Methodological differences between studies confound one-size-fits-all approaches to managing surface waterways for food and water safety

Even though differences in methodology (e.g., sample volume and detection method) have been shown to affect observed microbial water quality, multiple sampling and laboratory protocols continue to be used for water quality monitoring. Research is needed to determine how these differences impact the comparability of findings to generate best management practices and the ability to perform meta-analyses. This study addresses this knowledge gap by compiling and analyzing a data set representing 2,429,990 unique data points on at least one microbial water quality target (e.g., Salmonella presence and Escherichia coli concentration). Variance partitioning analysis was used to quantify the variance in likelihood of detecting each pathogenic target that was uniquely and jointly attributable to non-methodological versus methodological factors. The strength of the association between microbial water quality and select methodological and non-methodological factors was quantified using conditional forest and regression analysis. Fecal indicator bacteria concentrations were more strongly associated with non-methodological factors than methodological factors based on conditional forest analysis. Variance partitioning analysis could not disentangle non-methodological and methodological signals for pathogenic Escherichia coli, Salmonella, and Listeria. This suggests our current perceptions of foodborne pathogen ecology in water systems are confounded by methodological differences between studies. For example, 31% of total variance in likelihood of Salmonella detection was explained by methodological and/or non-methodological factors, 18% was jointly attributable to both methodological and non-methodological factors. Only 13% of total variance was uniquely attributable to non-methodological factors for Salmonella, highlighting the need for standardization of methods for microbiological water quality testing for comparison across studies.IMPORTANCEThe microbial ecology of water is already complex, without the added complications of methodological differences between studies. This study highlights the difficulty in comparing water quality data from projects that used different sampling or laboratory methods. These findings have direct implications for end users as there is no clear way to generalize findings in order to characterize broad-scale ecological phenomenon and develop science-based guidance. To best support development of risk assessments and guidance for monitoring and managing waters, data collection and methods need to be standardized across studies. A minimum set of data attributes that all studies should collect and report in a standardized way is needed. Given the diversity of methods used within applied and environmental microbiology, similar studies are needed for other microbiology subfields to ensure that guidance and policy are based on a robust interpretation of the literature.

Scale and detection method impacted Salmonella prevalence and diversity in ponds

Site-specific approaches for managing food safety hazards in agricultural water require an understanding of foodborne pathogen ecology. This study identified factors associated with Salmonella contamination in Virginia ponds. Grab samples (250 mL, N = 600) were collected from 30 sites across nine ponds. Culture- and culture-independent (CIDT)-based methods were used to detect Salmonella in each sample. Salmonella isolated by culture-based methods were serotyped by Kauffman-White classification. Environmental data were collected for each sample. McNemar's χ2 was used to determine if Salmonella detection differed by testing method. Separate mixed effect models were used to identify environmental factors associated with culture and CIDT-based Salmonella detection. Separate models were built for each pond, and for all ponds combined. Salmonella detection differed significantly (p < 0.001) between CIDT (31 %; 183/600)- and culture (13 %; 77/600)-based methods. Culture-based methods yielded 11 different serovars. All cultured Salmonella samples were confirmed by CIDT; 42.1 % of CIDT Salmonella-positive samples could be cultured. Associations between environmental factors and Salmonella detection also varied substantially by pond and detection method. In the all-pond model, associations were observed for five factors (total coliforms, Escherichia coli, air temperature, UV, rain) for both culture- and CIDT-based Salmonella detection. Rain prior to sampling (24 h) increased odds of Salmonella detection for culture (OR = 5.09) and CIDT (OR = 3.62) in the all-pond model. When all the pond data were used, models masked associations at the individual pond level, as there were noticeable differences between ponds and the odds of isolating Salmonella by environmental factors. Ponds were within a 187-ha area in this study, emphasizing water management needs to be individualized (i.e., assess hazards/risks by pond). Results also highlight detection methods and scale strongly affect observed water quality and should be considered when developing monitoring programs to develop guidance for growers.

