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Chronicle of the Narvaez Expedition ALVAR NUNEZ CABEZA DE VACA Translated by DAVID FRYE Edited by ILAN STAVANS New York: Norton, 2013 223 pp. The Norton Critical Edition of Alvar [...]

Worldling America: A Transnational Anthology of Short Narratives before 1800 Edited by OLIVER SCHEIDING and MARTIN SEIDL Stanford, CA: Stanford University Press, 2015 245 pp. Even while teaching these works, [...]

Evolutionary medicine attempts to solve a problem with which traditional medicine has struggled historically; how do we distinguish between diseased states and "healthy" responses to disease states? Fever and diarrhea represent classic examples of evolved adaptations that increase the likelihood of survival in response to the presence of pathogens in the body. Whereas, the severe mental disorders like psychotic mania or the schizophrenias may involve true "disease" states best treated pharmacologically, most non-psychotic "disorders" that revolve around negative affects like depression or anxiety are likely adaptations that evolved to serve a function that increased inclusive fitness in our ancestral past. What this likely means is that the proximal mechanisms underlying the non-psychotic "disorders" are "species typical" and neither diseases nor disorders. Rather, they are coordinated "whole body" responses that prepare the individual to respond in a maximally functional fashion to the variety of different challenges that our ancestors faced. A case can be made that depression evolved to facilitate a deliberate cognitive style (rumination) in response to complex (often social) problems. What this further suggests is that those interventions that best facilitate the functions that those adaptations evolved to serve (such as rumination) are likely to be preferred over those like medications that simply anesthetize the distress. We consider the mechanisms that evolved to generate depression and the processes utilized in cognitive behavior therapy to facilitate those functions from an adaptationist evolutionary perspective. [ABSTRACT FROM AUTHOR]

In the article, the author discusses the advisability of advisory committee notes to judicial rules by examining rule 804(3) of the Utah rules of evidence on hearsay. Also cited are the tackling of the issue by the U.S. Supreme Court and Utah Supreme Court, the ruling by the Utah court in the case In re Larsen, and the responsibility of the state Supreme Court to adopt rules of procedure and evidence.

Previous studies suggest that performance of a series system may be enhanced if those station(s) having smallest mean operation time requirement(s) and/or smallest variability are placed in the middle of the line. There has been considerable confusion relative to whether this 'bowl phenomenon' has to do with the placement of means, variances, or some combination of the two. The results of the current study show that the phenomenon observed is not related to an imbalance in means. Rather, it is associated with an imbalance in absolute variability. Furthermore, it is suggested that the bowl effect vanishes altogether in cases where a minimal level of in-process buffer stock is provided. [ABSTRACT FROM AUTHOR]

The article discusses the Utah Supreme Court's ruling in the 1974 case of "State v. Nielsen" which prohibits the use of the Utah Rules of Civil Procedure to take depositions in a criminal case or in anything pertaining to discovery. It cites the ruling in the case of "State v. Gonzales" which holds that the civil rules of procedure could be used in some discovery matters in criminal cases. Also discussed is the divisions and distinctions between criminal and civil law.

Moral attitudes justifying economic inequality are often embedded within conservative religion and politics in the United States, even as traditional Christian values assert the need for compassion toward the poor. Using the Baylor Religion Survey, we assessed the role of religion in influencing partisan attitudes about poverty, finding that Republicans not only oppose federal policy aimed toward redistribution of wealth but also articulate less of a personal moral obligation to help the poor. However, Republicans who believe in a highly engaged God are strikingly similar to Democrats on these economic justice issues, suggesting that some types of religion do make conservatives more “compassionate.” [ABSTRACT FROM AUTHOR]

