Atypical presentation of invasive meningococcal disease caused by serogroup W meningococci.

Neisseria meningitidis, a gram-negative diplococcus, is typically an asymptomatic coloniser of the oropharynx and nasopharynx. Passage of N. meningitidis into the bloodstream can cause invasive meningococcal disease (IMD), a potentially life-threatening illness with rapid onset that generally presents as meningitis, septicemia or both. Serogroup W IMD has been increasing in prevalence in recent years, and observations suggest that it may present with atypical signs and symptoms. Herein, a literature search was performed to identify trends in atypical serogroup W IMD presentation in order to review those that are most prevalent. Findings indicate that the most prevalent atypical presentations of serogroup W IMD include acute gastrointestinal (GI) symptoms, septic arthritis and bacteremic pneumonia or severe upper respiratory tract infection, notably epiglottitis. Atypical clinical presentation is associated with higher case fatality rates and can lead to misdiagnoses. Such risks highlight the need for clinicians to consider IMD in their differential diagnoses of patients with acute GI symptoms, septic arthritis or bacteremic pneumonia, primarily in regions where serogroup W is prevalent.

Installation and commissioning of the ion source systems for the new spallation neutron source 2.5 MeV injector.

The U.S. Spallation Neutron Source (SNS) is a state-of-the-art neutron scattering facility delivering the world's most intense pulsed neutron beams to a wide array of instruments, which are used to conduct investigations in many fields of engineering, physics, chemistry, material science, and biology. Neutrons are produced by spallation of liquid Hg by the bombardment of short (∼1 µs), intense (∼35 A) pulses of protons delivered at 60 Hz by an accumulator ring which is fed by a high-intensity, 1 GeV, H- LINAC (linear accelerator). This facility has operated nearly continuously since 2006 but has recently undergone a 4-month maintenance period, which featured a complete replacement of the 2.5 MeV injector feeding the LINAC. The new injector was developed at ORNL in an off-line beam test facility and consists of an ion source, low energy beam transport, and a Radio Frequency Quadrupole (RFQ). This report first describes the installed configuration of the new injector detailing the ion source system. The first beam current, RFQ transmission, emittance, and energy measurements from the injector installed on the SNS are reported. These data not only show a significant performance improvement for our existing facility but will also make accessible the higher beam current requirements for future SNS upgrade projects: the proton power upgrade and second target station.

Signs of defensive control locate conflicted topics in discourse.

BACKGROUND: Psychodynamic clinicians cite defensive actions observed in evaluation and treatment as a source of important information. Empirical support for such assertions has seldom been based on objective study of recorded psychotherapy. A quantitative study of the association of signs of defensive control with disclosure of conflicted beliefs was undertaken. METHODS: Brief dynamic psychotherapies of two patients with pathological grief reactions were recorded and reviewed by independent judges. Periods of heightened defensive control of verbal and nonverbal communication were quantified using operational definitions. Reliably scored defensive episodes were algorithmically selected by computer programs. The people and topics discussed by patients were independently scored. RESULTS: Highly defensive periods contained disproportionately more frequent instances of patient discourse about people involved in conflict and unresolved topics. CONCLUSIONS: The findings support the psychodynamic hypothesis that observation of defensive behaviors may locate times of communication about conflicted themes.

Cyclical patterns of states of mind in psychotherapy.

OBJECTIVE: A quantitative study of shifts in states of mind was conducted to demonstrate a clinically useful mode of observation. This mode categorizes observations of a patient's mental state into well-modulated, overmodulated, undermodulated, and shimmering patterns. METHOD: The authors used reliable systems for scoring a patient's state of mind on videotapes of all sessions of her brief psychotherapy and, using separate procedures, scored the topics of discourse. These data were then examined by means of a lagged log-linear sequential analysis for patterns of shifts from one state to another and for concurrent shifts in topics. RESULTS: The findings indicated nonrandom shifts in state. Patterns of shifting from a well-modulated state to alternative states and back again were overrepresented. Such shifts were related to conflictual topics of discourse. CONCLUSIONS: Observing such shifts in mental state may help psychotherapists to formulate the contents of conflict and also to make technical interventions to stabilize optimal states for doing the work of psychotherapy.

Diagnostic criteria for complicated grief disorder.