Role of Whole Genome Sequencing in Assessing Resident and Transient Listeria monocytogenes in a Produce Packinghouse

Whole genome sequencing (WGS) is a powerful tool that may be used to assist in identifying Listeria contamination sources and movement within environments, and to assess persistence. This study investigated sites in a produce packinghouse where Listeria had been historically isolated; and aimed to characterize dispersal patterns and identify cases of transient and resident Listeria. Environmental swab samples (n = 402) were collected from 67 sites at two time-points on three separate visits. Each sample was tested for Listeria, and Listeria isolates were characterized by partial sigB sequencing to determine species and allelic type (AT). Representative isolates from the three most common L. monocytogenes ATs (n = 79) were further characterized by WGS. Of the 144 Listeria species positive samples (35.8%), L. monocytogenes was the most prevalent species. L. monocytogenes was often coisolated with another species of Listeria. WGS identified cases of sporadic and continued reintroduction of L. monocytogenes from the cold storages into the packinghouse and demonstrated cases of L. monocytogenes persistence over 2 years in cold storages, drains, and on a forklift. Nine distinct clusters were found in this study. Two clusters showed evidence of persistence. Isolates in these two clusters (N = 11, with one historical isolate) were obtained predominantly and over multiple samplings from cold storages, with sporadic movement to sites in the packing area, suggesting residence in cold storages with opportunistic dispersal within the packinghouse. The other seven clusters demonstrated evidence of transient Listeria, as isolation was sporadic over time and space during the packing season. Our data provide important insights into likely L. monocytogenes harborage points and transfer in a packinghouse, which is key to root cause analysis. While results support Listeria spp. as a suitable indicator organism for environmental monitoring surveys, findings were unable to establish a specific species as an index organism for L. monocytogenes. Findings also suggest long-term persistence with substantial SNP diversification, which may assist in identifying potential contamination sources and implementing control measures.

Effects of Fumigation on the Reduction of Salmonella enterica in Soil

Due to the phaseout of methyl bromide (MeBr), there is a need for broad-spectrum soil fumigation alternatives for pest management. Little is known about the impact of fumigation alternatives on foodborne pathogens, such as Salmonella, in agricultural soils. This study investigated the effect of MeBr alternative fumigants on Salmonella reduction in soil. Sandy loam soil was collected from a conventional farmed vegetable field and inoculated with either Salmonella Newport J1892 or Typhimurium ATCC 14028 (5.9 ± 0.3 log10 colony-forming unit [CFU]/g). Each of the four fumigants labeled for pest management (1,3-dichloropropene, chloropicrin, dimethyl disulfide, and metam sodium) was applied at labeled maximum application field levels to soil in pots and stored for a 2-week period. Sterile water was used as a control. Following the 2-week period, Salmonella concentrations in soil samples were enumerated at 1, 7, 14, and 21 days postfumigation. The mean concentration of Salmonella Newport was significantly higher than that of Salmonella Typhimurium 1 day after fumigation (p = 0.015). Fumigation using 1,3-dichloropropene or dimethyl disulfide significantly reduced Salmonella Newport and Salmonella Typhimurium concentrations, compared with the sterile water control. The rate of Salmonella reduction in soil treated with dimethyl disulfide was higher (0.17 ± 0.02 log10 CFU/g/day), compared with soil treated with the other fumigants (0.10-0.12 log10 CFU/g/day). Due to the reduction of Salmonella, alternative fumigation treatments may mitigate potential Salmonella contamination in soil within farm environments.

Efficacy of Peracetic Acid and Chlorine on the Reduction of Shiga Toxin-producing Escherichia coli and a Nonpathogenic E. coli Strain in Preharvest Agricultural Water

Produce-borne outbreaks of Shiga toxin-producing Escherichia coli (STEC) linked to preharvest water emphasize the need for efficacious water treatment options. This study quantified reductions of STEC and generic E. coli in preharvest agricultural water using commercially available sanitizers. Water was collected from two sources in Virginia (pond, river) and inoculated with either a seven-strain STEC panel or environmental generic E. coli strain TVS 353 (∼9 log10 CFU/100 mL). Triplicate inoculated water samples were equilibrated to 12 or 32°C and treated with peracetic acid (PAA) or chlorine (Cl) [low (PAA:6ppm, Cl:2-4 ppm) or high (PAA:10 ppm, Cl:10-12 ppm) residual concentrations] for an allotted contact time (1, 5, or 10 min). Strains were enumerated, and a log-linear model was used to characterize how treatment combinations influenced reductions. All Cl treatment combinations achieved a ≥3 log10 CFU/100 mL reduction, regardless of strain (3.43 ± 0.25 to 7.05 ± 0.00 log10 CFU/100 mL). Approximately 80% (19/24) and 67% (16/24) of PAA treatment combinations achieved a ≥3 log10 CFU/100 mL for STEC and E. coli TVS 353, respectively. The log-linear model showed contact time (10 > 5 > 1 min) and sanitizer type (Cl > PAA) had the greatest impact on STEC and E. coli TVS 353 reductions (p < 0.001). E. coli TVS 353 in water samples was more resistant to sanitizer treatment (p < 0.001) indicating applicability as a good surrogate. Results demonstrated Cl and PAA can be effective agricultural water treatment strategies when sanitizer chemistry is managed. These data will assist with the development of in-field validation studies and may identify suitable candidates for the registration of antimicrobial pesticide products for use against foodborne pathogens in preharvest agricultural water treatment.