Background: Antidepressants (ADs) are commonly prescribed medications, but their long-term health effects are debated. ADs disrupt multiple adaptive processes regulated by evolutionarily ancient biochemicals, potentially increasing mortality. However, many ADs also have anticlotting properties that can be efficacious in treating cardiovascular disease. We conducted a meta-analysis assessing the effects of ADs on all-cause mortality and cardiovascular events in general-population and cardiovascular-patient samples.Methods: Two reviewers independently assessed articles from PubMed, EMBASE, and Google Scholar for AD-related mortality controlling for depression and other comorbidities. From these articles, we extracted information about cardiovascular events, cardiovascular risk status, and AD class. We conducted mixed-effect meta-analyses testing sample type and AD class as moderators of all-cause mortality and new cardiovascular events.Results: Seventeen studies met our search criteria. Sample type consistently moderated health risks. In general-population samples, AD use increased the risks of mortality (HR = 1.33, 95% CI: 1.14-1.55) and new cardiovascular events (HR = 1.14, 95% CI: 1.08-1.21). In cardiovascular patients, AD use did not significantly affect risks. AD class also moderated mortality, but the serotonin reuptake inhibitors were not significantly different from tricyclic ADs (TCAs) (HR = 1.10, 95% CI: 0.93-1.31, p = 0.27). Only "other ADs" were differentiable from TCAs (HR = 1.35, 95% CI: 1.08-1.69). Mortality risk estimates increased when we analyzed the subset of studies controlling for premedication depression, suggesting the absence of confounding by indication.Conclusions: The results support the hypothesis that ADs are harmful in the general population but less harmful in cardiovascular patients. [ABSTRACT FROM AUTHOR]

CASE HISTORY: One hundred and forty Cheviot and 100 Suffolk cross Mule primiparous 1–2-year-old ewes, from a flock of about 700 ewes, were vaccinated with an attenuated live 1B strainChlamydia abortusvaccine about 4 weeks before ram introduction (September 2011). Between 08 March and 01 April 2012, 50 2-year-old ewes aborted and 29 of these died, despite antimicrobial and anti-inflammatory treatment and supportive care. PATHOLOGICAL FINDINGS: Seven fetuses and three placentae from five 2-year-old ewes were submitted for pathological investigation. The aborted fetuses showed stages of autolysis ranging from being moderately fresh to putrefaction. Unusual, large multifocal regions of thickened membranes, with a dull red granular surface and moderate amounts of grey-white surface exudate were seen on each of the placentae. Intracellular, magenta-staining, acid fast inclusions were identified in Ziehl Neelsen-stained placental smears. Immunohistochemistry forChlamydia-specific lipopolysaccharide showed extensive positive labelling of the placental epithelia. LABORATORY FINDINGS: Molecular analyses of the aborted placentae demonstrated the presence of the 1B vaccine-type strain ofC. abortusand absence of any wild-type field strain. The vaccine strain bacterial load of the placental tissue samples was consistent with there being an association between vaccination and abortion. DIAGNOSIS: Initial laboratory investigations resulted in a diagnosis of chlamydial abortion. Further investigations led to the identification of the 1B vaccine strain ofC. abortusin material from all three of the submitted aborted placentae. CLINICAL RELEVANCE: Timely knowledge and understanding of any potential problems caused by vaccination againstC. abortusare prerequisites for sustainable control of chlamydial abortion. This report describes the investigation of an atypical abortion storm in sheep, and describes the identification of the 1B vaccine strain ofC. abortusin products of abortion. The significance of this novel putative association between the vaccine strain ofC. abortusand severe clinical disease is unknown. Aspects of the approach that is described are relevant to the investigation of all outbreaks of ovine abortion, irrespective of the diagnosis. Awareness of the changing role ofC. abortusas a major global cause of abortion ought to reinforce the importance of monitoring of adequate biosecurity in those countries which are currently free from chlamydial abortion. [ABSTRACT FROM PUBLISHER]

