Growth-based methods for detecting faecal contamination of recreational water require at least 24 hours to yield results, which can delay detection, action and remediation, if required. Such delays can put human health at risk while closing beaches inappropriately can cause unnecessary economic losses. There is a requirement for more rapid methods to facilitate the management of pollution events. In this study, undertaken in our respective laboratories, a molecular assay based on transcription-mediated amplification (TMA) technology was compared with established growth-based methods. The assays were used to quantitate enterococcal faecal indicator bacteria (relative to the legislative threshold of 104 colony forming units/100 mL) in 138 water samples collected from 41 different locations, representative of different recreational water types routinely sampled in Southern California. The results demonstrate the efficacy of the TMA assay for the detection of Enterococcus species in recreational water as a rapid alternative to traditional methods.

A new RoboCup soccer league is being developed, focusing on human-robot interaction. In this league each team consists of both a human player, mounted on a Segway HT scooter, and a robotic version of the Segway; both human and robot players must cooperate to score goals. This paper details the design of our robotic Segway Soccer Brain-Based Device (SS-BBD). The SS-BBD control system is based on a large scale neural simulation, whose design is dictated by details from the published literature on vertebrate neuroanatomy, neurophysiology, and psychophysics. The physical device is completely autonomous, and possesses special manipulators for kicking and capturing a full-sized soccer ball. The SS-BBD uses visual and laser rangefinder information to recognize a variety of game related objects, which enables it to perform actions such as capturing the ball, kicking the ball to another player, shooting a goal, and maneuvering safely across the field. The SS-BBD can act autonomously or obey voice commands from the human player. This is an unprecedented level of human-robot teamwork on a soccer field. in that our players are not merely acting autonomously, but also communicate with each other and support each other on the field.

Breast cancer incidence is lower and survival is longer in Asian women residing in Japan, China, or the Philippines than Caucasian women residing in the United States. Phytoestrogen intake has been examined as a possible reason for the disparity in breast cancer incidence and survival. This study examined the association between phytoestrogen intake prior to diagnosis of breast cancer and indicators of breast cancer prognosis (tumor size, estrogen and progesterone receptor status, histological grade, lymphovascular invasion, nodal spread, and stage) in 128 women, aged 40-79 yr, newly diagnosed with invasive breast cancer. After controlling for significant confounding factors, higher intakes of phytoestrogens were associated with favorable indicators of breast cancer. In women with higher intakes of phytoestrogens, there was a 32% reduction in the odds of being diagnosed with any stage of cancer other than stage 1 (95% confidence interval, CI = 0.49-0.93; P = 0.02), a 38% reduction in odds of being diagnosed with positive lymphovascular invasion (95% CI = 0.40-0.95; P = 0.03), and a 66% increase in the odds of being diagnosed with a positive progesterone receptor (95% CI = 1.06-2.58; P = 0.03). We conclude that phytoestrogen intake prior to diagnosis may improve prognosis of breast cancer.

BACKGROUND:Rates of fluoroquinolone-resistant Neisseria gonorrhoeae (QRNG) are increasing worldwide and in California.METHODS:As a supplement to established surveillance, the investigation of QRNG in California included expanded surveillance in southern California, with in-depth interviews of patients (who had QRNG during the period of January 2001-June 2002) and a cross-sectional study of patients at 4 sexually transmitted diseases clinics with gonococcal isolates that underwent susceptibility testing (for the period of July 2001-June 2002).RESULTS:The rate of QRNG increased from <1% in 1999 to 20.2% in the second half of 2003. The 2001-2002 expanded surveillance demonstrated that 66 (4.9%) of 1355 isolates were resistant to fluoroquinolones; the majority of these infections occurred after August 2001. Cross-sectional analysis of 952 patients with gonorrhea revealed that the prevalence of QRNG varied geographically during 2001-2002, with the highest rate being in southern California (8.9%) and the lowest being in San Francisco (3.6%). The QRNG prevalence was 8.6% among men who have sex with men (MSM), 5.1% among heterosexual men, and 4.3% among women. Although risk factors for QRNG varied by clinic, multivariate analysis demonstrated independent associations with race/ethnicity, recent antibiotic use, and MSM.CONCLUSIONS:The emergence and spread of QRNG in California appeared to evolve from sporadic importation to endemic transmission among both MSM and heterosexuals. Monitoring of both the prevalence of and risk factors for QRNG infections is critical for making treatment recommendations and for developing interventions to interrupt transmission.