Scale of analysis drives the observed ratio of spatial to non-spatial variance in microbial water quality: insights from two decades of citizen science data

AIMS

While fecal indicator bacteria (FIB) testing is used to monitor surface water for potential health hazards, observed variation in FIB levels may depend on the scale of analysis (SOA). Two decades of citizen science data, coupled with random effects models, were used to quantify the variance in FIB levels attributable to spatial versus temporal factors.

METHODS AND RESULTS

Separately, Bayesian models were used to quantify the ratio of spatial to non-spatial variance in FIB levels and identify associations between environmental factors and FIB levels. Separate analyses were performed for three SOA: waterway, watershed, and statewide. As SOA increased (from waterway to watershed to statewide models), variance attributable to spatial sources generally increased and variance attributable to temporal sources generally decreased. While relationships between FIB levels and environmental factors, such as flow conditions (base versus stormflow), were constant across SOA, the effect of land cover was highly dependent on SOA and consistently smaller than the effect of stormwater infrastructure (e.g. outfalls).

CONCLUSIONS

This study demonstrates the importance of SOA when developing water quality monitoring programs or designing future studies to inform water management.

Action potential conduction in the mouse and rat vagus nerve is dependent on multiple voltage-gated sodium channels (NaV1s)

Action potential (AP) conduction depends on voltage-gated sodium channels, of which there are nine subtypes. The vagus nerve, comprising sensory afferent fibers and efferent parasympathetic fibers, provides autonomic regulation of visceral organs, but the voltage-gated sodium channels (NaV1) subtypes involved in its AP conduction are poorly defined. We studied the A- and C-waves of electrically stimulated compound action potentials (CAPs) of the mouse and rat vagus nerves with and without NaV1 inhibitor administration: tetrodotoxin (TTX), PF-05089771 (mouse NaV1.7), ProTX-II (NaV1.7), ICA-121341 (NaV1.1, NaV1.3, and NaV1.6), LSN-3049227 (NaV1.2, NaV1.6, and NaV1.7), and A-803467 (NaV1.8). We show that TTX-sensitive NaV1 channels are essential for all vagal AP conduction. PF-05089771 but not ICA-121341 inhibited the mouse A-wave, which was abolished by LSN-3049227, suggesting roles for NaV1.7 and NaV1.2. The mouse C-wave was abolished by LSN-3049227 and a combination of PF-05089771 and ICA-121341, suggesting roles for NaV1.7 and NaV1.6. The rat A-wave was inhibited by ProTX-II, ICA-121341, and a combination of these inhibitors but only abolished by LSN-3049227, suggesting roles for NaV1.7, NaV1.6, and NaV1.2. The rat C-wave was abolished by LSN-3049227 and a combination of ProTX-II and ICA-121341, suggesting roles for NaV1.7 and NaV1.6. A-803467 also inhibited the mouse and rat CAP suggesting a cooperative role for the TTX-resistant NaV1.8. Overall, our data demonstrate that multiple NaV1 subtypes contribute to vagal CAPs, with NaV1.7 and NaV1.8 playing predominant roles and NaV1.6 and NaV1.2 contributing to a different extent based on nerve fiber type and species. Inhibition of these NaV1 may impact autonomic regulation of visceral organs.NEW & NOTEWORTHY Distinct NaV1 channels are involved in action potential (AP) initiation and conduction from afferent terminals within specific organs. Here, we have identified the NaV1 necessary for AP conduction in the entire murine and rat vagus nerve. We show TTX-sensitive channels are essential for all AP conduction, predominantly NaV1.7 with NaV1.2 and NaV1.6 playing lesser roles depending on the species and fiber type. In addition, we show that NaV1.8 is also essential for most axonal AP conduction.