Background: Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization among inpatients is a well-established risk factor for MRSA infection during the same hospitalization, but the long-term risk of MRSA infection is uncertain. We performed a retrospective cohort study to determine the one-year risk of MRSA infection among inpatients with MRSA-positive nasal polymerase chain reaction (PCR) tests confirmed by positive nasal culture (Group 1), patients with positive nasal PCR but negative nasal culture (Group 2), and patients with negative nasal PCR (Group 3). Methodology/Principal Findings: Subjects were adults admitted to a four-hospital system between November 1, 2006 and March 31, 2011, comprising 195,255 admissions. Patients underwent nasal swab for MRSA PCR upon admission; if positive, nasal culture for MRSA was performed; if recovered, MRSA was tested for Panton-Valentine Leukocidin (PVL). Outcomes included MRSA-positive clinical culture and skin and soft tissue infection (SSTI). Group 1 patients had a one-year risk of MRSA-positive clinical culture of 8.0% compared with 3.0% for Group 2 patients, and 0.6% for Group 3 patients (p<0.001). In a multivariable model, the hazard ratios for future MRSA-positive clinical culture were 6.52 (95% CI, 5.57 to 7.64) for Group 1 and 3.40 (95% CI, 2.70 to 4.27) for Group 2, compared with Group 3 (p<0.0001). History of MRSA and concurrent MRSA-positive clinical culture were significant risk factors for future MRSA-positive clinical culture. Group 1 patients colonized with PVL-positive MRSA had a one-year risk of MRSA-positive clinical culture of 10.1%, and a one-year risk of MRSA-positive clinical culture or SSTI diagnosis of 21.7%, compared with risks of 7.1% and 12.5%, respectively, for patients colonized with PVL-negative MRSA (p = 0.04, p = 0.005, respectively). Conclusions/Significance: MRSA nasal colonization is a significant risk factor for future MRSA infection; more so if detected by culture than PCR. Colonization with PVL-positive MRSA is associated with greater risk than PVL-negative MRSA. [ABSTRACT FROM AUTHOR]

: Nathan Ledeboer and colleagues assess the performance of a diagnostic platform for detecting Gram-positive bacteria in blood cultures, an important step in the diagnosis and treatment of patients with sepsis. Please see later in the article for the Editors' Summary [ABSTRACT FROM AUTHOR]

Clostridium difficile infection (CDI) is changing as evidenced by increasing virulence, rising incidence, unresponsiveness to metronidazole therapy, and worse outcomes. Thus, it is critical that CDI diagnosis be accurate so ongoing epidemiology, disease prevention, and treatment remain satisfactory. We tested 10 diagnostic assays, including 1 commercial real-time polymerase chain reaction (qPCR) test for the laboratory detection of toxigenic C difficile on 1,000 stool samples. Sensitive culture for toxigenic C difficile using 2 types of media with broth enrichment defined the reference standard. For the study, 1,000 tests were performed on samples from 919 patients. Of the samples, 146 contained evidence for toxigenic C difficile and represented the true-positive results. Only the US Food and Drug Administration--cleared qPCR assay (Becton Dickinson, Franklin Lakes, NJ) and 1 glutamate dehydrogenase test (TechLab, Blacksburg, VA) were not statistically inferior to culture in sensitivity. The common enzyme immunoassay tests all had sensitivity values less than 50%. Clinical laboratory professionals need to seriously consider their diagnostic testing and use the assays that perform best for the detection of CDI. [ABSTRACT FROM AUTHOR]

Depression is the primary emotional condition for which help is sought. Depressed people often report persistent rumination, which involves analysis, and complex social problems in their lives. Analysis is often a useful approach for solving complex problems, but it requires slow, sustained processing, so disruption would interfere with problem solving. The analytical rumination hypothesis proposes that depression is an evolved response to complex problems, whose function is to minimize disruption and sustain analysis of those problems by (a) giving the triggering problem prioritized access to processing resources, (b) reducing the desire to engage in distracting activities (anhedonia), and (c) producing psychomotor changes that reduce exposure to distracting stimuli. As processing resources are limited, sustained analysis of the triggering problem reduces the ability to concentrate on other things. The hypothesis is supported by evidence from many levels--genes, neurotransmitters and their receptors, neurophysiology, neuroanatomy, neuroenergetics, pharmacology, cognition, behavior, and efficacy of treatments. In addition, the hypothesis provides explanations for puzzling findings in the depression literature, challenges the belief that serotonin transmission is low in depression, and has implications for treatment. [ABSTRACT FROM AUTHOR]

