Effects of Finishing Diet and Packaging on Longissimus Dorsi Color

ObjectivesMeat color is extremely influential in purchasing decisions as consumers associate a bright-red color with freshness. The type of finishing diet can influence beef color. Previous studies have shown that grass-finished cattle have darker muscle color than grain-finished cattle. With the use of modified atmospheric packaging (MAP), beef purveyors are able to vary the gas compositions within a package and enhance beef color. However, limited studies have determined the effects of modified atmospheric packaging on grass-finished beef color. The objective of this study was to determine how finishing diet and packaging type affects the color of the longissimus dorsi (LD) muscle.Materials and MethodsDuring the stocker period, all of the cattle were on a forage diet. Cattle were then randomly assigned to either a conventional grain-based diet or an alfalfa pasture diet for finishing. Both conventionally and pasture-finished cattle were fed for 91 d. Cattle were slaughtered on the same day at a commercial beef processing facility under normal conditions and chilled for approximately 30 h. After grading, one strip loin from each carcass was collected and transported to Oklahoma State University. At 11 d postmortem, one steak (n = 60) from each strip loin was vacuum packaged and randomly assigned to display. Those steaks were then randomly assigned to PVC, HiOx-MAP (80% oxygen and 20% carbon dioxide), or CO-MAP (0.4% carbon monoxide, 69.5% nitrogen, and 30% carbon dioxide) packaging and were displayed under retail conditions for 5 d. Muscle darkening (MD), muscle color (MC), and surface discoloration (SD) were all analyzed by a trained panel (n = 6). MD was evaluated only on d 0 and MC and SD were scored once every 24 h for 0, 1, 2, 3, and 4 d. Lipid oxidation was measured by thiobarbituric acid reactive substances (TBARS) assay on d 4. Data were analyzed using the Mixed Procedure of SAS.ResultsThere was a significant display day by finishing diet by packaging interaction (P < 0.05) for muscle color and surface discoloration. There was also a significant finishing diet by packaging interaction (P < 0.05) for muscle darkening. Steaks packaged in HiOx-MAP remained the most stable in color and the brightest cherry-red colored throughout display time (P < 0.05) compared with other packaging types. PVC was the most discolored (P < 0.05) on d 3 and 4 when compared to HiOx-MAP and CO-MAP with the grain-finished PVC packaged steaks showing the most discoloration on d 4. Pasture-finished steaks packaged in CO-MAP displayed the darkest colored muscle (P < 0.05) on d 0. Steaks packaged in PVC had a higher amount of lipid oxidation (P < 0.05) compared with other packaging types.ConclusionThese results indicate that HiOx-MAP more effectively maintains the desired beef color of bright cherry-red for pasture-finished beef. The results also indicate that the use of appropriate packaging type can minimize the losses due to discoloration of steaks from either grain or grass-finished beef.

The Effect of Modified Atmospheric Packaging on Beef Color Sensory Characteristics of Different Muscle pH Categories

ObjectivesAny deviation from the bright-red color of beef can lead to discounted price or consumer rejection. Fresh beef lean color is influenced by pH. Various packaging techniques have been developed to enhance the lean color of beef steaks. Therefore, the objective of the current study was to evaluate the effects of modified atmospheric packaging on three different beef muscle pH categories.Materials and MethodsThe three categories evaluated for this study were: Normal (pH = 5.57 ± 0.1; N-pH), Moderately high (pH = 5.70 ± 0.09; M-pH), and High (pH = 6.39 ± 0.03; H-pH). The pH was taken on the carcass, at the 12th and 13th rib interface within 72 h of harvest at a commercial beef processing plant. Strip loins were fabricated from each carcass (n = 12) and sent to Oklahoma State University for further analysis. Strip loins were then cut into 2.54 cm steaks and randomly assigned to 1 of 3 packaging treatments: polyvinyl chloride overwrap (PVC), carbon monoxide modified atmosphere packaging (CO-MAP; 0.4% CO, 69.6% N, and 30% CO2) and high-oxygen modified atmospheric packaging (HiOx-MAP; 80% O2, and 20% CO2). Visual color measurements for muscle color (MC; (1 = extremely bright cherry-red and 7 = extremely dark red), and surface discoloration (SD; 1 = no discoloration [0%] and 7 = extensive discoloration [81–100%]) were recorded on d 2, 4, and 6 of retail display by a trained panel. Data were analyzed using the Mixed Procedure of SAS.ResultsFor all pH treatments, PVC packaging possessed the darkest muscle color (P < 0.05) score compared to CO- and HiOx-MAP. When comparing N-pH, M-pH, and H-pH values, CO-MAP had approximately a 27.3%, 22.2%, and 25.3% improvement in muscle color, indicating a brighter lean color compared to PVC. Additionally, HiOx-MAP had approximately a 10.9%, 17.4%, and 16.5% improvement in muscle color score for N-pH, M-pH, and H-pH, respectively. When packaging steaks in either CO- or HiOx-MAP there was no significant difference (P > 0.05) between d 4 and 6 of retail display for muscle color. However, there was a significant (P < 0.05) darkening in muscle color for steaks packaged in PVC from d 4 to 6 of retail display. By the fourth d of retail, N-pH steaks packaged in PVC had 38.3% and 39.0% greater (P < 0.05) surface discoloration than CO- and HiOx-MAP, respectively.ConclusionThese results suggest that packaging steaks of different pH categories in CO- or HiOx-MAP can improve the surface color compared to PVC packaging.

