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Seasonal-to-decadal predictions are initialized using observations of the present climatic state in full field initialization (FFI). Such model integrations undergo a drift toward the model attractor due to model deficiencies that incur a bias in the model. The anomaly initialization (AI) approach reduces the drift by adding an estimate of the bias onto the observations at the expense of a larger initial error. In this study FFI is associated with the fidelity paradigm, and AI is associated with an instance of the mapping paradigm, in which the initial conditions are mapped onto the imperfect model attractor by adding a fixed error term; the mapped state on the model attractor should correspond to the nature state. Two diagnosis tools assess how well AI conforms to its own paradigm under various circumstances of model error: the degree of approximation of the model attractor is measured by calculating the overlap of the AI initial conditions PDF with the model PDF; and the sensitivity to random error in the initial conditions reveals how well the selected initial conditions on the model attractor correspond to the nature states. As a useful reference, the initial conditions of FFI are subjected to the same analysis. Conducting hindcast experiments using a hierarchy of low-order coupled climate models, it is shown that the initial conditions generated using AI approximate the model attractor only under certain conditions: differences in higher-than-first-order moments between the model and nature PDFs must be negligible. Where such conditions fail, FFI is likely to perform better.

Background: Infections with carbapenem-resistant Enterobacteriaceae (CRE) are increasingly being reported from patients in healthcare settings. They are associated with high patient morbidity, attributable mortality and hospital costs. Patients who are “at-risk” may be carriers of these multidrug-resistant Enterobacteriaceae (MDR-E). The purpose of this guidance is to raise awareness and identify the “at-risk” patient when admitted to a healthcare setting and to outline effective infection prevention and control measures to halt the entry and spread of CRE. Methods: The guidance was created by a group of experts who were functioning independently of their organisations, during two meetings hosted by the European Centre for Disease Prevention and Control. A list of epidemiological risk factors placing patients “at-risk” for carriage with CRE was created by the experts. The conclusions of a systematic review on the prevention of spread of CRE, with the addition of expert opinion, were used to construct lists of core and supplemental infection prevention and control measures to be implemented for “at-risk” patients upon admission to healthcare settings. Results: Individuals with the following profile are “at-risk” for carriage of CRE: a) a history of an overnight stay in a healthcare setting in the last 12 months, b) dialysis-dependent or cancer chemotherapy in the last 12 months, c) known previous carriage of CRE in the last 12 months and d) epidemiological linkage to a known carrier of a CRE. Core infection prevention and control measures that should be considered for all patients in healthcare settings were compiled. Preliminary supplemental measures to be implemented for “at-risk” patients on admission are: preemptive isolation, active screening for CRE, and contact precautions. Patients who are confirmed positive for CRE will need additional supplemental measures. Conclusions: Strengthening the microbiological capacity, surveillance and reporting of new cases of CRE in healthcare settings and countries is necessary to monitor the epidemiological situation so that, if necessary, the implemented CRE prevention strategies can be refined in a timely manner. Creating a large communication network to exchange this information would be helpful to understand the extent of the CRE reservoir and to prevent infections in healthcare settings, by applying the principles outlined here. This guidance document offers suggestions for best practices, but is in no way prescriptive for all healthcare settings and all countries. Successful implementation will result if there is local commitment and accountability. The options for intervention can be adopted or adapted to local needs, depending on the availability of financial and structural resources., peer-reviewed

Since 2008, annual surveys of influenza vaccination policies, practices and coverage have been undertaken in 29 European Union (EU)/ European Economic Area (EEA) countries. After 2009, this monitored the impact of European Council recommendation to increase vaccination coverage to 75% among risk groups. This paper summarises the results of three seasonal influenza seasons: 2008/09, 2009/10 and 2010/11. In 2008/09, 27/29 countries completed the survey; in 2009/10 and 2010/11, 28/29 completed it. All or almost all countries recommended vaccination of older people (defined as those aged ≥50, ≥55, ≥59, ≥60 or ≥65 years), and people aged ≥6 months with clinical risk and healthcare workers. A total of 23 countries provided vaccination coverage data for older people, but only 7 and 10 had data for the clinical risk groups and healthcare workers, respectively. The number of countries recommending vaccination for some or all pregnant women increased from 10 in 2008/09 to 22 in 2010/11. Only three countries could report coverage among pregnant women. Seasonal influenza vaccination coverage during and after the pandemic season in older people and clinical groups remained unchanged in countries with higher coverage. However, small decreases were seen in most countries during this period. The results of the surveys indicate that most EU/EEA countries recommend influenza vaccination for the main target groups; however, only a few countries have achieved the target of 75% coverage among risk groups. Coverage among healthcare workers remained low.