RATIONALE: We aimed to assess the clinical significance of mucosal mast cells (MC) in the upper gastrointestinal tract of infants with presenting with persistent crying and symptomatic gastroesophageal reflux (GER). METHODS: Forty infants (median age 4 months, range 2-11; 28 male) with persistent distress and symptomatic GER were studied. All infants underwent upper gastrointestinal endoscopy and 24-hour esophageal pH monitoring. Double-blind placebo-controlled challenges (DBPCFC) were performed with cow milk formula vs amino acid-based formula. Immunohistochemical staining for tryptase, a MC specific mediator, was performed on paraffin-embedded esophageal, gastric, and duodenal biopsies, using an anti-tryptase monoclonal antibody. MC's were counted in the entire esophageal epithelium, gastric mucosa and duodenal mucosa (epithelium and lamina propria), and analyzed as cells per mm2. RESULTS: MC numbers were significantly lower in the esophagus (14.8±15.3/mm2) than in the stomach (45.4±14.5/mm2) or duodenum (57.4±33.1/mm2); ANOVA p<0.001. In infants with esophagitis (n=10), there were significantly more epithelial MC than in infants with normal esophageal biopsies (24.0±21.6 vs 9.3±6.8/mm2; p=0.007). In the esophagus, MC numbers correlated well with eosinophils (r=0.785; p<0.001), but not with neutrophil numbers (r=0.152; p=0.41). No correlation was found between mucosal MC numbers and eosinophils in stomach or duodenum. Furthermore, there was no significant difference in MC numbers in esophagus, stomach or duodenum in relation to severity of GER or outcome of DBPCFC. CONCLUSION: The esophageal epithelial MC count was increased in infants with esophagitis and correlated well with epithelial eosinophil numbers. No relationship was found between upper gastrointestinal MC numbers and GER severity or cow milk protein allergy.

To address the local health care needs of both patients and primary care providers in Montana, an integrated primary care and behavioral health family practice clinic was developed. In this paper we describe our experience with integrating mental health and substance abuse services into a primary care setting (a community health center) while simultaneously teaching family practice physicians to take the lead in providing these services. The Deering Community Health Center in Billings, Montana, is a Federally Qualified Health Center serving a largely low-income patient population. The medical care at the clinic is provided primarily by the faculty and residents of the Montana Family Medicine Residency. The teaching model was founded on the belief that improved care will result when physicians have increased comfort with, and are able to enjoy the challenges of, patients with mental illnesses. The enhanced longitudinal curriculum incorporates mental health across the 3 years of the family practice residency. Unique characteristics of this model include staffing and the concurrent delivery of a high volume mental health service while teaching family practice resident physicians and the faculty to integrate this competency into their primary care practices.

Geophysical surveys crossed the Mission Creek Fault, a branch of the San Andreas Fault system near Desert Hot Springs, California. The fault is situated in the alluvial Coachella Valley, and is a major barrier to groundwater flow. The fault trace is marked sporadically by oases and vegetation, and is associated with hot springs and hot water wells. Resistivity, VLF, VLFresistivity, and horizontal-loop electromagnetics (HLEM) have been employed to visualize the subsurface near the fault, and image the fault gouge. The main geophysical response is due to the water table which is deeper on the southwest side of the fault, according to observations in nearby wells. We believe that the geophysical response of the fault is distinct enough to allow its delineation in other locations where not exposed and/or mapped. The measurements were carried out as an undergraduate field trip and class project.

