investigators wishing to cast a wider net could use a less restrictive system such as the RDC, with or without schizoaffectives included.

Diagnostic criteria for schizophrenia: prognostic implications and diagnostic overlap.

The files of 120 hospitalized patients who had participated in drug studies between 1964 and 1966 were examined without knowledge of the patient's subsequent history. These patients, who had originally been diagnosed by DSM-II criteria, were retrospectively diagnosed by New York Research Diagnostic Criteria (RDC), the New Haven Schizophrenia Index (NHSI), the St. Louis criteria, Bland and Orn's modification of the St. Louis critera, Schneider's first rank symptoms (FRS) criteria, and the 12-point "Flexible" system developed by the Washington field center of the International Pilot Study of Schizophrenia. By RDC criteria, 12 patients were diagnosed as major depressive disorders and the remaining 108 patients were diagnosed either schizophrenias, schizoaffective disorders, or unspecified functional psychoses. Of these 108, 97 were also diagnosed schizophrenic or schizoaffective by at least three other sets of critera. Ten-year followups were obtained on 82 (68%) of the 120 patients. Outcome was not significantly predicted by either presence or number of FRS, by an NHSI diagnosis of schizophrenia, or by a diagnosis of schizophrenia using the 12-point Flexible system with a 5-point cutoff. However, a significant relationship was found with the St. Louis criteria and the Bland-Orn score obtained from these criteria. An even higher correlation was found between followup and the Stephens-Astrup scale and the Strauss-Carpenter prognostic scale. RDC and DSM-II diagnoses were also significantly correlated with followup but to a lesser degree.