Background: The effect of large-scale expanded surveillance for methicillin-resistant Staphylococcus aureus (MRSA) on health care-associated MRSA disease is not known. Objective: To examine the effect of 2 expanded surveillance interventions on MRSA disease. Design: Observational study comparing rates of MRSA clinical disease during and after hospital admission in 3 consecutive periods: baseline (12 months), MRSA surveillance for all admissions to the intensive care unit (ICU) (12 months), and universal MRSA surveillance for all hospital admissions (21 months). Setting: A 3-hospital, 850-bed organization with approximately 40 000 annual admissions. Intervention: Polymerase chain reaction-based nasal surveillance for MRSA followed by topical decolonization therapy and contact isolation of patients who tested positive for MRSA. Measurements: Poisson and segmented regression models were used to compare prevalence density of hospital-associated clinical MRSA disease (bloodstream, respiratory, urinary tract, and surgical site) in each period. Rates of bloodstream disease with methicillinsusceptible S. aureus were used as a control. Results: The prevalence density of aggregate hospital-associated MRSA disease (all body sites) per 10 000 patient-days at baseline, during ICU surveillance, and during universal surveillance was 8.9 (95% CI, 7.6 to 10.4), 7.4 (CI, 6.1 to 9.0; P = 0.15 compared with baseline), and 3.9 (CI, 3.2 to 4.7; P < 0.001 compared with baseline and ICU surveillance), respectively. During universal surveillance, the prevalence density of MRSA infection at each body site had a statistically significant decrease compared with baseline. The methicillin-susceptible S. aureus bacteremia rate did not statistically significantly change during the 3 periods. In a segmented regression model, the aggregate hospital-associated MRSA disease prevalence density changed by -36.2% (CI, -65.4% to 9.8%; P = 0.17) from baseline to ICU surveillance and by -69.6% (CI, -89.2% to -19.6%]; P = 0.03) from baseline to universal surveillance. During universal surveillance, the MRSA disease rate decreased during hospitalization and in the 30 days after discharge; no further reduction occurred thereafter. Surveillance with clinical cultures would have identified 17.8% of actual MRSA patient-days, and ICU-based surveillance with polymerase chain reaction would have identified 33.3%. Limitation: The findings rely on observational data. Conclusion: The introduction of universal admission surveillance for MRSA was associated with a large reduction in MRSA disease during admission and 30 days after discharge. [ABSTRACT FROM AUTHOR]

Background. Clostridium difficile-associated diarrhea (CDAD) is the major cause of health care-associated infectious diarrhea. Current laboratory testing lacks a single assay that is sensitive, specific, and rapid. The purpose of this work was to design and validate a sensitive and specific real-time polymerase chain reaction (PCR) diagnostic test for CDAD. Methods. This observational validation study of a new real-time PCR assay occurred from July 2004 through April 2006 and involved the testing of 1368 stool samples. As the final validation portion of the investigation, 350 inpatients were prospectively interviewed for clinical findings for 365 episodes of diarrheal illness. Test results and clinical criteria were used to assess the performance of 4 assays. Results. Using clinical criteria requiring at least 3 loose stools in 1 day as part of the reference standard for a positive test result supporting CDAD, the sensitivity, specificity, and positive and negative predictive values were 73.3%, 97.6%, 73.3%, and 97.6%, respectively, for enzyme immunoassay; 93.3%, 97.4%, 75.7%, and 99.4%, respectively, for real-time PCR; 76.7%, 97.1%, 69.7%, and 97.9%, respectively, for cell culture cytotoxin assay; and 100.0%, 95.9%, 68.2%, and 100.0%, respectively, for anaerobic culture (for toxigenic C. difficile strains). The realtime PCR and anaerobic culture assays were significantly more sensitive than the enzyme immunoassay (P < .01 to ). P > .05 Conclusions. With an assay turnaround time of <4 h, real-time PCR is a more sensitive and equally rapid test, compared with enzyme immunoassay, and is a feasible laboratory option to replace enzyme immunoassay for toxigenic C. difficile detection in clinical practice, as well as for use during the development of new therapeutic agents [ABSTRACT FROM AUTHOR]

Rationale: The bone morphogenetic receptor type II gene is the major genetic determinant for the inherited form of pulmonary arterial hypertension. However, deleterious mutations of this gene are not observed in the majority of subjects who develop the condition spontaneously and familial disease displays age- and sex-dependent penetrance, indicating the requirement for additional environmental and/or genetic modifiers for disease development. Methods: We investigated polymorphic variation of the serotonin transporter gene, a biological candidate for predisposition to this vascular disorder. Results: No significant evidence of association between alleles of the serotonin transporter gene and pulmonary hypertension was detected, nor did we observe a relationship with age of onset in familial and idiopathic disease. Conclusions: Variation of the serotonin transporter gene appears unlikely to confer significant susceptibility to pulmonary arterial hypertension. This study emphasizes the need for adequately powered cohorts for association analyses to identify not only genetic determinants of disease susceptibility but also inherited modifiers for disease development. [ABSTRACT FROM AUTHOR]