OBJECTIVE: Some prolonged and turbulent grief reactions include symptoms that differ from the DSM-IV criteria for major depressive disorder. The authors investigated a new diagnosis that would include these symptoms. METHOD: They developed observer-based definitions of 30 symptoms noted clinically in previous longitudinal interviews of bereaved persons and then designed a plan to investigate whether any combination of these would serve as criteria for a possible new diagnosis of complicated grief disorder. Using a structured diagnostic interview, they assessed 70 subjects whose spouses had died. Latent class model analyses and signal detection procedures were used to calibrate the data against global clinical ratings and self-report measures of grief-specific distress. RESULTS: Complicated grief disorder was found to be characterized by a smaller set of the assessed symptoms. Subjects elected by an algorithm for these symptoms patterns did not significantly overlap with subjects who received a diagnosis of major depressive disorder. CONCLUSIONS: A new diagnosis of complicated grief disorder may be indicated. Its criteria would include the current experience (more than a year after a loss) of intense intrusive thoughts, pangs of severe emotion, distressing yearnings, feeling excessively alone and empty, excessively avoiding tasks reminiscent of the deceased, unusual sleep disturbances, and maladaptive levels of loss of interest in personal activities.

Dysfluency and topic orientation in bereaved individuals: bridging individual and group studies.

Discourse of bereaved individuals talking about the deceased and other topics was examined using computer-based text analyses and judged ratings of verbal behavior for patterns indicating dysfluency and orientation toward topics. Using factor analysis, the discourse structure of low-distress bereaved individuals was compared with that of high-distress bereaved individuals and with that of single bereaved individual both early and late in psychotherapy. Meaningful differences were observed for the distress groups and for the single individual early and late in therapy, and these findings indicate possible quantitative and qualitative means for detecting maladaptive responses to stressors.

Topics and signs: defensive control of emotional expression.

This single-case study examined frank disclosure of important topics in a brief exploratory psychotherapy, including topics closely related to a recent, unintegrated stressor life event. Quantitative measures of emotion and control variables showed heightened levels of both emotionally and defensive control during discourse on the topic of the stressor event. In future studies, such measures of verbal and nonverbal signs of emotional expression and defensive control might be used to identify topics in an unresolved state.

Seasonal changes in the architecture of natural plant communities and its relevance to insect herbivores.

The seasonal changes in plant community architecture and its importance to insect herbivores during the ruderal-early stages of an experimental secondary successional gradient are described. The dominant group of insect herbivores, the Auchenorrhyncha (Hemiptera: Homoptera) are considered together with their host plants, the Gramineae. Here plant structure is analysed in terms of the height profile of the vegetation and its complexity of form. Correlations between insect and plant parameters indicate that the number of different types of grass structure (a measure of architecture) account for 79% and 86% of the variance in leafhopper species richness and total abundance respectively. It is suggested that plant architecture may influence insect herbivore diversity by providing a templet, principally in terms of resource availability, for insect colonisation.

The experimental manipulation of insect herbivore load by the use of an insecticide (malathion): The effect of application on plant growth.

The effects of insect herbivores on natural communities of plants may be demonstrated by manipulative experimetns. Such experiments, which reduce the natural levels of herbivory by application of insecticide, incorporate the assumption that the insecticide has no direct effect on the vegetation. A test of this assumption should therefore be an integral part of any study of herbivory employing chemical exclusion. Here a single compound (Malathion-60), which is commonly used in such studies, is tested both in the field and on selected plant species under controlled conditions. It was found to have no effect on a range of early successional plant species. The limitations of the tests are discussed.

Dominance and aggression in social groups of male and female rats.

Two experiments were performed to examine aggression and dominance in domestic male and female Rattus norvegicus living in small mixed-sex (3 males and 3 females) groups. Experiment 1 examined the development of aggression in females. A single female (alpha) within each of the six colonies tested showed the preponderance of attacks on male intruders placed into the home-cage when male colony residents were absent. Over 12 weeks of intruder-aggression training female alphas showed only a mild nonsignificant elevation of aggressive behavior. A comparison of aggression of male and female colony alphas tested with opponents of each sex revealed that aggression was mainly directed at like-sex opponents, and that female attack was more defensive in character than male attack regardless of opponent sex. The highest intensity of aggression occurred when male alphas confronted male intruders. Although intruders never showed offense toward male residents, 61% of intruding males showed offense in response to attack by females. Experiment 2 investigated the relationship between aggressive dominance and competitive measures of dominance within each of 10 mixed-sex colonies. Alpha stat s of male and female colony residents did not reliably predict priority of access to food or water in tests of direct resource competition with like-sex colony members. When colony males were simultaneously tested for copulation, the copulatory behavior of alpha males was significantly greater than that of other colony males. Results are discussed in relation to the role of aggression in the reproductive strategy of male and female Rattus norvegicus .

Psyclops: an exploratory graphical system for clinical research and education.

