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Rubella (German measles or 3-day measles) was officially proclaimed eliminated from the United States in 2004, largely due to intense vaccination efforts; with <10 cases reported per year, these are often travel associated and sporadic. Serologic testing for detection of antirubella antibodies can be used to establish immunity or to provide laboratory-based evidence for rubella infection ( Table 57 ). The presence of IgG antibodies to rubella virus in an asymptomatic individual indicates lifelong immunity to infection. Acute rubella infection can be serologically confirmed by documenting seroconversion to IgM and/or IgG positivity or a 4-fold rise in antirubella IgG titers between acute and convalescent serum specimens. As with measles and mumps serologic assays, however, assays providing quantitative titers for antibodies to rubella are not commonly offered at local or reference laboratories.

Table 57.

Laboratory Diagnosis of Rubella

Abbreviations: NAAT, nucleic acid amplification test; RT, room temperature; SST, serum separator tube.

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Table 57.

Laboratory Diagnosis of Rubella

Abbreviations: NAAT, nucleic acid amplification test; RT, room temperature; SST, serum separator tube.

View Large

Only approximately 50% of patients are positive for IgM antibodies to rubella at the time of rash onset, which emphasizes the importance of collecting a convalescent sample. Acute phase serum should be collected upon patient presentation and again 14–21 days (minimum of 7) days later. Due to the rarity of rubella in the United States and thus the low pretest probability of infection, serologic evaluation should only be performed in patients with appropriate exposure risks and a clinical presentation highly suggestive of acute rubella; in patients not meeting these criteria, positive rubella IgM results should be interpreted with caution as they may be falsely positive.

Congenital rubella syndrome can be diagnosed by the presence of IgM-class antibodies to rubella in a neonate, alongside symptoms consistent with congenital rubella syndrome, appropriate exposure history of the mother, and lack of maternal protective immunity. NAAT for detection of rubella RNA can be performed on throat or nasal swabs and urine, though such testing is largely limited to public health laboratories and/or the CDC. Specimens for NAAT should be collected within 7 days of presentation to enhance sensitivity.

BK virus is a polyomavirus that may cause allograft nephropathy in renal transplant recipients and hemorrhagic cystitis, especially in bone marrow transplant patients. A definitive diagnosis of these conditions requires renal allograft biopsy with in situ hybridization for BK virus.

Detection of BK virus by NAAT in plasma may provide an early indication of allograft nephropathy, although there are currently no FDA-cleared NAATs ( Table 58 ) [ 276 ]. Urine cytology or quantitative NAAT may be used as a screening test, and if positive, may be followed by BK viral load testing of plasma, which has a higher clinical specificity. As there are no FDA-cleared quantitative NAATs available for monitoring BK viral loads, each institution must establish a threshold for identifying patients at highest risk of BK virus–associated nephropathy. Urine NAATs for BK virus may be more sensitive than detection of decoy cells (virus-infected cells shed from the tubules or urinary tract epithelium) using urine cytology, as BK virus DNA is typically detectable earlier in the urine than are decoy cells. However, shedding of BK virus in urine is common. Therefore, if used as a screening test, only high levels (ie, above a laboratory-established threshold that correlates with disease) should be considered significant. Urine testing for BK virus places the laboratory at risk for specimen cross-contamination, as extremely high levels of virus in the urine may lead to carryover between specimens and, potentially, false-positive results.

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Welcome to the February 2018 Birth Club!
Welcome to your birth club! Moms from all over the country, and maybe even the world, who are due or trying to conceive for this month will gather here to talk about their pregnancy, birth, and baby with you! (Dads are welcome, too!) A few things to get you started: Birth Club Goal: Your birth club should be a place to share your journey, ask questions, and support each other. Treat other members with respect. You may disagree respectfully and your paths may be different, but you're all here because you care about your family. When in doubt, be kind. Community Guidelines: These are the guidelines for the site that you agreed to when you created your account. Take a look and be sure your participation in all areas of our site conforms. http://www.babycenter.com/community-help-guidelines Facebook and Privacy: Please do not use this group to advertise or solicit members for Facebook groups. This has turned into a big privacy issue in the past. If you wish to create a private place to connect with a smaller group of BabyCenter friends, click on this link to create your own group: http://community.babycenter.com/a/create/groups If you need help creating your own group, you can ask your Big Sisters or Group Owners, or read the guide here: http://www.babycenter.com/community-help-howto#groups Friends of BabyCenter: You'll find a link to this on the right-hand side of the page. Go here to talk about the site itself when you have questions, problems using the site, and so on. http://community.babycenter.com/groups/a45/friends_of_babycenter Help: At the bottom of the page you'll see a link to Community Help, which leads to our help pages. There you'll find information about the Community staff, how to use your account, and - perhaps most important - a list of abbreviations commonly used in our Community, such as BFP, FF, BF, CD, and BD, not to mention DH, DD, and DS! Our Community Guidelines are linked to from there as well. http://www.babycenter.com/community-help Group Owners: Your birth club starts off with two of our Staff members designated Group Owners, and it will be assigned Big Sisters soon. Big Sisters are experienced Group Owners who help guide the group at the beginning and give you an idea of what a Group Owner does. After your first trimester, you'll have an opportunity to volunteer to be a Group Owner and to vote for Group Owners from among birth club members. Privacy on BabyCenter: Things posted in this birth club are publicly accessible. To find out more about protecting your privacy, look here: http://www.babycenter.com/community-help-privacy There you go - you're all set. Enjoy your group and enjoy getting to know each other. Wishing a happy and healthy nine months to you all!

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The expansion of Medi-Cal to undocumented children through SB75 Health4All Kids has been implemented through perhaps the most rapid and issue-free transition in California’s healthcare history.

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Originally published as:

Samuel Alexander. "Universal, Particular and Individual." Chapter 3 of Book 2 in Space, Time and Deity: The Gifford Lectures at Glasgow, 1916-1918 , Vol I. London: Macmillan Company (1927): 208-237.

Editors' notes

In her "Foreword" to the 1966 republication of Dorothy Emmet referred to this work as "among the great ventures in systematic metaphysics." We have included is as part of the documentation for George Herbert Mead's .

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EXISTENCE is identity of place and time, or numerical identity, and distinct from other such identities. Universality is identity of kind. It is the existence or subsistence of a universal or concept which unites its particulars, which they imitate or in which they participate, or however else we may provisionally and traditionally describe the relation between the universal and its particulars—the transaction in which they are engaged. An individual is a particular as determined by its universal. Strictly speaking, there is no such thing as a particular or a universal. All things are individuals. But every individual possesses particularity which separates it from others of the same kind, or under the same universal ; and it possesses universality which converts its bare particularity into individuality. Universality is thus a categorial character of all things. Such a thing need not be a thing with continued existence in time. It may be a sensory object, a flash of colour, or of sweetness, which is momentary and yet as being of a certain kind, red or sweet, is individual. A bare event or point-instant is particular as distinct from other events, but as qualified by the universal character of existence, its particularity is determined in total Space-Time and it is individual though from the nature of the case momentary and punctual. Can we discover in Space Time any fundamental feature in virtue of which the empirical complexes within it possess universality and hence are individualised so that throughout the world we have existents embodying laws of construction ?

Singular universals

Let us begin with an individual of a low type or organisation, for example a marble ball whose particularity may be supposed secured by its markings of colour. Let us suppose for simplicity that these do not change in colour, and let us disregard the intramolecular movements of the ball, confining our attention to its spherical form. The ball changes its place in space and time as the earth moves, and may also be displaced on the relatively resting earth. Its universality is that in all these changes it is unaffected in form ; that wherever it is, it undergoes no distortion, and this arises from the uniformity of Space-Time or, as it may be expressed equivalently, from the constant 'curvature ' [1] of Space. The same account applies obviously to balls which are turned out from one machine, so that they differ from one another, let us say, only in their place and time. They are identical in kind because owing to the constant curvature of Space their form is unaffected, and so far as form goes one can take the place of the other. A round ball does not become in another place elliptic or crooked.

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