Modified Atmospheric Packaging and Antioxidant Enhancement Improves Redness of Atypical Dark-Cutting Beef

ObjectivesDark-cutting carcasses occur when muscle pH does not decrease sufficiently during rigor mortis because of antemortem glycogen depletion. Typical dark-cutting beef have a pH > 6.0, however, atypical dark-cutting (ADC) beef have a pH around 5.7- 5.9 but have a darker lean color similar to dark-cutting beef. Previous studies noted that greater muscle pH in dark-cutting beef increase oxygen consumption and decrease myoglobin oxygenation. However, limited research has determined the biochemical basis of ADC. Therefore, the objectives of this study were to characterize the biochemical basis of ADC beef carcasses and to utilize modified atmosphere packaging (MAP) and rosemary enhancement to improve appearance during retail display.Materials and MethodsStrip loins from ADC and USDA Low Choice (C) carcasses were selected from a commercial beef processing plant and transported to the Food and Agricultural Products Center in Stillwater, OK. Control (C) and ADC steaks (prior to enhancement and packaging) were utilized to measure pH, color, oxygen consumption, and proximate compositions. Loin sections were cut into halves and randomly assigned to combinations of packaging types and enhancement treatment. Packaging included high-oxygen MAP (HiOx-MAP; 80% oxygen and 20% carbon dioxide), carbon monoxide MAP (CO-MAP; 0.4% CO, 69.6% N, and 30% CO2), and PVC. Enhancement includes 0.1% rosemary oleoresin pumped to 10% of loin green weights. Following enhancement and packaging, steaks were displayed under retail conditions for 6 d to measure color changes using a HunterLab spectrophotometer. The data were analyzed using the Mixed Procedure of SAS, and the experiment was replicated 13 times (n = 13).ResultsThere were no differences for initial pH or proximate compositions (P < 0.05) between C and ADC. However, ADC had lower initial lightness (L* values), redness (a* values), and red intensity (chroma) compared with C. Further, ADC had greater (P < 0.05) oxygen consumption than C. There was a significant packaging × enhancement × display time interaction resulted for L*, a*, and chroma. CO-MAP and HiOx-MAP in combination with rosemary enhancement improved (P < 0.05) redness of ADC by 61.7% and 42.3%, respectively, compared with ADC in PVC packaging. Similarly, MAP and enhancement improved lightness (L* values) and chroma compared with ADC in PVC. By Day 6 of display, enhanced ADC steaks packaged in both HiOx-MAP and CO-MAP had similar color parameters to control choice steaks; however, non-enhanced ADC steaks had significantly lower a* (P < 0.0001) and chroma (P < 0.01) values when packaged in HiOx-MAP when compared to both C and enhanced ADC.ConclusionThe results suggest that ADC beef has greater oxygen consumption than C steaks even at similar muscle pH. Use of modified atmospheric packaging in combination with enhancement has the potential to improve surface color of ADC beef.

Myoglobin Modeling to Study Species-Specific Differences in the Distance Between Heme Iron and Proximal and Distal Histidines

ObjectivesSpecies-specific differences in amino acid sequence influence myoglobin redox properties. Previous studies reported that the number and location of histidine residues can influence myoglobin redox stability. However, limited knowledge is currently available on the species-specific differences in the distances between the proximal (His 93) and distal (His 64) histidines and the heme iron in myoglobin. The objective of the current research was to utilize homology-based modeling to determine the distances between the proximal and distal histidines and the heme iron in the myoglobins from beef, pork, goat, bison, sheep, water-buffalo, venison, and emu.Materials and MethodsThe homology-based modeling was conducted using the Iterative Threading Assembly Refinement server (I-TASSER), which identifies the homologous structure models of myoglobins (beef, pork, goat, bison, sheep, water-buffalo, venison, and emu) from Protein Data Bank (PDB) using an algorithm named Local Meta-Threading-Server. The secondary structure of the target protein was predicted based on sequence information from the Protein Secondary Structure PREDiction algorithm. The lowest free energy conformations of the proteins were determined by SPICKER (a clustering approach to identify near-native protein folds). Refinement of the low free energy conformations were done by using Fragment Guided Molecular Dynamics simulations and ModRefiner. Prediction of the ligand-binding site of the target proteins were made by COACH algorithm. The distances between histidines (His 64 and His 93) and the iron in the heme group in the predicted structure of eight different species were determined using PyMOL, a computer software used for molecular visualization.ResultsThe homology-based modeling has shown that despite having 80% sequence similarity and conserved histidine residues (His 64 and His 93), the distance between the distal histidine (His 64) and heme iron varied between 4.3–5.5 Angstrom. Pork myoglobin has the shortest distance, and beef myoglobin has the longest distance. The distance between the proximal histidine (His 93) to the heme varied between 1.9 to 3 Angstrom; sheep myoglobin had the shortest and bison had the longest.ConclusionThe results suggest that in addition to the inherent differences in muscle biochemistry, variations in myoglobin structure also contributes to species-specific differences in meat color.