We present Psyclops, an interactive computer graphic system designed to help address a growing information dilemma in the examination of individual psychiatric cases. Ever more information is needed to better understand conscious experience, interpersonal behavior, and the formation of psychiatric signs and symptoms, yet the information load already exceeds our usual methods of handling it. Psyclops consists of a suite of software modules, manual sections, and standards that have been developed according to guiding concepts intended to help one collect, organize, access, and explore complex data about a single subject for research, education, and ultimately, clinical care purposes. This document provides background in clinical information science and a description of the system; the reader interested in its application in clinical research theory development is referred to the companion paper in this issue (Horowitz et al., Pathological Grief: An Intensive Case Study).

Pathological grief: an intensive case study.

Pathological mourning is such an excessive, blocked, or distorted process that psychiatric signs and symptoms develop. Explanation of how and why these signs and symptoms form could deepen an understanding of both normal and pathological mourning. Because many variables are involved in such explanations, intensive case study is a desirable methodology because it permits a detailed look at how various factors interact (Brewer and Hunter 1989; Luborsky and Mintz 1972; Luborsky and Spence 1971; Nessleroade and Ford 1985). While a patient may complain of symptoms as experiences that endure or occur episodically over days and weeks, a clinician observes psychiatric signs in the here-and-now seconds and minutes of an interview. Relating signs and symptoms to each other and to other variables in order to form a theoretical model of their formation requires exploration of data across long and short time frames. It is important to understand how the here-and-now phenomena combine to form patterns across longer periods of the individual's life. Hence, we developed a combined macro- and microanalytic approach to intensive case studies.

Survival trends of Staphylococcus aureus, Pseudomonas aeruginosa, and Clostridium perfringens in a sandy South Florida beach.

The search for alternative indicators of disease-risk from non-enteric pathogens at the beach revealed high densities of targeted bacteria. To explain the high numbers of potential non-enteric pathogens, Staphylococcus aureus and Pseudomonas aeruginosa, in beach sand, we investigated factors affecting their survival and distribution, as well as those of a potential fecal indicator, Clostridium perfringens. Results indicated greater S. aureus and P. aeruginosa survival and proliferation in sterile beach sand, than seawater, with diminished numbers upon exposure to natural micro-predators. C. perfringens remained relatively consistent with initial numbers. Intermediate sand particles (850 µm-2 mm) constituted the major micro-niche; creating implications for beach classification programs. Colonization of sterile sand boxes at the beach by S. aureus and P. aeruginosa confirmed the filtering action (>100×) of beach sand. The use of these potential pathogens in periodic sanitary evaluation of beach sand quality is indicated, regardless of the factors influencing their abundance.

Use of a structured reminiscence protocol to decrease depression in older women.

Depression is a major public health problem for older women. Medications do not always decrease depression. Therefore, there is a need to research alternative approaches to dealing with depression in this age group. Structured reminiscence has been suggested as a cognitive behaviour approach for dealing with depression in older women. However, the research is limited. This article presents a research study using a structured reminiscence protocol to decrease depression in older women. This study found significant positive results. First, structured reminiscence decreases depression levels of women 60 years and older residing in assisted living facilities when offered twice weekly for 6-week duration to document significant improvement in depression scores. Second, engagement in reminiscence must occur longer than 3 weeks to measure a significant improvement in depression scores. The study also recommends screening of all older women admitted to assisted living facilities for depression on admission and offering education to nurses working with older adults to educate them on the positive effects of structured reminiscence group interventions.

Toxicant extraction efficiency and branchial NaCl fluxes in lampreys exposed to Kepone.

Freshwater fish (larval lampreys Petromyzon marinus) occupied plastic tubes and ventilated aqueous solutions (around 1.0 mg/L) of the organochlorine pesticide Kepone at 13 degrees C. The efficiency with which Kepone was extracted from solution during a single pass through the pharynx, and the effect of Kepone on fluxes of Na+ and Cl- across the gills were measured. The efficiency with which lampreys extracted Kepone from local tap water averaged 55-66%, confirmed by measuring Kepone accumulation within the lampreys (as 14C-equivalents), using a mass-balance approach. The extraction efficiency matches predictions based on studies using teleosts. Extraction efficiencies declined slowly throughout the exposure period and related inversely to ventilatory rates. In ion-flux measurements, Kepone produced a 40% decline in the rate of influx of Cl- across the pharynx. Effluxes of Na+ and Cl- were not affected, nor was influx of Na+. These latter findings are difficult to reconciliate with accepted theories of Kepone's toxic action; they may relate to the fact that lampreys are unusually tolerant to Kepone poisoning.

Evaluation of Quick Bacterial Count Methods for Assessment of Food Plant Sanitation.

