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Objective: The largest outbreak of Legionnaires Disease (LD) in the UK for a decade occurred in Edinburgh in June 2012. We describe the clinical and public health management of the outbreak. Setting: Three acute hospitals covering an urban area of ∼480 000. Methods: Data were collected on confirmed and suspected cases and minutes of the Incident Management Team meetings were reviewed to identify key actions. Results: Over 1600 urine samples and over 600 sputum samples were tested during the outbreak. 61 patients with pneumonia tested positive for Legionella pneumophila serogroup 1 by urinary antigen detection, culture, respiratory PCR or serology. A further 23 patients with pneumonia were treated as suspected cases on clinical and epidemiological grounds but had no microbiological diagnosis. 36% of confirmed and probable cases required critical care admission. Mean ICU length of stay was 11.3 (±7.6) days and mean hospital length of stay for those who were admitted to ICU was 23.0 (±17.2) days. For all hospitalized patients the mean length of stay was 15.7 (±14) days. In total there were four deaths associated with this outbreak giving an overall case fatality of 6.5%. Hospital and critical care mortality was 6.1% and 9.1%, respectively. Conclusions: A significant proportion of patients required prolonged multiple organ support or complex ventilation. Case fatality compared favourably to other recent outbreaks in Europe. Access to rapid diagnostic tests and prompt antibiotic therapy may have mitigated the impact of pre-existing poor health among those affected.

We introduce an abstract algebraic structure — a lattice defi ned on a generalized truth value space of constructive logic. For background one can refer to the idea of ‘under-determined’ and ‘over-determined’ valuations (Dunn), a ‘useful four-valued logic’ (Belnap), and the notion of a bilattice (Ginsberg). We consider within one general framework the notions of constructive truth and constructive falsity, as well as the notions of non-constructive truth and non-constructive falsity. All possible combinations of th e basic truth values give rise to an interesting ‘16-valued logic’. It appears that these 16 truth values constitute what we call a trilattice — a natural mathematical structure with three partial orderings that represent respectively a n increase in information, truth and constructivity. The presentation of the paper is essentially conceptual: the stress is laid on introducing new concepts and structures as well as on their general interpretation.

During the first 2 years (July 1989 to July 1991) of the Avon Breast Screening Service, fine-wire localization biopsy was indicated in 213 impalpable breast lesions. A total of 144 lesions were benign and 69 malignant. Only four of 213 lesions (1.9 per cent) were not excised at the first localization. Factors influencing reoperation in the 69 patients with malignant impalpable lesions were examined. There was a significant association (P < 0.001) between parenchymal disturbances on mammography and invasive carcinoma, and between non-invasive carcinoma and microcalcification (P < 0.001). In 31 patients the localization biopsy was the only surgical procedure. Thirty-eight patients required further surgery: 12 underwent further local excision and 26 mastectomy. Reoperation was more frequent in patients with calcification than in those with parenchymal disturbance (P < 0.001). The most frequent indications for mastectomy were inadequate excision of widespread comedo ductal carcinoma in situ or invasive ductal carcinoma combined with extensive ductal carcinoma in situ. Fine-wire localization biopsy was a combined therapeutic and diagnostic procedure in 31 of 69 women with impalpable screen-detected lesions. The majority of patients required further surgery because radiological abnormalities underestimated the extent of disease.

Eleven Yorkshire x Landrace gravid gilts were used in two Latin square trials to determine the N requirement for pregnancy. Semipurified diets were formulated to be adequate in indispensable amino acids (IAA) and other nutrients. Diets were fed once daily (1.82 kg); L-glutamic acid, corn sugar, powdered cellulose, and soybean oil percentages differed to maintain isocaloric diets. In Trial 1, six gilts were fed diets containing 6.6 to 17.2% CP equivalent (19.2 to 50.1 g of N/d) during six 10-d periods beginning on d 40 postcoitum. In Trial 2, five gilts were fed diets containing 4.3 to 12.6% CP equivalent (12.5 to 36.8 g of N/d) during five 10-d periods beginning on d 50 postcoitum. Nitrogen balance trials were conducted during the last 5 d of each period. Blood samples were taken both before and 3 h after the last feeding of each period. Results from Trial 1 suggested that adequate N retention (10 g/d) could be attained by pregnant gilts fed less than 28 g of N/d intake when the diet contained indispensible amino acids at levels suggested by Nutrient Requirements of Swine (NRC, 1988). An intake of 20.6 g of N/d (7.1% CP equivalent) yielded near maximum N retention among pregnant gilts fed the semipurified diets in Trial 2. Other criteria measured (urine urea nitrogen and plasma urea nitrogen) had limited value in the evaluation of the N status of the pregnant gilts in these trials.