A regional shoreline microbiology study was conducted in order to examine microbiological water quality along the entire shoreline of the Southern California Bight (SCB). A major goal of the study was to compare the responses among indicator bacteria. Samples were collected weekly at 307 sites between Point Conception, California, and Punta Banda, Mexico, beginning August 2, 1998, and continuing for five weeks. Three analytical methods, multiple tube fermentation (MTF), membrane filtration (MF), and chromogenic substrate tests, were used to test for the three bacterial indicators currently used in southern California for human water-contact health standards: total and fecal coliforms, and enterococci. Samples were collected using standardized protocols. Total and fecal coliforms were analyzed for all samples, and enterococci were measured in approximately 70% of the samples. Sampling sites were selected using a stratified random design, with six sampling strata: highand low-use sandy beaches and rocky shoreline, and ephemeral and perennial freshwater outlets. Results demonstrated that total and fecal coliforms correlated strongly with one another (r = 0.93). The correlation between enterococci and either total or fecal coliforms was much lower, but still significant (r = 0.29). However, these correlation coefficients were produced by including 564 values that had qualifiers; i.e., < or > symbols qualified the discreet value. Analysis of the data without the qualified results demonstrated stronger correlations between enterococci and fecal coliforms (r = 0.40) and enterococci and total coliforms (r = 0.77). No indication was found that the relationship between one bacterial indicator and another was dependent upon strata. However, the probability of exceeding a bacterial indicator threshold differed substantially between the indicators. The allocation of threshold exceedences among indicators was very dependent upon the indicator examined. Enterococci alone exceeded the bacterial indicator thresholds most often; i.e., one out of every three bacterial indicator exceedences was for enterococci alone. This finding demonstrated that enterococci was by far the most “conservative” indicator of bacteriological water quality in this study. Less than one-half of the enterococci threshold exceedences paired with threshold exceedences of another indicator, while nearly 90% of the total and fecal coliform threshold exceedences were partnered with exceedences of another indicator. These results shed new light on the quantitative assessments of bacteriological water quality and the interpretion of the results of bacteriological water quality analyses. This picture not available at this time

Objective: To evaluate the efficacy of cisapride in the treatment of uncomplicated gastroesophageal reflux in children younger than 36 months of age.Study design: A total of 95 patients satisfied the entry criteria and were randomly assigned to double-blind treatment with either cisapride (n = 50), 0.2 mg/kg 4 times daily, or placebo (n = 45) for 2 weeks. At the end of the 2- week treatment period, symptom diary and parental evaluation with repeat 24-hour pH study were performed.Results: Sixty-eight patients completed the trial (38 in the cisapride group and 30 in the placebo group). There were no significant differences in the symptoms of crying, vomiting, or gagging; the overall symptom intensity score; or parental global evaluations. There was a significant difference (P < .03) in the percent time pH <4, the number of reflux episodes lasting more than 5 minutes, and the duration of the longest episode. No significant difference was demonstrated for the number of episodes with pH <4 or the reflux score.Conclusions: Cisapride was no better than placebo for relief of symptoms in children with uncomplicated gastroesophageal reflux. A beneficial effect was demonstrated in the cisapride group in relation to the measured parameters for esophageal acid exposure time.

A 16 year old boy has been followed up since 1952. Though he now experiences slight exertional dyspnea, his cardiac status has not changed during this 14 year period. The clinical and catheterization data indicate that this patient represents a case of idiopathic hypertrophic cardiomyopathy that involves the septum and has produced narrowing of the apex of the right ventricle. Marked blood oxygen desaturation and elevated pressures were found at the right ventricular apex and are believed to be due to systolic obliteration and isolation of the apex by muscular contraction. No obstruction to pulmonary flow was found, and there was no gradient across the left ventricular outflow tract at rest. Our findings are similar to some observations made by others in patients with idiopathic hypertrophic cardiomyopathy, and different from reported cases of double-chambered right ventricle. They indicate that idiopathic hypertrophic cardiomyopathy represents a wide spectrum of manifestations and may involve predominantly the right ventricle.

Atrioventricular block was accidentally produced in 51 patients during the courseof 1,556 consecutive cardiac catheterizations over a ten-year period in a children's hospital. A majority of these incidents occurred in infants under 1 year of age. Although the duration of heart block was usually short and not attended by serious consequences, in 6 patients heart block persisted for periods up to 6 days, and 2 small infants died with the arrhythmia unrelieved. Factors important in the production of heart block during cardiac catheterization include the presence of a low arterial oxygen saturation, and a cardiac malformation which for diagnosis requires increased manipulation of the catheter.

Spontaneous closure of the defect occurred in 2 of 28 survivors from a series of 42 infants with ventricular septal defects severe enough to cause cardiac failure prior to the age of 6 months. The presence and subsequent complete obliteration of the ventricular septal defect was demonstrated in each instance by serial cardiac catheterization. Although on clinical grounds spontaneous closure of small benign defects is not uncommon, reports of complete or functional spontaneous closure of severer ventricular septal defects are few. Nonetheless this report indicates that spontaneous closure of larger defects occurs with greateer frequency than is generally realized.