Four methods to detect microbial contamination on food plant equipment surfaces were compared to determine the accuracy, precision, cost and time required to do each test. A standard method for swabbing; a simplified swab test (Millipore Corporation); a contact-transfer method (Con-Tact-It, Birko Chemical Corporation) and a direct method using Rodac plates (BBL) were evaluated. The equipment surfaces were found to be highly contaminated indicating the necessity for regular microbial testing. Under conditions of the test, there was good agreement in enumeration of bacteria between the standard swab test and both the Millipore swab method and the Con-Tact-It system; the standard swab method and Rodac plates showed the best precision. The contact methods were by far the quickest tests to do, and the Con-Tact-It system was the least expensive.

Relation of Lake Ontario fish consumption, lifetime lactation, and parity to breast milk polychlorobiphenyl and pesticide concentrations.

Lactating female members and spouses of male members of the New York State Angler Cohort who agreed to provide breast milk samples were the subjects of this study. Questionnaires were provided to participants focusing on Lake Ontario fish consumption, reproductive history, and lactation history. Milk samples were analyzed for 77 polychlorinated biphenyls (PCB) congeners, 1,1-dichloro-2,2-bis (p-chlorophenyl)-ethylene (DDE), a metabolite of dichlorodiphenyltrichloroethane (DDT), hexachlorobenzene (HCB), and 1,1a,2,2,3,3a, 4,5,5,5a,5b,6-dodecachlorooctahydro-1,3, 4-methano-1H-cyclobuta[cd]pentalene (Mirex). The percentage of samples with quantifiable levels, above the limit of detection (LOD), varied among the individual congeners from 10 to 100%. Nine PCB congeners (designated by their IUPAC No.) and DDE were found in all of the 100 samples analyzed. These include the following, in decreasing order of concentration: DDE>153>138>180>118>187>188>177>200. Total PCB concentrations were estimated by taking the sum of the concentrations of all PCB congeners (up to 77 congeners) above their respective LOD in a given sample. PCB concentrations increased with increasing concentration of milk lipid. Lipid adjusted PCB concentrations increased as a function of maternal age. PCB congener profiles in milk favored the higher chlorinated congeners, with the four highest congeners having 5 to 7 chlorine atoms. Fish eaters had a significantly higher level of several major PCB congeners with congeners 153 and 138 being 1.36 and 1.34 times higher, respectively. PCB and DDE concentrations, expressed on a lipid basis, varied inversely with parity. The total number of months of lifetime lactation varied inversely with the total PCB concentration in breast milk. A similar relationship was evident for DDE. These data are of use for risk assessment in estimating the relative exposure to these environmental contaminants in breast fed infants whose mothers consumed contaminated Lake Ontario fish.

Comparison of PCB congeners and pesticide levels between serum and milk from lactating women.

Samples of blood and milk were obtained from lactating women participating in the New York State Angler study. A total of seven women gave one blood and one milk sample at time intervals between blood and milk collection different for each woman. The time between samples varied from 3 to 318 days. One subject provided a second milk sample 219 days after the first milk sample. The samples were analyzed for 69 PCB congeners, DDE (a metabolite of DDT), Mirex, and hexachlorobenzene (HCB). Lipid content was determined by gravimetric analysis. The congener profiles in serum and milk were similar for each individual but different among all subjects. The sum of the concentrations of the congeners present above the limit of detection was used to estimate the total PCB concentration that was in the range of 2.6 to 5.8 ng/g of serum and 3.5 to 14.1 ng/g of milk. The ratio of serum to milk concentrations varied from 0.18 to 1.66 with a mean of 0.65+/-0.49 showing no consistency among individuals prior to adjusting the data for lipid content. The total PCB levels normalized for lipid content were 320-728 ng/g of serum lipid and 239-428 ng/g of milk lipid. The range of the lipid adjusted serum/milk ratio was 1.1 to 2.8 and the mean+/-SD serum/milk ratio was 1.9+/-0.5. The ranges of lipid adjusted serum concentration of DDE, HCB, and Mirex were 95 to 591, 8 to 48, and 3 to 29 ng/g lipid, respectively. The ranges of lipid adjusted milk concentration of DDE, HCB, and Mirex were 90 to 577, 11 to 22, and 1 to 10 ng/g lipid, respectively. For DDE, HCB, and Mirex, the means of the individual lipid adjusted serum to milk ratios were 1.5+/-0.7, 2.5+/-1.5, and 5. 3+/-4.6, respectively. Considerable differences were found among lipid adjusted concentrations of these environmental pollutants in serum and milk samples from the same individual. This suggests that body burden estimates in lactating women using different matrices may not be equivalent even when lipid adjusted values are used.