A community outbreak of legionellosis occurred in Barrow-in-Furness, Cumbria, during July and August 2002. A descriptive study and active case-finding were instigated and all known wet cooling systems and other potential sources were investigated. Genotypic and phenotypic analysis, and amplified fragment length polymorphism of clinical human and environmental isolates confirmed the air-conditioning unit of a council-owned arts and leisure centre to be the source of infection. Subsequent sequence-based typing confirmed this link. One hundred and seventy-nine cases, including seven deaths [case fatality rate (CFR) 3·9%] were attributed to the outbreak. Timely recognition and management of the incident very likely led to the low CFR compared to other outbreaks. The outbreak highlights the responsibility associated with managing an aerosol-producing system, with the potential to expose and infect a large proportion of the local population and the consequent legal ramifications and human cost.
CORRESPONDENCE be discarded, because it constitutes ‘¿ an enduring pejorative judgement'. This point of view would be laudable if they had shown that the diagnosis could not be reliably made, or that it held no validity, but this they have not done. Drs Lewis & Appleby have shown that the diag nosis ofpersonality disorder conveys to psychiatrists
Psychiatrists suffer the highest rate of violence compared with other specialities; current developments are likely to increase this.
A 45-year-old woman with no previous psychiatric history had three psychiatric in-patient admissions with symptoms of suicidal ideation and depression which she attributed solely to the effect on her of Princess Diana's death.
JAMA is undoubtedly the elephant, and not only because of its size. It is dominant and loud, ranging over a huge territory, within which, however, it commutes on well trodden paths. It can do a lot of damage by pushing, shoving, and trampling, and ultimately it can devastate its own environment. It is a poor converter of food, and many other species thrive on its droppings. It has stamina, it is gregarious and supportive, and it has the wisdom of the conservative kind. It has a good memory. It revisits fruiting trees regularly. It can survive drought by adapting to meagre food supplies and by digging for water, an activity from which other species benefit.The New England Journal of Medicine is the rhinoceros. Solitary and ill tempered, it can smell and hear but it cannot see well, hence its horizon is narrow. It charges everything that moves (but never anything that is immobile such as the churches and the universities). It can survive on coarse food, and it can swallow thorns. Of the five, it is the one most difficult to sex. Experienced hunters maintain the female of the species is more territorial and irascible then the male.The Annals of Internal Medicine resembles the buffalo. It is the only ruminant of the five. It has better eyes than the former two; it can see far. It charges using its sight, not its nose or ears, and it does not often miss. However, its condition rapidly changes in accordance with food supply, therefore sometimes its ribs stick out. In good seasons, when there is plenty of nutritious forage, it can suffer from diarrhoea.The two Britons are the carnivores: the lion and the leopard. They are higher in the food chain than the transatlantic herbivores. Both, but particularly the leopard, may be found in diverse habitats. Their food preferences change according to availability. They regularly kill prey much larger than themselves.The Lancet is akin to the leopard. It has the better nose. It is the more subtle, more cunning, and more elegant of the two. When in pursuit of its quarry it is single minded and quiet, preferring to kill by stealth. It returns to the kill until it is completely consumed. It is a true cat, has its own ways, and is unlikely to change its spots.The parallels between the BMJ and the lion are more subtle. The lion is loud and visible, spending much time in displaying. It is a strong and methodical hunter and uses multifarious strategies to bring down its prey. It has a big appetite and when game is in short supply it scavenges and may rob other predators. (It is said that the leopard has stories to tell.) It is gregarious and playful and carries on with most of its transactions in the daylight, yet it can behave like the leopard. It is known to have eaten men. Imre Loefler, editor, Nairobi Hospital Proceedings, Nairobi, KenyaShip?T he New England Journal of Medicine, the Lancet, and the BMJ have for many years competed in the midAtlantic in the Blue Band. Now they navigate in different waters and can be distinguished by the cuts of their jibs.The Lancet still sails the ...
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