Sanitizer Type and Contact Time Influence Salmonella Reductions in Preharvest Agricultural Water Used on Virginia Farms

No Environmental Protection Agency (EPA) chemical treatments for preharvest agricultural water are currently labeled to reduce human health pathogens. The goal of this study was to examine the efficacy of peracetic acid- (PAA) and chlorine (Cl)-based sanitizers against Salmonella in Virginia irrigation water. Water samples (100 mL) were collected at three time points during the growing season (May, July, September) and inoculated with either the 7-strain EPA/FDA-prescribed cocktail or a 5-strain Salmonella produce-borne outbreak cocktail. Experiments were conducted in triplicate for 288 unique combinations of time point, residual sanitizer concentration (low: PAA, 6 ppm; Cl, 2-4 ppm or high: PAA, 10 ppm; Cl, 10-12 ppm), water type (pond, river), water temperature (12°C, 32°C), and contact time (1, 5, 10 min). Salmonella were enumerated after each treatment combination and reductions were calculated. A log-linear model was used to characterize how treatment combinations influenced Salmonella reductions. Salmonella reductions by PAA and Cl ranged from 0.0 ± 0.1 to 5.6 ± 1.3 log10 CFU/100 mL and 2.1 ± 0.2 to 7.1 ± 0.2 log10 CFU/100 mL, respectively. Physicochemical parameters significantly varied by untreated water type; however, Salmonella reductions did not (p = 0.14), likely due to adjusting the sanitizer amounts needed to achieve the target residual concentrations regardless of source water quality. Significant differences (p < 0.05) in Salmonella reductions were observed for treatment combinations, with sanitizer (Cl > PAA) and contact time (10 > 5 > 1 min) having the greatest effects. The log-linear model also revealed that outbreak strains were more treatment-resistant. Results demonstrate that certain treatment combinations with PAA- and Cl-based sanitizers were effective at reducing Salmonella populations in preharvest agricultural water. Awareness and monitoring of water quality parameters are essential for ensuring adequate dosing for the effective treatment of preharvest agricultural water.

16S microbiome analysis of microbial communities in distribution centers handling fresh produce

Little is known about the microbial communities found in distribution centers (DCs), especially in those storing and handling food. As many foodborne bacteria are known to establish residence in food facilities, it is reasonable to assume that DCs handling foods are also susceptible to pathogen colonization. To investigate the microbial communities within DCs, 16S amplicon sequencing was completed on 317 environmental surface sponge swabs collected in DCs (n = 18) across the United States. An additional 317 swabs were collected in parallel to determine if any viable Listeria species were also present at each sampling site. There were significant differences in median diversity measures (observed, Shannon, and Chao1) across individual DCs, and top genera across all reads were Carnobacterium_A, Psychrobacter, Pseudomonas_E, Leaf454, and Staphylococcus based on taxonomic classifications using the Genome Taxonomy Database. Of the 39 16S samples containing Listeria ASVs, four of these samples had corresponding Listeria positive microbiological samples. Data indicated a predominance of ASVs identified as cold-tolerant bacteria in environmental samples collected in DCs. Differential abundance analysis identified Carnobacterium_A, Psychrobacter, and Pseudomonas_E present at a significantly greater abundance in Listeria positive microbiological compared to those negative for Listeria. Additionally, microbiome composition varied significantly across groupings within variables (e.g., DC, season, general sampling location).

Spatial Versus Nonspatial Variance in Fecal Indicator Bacteria Differs Within and Between Ponds