Tribal enemas obtained from traditional healers are used widely in Southern Africa for a variety of indications. Inclusion of injurious substances such as potassium dichromate may cause serious colonic and renal complications. Nine such patients, in seven of whom chromate use was confirmed, presented after a mean delay of 7·3 days. All patients had bloody diarrhoea and vomiting and three underwent major colonic resection, requiring a total of ten procedures. One patient suffered mechanical perforation of the rectum, with subsequent necrotizing fasciitis, necessitating rectal excision. Eight patients had acute renal failure and seven required dialysis. One patient died. At follow-up one patient has chronic renal failure and only three are completely well. Although local medical practitioners are aware of the problem, the challenge of preventing harmful cultural practices remains.

We studied the effects of different blood collection and processing procedures on quantification of apolipoprotein (apo) B by radioimmunoassay. High-density lipoprotein subfractions HDL3 and HDL2 and isolated apoA-I did not cross-react in the assay. Analytical recovery of apoB at different doses of very-low- and low-density lipoproteins were complete. Inter- and intra-assay coefficients of variation (CVs) averaged 7.4% and 6.0%, respectively. Blood from 20 subjects was collected into tubes containing EDTA alone or EDTA with antiproteolytic and antioxidant agents; one half of each plasma was separated immediately, half after 3 h at 4 degrees C. Regardless of the addition of protective agents or the time difference in separating plasma from other blood elements, freezing plasma at -70 degrees C decreased apoB content a similar amount, an average of 6.8%. This loss of apoB immunoreactivity was not related to apoB content in fresh plasma. Analysis of variance showed no differential effect on apoB content by the various additions to whole blood or plasma. No additional apoB content was lost in once-frozen aliquots of three human plasma pools during storage at -70 degrees C for up to 18 months. We conclude that concentrations of apoB in human plasma can be measured reliably after long-term storage, although the absolute value may decrease slightly as a result of freezing.

Epidermal growth factor (EGF) receptor status is a useful prognostic indicator in women with breast cancer. Lack of standardization and correlation of methodology for the detection of EGF receptor has hampered its further evaluation. EGF receptor status was ascertained by immunohistochemistry and radioligand assay in 120 breast cancers. Of 52 tumours negative for EGF receptor on radioligand assay, 47 were negative on immunohistochemistry and, of 68 tumours positive for the receptor on assay, 52 were positive on immunohistochemistry. If the more widely evaluated radioligand assay is assumed to be the ‘gold standard’, immunohistochemistry has a sensitivity of 81 per cent and a specificity of 91 per cent.

Abnormalities of the p53 gene and protein were examined in 81 primary breast carcinoma samples. Using a polymerase chain reaction–single-strand conformational polymorphism (PCR—SSCP) analysis, mutations in p53 exons 5–8 were identified in 13 of 81 tumours (16 per cent) and confirmed by DNA sequencing. Positive staining for p53 protein was detected in ten of 77 (13 per cent) of these tumours using polyclonal CM1 antibody on formalin-fixed tissue. Mutations detected by PCR—SSCP analysis were more common in grade III tumours (P = 0·015), but no correlation was found with tumour size, node status or level of epidermal growth factor receptor expression. A p53 mutation was associated with positive antibody staining in only two patients. Positive immunohistochemical staining using a p53 antibody may detect p53 protein expression, but this may not correlate directly with an underlying mutation in the hot spot region examined.