Initialization techniques for seasonal-to-decadal climate predictions fall into two main categories; namely full-field initialization (FFI) and anomaly initialization (AI). In the FFI case the initial model state is replaced by the best possible available estimate of the real state. By doing so the initial error is efficiently reduced but, due to the unavoidable presence of model deficiencies, once the model is let free to run a prediction, its trajectory drifts away from the observations no matter how small the initial error is. This problem is partly overcome with AI where the aim is to forecast future anomalies by assimilating observed anomalies on an estimate of the model climate. The large variety of experimental setups, models and observational networks adopted worldwide make it difficult to draw firm conclusions on the respective advantages and drawbacks of FFI and AI, or to identify distinctive lines for improvement. The lack of a unified mathematical framework adds an additional difficulty toward the design of adequate initialization strategies that fit the desired forecast horizon, observational network and model at hand. Here we compare FFI and AI using a low-order climate model of nine ordinary differential equations and use the notation and concepts of data assimilation theory to highlight their error scaling properties. This analysis suggests better performances using FFI when a good observational network is available and reveals the direct relation of its skill with the observational accuracy. The skill of AI appears, however, mostly related to the model quality and clear increases of skill can only be expected in coincidence with model upgrades. We have compared FFI and AI in experiments in which either the full system or the atmosphere and ocean were independently initialized. In the former case FFI shows better and longer-lasting improvements, with skillful predictions until month 30. In the initialization of single compartments, the best performance is obtained when the stabler component of the model (the ocean) is initialized, but with FFI it is possible to have some predictive skill even when the most unstable compartment (the extratropical atmosphere) is observed. Two advanced formulations, least-square initialization (LSI) and exploring parameter uncertainty (EPU), are introduced. Using LSI the initialization makes use of model statistics to propagate information from observation locations to the entire model domain. Numerical results show that LSI improves the performance of FFI in all the situations when only a portion of the system's state is observed. EPU is an online drift correction method in which the drift caused by the parametric error is estimated using a short-time evolution law and is then removed during the forecast run. Its implementation in conjunction with FFI allows us to improve the prediction skill within the first forecast year. Finally, the application of these results in the context of realistic climate models is discussed.

In 1992, an outbreak of chronic diarrhea occurred among passengers on a cruise ship visiting the Galapagos Islands, Ecuador. Passengers (548) were surveyed, and stool and biopsy specimens from a sample who reported chronic diarrhea were examined. On completed questionnaires, returned by 394 passengers (72%), 58 (15%) reported having chronic diarrhea associated with urgency (84%), weight loss (77%), fatigue (71%), and fecal incontinence (62%). Illness began 11 days (median) after boarding the ship and lasted 7 to >42 months. Macroscopic and histologic abnormalities of the colon were common, but extensive laboratory examination revealed no etiologic agent. No one responded to antimicrobial therapy. Patients were more likely than well passengers to have drunk the ship's unbottled water or ice before onset of illness and to have eaten raw sliced fruits and vegetables washed in unbottled water. Water handling and chlorination on the ship were deficient. Outbreaks of a similar illness, Brainerd diarrhea, have been reported in the United States. Although its etiology remains unknown, Brainerd diarrhea may also occur among travelers.

To determine whether US residents are infected with subtypes of human immunodeficiency virus (HIV) type 1 other than subtype B (Western), the predominant North American subtype with a unique GPGR genetic sequence in the V3 loop, viruses from 22 HIV-infected adults were serotyped and subtyped. Twenty patients had subtype B (Western), of whom 15 had serotype B (Western), 3 had serotype A/C, 1 had serotype B (Thai), and 1 had a nontypeable serotype. Two had subtype A, both serotype A/C. Both subtype A-infected patients, only 1 of whom had been outside the United States, reported sex with persons traveling abroad, suggesting possible acquisition in the United States. Because US residents are infected with non-subtype B (Western) strains, US surveillance for HIV-1 diversity is needed to elucidate subtype-specific transmission patterns and pathogenesis and to guide evaluation and development of HIV diagnostic tests and vaccines.

In August 2010 the Vaccine European New Integrated Collaboration Effort (VENICE) project conducted a survey to collect information on influenza A(H1N1)pdm09 vaccination policies and vaccination coverage in the European Union (EU), Norway and Iceland. Of 29 responding countries, 26 organised national pandemic influenza vaccination and one country had recommendations for vaccination but did not have a specific programme. Of the 27 countries with vaccine recommendations, all recommended it for healthcare workers and pregnant women. Twelve countries recommended vaccine for all ages. Six and three countries had recommendations for specific age groups in children and in adults, countries for specific adult age groups. Most countries recommended vaccine for those in new risk groups identified early in the pandemic such as morbid obese and people with neurologic diseases. Two thirds of countries started their vaccination campaigns within a four week period after week 40/2009. The reported vaccination coverage varied between countries from 0.4% to 59% for the entire population (22 countries); 3% to 68% for healthcare workers (13 countries); 0% to 58% for pregnant women (12 countries); 0.2% to 74% for children (12 countries). Most countries identified similar target groups for pandemic vaccine, but substantial variability in vaccination coverage was seen. The recommendations were in accordance with policy advice from the EU Health Security Committee and the World Health Organization.

SummaryTo determine risk factors for cholera in an epidemic-disease area in South America, a case–control investigation was performed in Guayaquil, Ecuador, in July 1991. Residents > 5 years old who were hospitalized for treatment of acute, watery diarrhoea and two matched controls for each were interviewed regarding sources of water and food, and eating, drinking, and hygienic habits. Interviewers inspected homes of case-patients and controls to document water treatment, food-handling, and hygienic practices. Faecal specimens and shellfish were cultured forVibrio choleraeO 1. Isolates were tested for susceptibility to a variety of antimicrobial agents. Drinking unboiled water (odds ratio [OR] = 4.0, confidence interval [CI] = 1.8–7.5), drinking a beverage from a street vendor (OR = 2.8, CI = 1.3–5.9), eating raw seafood (OR = 3.4, CI = 1.4–11.5), and eating cooked crab (OR = 5.1, CI = 1.4–19.2) were associated with illness. Always boiling drinking water at home (OR = 0.5, CI = 0.2–0.9) was protective against illness. The presence of soap in either the kitchen (OR = 0.3, CI = 0.2–0.8) or bathroom (OR = 0.4, CI = 0.2–0.9) at home was also protective.V. choleraeO 1 was recovered from a pooled sample of a bivalve mollusc and from 68% of stool samples from case-patients. Thirty-six percent of the isolates from stool specimens were resistant to multiple antimicrobial agents. Specific prevention measures may prevent transmission through these vehicles in the future. The appearance of antimicrobial resistance suggests the need for changes in current methods of prevention and treatment.

We describe a case of wound botulism associated with a tooth abscess in a 5-year-old boy. We reviewed the literature and reports to the Centers for Disease Control and Prevention (Atlanta) of laboratory-confirmed cases of wound botulism. From 1943 through 1990, 47 cases were reported. Type A botulinus toxin was identified in 32 cases, type B in 13, types A and B in 1, and an unknown type in 1. Botulism was associated with wounds from trauma, use of injectable drugs, and surgery. Sinusitis after use of intranasal cocaine has also been associated with botulism. Treatment for wound botulism includes prompt debridement of the wound for eliminating anaerobic conditions, intensive care, and treatment with antitoxin.

In 2009 the second cross-sectional web-based survey was undertaken by the Vaccine European New Integrated Collaboration Effort (VENICE) project across 27 European Union (EU) member states (MS), Norway and Iceland (n=29) to determine changes in official national seasonal influenza vaccination policies since a survey undertaken in 2008 and to compare the estimates of vaccination coverage between countries using data obtained from both surveys. Of 27 responding countries, all recommended vaccination against seasonal influenza to the older adult population. Six countries recommended vaccination of children aged between six months and

In May 2003, the 56th World Health Assembly (WHA) recommended influenza vaccination for all people at high risk defined as the elderly and persons with underlying diseases [1]. The WHA countries, including all European Union (EU) Member States, also committed to the goal of attaining vaccination coverage of the elderly population of at least 50% by 2006 and 75% by 2010 and to having mechanisms for monitoring the uptake [1]. To date there has been no published survey on how successful European countries have been in implementing this WHA resolution.

Our previous studies using an in vitro model of traumatic injury have shown that stretch injury of astrocytes causes a rapid elevation in intracellular free calcium ([Ca2+]i), which returns to near normal by 15 min postinjury. We have also shown that after injury astrocyte intracellular calcium stores are no longer able to release Ca2+ in response to signal transduction events mediated by the second messenger inositol (1,4,5)-trisphosphate (IP3, Rzigalinski et al., 1998). Therefore, we tested the hypothesis that in vitro injury perturbs astrocyte IP3 levels. Astrocytes grown on Silastic membranes were labeled with [3H]-myo-inositol and stretch-injured. Cells and media were acid-extracted and inositol phosphates isolated using anion-exchange columns. After injury, inositol polyphosphate (IPx) levels increased up to 10-fold over uninjured controls. Significant injury-induced increases were seen at 5, 15, and 30 min and at 24 and 48 h postinjury. Injury-induced increases in IPx were equivalent to the maximal glutamate and trans-(1S,3R)-1-amino-1,3-cyclopentanedicarboxylic acid-stimulated IPx production, however injury-induced increases in IPx were sustained through 24 and 48 h postinjury. Injury-induced increases in IPx were attenuated by pretreatment with the phospholipase C inhibitors neomycin (100 microM) or U73122 (1.0 microM). Since we have previously shown that astrocyte [Ca2+]i returns to near basal levels by 15 min postinjury, the current results suggest that IP3-mediated signaling is uncoupled from its target, the intracellular Ca2+ store. Uncoupling of IP3-mediated signaling may contribute to the pathological alterations seen after traumatic brain injury.

15 amino acid peptide from the transmembrane 5-intracellular loop 3 region of the human 5HT1a receptor produced concentration-dependent decreases in agonist binding. This result is consistent with a competitive interaction between peptide, receptor, and G protein at the receptor-G protein interface. Bombesin and a 13 amino acid peptide from the carboxyl terminus region of the receptor were inactive. Additionally, the peptide decreased forskolin-mediated cAMP elevation. Overall, these results suggest that amino acid residues from this region of the receptor are involved in receptor-G protein coupling and that G protein is activated by the receptor.

Flue Gas Desulfurization (FGD) residue is produced when SOx and NOx are removed from gases produced during the combustion of coal. This by-product is becoming increasingly significant with more stringent air quality standards, and increasing fossil fuel consumption. FGD residues vary widely in their composition; ranging from products composed mainly of gypsum to materials which contain large quantities of fly ash. Factors that influence the final composition of the material include the source of the parent coal, and the type of FGD system used. With more advanced FGD systems sulfur removal is more efficient, and the material is of a higher purity. Older techniques frequently produce materials that are contaminated with fly ash. FGD residue does not contain significant quantities of heavy metals; contamination or mixing with fly ash contributes trace elements such as boron, arsenic and selenium to the material making their disposal a potential environmental risk. While many construction-based re-use avenues are being explored, the potential use of FGD as a soil amendment remains the most promising. Gypsum-containing materials have been used in the amelioration of physical soil problems such as water holding capacity and subsurface acidity. The production, reuse and environmental effects of FGD are discussed in detail in this chapter. A greenhouse-based pot study and a large scale mesocosm experiment indicate that while concerns about heavy metal leaching are not without basis, concentrations of B, Se and As do not exceed drinking water standards, and do not accumulate significantly in any of the plant species tested. Furthermore, FGD addition produced an increase in the dry matter production of cotton, corn, soybean and radish crops. Strict observance of safe upper limits for FGD application (approximately 100 t ha−1 in this study), and careful consideration of the site topography are necessary for the safe use of FGD material, and should follow careful characterization of the material for the extent of fly ash contamination.

We describe trends in seropositivity among clients attending publicly funded HIV counseling and testing sites across the United States and discuss implications for prevention policy.The present analysis used client-level data from 1990 through 1994 for 26 of 65 state, territorial, and local health departments receiving Centers for Disease Control and Prevention funds. Logistic regression was used to predict the proportion of HIV tests that were positive. Curves were created representing adjusted HIV seropositivity trends for 1990 through 1994.HIV seropositivity rates were higher before 1992. Throughout, rates were higher among men, most racial/ethnic minorities tested, and persons 30 years or older. Although rates for men remained higher than those for women, the gap has narrowed in recent years. For both men and women, rates remained low for those reporting heterosexual activity as their only potential risk for HIV. Over time, more high-risk seronegatives are being repeatedly tested.Lower, stabilized seropositivity rates after 1992 reflect large increases in testing volume, increasing frequency of repeat testing, and fewer asymptomatic-infected persons entering this public system. Various program innovations including enhanced outreach, improved access, rapid testing, and client-centered counseling should be considered as strategies to increase the number of infected persons who learn their serostatus early and enter into medical care.

To determine whether US residents are infected with subtypes of human immunodeficiency virus (HIV) type 1 other than subtype B (Western), the predominant North American subtype with a unique GPGR genetic sequence in the V3 loop, viruses from 22 HIV-infected adults were serotyped and subtyped. Twenty patients had subtype B (Western), of whom 15 had serotype B (Western), 3 had serotype A/C, 1 had serotype B (Thai), and 1 had a nontypeable serotype. Two had subtype A, both serotype A/C. Both subtype A-infected patients, only 1 of whom had been outside the United States, reported sex with persons traveling abroad, suggesting possible acquisition in the United States. Because US residents are infected with non-subtype B (Western) strains, US surveillance for HIV-1 diversity is needed to elucidate subtype-specific transmission patterns and pathogenesis and to guide evaluation and development of HIV diagnostic tests and vaccines.

Data are collected and reported through the Centers for Disease Control and Prevention (CDC) Counseling and Testing System (CTS) on episodes of publicly funded counseling and HIV testing in the Unites States. The objective of this analysis is to describe testing data reported from 1992 through 1995. In 1992, 2,689,056 tests were performed, and 55,024 (2.0%) were positive; in 1995, 2,491,434 tests were performed, of which 40,605 (1.6%) were positive. Among tests reported with client-level data, the proportion of tests of men and women at higher risk for HIV infection remained stable or declined; the proportion of tests of persons who had been previously tested increased each year; and in 1995, the proportion of tests that included posttest counseling was 86% for anonymous and 70% for confidential tests. Although information collected through CTS could be improved by changing the system so that individuals could be distinguished from testing episodes, the CTS does provide important monitoring information to local and state health departments.

The delay between collection of blood samples and availability of test results may be as long as 3 weeks and is one barrier to the acceptance of voluntary testing for human immunodeficiency virus (HIV) infection. Serologic tests that provide results rapidly could overcome this barrier, but the accuracy and reliability of rapid tests have not been well characterized in the United States.To evaluate, in a "real world" setting, the performance characteristics of a rapid HIV assay that reduces the need for patients to return for counseling after the test.Testing of HIV antibodies by rapid and nonrapid assays and survey about risk behaviors for HIV.A hospital in Bronx, New York, with a high prevalence of HIV-seropositive patients.837 patients who were not known to be infected with HIV, had not been admitted for conditions related to the acquired immunodeficiency syndrome, and agreed to participate in HIV testing and an interview.Sensitivity and specificity of a rapid HIV antibody assay based on comparisons with nonrapid assay and Western blot assay.According to nonrapid assays, 5.4% of patients were infected with HIV. The rapid assay was highly accurate in this sample overall: its sensitivity was 1.00, its specificity was 0.991, its positive predictive value was 0.865, and its negative predictive value was 1.00. The assay was also highly accurate in various subgroups.Accurate, rapid tests for HIV infection may enhance testing programs by preventing the need for delayed counseling of seronegative patients and by providing preliminary results to seropositive patients. These preliminary results may encourage patients to return for confirmatory test results and to adopt risk-reducing behaviors sooner.

Background : Although human immunodeficiency virus type 2 (HIV-2) infection among United States residents is considered rare, there are US populations at high risk. Few studies have surveyed these populations with a high likelihood of infection, that is, those with high percentages of persons from HIV-2-endemic areas and high prevalences of behaviors that would allow for transmission. Study Design and Methods : Patients (n = 832) enrolled in a confidential HIV serosurvey at a hospital that serves a community with a relatively high percentage of WestAfrican immigrants, drug injectors, and persons who practice high-risk sexual activity were evaluated. Sera were tested for HIV type 1 (HIV-1) and HIV-2 by rapid enzyme immunoassays, standard enzyme immunoassays and Western blots. Results : Eight of 832 patients were weakly reactive to HIV-2 on rapid assay, but none was confirmed to be infected when tested by standard immunoassay and Western blot. Five of these eight were reactive to HIV-1. Conclusion : Weak reactivity to HIV-2 antibody on the rapid assay is best explained by cross-reactivity with HIV-1 antibody ; thus, even in this population at high risk for infection, false-positive reactions are more likely than true infections. The finding that HIV-2 is absent in this population at potentially high risk for infection corroborates the findings of other studies that HIV-2 infection is rare among US residents. These results support previous recommendations that, in settings other than blood collection facilities, HIV-2 testing should be selectively offered to persons with epidemiologic risk factors.

To provide information for the formulation of treatment guidelines, we review recently published articles and abstracts on advances in the treatment of Chlamydia trachomatis genital infection. We ask specific questions about new treatments that are answered on the basis of the results of clinical trials and efficacy studies. New, potentially effective treatments for C. trachomatis genital infection include azithromycin and ofloxacin. Clinical studies indicate that the efficacy of these agents is equivalent to that of the current recommended agent doxycycline. Both azithromycin and ofloxacin are substantially more expensive than doxycycline. Azithromycin has the advantage of being given as a single dose, while doxycycline and ofloxacin are administered for 1 week. Issues of compliance, cost, and toxicity for specific patients should be considered when deciding whether to treat C. trachomatis genital infections with these agents.

Presented here is a report on an unusual liposarcoma of the esophagus. A 66-year-old-woman was treated successfully by surgical excision without removal of the esophagus. Thirty months after surgery and radiation she presented with neither complaint nor recurrence.

Context.—Policies requiring confidential reporting by name to state health departments of persons infected with the human immunodeficiency virus (HIV) have potential to cause some of them to avoid HIV testing.Objective.—To describe trends in use of HIV testing services at publicly funded HIV counseling and testing sites before and after the implementation of HIV reporting policies.Design and Setting.—Analysis of service provision data from 6 state health departments (Louisiana, Michigan, Nebraska, Nevada, New Jersey, and Tennessee) 12 months before and 12 months after HIV reporting was introduced.Main Outcome Measure.—Percent change in numbers of persons tested at publicly funded HIV counseling and testing sites after implementation of confidential HIV reporting by risk group.Results.—No significant declines in the total number of HIV tests provided at counseling and testing sites in the months immediately after implementation of HIV reporting occurred in any state, other than those expected from trends present before HIV reporting. Increases occurred in Nebraska (15.8%), Nevada (48.4%), New Jersey (21.3%), and Tennessee (62.8%). Predicted decreases occurred in Louisiana (10.5%) and Michigan (2.0%). In all areas, testing of at-risk heterosexuals increased in the year after HIV reporting was implemented (Louisiana, 10.5%; Michigan, 225.1%; Nebraska, 5.7%; Nevada, 303.3%; New Jersey, 462.9%; Tennessee, 603.8%). Declines in testing occurred among men who have sex with men in Louisiana (4.3%) and Tennessee (4.1%) after HIV reporting; testing increased for this group in Michigan (5.3%), Nebraska (19.6%), Nevada (12.5%), and New Jersey (22.4%). Among injection drug users, testing declined in Louisiana (15%), Michigan (34.3%), and New Jersey (0.6%) and increased in Nebraska (1.7%), Nevada (18.9%), and Tennessee (16.6%).Conclusions.—Confidential HIV reporting by name did not appear to affect use of HIV testing in publicly funded counseling and testing programs.

Objective. —Esherichia coliO157:H7 causes hemorrhagic colitis and the hemolytic uremic syndrome. In the fall of 1991, an outbreak ofE coliO157:H7 infections in southeastern Massachusetts provided an opportunity to identify transmission by a seemingly unlikely vehicle. Design. —Case-control study to determine the vehicle of infection. New England cider producers were surveyed to assess production practices and determined the survival time ofE coliO157:H7 organisms in apple cider. Results. —Illness was significantly associated with drinking one brand of apple cider. Thirteen (72%) of 18 patients but only 16 (33%) of 49 controls reported drinking apple cider in the week before illness began (odds ratio [OR], 8.3; 95% confidence interval [CI], 1.8 to 39.7). Among those who drank cider, 12 (92%) of 13 patients compared with two (13%) of 16 controls drank cider from cider mill A (lower 95% CI, 2.9;P Conclusions. —Fresh-pressed, unpreserved apple cider can transmitE coliO157:H7 organisms, which cause severe infections. Risk of transmission can be reduced by washing and brushing apples before pressing, and preserving cider with sodium benzoate. Consumers can reduce their risk by only drinking cider made from apples that have been washed and brushed. (JAMA. 1993;269:2217-2220)

The horseradish peroxidase tracing method has been used to study the cells of origin of the tectospinal projections in the opossum, the tree shrew, and the cat. The present data show that only those collicular neurons which occupy the deep (ventral to the stratum opticum) tectal laminae send axons to the cervical spinal cord. In particular, layer IV contains the greatest number of spinal projecting neurons. Our results also reveal that while only the large sized collicular neurons project upon the cervical spinal cord in the opossum and the tree shrew, neurons comprising several different size categories do so in the cat. We thus suggest that several different descending channels exist over which the superior colliculus can influence the neck musculature in the cat.