Consumer Perception Towards the Enhanced Color of Atypical Dark-Cutting Beef by Nitrite-Embedded Packaging

ObjectivesMeat color is often seen by consumers as an indicator of freshness and wholesomeness. Nitrite-embedded (NE) packaging forms nitric oxide myoglobin, which imparts a bright red color similar to oxymyoglobin. However, limited research has determined the effects of NE packaging to improve the appearance of atypically dark cutting beef. Consumers’ perception of NE packaging ultimately determines its success in the market. Educating consumers through infographics can transfer knowledge more effectively than text alone, potentially being a useful method to introduce and simplify the complexity of NE packaging’s role in improving the surface color of beef steaks. The objectives of this study were to evaluate FreshCase® nitrite-embedded packaging’s effect on atypical dark-cutting beef steaks and to evaluate student consumer perception of nitrite-embedded packaging improving the surface color of beef before and after exposure to infographics containing equal content.Materials and MethodsAtypical dark-cutting (n = 13, pH 5.70 ± 0.09) and normal-pH (n = 13, pH = 5.57 ± 0.1) USDA Low Choice beef strip loins were selected 3 d postharvest. Atypical dark-cutting loins were cut into 2.54 cm thick steaks and randomly packaged in polyvinyl chloride film (PVC) or NE film. Normal-pH control loins were cut 2.54 cm and randomly packaged in PVC overwrap. Packages were placed in a coffin-style retail case under fluorescent lighting for 6 d. Instrumental color was observed every 24 h using a HunterLab MiniScan XE spectrophotometer. The color was determined as a* values and chroma. In the second objective, surveys using a ten-point Likert sliding scale (0 = not familiar at all, 10 = extremely familiar) were randomly allocated and emailed via Qualtrics to students enrolled in the Introduction to Animal Science course at Oklahoma State University. These surveys used a pre-questionnaire to evaluate students’ pre-perception of their knowledge of beef color and NE packaging. After the pre-perception questionnaire students were provided one of the following: a static infographic presented as a still image with annotated graphics, a 46 s video infographic with audio and animated graphics, or both infographic formats. A post-questionnaire followed exposure to students’ respective infographic to evaluate changes in the perception of knowledge.ResultsAtypical dark-cutting steaks treated in NE packaging had higher (P < 0.05, more red intensity) chroma and a* values compared to atypical dark-cutting steaks in PVC on d 4, 5, and 6. There was a significant difference (P < 0.05) in the students’ (n = 288) pre- and post-questionnaire self-assessment of their familiarity with NE packaging. Prior to randomly viewing infographics, students were less familiar (= 3.18) with NE packaging than after viewing infographics (= 6.46). However, there was no significant difference in perceptions (P = 0.22) between viewing the different infographic formats.ConclusionThe results suggest that NE packaging with consumer education can improve their perceptions and knowledge and enhance the appearance of atypical dark-cutting beef.

Immediate effect of horse riding simulator on adductor spasticity in children with cerebral palsy: A randomized controlled trial

BACKGROUND

Spastic cerebral palsy (CP) is the most common type of CP. Hip adductor spasticity leads to discomfort, stiffness, and difficulties in doing physical activities such as sitting, transfer, and walking. Management of hip adductor spasticity is still a challenge in the field of rehabilitation. Horse riding simulator (HRS) has been reported to have beneficial effects on spasticity, postural control, and motor function in children with spastic CP.

OBJECTIVE

The aim of the study was to determine the immediate effect of HRS on adductor spasticity in children with CP.

METHODS

Twenty-four children with CP were selected and were divided into two groups: experimental and control (12 children in each group). Experimental group was exposed to HRS and control group to the corner seat placement. Adductor tone and passive hip abduction range of motion were measured before and after the intervention.

RESULTS

Post intervention scores in the group of HRS show significant reduction in adductor spasticity and improvement in hip abduction range of motion, whereas no difference have been reported in the control group. HRS has positive effects on reducing spasticity and improving range of motion in hip joint in spastic CP.

CONCLUSION

It was concluded that immediate effect of HRS is successful in reducing the adductor spasticity and improving abduction range of motion in hip, which could be incorporated with regular physiotherapy intervention.