Restaurant-ready (21-d aged, needle tenderized) loin steaks (strip, S; and T-bone, TB) representing three portion sizes (227, 284, and 340 g for S; 397, 454, and 510 g for TB) were portioned from 71 low-Choice beef carcasses representing seven ribeye size groups (70.9 cm2 and less to 103.2 cm2 and greater, in 6.3-cm2 increments). Steaks (n = 568) were cooked on a grooved grill to temperatures of either 67 or 77 degrees C and evaluated for cooking characteristics, sensory attributes (n = 284), and shear force (n = 284) to identify optimal ribeye areas for portioned steaks. As expected, thickness of all portioned steaks decreased (P.05) as ribeye size increased, whereas thickness of steaks increased (P.05) as portion size increased. The S were significantly thicker than TB. The TB cooked faster (P.05) than did S for ribeye areas 77.4 to 83.8 cm2 in the average portion sizes and for ribeye areas 71.0 to 96.6 cm2 in the large portion sizes. However, S cooked significantly faster than did TB for ribeye areas less than 70.9 cm2 in the average portion sizes. The S had higher (P.05) initial tenderness scores and lower (P.05) shear values than did TB. Initial tenderness scores were lower (P.05) for ribeye areas greater than 103.2 cm2 compared with ribeye areas less than 83.8 cm2 and 90.3 to 96.6 cm2, with all others being intermediate. Shear force tended (P = .08) to follow the initial tenderness results. The S cooked to both end point temperatures, and TB cooked to 67 degrees C had higher (P.05) initial tenderness scores than did TB cooked to 77 degrees C. Tenderness was reduced in TB cooked to higher temperatures as well as in S and TB portioned from ribeye areas greater than 103.2 cm2. Steaks portioned from carcasses with ribeye areas between 77.4 to 96.6 cm2 can optimize both cooking time and tenderness for the foodservice sector.

On Two Deflationary Truth Theories.- Some Reflections On The Prosentential Theory of Truth.- Paradox and Reference.- Two Theorems concerning Stability.- The Complexity of Decision Procedures in Relevance Logic.- Relevant Predication 3: Essential Properties.- The Dog: Relevance and Rationality.- Consistency and Logical Consequence.- On What Cannot Be.- Durations: Temporal Intervals with Gaps and Undetermined Edges.- Categorical Semantics.- The Myth of the Intuitionistic "Or".- What Mathematical Truth Need Not Be.- A Tour of the Multivariate Lambda Calculus.- Choice Trees.- The Extensional but Hyper-Intensional Calculus C? with Orderless Constants and Variables.- A Skeptical Theory of Mixed Inheritance.- The Logic of Mitchill v. Lath.- What are Absolute Probabilities a Function of?.- How Prediction Enhances Confirmation.- Figures in a Probability Landscape.- Nuel Belnap: Curriculum Vitae.- Nuel Belnap: Doctoral Students.- Nuel Belnap: Publications.- Index of Names.- Index of Subjects.

A disposable pipette method adapted from Kigaye, M. K., and Matthysse, J. G., 1973, Bull. Epizoot. Dis. Afr. 21: 429-35, was used to assay acarlcides against the active life stages, i.e., larva, nymph, adult males and adult females. This method consisted of dipping disposable glass pipettes into acetone-based concentrations of the acaricides and then confining the ticks to the interior treated surface (after 20 mln drying time) for an 18 hr period of time. Pipettes used for larvae and nymphs were 1 ml In size and those used for adults were 3 ml in size. Adults and nymphs were anesthetized with CO^ before aspiration Into the pipettes. Larvae were aspirated without anesthesia. The large ends of the pipettes were covered with organdy cloth and the transfer ends were plugged with modeling clay. Larvae were assayed in groups of ca 30 while adults and nymphs were assayed in groups of 10. Unfed larvae were assayed at 1-2 wk of age after hatching while unfed adults and nymphs were assayed at ca 2 mo of age after molting. All ticks were held at 80°F and ca 95% RH.

Wooded plots (80 ft-sq) in eastern OK infested with late-season nymphs were treated with acaricides in late Aug. These infestations of late-season nymphs consisted mostly of nymphs that had molted during summer from engorged larvae. The objective of these tests was to compare the efficacies of acaricides against newly molted nymphs to efficacies obtained previously against overwintered infestations of nymphs. Water-based formulations of acaricides (7.5 gal spray/a) were made with a motorized knapsack mist blower. The experimental design was a randomized complete block with 5 blocks.