British Escherichia coli O157 in Cattle Study (BECS): to determine the prevalence of E. coli O157 in herds with cattle destined for the food chain.

Escherichia coli O157 are zoonotic bacteria for which cattle are an important reservoir. Prevalence estimates for E. coli O157 in British cattle for human consumption are over 10 years old. A new baseline is needed to inform current human health risk. The British E. coli O157 in Cattle Study (BECS) ran between September 2014 and November 2015 on 270 farms across Scotland and England & Wales. This is the first study to be conducted contemporaneously across Great Britain, thus enabling comparison between Scotland and England & Wales. Herd-level prevalence estimates for E. coli O157 did not differ significantly for Scotland (0·236, 95% CI 0·166-0·325) and England & Wales (0·213, 95% CI 0·156-0·283) (P = 0·65). The majority of isolates were verocytotoxin positive. A higher proportion of samples from Scotland were in the super-shedder category, though there was no difference between the surveys in the likelihood of a positive farm having at least one super-shedder sample. E. coli O157 continues to be common in British beef cattle, reaffirming public health policy that contact with cattle and their environments is a potential infection source.

Identifying bias in CCR1 antagonists using radiolabelled binding, receptor internalization, ß-arrestin translocation and chemotaxis assays.

BACKGROUND AND PURPOSE: Investigators have suggested that the chemokine receptor CCR1 plays a role in multiple myeloma. Studies using antisense and neutralizing antibodies to CCR1 showed that down-regulation of the receptor altered disease progression in a mouse model. More recently, experiments utilizing scid mice injected with human myeloma cells demonstrated that the CCR1 antagonist BX471 reduced osteolytic lesions, while the CCR1 antagonist MLN-3897 prevented myeloma cell adhesion to osteoclasts. However, information is limited regarding the pharmacology of CCR1 antagonists in myeloma cells. EXPERIMENTAL APPROACH: We compared several well-studied CCR1 antagonists including AZD4818, BX471, CCX354, CP-481715, MLN-3897 and PS899877 for their ability to inhibit binding of [(125)I]-CCL3 in vitro using membranes prepared from RPMI 8226 cells, a human multiple myeloma cell line that endogenously expresses CCR1. In addition, antagonists were assessed for their ability to modulate CCL3-mediated internalization of CCR1 and CCL3-mediated cell migration using RPMI 8226 cells. As many GPCRs signal through ß-arrestin-dependent pathways that are separate and distinct from those driven by G-proteins, we also evaluated the compounds for their ability to alter ß-arrestin translocation. KEY RESULTS: There were clear differences between the CCR1 antagonists in their ability to inhibit CCL3 binding to myeloma cells, as well as in their ability to inhibit G-protein-dependent and -independent functional responses. CONCLUSIONS AND IMPLICATIONS: Our studies demonstrate that tissue phenotype seems to be relevant with regards to CCR1. Moreover, it appears that for CCR1 antagonists, inhibition of ß-arrestin translocation is not necessarily linked to chemotaxis or receptor internalization.

Screening CMHC outpatients for physical illness.

To assess the prevalence of physical disorders among outpatients treated in Colorado's public mental health system, a total of 175 patients from two community mental health centers received a comprehensive medical screening that included a standard physical examination and laboratory analyses. Of these patients, 46 percent had physical conditions or laboratory test results warranting further medical evaluation. A previously undiagnosed physical health problem was identified in 20 percent of the screened patients, and about 16 percent had conditions that could cause or exacerbate their mental disorder. The authors conclude that public mental health systems should ensure routine assessment of the physical health of psychiatric outpatients and suggest guidelines for developing medical screening procedures in public settings.

Milieu reactions to ECT.

Electroconvulsive therapy (ECT) evokes strong emotional reactions and disagreements among mental health professionals, patients, and families. The indications for ECT, its efficacy and sequelae, theories of its mechanism of action, social and political debate, and the technique itself have all been sources of controversy. In the forty years since its advent, knowledge of these issues has evolved. The efficacy of ECT in major depressive illness is now well established, but at the same time we can eliminate most of the fifty theories that Gordon listed in 1948 to explain how ECT works. While the mechanism of action appears likely to be a neurochemical one, it is far from being clearly understood. But is is not just uncertainty about how ECT works that remains. Not only are there arguments among the lay public, but even knowledgeable mental health workers are sharply divided in their opinions of ECT (Frankel et el. 1978). We believe that even when ECT is administered in a humane manner with informed consent to appropriately selected patients who derived lasting benefit without major sequelae, it will continue to evoke strong emotional reactions in therapists, patients, and ward staff. In this paper, some of the continuing controversy surrounding ECT is examined through reactions to it in the therapeutic milieu among therapists, staff, and patients. We hypothesize that ECT can be especially upsetting because it often produces rapid improvement in patients who had previously not responded to treatment. This tends to create an inflated estimation of ECT. Devaluation of other therapeutic modalities, staff splitting, and disruptions in the therapeutic alliance may follow. We present two cases to exemplify aspects of how the milieu reacts to ECT, and conclude with recommendations to improve the delivery of treatment.

Screening for adult phenylketonuria in state psychiatric hospitals.

The authors report the results of screening patients admitted to a state psychiatric hospital for unrecognized adult phenylketonuria. The results suggest that unrecognized adult phenylketonuria is very uncommon in these patients.

Treatment of chronic pain in the general psychiatric hospital.

Patients with chronic pain present many diagnostic and therapeutic challenges to primary physicians and psychiatric consultants. The authors present a series of twelve patients with chronic pain who were hospitalized on the psychiatric ward of a general hospital. Ten of the twelve patients presented decreased their medication use and were markedly improved at the end of their brief stay. Treatment goals, attitudes and interventions are discussed.

Implementation of laboratory screening procedures on a short-term psychiatric inpatient unit.

A health maintenance screening procedure was done on blood and urine specimens on 636 patients admitted to short term adult psychiatric ward. The data obtained was assessed by laboratory test and by its effect on the subsequent work-up and diagnostic thinking about those patients who had unexpected abnormal findings. The overall incidence of unexpected abnormal tests was low (3.0%). Similarly the incidence of new disease found by these procedures was low (between 2.2% and 8.5%). In no case was an underlying medical cause for the mental disorder for which the patient was admitted detected by the screening procedure. The authors conclude that these routine blood and urine screening tests add very little to the care of psychiatric inpatients.

A favorable response to lithium carbonate in a "schizo-affective" father and son.

It has recently been suggested that patients with mania are often misdiagnosed as having schizophrenia. The authors report a favorable clinical response to lithium carbonate in a father and son with an apparent schizo-affective syndromes may respond favorably to lithium but caution that a favorable response in such cases does not absolutely confirm a diagnosis of mania.