Surface water environments are inherently heterogenous, and little is known about variation in microbial water quality between locations. This study sought to understand how microbial water quality differs within and between Virginia ponds. Grab samples were collected twice per week from 30 sampling sites across nine Virginia ponds (n = 600). Samples (100 mL) were enumerated for total coliform (TC) and Escherichia coli (EC) levels, and physicochemical, weather, and environmental data were collected. Bayesian models of coregionalization were used to quantify the variance in TC and EC levels attributable to spatial (e.g., site, pond) versus nonspatial (e.g., date, pH) sources. Mixed-effects Bayesian regressions and conditional inference trees were used to characterize relationships between data and TC or EC levels. Analyses were performed separately for each pond with ≥3 sampling sites (5 intrapond) while one interpond model was developed using data from all sampling sites and all ponds. More variance in TC levels were attributable to spatial opposed to nonspatial sources for the interpond model (variance ratio [VR] = 1.55) while intrapond models were pond dependent (VR: 0.65-18.89). For EC levels, more variance was attributable to spatial sources in the interpond model (VR = 1.62), compared to all intrapond models (VR < 1.0) suggesting that more variance is attributable to nonspatial factors within individual ponds and spatial factors when multiple ponds are considered. Within each pond, TC and EC levels were spatially independent for sites 56-87 m apart, indicating that different sites within the same pond represent different water quality for risk management. Rainfall was positively and pH negatively associated with TC and EC levels in both inter- and intrapond models. For all other factors, the direction and strength of associations varied. Factors driving microbial dynamics in ponds appear to be pond-specific and differ depending on the spatial scale considered.

Anaerobic soil disinfestation, amendment-type, and irrigation regimen influence Salmonella survival and die-off in agricultural soils

AIMS

This study investigated Salmonella concentrations following combinations of horticultural practices including anaerobic soil disinfestation (ASD), soil amendment type and irrigation regimen.

METHODS AND RESULTS

Sandy-loam soil was inoculated with a five-serovar Salmonella cocktail (5.5 ± 0.2 log CFU per gram) and subjected to one of six treatments: (i) no soil amendment, ASD (ASD control), (ii) no soil amendment, no-ASD (non-ASD control) and (iii-vi) soil amended with pelletized poultry litter, rye, rapeseed or hairy vetch with ASD. The effect of irrigation regimen was determined by collecting samples 3 and 7 days after irrigation. Twenty-five-gram soil samples were collected pre-ASD, post-soil saturation (i.e. ASD-process), and at 14 time-points post-ASD, and Salmonella levels enumerated. Log-linear models examined the effect of amendment type and irrigation regimen on Salmonella die-off during and post-ASD. During ASD, Salmonella concentrations significantly decreased in all treatments (range: -0.2 to -2.7 log CFU per gram), albeit the smallest decrease (-0.2 log CFU per gram observed in the pelletized poultry litter) was of negligible magnitude. Salmonella die-off rates varied by amendment with an average post-ASD rate of -0.05 log CFU per gram day (CI = -0.05, -0.04). Salmonella concentrations remained highest over the 42 days post-ASD in pelletized poultry litter, followed by rapeseed, and hairy vetch treatments. Findings suggested ASD was not able to eliminate Salmonella in soil, and certain soil amendments facilitated enhanced Salmonella survival. Salmonella serovar distribution differed by treatment with pelletized poultry litter supporting S. Newport survival, compared with other serovars. Irrigation appeared to assist Salmonella survival with concentrations being 0.14 log CFU per gram (CI = 0.05, 0.23) greater 3 days, compared with 7 days post-irrigation.

CONCLUSIONS

ASD does not eliminate Salmonella in soil, and may in fact, depending on the soil amendment used, facilitate Salmonella survival.

SIGNIFICANCE AND IMPACT OF THE STUDY

Synergistic and antagonistic effects on food safety hazards of implementing horticultural practices should be considered.

Wet versus Dry Inoculation Methods Have a Significant Effect of Listeria monocytogenes Growth on Many Types of Whole Intact Fresh Produce

ABSTRACT

Listeria monocytogenes causes relatively few outbreaks linked to whole fresh produce but triggers recalls each year in the United States. There are limited data on the influence of wet versus dry inoculation methods on pathogen growth on whole produce. A cocktail of five L. monocytogenes strains that included clinical, food, and environmental isolates associated with foodborne outbreaks and recalls was used. Cultures were combined to target a final wet inoculum concentration of 4 to 5 log CFU/mL. The dry inoculum was prepared by mixing wet inoculum with 100 g of sterile sand and drying for 24 h. Produce investigated belonged to major commodity families: Ericaceae (blackberry, raspberry, and blueberry), Rutaceae (lemon and mandarin orange), Rosaceae (sweet cherry), Solanaceae (tomato), Brassaceae (cauliflower and broccoli), and Apiaceae (carrot). Whole intact, inoculated fruit and vegetable commodities were incubated at 2, 12, 22, and 35 ± 2°C. Commodities were sampled for up to 28 days, and the experiment was replicated six times. The average maximum growth increase was obtained by measuring the maximum absolute increase for each replicate within a specific commodity, temperature, and inoculation method. Data for each commodity, replicate, and temperature were used to create primary growth or survival models describing the lag phase and growth or shoulder and decline as a function of time. Use of a liquid inoculum (versus dry inoculum) resulted in a markedly increased L. monocytogenes growth rate and growth magnitude on whole produce surfaces. Temperature highly influenced this difference: a greater effect seen with more commodities at higher temperatures (22 and 35°C) versus lower temperatures (2 and 12°C). These findings need to be explored for other commodities and pathogens. The degree to which wet or dry inoculation techniques more realistically mimic contamination conditions throughout the supply chain (e.g., production, harvest, postharvest, transportation, or retail) should be investigated.

HIGHLIGHTS

ComBase Models Are Valid for Predicting Fate of Listeria monocytogenes on 10 Whole Intact Raw Fruits and Vegetables

ABSTRACT

Listeria monocytogenes was associated with more than 60 produce recalls, including tomato, cherry, broccoli, lemon, and lime, between 2017 and 2020. This study describes the effects of temperature, time, and food substrate as factors influencing L. monocytogenes behavior on whole intact raw fruits and vegetables. Ten intact whole fruit and vegetable commodities were chosen based on data gaps identified in a systematic literature review. Produce investigated belong to major commodity families: Ericaceae (blackberry, raspberry, and blueberry), Rutaceae (lemon and mandarin orange), Roseaceae (sweet cherry), Solanaceae (tomato), Brassaceae (cauliflower and broccoli), and Apiaceae (carrot). A cocktail of five L. monocytogenes strains that included clinical, food, or environmental isolates linked to foodborne outbreaks was used to inoculate intact whole fruits and vegetables. Samples were incubated at 2, 12, 22, 30, and 35°C with relative humidities matched to typical real-world conditions. Foods were sampled (n = 6) for up to 28 days, depending on temperature. Growth and decline rates were estimated using DMFit, an Excel add-in. Growth rates were compared with ComBase modeling predictions for L. monocytogenes. Almost every experiment showed initial growth, followed by subsequent decline. L. monocytogenes was able to grow on the whole intact surface of all produce tested, except for carrot. The 10 produce commodities supported growth of L. monocytogenes at 22 and 35°C. Growth and survival at 2 and 12°C varied by produce commodity. The standard deviation of the square root growth and decline rates showed significantly larger variability in both growth and decline rates within replicates as temperature increased. When L. monocytogenes growth occurred, it was conservatively modeled by ComBase Predictor, and growth was generally followed by decreases in concentration. This research will assist in understanding the risks of foodborne disease outbreaks and recalls associated with L. monocytogenes on fresh whole produce.

HIGHLIGHTS

Brain morphometry in 22q11.2 deletion syndrome: an exploration of differences in cortical thickness, surface area, and their contribution to cortical volume

22q11.2 Deletion Syndrome (22q11.2DS) is the most common microdeletion in humans, with a heterogenous clinical presentation including medical, behavioural and psychiatric conditions. Previous neuroimaging studies examining the neuroanatomical underpinnings of 22q11.2DS show alterations in cortical volume (CV), cortical thickness (CT) and surface area (SA). The aim of this study was to identify (1) the spatially distributed networks of differences in CT and SA in 22q11.2DS compared to controls, (2) their unique and spatial overlap, as well as (3) their relative contribution to observed differences in CV. Structural MRI scans were obtained from 62 individuals with 22q11.2DS and 57 age-and-gender-matched controls (aged 6-31). Using FreeSurfer, we examined differences in vertex-wise estimates of CV, CT and SA at each vertex, and compared the frequencies of vertices with a unique or overlapping difference for each morphometric feature. Our findings indicate that CT and SA make both common and unique contributions to volumetric differences in 22q11.2DS, and in some areas, their strong opposite effects mask differences in CV. By identifying the neuroanatomic variability in 22q11.2DS, and the separate contributions of CT and SA, we can start exploring the shared and distinct mechanisms that mediate neuropsychiatric symptoms across disorders, e.g. 22q11.2DS-related ASD and/or psychosis/schizophrenia.

The Neuroanatomy of Autism Spectrum Disorder Symptomatology in 22q11.2 Deletion Syndrome

22q11.2 Deletion Syndrome (22q11.2DS) is a genetic condition associated with a high prevalence of neuropsychiatric conditions that include autism spectrum disorder (ASD). While evidence suggests that clinical phenotypes represent distinct neurodevelopmental outcomes, it remains unknown whether this translates to the level of neurobiology. To fractionate the 22q11.2DS phenotype on the level of neuroanatomy, we examined differences in vertex-wise estimates of cortical volume, surface area, and cortical thickness between 1) individuals with 22q11.2DS (n = 62) and neurotypical controls (n = 57) and 2) 22q11.2DS individuals with ASD symptomatology (n = 30) and those without (n = 25). We firstly observed significant differences in surface anatomy between 22q11.2DS individuals and controls for all 3 neuroanatomical features, predominantly in parietotemporal regions, cingulate and dorsolateral prefrontal cortices. We also established that 22q11.2DS individuals with ASD symptomatology were neuroanatomically distinct from 22q11.2DS individuals without ASD symptoms, particularly in brain regions that have previously been linked to ASD (e.g., dorsolateral prefrontal cortices and the entorhinal cortex). Our findings indicate that different clinical 22q11.2DS phenotypes, including those with ASD symptomatology, may represent different neurobiological subgroups. The spatially distributed patterns of neuroanatomical differences associated with ASD symptomatology in 22q11.2DS may thus provide useful information for patient stratification and the prediction of clinical outcomes.

Oral microbiota in youth with perinatally acquired HIV infection

BACKGROUND

Microbially mediated oral diseases can signal underlying HIV/AIDS progression in HIV-infected adults. The role of the oral microbiota in HIV-infected youth is not known. The Adolescent Master Protocol of the Pediatric HIV/AIDS Cohort Study is a longitudinal study of perinatally HIV-infected (PHIV) and HIV-exposed, uninfected (PHEU) youth. We compared oral microbiome levels and associations with caries or periodontitis in 154 PHIV and 100 PHEU youth.

RESULTS

Species richness and alpha diversity differed little between PHIV and PHEU youth. Group differences in average counts met the significance threshold for six taxa; two Corynebacterium species were lower in PHIV and met thresholds for noteworthiness. Several known periodontitis-associated organisms (Prevotella nigrescens, Tannerella forsythia, Aggregatibacter actinomycetemcomitans, and Filifactor alocis) exhibited expected associations with periodontitis in PHEU youth, associations not observed in PHIV youth. In both groups, odds of caries increased with counts of taxa in four genera, Streptococcus, Scardovia, Bifidobacterium, and Lactobacillus.

CONCLUSIONS

The microbiomes of PHIV and PHEU youth were similar, although PHIV youth seemed to have fewer "health"-associated taxa such as Corynebacterium species. These results are consistent with the hypothesis that HIV infection, or its treatment, may contribute to oral dysbiosis.

Shifting brain inhibitory balance and connectivity of the prefrontal cortex of adults with autism spectrum disorder

Currently, there are no effective pharmacologic treatments for the core symptoms of autism spectrum disorder (ASD). There is, nevertheless, potential for progress. For example, recent evidence suggests that the excitatory (E) glutamate and inhibitory (I) GABA systems may be altered in ASD. However, no prior studies of ASD have examined the 'responsivity' of the E-I system to pharmacologic challenge; or whether E-I modulation alters abnormalities in functional connectivity of brain regions implicated in the disorder. Therefore, we used magnetic resonance spectroscopy ([1H]MRS) to measure prefrontal E-I flux in response to the glutamate and GABA acting drug riluzole in adult men with and without ASD. We compared the change in prefrontal 'Inhibitory Index'-the GABA fraction within the pool of glutamate plus GABA metabolites-post riluzole challenge; and the impact of riluzole on differences in resting-state functional connectivity. Despite no baseline differences in E-I balance, there was a significant group difference in response to pharmacologic challenge. Riluzole increased the prefrontal cortex inhibitory index in ASD but decreased it in controls. There was also a significant group difference in prefrontal functional connectivity at baseline, which was abolished by riluzole within the ASD group. Our results also show, for we believe the first time in ASD, that E-I flux can be 'shifted' with a pharmacologic challenge, but that responsivity is significantly different from controls. