Preliminary Scales for ICD-11 Personality Disorder: Self and Interpersonal Dysfunction Plus Five Personality Disorder Trait Domains.

The ICD-11 personality disorder model is the first fully dimensional assessment of personality pathology. It consists of a personality disorder (PD) dysfunction-severity dimension, which encompasses both self- and interpersonal dysfunction, and six optional qualifiers for five prominent personality traits-Negative Affectivity (NA), Detachment (DET), Dissociality (DSL), Disinhibition (DSN), and Anankastia (ANK)-plus a borderline pattern that is defined by the criteria of DSM-IV borderline PD. This article reports on the development of a new self-report measure to assess self- and interpersonal dysfunction and the five trait qualifiers. It is the first comprehensive measure of the ICD-11 PD model in that (a) it is the only one to include both PD dysfunction-severity as well as trait scales and because (b) it is based on the Clinical Description and Diagnostic Guidelines, which are more detailed than the "statistical" model description that is currently on the ICD-11 website. The authors wrote 992 items and then reduced the pool to 300 items by eliminating redundancy and selecting the consensus best few items for each subconstruct. Data were collected using an online sample of 383 Prolific workers. Using exploratory factor analysis, seven domain scales were developed, each of which contained two to four scales assessing components of the domain. These preliminary scales' psychometrics were excellent, as were the domains' and their components' convergent and discriminant validity, with a few generally minor exceptions. Structural analyses at the component level revealed a three-factor structure consisting of two moderately correlated Internalizing factors, one centered on Self Dysfunction with two NA components and a DSN component (Distractibility) and the other on Interpersonal Dysfunction with DET and ANK components; as well as an Externalizing factor with DSL and a DSN component (Reckless Impulsivity) that was uncorrelated with the other two factors. Two aspects of the results in particular are striking: (1) ANK was not the opposite end of a DSN dimension, but rather contributed to an Internalizing Interpersonal Dysfunction dimension and (2) DSN had both an Internalizing and an Externalizing component. Implications of the findings and study limitations are discussed.

Healthcare-Associated Pertussis Outbreak in Arizona: Challenges and Economic Impact, 2011.

An outbreak investigation identified 15 pertussis cases among 5 infants and 10 healthcare professionals at 1 hospital's neonatal intensive care unit (NICU). The cost of the outbreak to this hospital was $97 745. Heightened awareness of pertussis in NICUs is key to preventing healthcare-associated spread and minimizing outbreak-control-related costs. Bordetella pertussis is a highly communicable bacterial pathogen that causes a prolonged cough illness and is spread by respiratory droplet transmission. Infants aged ≤6 months are most susceptible to B pertussis infection and pertussis-associated complications, including pneumonia, encephalopathy, and death, and are commonly hospitalized for treatment [ 1]. Despite a universal pertussis vaccination program, 27 550 pertussis cases were reported in the United States during 2010 [ 2]. Pertussis outbreaks in healthcare settings can be challenging and costly to control [3]. On September 13, 2011 and September 15, 2011, 3 pertussis cases, including 2 confirmed by B pertussis isolation, among preterm infants discharged ≤30 days previously from a 71-bed NICU of a general hospital (NICU A) were reported by Hospital B, a large pediatric facility, to Maricopa County Department of Public Health. This report describes the outbreak, examines outbreak-associated costs and risk factors that might have contributed to healthcare-associated transmission, and provides guidance to prevent outbreaks in healthcare settings.

Chryseobacterium indologenes in a woman with metastatic breast cancer in the United States of America: a case report.

INTRODUCTION: We report the seventh case of Chryseobacterium indologenes occurring in the United States of America. C. indologenes is seldom isolated from clinical specimens but has caused hospital-acquired infections in Taiwan and rarely elsewhere. CASE PRESENTATION: A 32-year-old Caucasian woman with metastatic breast cancer presented to a hospital emergency department with bilateral radiation-induced pleural effusions and respiratory failure. The patient was hospitalized and ventilated for 26 days; tracheal aspirates collected on ventilation days 24 and 26 grew C. indologenes. The patient subsequently died as a result of worsening ventilator-associated pneumonia and stage IV breast cancer. CONCLUSIONS: C. indologenes infection should be considered for hospitalized patients with a history of malignancy, especially those with indwelling devices and antibiotic use for >14 days.

Cross-over trial of fetal heart rate response to halogen light and vibroacoustic stimulation.

OBJECTIVE: The purpose of this study was to compare the effect of halogen light and vibroacoustic stimulation on fetal heart rate (FHR) responsiveness and on nonstress test (NST) results. METHODS: Sixty consecutively-chosen patients between 33 and 39 weeks of gestation underwent an NST on at least three weekly occasions. Each received halogen light (Vector Compact Sport Spot, Ft Lauderdale, FL, USA), vibroacoustic (SolaTone Artificial Larynx, Temecula, CA, USA), and no stimulation in a randomized order. The transabdominal light or vibroacoustic stimulation lasted for 10 seconds. If no initial FHR acceleration occurred, then the stimulus was repeated 10 minutes later up to a maximum of three times. The investigators who interpreted the FHR patterns were blinded as to the type of stimulus used. RESULTS: Reactive results were present in 171 tests (vibroacoustic: 98.3%; light: 96.6%; none: 93.3%). Compared with no stimulation, the mean difference in time from the onset of recorded "stimulation" to the first FHR acceleration was shorter (p < 0.01) with either light (2.7 minutes, 95% confidence interval (CI) 0.9-4.5 minutes) or vibroacoustic stimulation (2.6 minutes, 95% CI 0.8-4.4 minutes). The mean time difference until a reactive result was also shorter (p < 0.05) with either light (2.7 minutes, 95% CI 0.1-4.9 minutes) or vibroacoustic stimulation (2.4 minutes, 95% CI 0.1-4.7 minutes) than with no stimulation. The need for repeated stimulation during each test was infrequent (light: 5.0%; vibroacoustic: 3.3%). No adverse effect from external stimulation was noted on the FHR tracing. CONCLUSION: Halogen light stimulation is an acceptable alternative to vibroacoustic stimulation in provoking a more rapid fetal heart rate response and in shortening the time before a reactive nonstress test result.