Effects of Aging, Modified Atmospheric Packaging, and Display Time on Metmyoglobin Reducing Activity and Oxygen Consumption of High-pH Beef

The objective of current research was to determine the effects of extended aging, modified atmospheric packaging (MAP), and display time on metmyoglobin reducing activity (MRA) and oxygen consumption (OC) of high-pH beef using pH sensitive methodology for MRA and OC. Ten normal-pH (mean pH = 5.6) and 10 high-pH loins (mean pH = 6.4) were vacuum packaged on d 3 postmortem and aged for 0, 21, 42, and 62 d at 2°C. Following aging, 2.0-cm-thick steaks were cut from each of the normal- and high-pH loin sections and packaged in either PVC film, high-oxygen (HiOx-MAP), or carbon monoxide modified atmospheric (CO-MAP) packaging. Surface color, OC, and MRA were measured on d 0 and 6 of the respective aging periods. Steaks in HiOx-MAP and CO-MAP had similar (P > 0.05) L* values, which were greater (P < 0.05) than high-pH steaks packaged in PVC film. On 21-d of aging, steaks with at both pHs in CO-MAP and HiOx-MAP had greater (P < 0.05) a* values than steaks packaged in PVC. As aging time increased, MRA decreased (P < 0.05) for steaks with normal- and high-pH when packaged in PVC and HiOx-MAP. Steaks with a high-pH in CO-MAP had greater (P < 0.05) MRA than steaks with a normal-pH in CO-MAP at all aging periods. Steaks with a high-pH had greater (P < 0.05) OC on d 0 and 6 than normal-pH steaks. Steaks with a normal-pH aged for 21 d and packaged in PVC and HiOx-MAP had greater (P < 0.05) lipid oxidation than high-pH steaks aged for 21 d and packaged in PVC and HiOx-MAP. After 62 d of aging and 6 d of display, the greatest color stability chemistry (based on MRA and OC for all package types) were: high-pH meat > normal-pH meat; thus the MRA and OC methodology was useful in relative comparison of packaged meat color stability differences due to pH.

Evaluation of Oxygen Saturation Index Compared With Oxygenation Index in Neonates With Hypoxemic Respiratory Failure

IMPORTANCE

Oxygenation index (OI), an invasive measurement, is routinely used as a marker of severity of hypoxemic respiratory failure in neonates. Oxygen saturation index (OSI) is a noninvasive measurement and has been shown to be a reliable surrogate marker of OI in children and adults with respiratory failure.

OBJECTIVES

To evaluate the correlation of OI with OSI and to derive and validate predictive OI from noninvasive OSI measurements for clinically relevant OI values.

DESIGN, SETTING, AND PARTICIPANTS

For this retrospective cohort study, 220 neonates requiring invasive mechanical ventilation for hypoxic respiratory failure during the first 3 days of admission were recruited from a level III neonatal intensive care unit during a 6-year period, from January 1, 2012, to December 31, 2017. Data were analyzed from January 2017 to December 2017.

MAIN OUTCOMES AND MEASURES

The primary outcome was correlation of OI with OSI, analyzed using Pearson correlation coefficient. The secondary outcome was derivation and validation of OI from OSI. The data were split into derivative samples, from which a predictive equation for OI was derived using generalized linear model, and a validation sample was used to assess the predictive ability of the derived OI. Bland-Altman plot was used to assess agreement between derived OI and measured OI.

RESULTS

A total of 1442 paired OI and OSI measurements from 220 infants (190 preterm and 30 term; median [interquartile range] gestational age, 29 [26-33] weeks; mean [SD] birth weight, 1602 [1092] g) were recorded during the study. The median (interquartile range) number of samples was 5 (3-9) per patient. Overall, OI and OSI showed strong correlation (r = 0.89). The correlation was stronger in preterm infants (<28 weeks, r = 0.93; 28-33 weeks, r = 0.93) and within an oxygen saturation range of 85% to 95% (r = 0.94). The predictive derivative equation showed a strong linear association and good agreement in both derivation and validation data sets, with strong accuracy measures of derived OI for OI cutoffs of 5, 10, 15, 20, and 25.

CONCLUSIONS AND RELEVANCE

A strong correlation of OI with OSI was found. Derived OI from OSI was in good agreement and strongly predictive of clinically relevant OI cutoffs from 5 to 25. Oxygenation index derived from noninvasive sources may be useful to reliably assess severity of respiratory failure and response to therapy on a continuous basis.

High unbound bilirubin for age: a neurotoxin with major effects on the developing brain

Neonatal hyperbilirubinemia is one of the most frequent diagnoses made in neonates. A high level of unconjugated bilirubin that is unbound to albumin is neurotoxic when the level exceeds age-specific thresholds or at lower levels in neonates with neurotoxic risk factors. Lower range of unbound bilirubin results in apoptosis, while moderate-to-high levels result in neuronal necrosis. Basal ganglia and various brain stem nuclei are more susceptible to bilirubin toxicity. Proposed mechanisms of bilirubin-induced neurotoxicity include excessive release of glutamate, mitochondrial energy failure, release of proinflammatory cytokines, and increased intracellular calcium concentration. These mechanisms are similar to the events that occur following hypoxic-ischemic insult in neonates. Severe hyperbilirubinemia in term neonates has been shown to be associated with increased risk for autism spectrum disorders. The neuropathological finding of bilirubin-induced neurotoxicity also includes cerebellar injury with a decreased number of Purkinje cells, and disruption of multisensory feedback loop between cerebellum and cortical neurons which may explain the clinical characteristics of autism spectrum disorders. Severe hyperbilirubinemia occurs more frequently in infants from low- and middle-income countries (LMIC). Simple devices to measure bilirubin, and timely treatment are essential to reduce neurotoxicity, and improve outcomes for thousands of neonates around the world.

Resource utilization patterns using non-invasive ventilation in neonates with respiratory distress syndrome

OBJECTIVES

To describe the frequency of non-invasive ventilation (NIV) and endotracheal intubation use in neonates diagnosed with respiratory distress syndrome (RDS); to describe resources utilization (length of stay (LOS), charges, costs) among NIV and intubated RDS groups.

STUDY DESIGN

Retrospective study from the national Kid's Inpatient Database of the Healthcare Cost and Utilization Project, for the years 1997-2012. Propensity scoring and multivariate regression analysis used to describe differences.

RESULTS

A total of 595,254 out of 42,912,090 cases were identified with RDS. There was an increase in NIV use from 6% in 1997 to 17% in 2012. After matching, patients receiving NIV only were associated with shorter LOS: (95%CI) 25 (25.3,25.7) vs. 35 (34.2,34.9) days, decreased costs: ($/1k) 46.1 (45.5,46.8) vs. 65.0 (64.1,66.0), decreased charges: 130.3 (128.6,132.1) vs. 192.1 (189.5,194.6) compared to intubated neonates.

CONCLUSION

There was a three-fold increase in NIV use within the 15-year study period. NIV use was associated with decreased LOS, charges and costs compared to intubated patients.

Knowledge gaps persist and hinder progress in eliminating mumps

Mumps, a common childhood disease in the pre-vaccine era that causes swelling of the parotid salivary glands, can lead to orchitis, viral meningitis, and sensorineural deafness. While the incidence of disease decreased dramatically after the vaccine was added to standard vaccination schedules, the disease has made a substantial resurgence in recent years. As a result, it becomes critical to examine the factors involved in recurring outbreaks. Although low and incomplete vaccination coverage may be a key reason, it does not fully explain the issue due to the high rate of occurrence in populations with high vaccination coverage rates. Multiple studies suggest that waning immunity and secondary vaccine failure play a large role, the effects of which were previously masked by subclinical boosting. Significant knowledge gaps persist around the exact role and mechanism of waning immunity and demonstrate the need for more research in this area, as well as a reevaluation of mumps vaccine policy.

Non-invasive high-frequency oscillatory ventilation versus nasal continuous positive airway pressure in preterm infants with respiratory distress syndrome: Study protocol for a multi-center prospective randomized controlled trial

BACKGROUND

Invasive mechanical ventilation (IMV) is associated with the development of adverse pulmonary and non-pulmonary outcomes in very premature infants. Various modes of non-invasive respiratory support are increasingly being used to decrease the incidence of bronchopulmonary dysplasia. The aim of this trial is to compare the effect of non-invasive high-frequency oscillatory ventilation (NHFOV) and nasal continuous positive airway pressure (NCPAP) in preterm infants with respiratory distress syndrome (RDS) as a primary non-invasive ventilation support mode.

METHODS/DESIGN

In this multi-center randomized controlled trial, 300 preterm infants born at a gestational age of 266/7 to 336/7 weeks with a diagnosis of RDS will be randomized to NHFOV or NCPAP as a primary mode of non-invasive respiratory support. The study will be conducted in 18 tertiary neonatal intensive care units in China. The primary outcome is the need for IMV during the first 7 days after enrollment in preterm infants randomized to the two groups. The prespecified secondary outcomes include days of hospitalization, days on non-invasive respiratory support, days on IMV, days on supplemental oxygen, mortality, need for a surfactant, severe retinopathy of prematurity requiring laser treatment or surgery, patent ductus arteriosus needing ligation, bronchopulmonary dysplasia, abdominal distention, air leak syndromes, intraventricular hemorrhage (≥ grade 3), spontaneous intestinal perforation, necrotizing enterocolitis (≥II stage), and nasal trauma. Other secondary outcomes include Bayley Scales of Infant Development at 18-24 months of corrected age.

DISCUSSION

In recent decades, several observational studies have compared the effects of NHFOV and NCPAP in neonates as a rescue mode or during weaning from IMV. To our knowledge, this will be the first multi-center prospective, randomized controlled trial to evaluate NHFOV as a primary mode in preterm infants with RDS in China or any other part of the world. Our trial may help to establish guidelines for NHFOV in preterm infants with RDS to minimize the need for IMV, and to decrease the significant pulmonary and non-pulmonary morbidities associated with IMV.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03099694 . Registered on 4 April 2017.

Modified Atmosphere Packaging Improves Surface Color of Dark-Cutting Beef

The objective was to determine the effects of modified atmosphere packaging (MAP) on the surface color of dark-cutting beef that had been aged for 21 d. The USDA Choice (normal-pH; IMPS #180) strip loins (n = 10) and no-roll dark-cutter strip loins (n = 10) were obtained from a commercial packing plant within 72 h of harvest. Both normal-pH and dark-cutting beef were vacuum packaged and aged for 21 d. Steaks were cut from both normal and dark-cutting loins, assigned to 1 of 3 packaging treatments; PVC, HiOx-MAP, and CO-MAP, and stored in a simulated retail display under continuous fluorescent lighting at 2°C for 6 d. Instrumental and visual color were measured every 24 h. Thiobarbituric acid assay was used as an indicator for lipid oxidation. There was a packaging × muscle type × display time interaction (P < 0.0001) for instrumental and visual color. On d 1 of display, dark-cutting steaks packaged in HiOx-MAP had greater (P < 0.001) a* values and chroma than dark-cutting PVC steaks. On d 6 of the display, dark-cutting steaks packaged in CO-MAP had 10 units greater a* values than dark-cutting steaks packaged in PVC. The visual panel also noted less muscle darkening (P < 0.002) in HiOx-MAP and CO-MAP compared with steaks packaged in PVC on d 6 of the display. There was less surface discoloration (P < 0.001) in HiOx-MAP and CO-MAP dark-cutting steaks compared with PVC dark-cutting steaks by the end of the display. There was a packaging × muscle type interaction for instrumental L* values and lipid oxidation. Dark-cutting steaks packaged in HiOx-MAP and CO-MAP had greater (P < 0.05) L* values compared with dark-cutting steaks in PVC packaging. In conclusion, HiOx-MAP improved redness of dark-cutting beef during the initial phase of display, while CO-MAP resulted in a stable red color.

Improving the lean muscle color of dark-cutting beef by aging, antioxidant-enhancement, and modified atmospheric packaging

The objective was to evaluate the effects of wet-aging, rosemary-enhancement, and modified atmospheric packaging on the color of dark-cutting beef during simulated retail display. No-roll dark-cutting strip loins ( = 12; pH > 6.0) were selected from a commercial packing plant within 3 d postharvest. Using a balanced incomplete block design, dark-cutting loins were sectioned in half, and assigned to 1 of 3 aging periods: 7, 14, or 21 d. After respective aging, each aged section was divided into 3 equal parts, and randomly assigned to 1 of 3 enhancement treatments: nonenhanced dark-cutting, dark-cutter enhanced with 0.1% rosemary, and dark-cutter enhanced with 0.2% rosemary. Following enhancement, steaks were randomly assigned to 1 of 3 packaging treatments: high-oxygen modified atmospheric packaging (HiOx-MAP; 80% O and 20% CO), carbon monoxide modified atmospheric packaging (CO-MAP; 0.4% CO, 69.6% N, and 30% CO), and polyvinyl chloride overwrap (PVC; 20% O). Instrumental and visual color measurements were recorded during 5 d simulated retail display. Lipid oxidation was determined utilizing the thiobarbituric acid reactive substances (TBARS) method. There was a significant packaging × enhancement × display time interaction for values and chroma ( 0.001). On d 0 of display, dark-cutting steaks enhanced with 0.1% and 0.2% rosemary and packaged in HiOx-MAP had greater ( 0.001) values and chroma than other dark-cutting packaging/enhancement treatments. A significant packaging × enhancement × display time interaction resulted for values ( 0.001). Dark-cutting steaks enhanced with 0.2% rosemary and packaged in HiOx-MAP was lighter ( 0.001; greater values) than other dark-cutting treatments on d 5 of display. There were no differences ( 0.34) in discoloration scores on d 5 among different dark-cutting treatments when steaks were packaged in HiOx- and CO-MAP. There was an aging period × enhancement × packaging interaction ( < 0.0033) for lipid oxidation. On d 0 of display, there were no differences ( 0.54) in TBARS values between different aging periods and enhancement treatments. Dark-cutting steaks enhanced with 0.2% rosemary had lower ( 0.001) TBARS values than 0.1% rosemary on d 5 when aged for 21 d and in HiOx-MAP. The results suggest that rosemary enhancement with CO- or HiOx-MAP has the potential to improve the surface color of dark-cutting beef.

Communication-related allegations against physicians caring for premature infants

OBJECTIVE

Maternal-fetal medicine physicians (MFMp) and neonatal-perinatal medicine physicians (NPMp) caring for premature infants and their families are exposed to significant risk for malpractice actions. Effective communication practices have been implicated to decrease litigious intentions but the extent of miscommunication as a cause of legal action is essentially unknown in this population. Analysis of communication-related allegations (CRAs) may help toward improving patient care and physician-patient relationships as well as decrease litigation risks.

STUDY DESIGN

We retrospectively reviewed the Westlaw database, a primary online legal research resource used by United States lawyers and legal professionals, for malpractice cases against physicians involving premature infants. Inclusion criteria were: 22 to 36 weeks gestational age, cases related to peripartum events through infant discharge and follow-up, and legal records with detailed factual narratives.

RESULTS

The search yielded 736 legal records, of which 167 met full inclusion criteria. A CRA was identified in 29% (49/167) of included cases. MFMp and/or NPMp were named in 104 and 54 cases, respectively. CRAs were identified in 26% (27/104) and 35% (19/54) of MFMp- and NPMp-named cases, respectively, with a majority involving physician-family for both specialties (81% and 74%, respectively). Physician-family CRAs for MFMp and NPMp most often regarded lack of informed consent (50% and 57%, respectively), lack of full disclosure (41% and 29%, respectively) and lack of anticipatory guidance (36% and 21%, respectively).

CONCLUSIONS

This study of a major legal database identifies CRAs as significant causes of legal action against MFMp and NPMp involved in the care of high-risk women and infants delivered preterm. Physicians should be especially vigilant with obtaining genuine informed consent and maintaining open communication with families.

Chorioamnionitis and Management of Asymptomatic Infants ≥35 Weeks Without Empiric Antibiotics

BACKGROUND AND OBJECTIVE

Management of asymptomatic infants ≥35 weeks' gestation born to mothers with chorioamnionitis remains controversial, with many clinicians considering the need for changes to the current guidelines. The study objective was to evaluate the outcomes of asymptomatic chorioamnionitis-exposed neonates without the use of immediate empirical antibiotics.

METHODS

A retrospective data review was conducted from May 2008 to December 2014, including asymptomatic infants ≥35 weeks' gestation with a maternal diagnosis of clinical chorioamnionitis.

RESULTS

A total of 240 asymptomatic infants with chorioamnionitis exposure were identified. The majority of asymptomatic chorioamnionitis-exposed infants, 162 (67.5%), remained well in the mother-infant unit with a median stay of 2 days. There were 78 (32.5%) infants admitted to the NICU and exposed to antibiotics due to abnormal laboratory data or development of clinical symptoms. Of those infants admitted to the NICU, 19 (24%) received antibiotics for <72 hours, 47 (60%) were treated for culture-negative clinical sepsis, and 12 (15%) for culture-positive sepsis, with a median NICU stay of 7 days.

CONCLUSIONS

Nonroutine use of empirical antibiotics in asymptomatic newborns ≥35 weeks' gestation with maternal chorioamninonitis prevented NICU admission in two-thirds of these infants. This prevented unnecessary antibiotic exposure, increased hospitalization costs, and disruption of mother-infant bonding and breastfeeding. Laboratory evaluation and clinical observation without immediate antibiotic administration may be incorporated into a management approach in asymptomatic chorioamnionitis-exposed neonates. Additional studies are needed to establish the safety of this approach.

Evolution of surfactant therapy for respiratory distress syndrome: past, present, and future

Respiratory distress syndrome (RDS) due to surfactant deficiency is the most common cause of respiratory failure in preterm infants. Tremendous progress has been made since the original description that surfactant deficiency is the major cause of RDS. Surfactant therapy has been extensively studied in preterm infants and has been shown to significantly decrease air leaks and neonatal and infant mortality. Synthetic and animal-derived surfactants from bovine as well as porcine origin have been evaluated in randomized controlled trials. Animal-derived surfactants generally result in faster weaning of respiratory support, shorter duration of invasive ventilation, and decreased mortality when compared to first- or second-generation of synthetic surfactants, but some of the second-generation synthetic surfactants are at least not inferior to the animal-derived surfactants. Using a higher initial dose of porcine derived surfactant may provide better outcomes when compared with using lower doses of bovine surfactants, likely, due to compositional difference and/or the dose. Third-generation synthetic surfactant containing peptide analogs of surfactant protein B and C are currently being studied. Less invasive intra-tracheal surfactant administration techniques in spontaneously breathing neonate receiving noninvasive ventilator support are also being evaluated. In the present era, prophylactic surfactant is not recommended as it may increase the risk of lung injury or death. In the future, surfactants may be used as vector to deliver steroids, or used in combination with molecules, such as, recombinant Club Cell Protein-10 (rhCC-10) to improve pulmonary outcomes. Also, noninvasive surfactant administration techniques, such as aerosolization or atomization of surfactant may play a greater role in the future.

The state of point-of-care ultrasonography use and training in neonatal-perinatal medicine and pediatric critical care medicine fellowship programs

OBJECTIVE

The current state of point-of-care ultrasonography (POCUS) use and education in neonatal-perinatal medicine (NPM) and pediatric critical care medicine (PCCM) is unknown. Our aim was to quantify POCUS use, training and perceptions regarding education and barriers among the United States NPM and PCCM fellowship programs.

STUDY DESIGN

A 14-question survey was emailed to the fellowship directors of all the United States NPM and PCCM fellowship programs.

RESULTS

The response rate was 55% (52/95) and 59% (39/66) for NPM and PCCM programs, respectively. Over 90% of respondents in both groups believe that fellows and attendings should receive POCUS training. PCCM programs, compared with NPM, had greater access to POCUS machines (97% vs 63%, P<0.001), and more often used POCUS for diagnoses and management (76% vs 29%, P<0.001) and procedural guidance (95% vs 37%, P<0.001). The most common indications were cardiac/hemodynamics, pulmonary pathology and vascular access in both specialties. PCCM reported more training to fellows (90% vs 29%, P<0.001). Both group perceived lack of time to learn, lack of equipment/funds, liability concerns, lack of personnel to train physicians and cardiology/radiology resistance as significant barriers to POCUS implementation.

CONCLUSIONS

Both NPM and PCCM fellowship programs believe in the benefits of POCUS and that their physicians should receive the necessary training. Compared with PCCM, NPM fellowships programs have less access to POCUS machines and less frequently use POCUS and train their fellows and attendings. There remain significant barriers to utilization of POCUS, especially in NPM.

Graded oxygen saturation targets and retinopathy of prematurity in extremely preterm infants

BACKGROUND

We compared the incidence of severe retinopathy of prematurity (ROP) and need for laser treatment before and after implementing graded pulse oximeter oxygen saturation (SpO2) targets in extremely preterm infants. Mortality and other secondary outcomes were compared.

METHODS

Before 2002, we used 90-94% as the SpO2 target in infants 24(0/7)-27(6/7)wk gestation and birth weight <1,000 g until 35(6/7) wk postmenstrual age (PMA). We implemented graded SpO2 targets based on vaso-obliterative and vaso-proliferative phases of ROP in 2002. Group 1 (1995-2001) before, and Group 2 (2003-2010) after implementation of graded SpO2 targets based on PMA (83-89% until 32(6/7) wk, 90-94% until 35(6/7) wk and >94% at ≥ 36 wk PMA).

RESULTS

There were 267 patients in Group 1 and 220 in Group 2. There was no significant difference in birth weight or gestational age. Severe ROP (adjusted OR: 0.18, 95% CI: 0.11, 0.30; P < 0.001) and laser surgery rates (adjusted OR: 0.31, 95% CI: 0.18, 0.52; P < 0.001) decreased significantly in Group 2. There was no difference in mortality (adjusted OR: 0.74, 95% CI: 0.37, 1.49; P = 0.40).

CONCLUSION

In this retrospective cohort study, implementation of graded SpO2 targets decreased severe ROP and need for laser therapy, without increasing mortality.

Biophysical characterization of small molecule antiviral-loaded nanolipogels for HIV-1 chemoprophylaxis and topical mucosal application

Nanocarriers are versatile vehicles for drug delivery, and emerging as platforms to formulate and deliver multiple classes of antiretroviral (ARV) drugs in a single system. Here we describe the fabrication of hydrogel-core and lipid-shell nanoparticles (nanolipogels) for the controlled loading and topical, vaginal delivery of maraviroc (MVC) and tenofovir disoproxil fumarate (TDF), two ARV drugs with different mechanisms of action that are used in the treatment of HIV. The nanolipogel platform was used to successfully formulate MVC and TDF, which produced ARV drug-loaded nanolipogels that were characterized for their physical properties and antiviral activity against HIV-1 BaL in cell culture. We also show that administration of these drug carriers topically to the vaginal mucosa in a murine model leads to antiviral activity against HIV-1 BaL in cervicovaginal lavages. Our results suggest that nanolipogel carriers are promising for the encapsulation and delivery of hydrophilic small molecule ARV drugs, and may expand the nanocarrier systems being investigated for HIV prevention or treatment.

STATEMENT OF SIGNIFICANCE

Topical, mucosal intervention of HIV is a leading strategy in the efforts to curb the spread of viral infection. A significant research thrust in the field has been to characterize different dosage forms for formulation of physicochemically diverse antiretroviral drugs. Nanocarriers have been used to formulate and deliver small molecule and protein drugs for a range of applications, including ARV drugs for HIV treatment. The broad significance of our work includes evaluation of lipid-shell, hydrogel-core nanoparticles for formulation and topical, vaginal delivery of two water-soluble antiretroviral drugs. We have characterized these nanocarriers for their physical properties and their biological activity against HIV-1 infection in vitro, and demonstrated the ability to deliver drug-loaded nanocarriers in vivo.