Enterohemorrhagic Escherichia coli, also known as Shiga-toxin-producing E. coli, is recognized as an important cause of human diarrhea, hemorrhagic colitis, and hemolytic uremic syndrome. Over the last 20 years, E. coli O157:H7 has been documented as the most common cause of sporadic and epidemic outbreaks of this diarrheal disease and its associated complications of hemorrhagic colitis and hemolytic uremic syndrome. However, it has become increasingly apparent that many other serotypes of E. coli are capable of producing the same disease syndromes. This article will present an overview of the various bacterial etiologies responsible for infection, the pathogenesis and epidemiology of disease, and recommended methods for establishing the improved laboratory diagnosis of this infectious disease process. [Copyright &y& Elsevier]

Influenza is unique among viral infections because of its propensity for seasonal epidemics and occasional pandemics, and because of the morbidity and mortality that result from its pulmonary complications. In contrast to the majority of viruses, effective well-tolerated influenza vaccines, antivirals and chemoprophylaxis are available. The need for a timely diagnosis, which allows for optimal use of these treatments, led to the introduction of numerous rapid diagnostic tests (with turnaround times of less than 30 minutes). However, during influenza season, clinical diagnosis (based on cough and high fever of acute onset) can be highly predictive of influenza. Thus diagnostic tests are not required for all patients with suspected influenza but may be of value if the clinical diagnosis is unclear and if antiviral or antibiotic treatment is a consideration. When evaluating performance of various rapid diagnostic tests for influenza, it is important to consider the type and quality of specimen and type of patient to be tested. Specimen-type drives performance of the rapid diagnostic tests. Swab specimens, particularly throat swabs are the most frequently submitted but least desirable specimen-type. Thus, although current rapid diagnostic tests are specific for influenza, sensitivity is highly variable. To improve diagnostic accuracy, a nasal/nasopharyngeal aspirate or sputum specimen should be obtained. Because of their highly variable sensitivity and negative predictive value, it is our opinion, that rapid diagnostic tests should only be used in influenza season and that results should be confirmed with virus culture. Despite these reservations, during influenza-season, detection of influenza by rapid diagnostic test may, potentially, be of great benefit to the patient and public health. [Copyright &y& Elsevier]

Particulate sol-gel technology uses larger particles than that of alkoxide-derived gels and provides larger pore sizes in the gelled object. This allows relatively rapid drying and fabrication of large rods or tubular shapes. However, the formation of more complex or flat shapes, which require extensive surface contact with a mold, is more difficult. The shrinkage during drying, with the significantly greater stress of surface friction due to adhesion, frequently leads to cracking.We have demonstrated a solution to this problem by floating the gel on the surface of a dense liquid. Dry silica panels up to 28 × 40 × 0.7 cm3 were prepared in this way. The use of patterning molds allowed the fabrication of more sophisticated shapes. These bodies were sintered to transparent vitreous silica articles of near net dimensions. [ABSTRACT FROM AUTHOR]

Deals with a study which analyzed the trends in microbiology laboratory practice, in relation to their likely impact on the management of infectious diseases. Review of reports discussing contemporary controversies in clinical microbiology; Factors to consider when consolidation of a clinical microbiology laboratory is being planned; Importance of maintenance of clinical microbiology laboratories.

This report presents a safe, simple method of bypassing the abdominal aorta in a patient in whom the infrarenal portion of the aorta is unusable for proximal grafting and in whom axillofemoral bypass grafting is contraindicated. In our patient the standard aortofemoral bypass was considered unwise because of previous abdominal surgery and an occluded infrarenal aorta. A left axillofemoral with femorofemoral was ruled out in view of his left hemiparesis and probable need for subsequent left nephrectomy. A right axillofemoral grafting was not possible because of right subclavian artery stenosis. [ABSTRACT FROM AUTHOR]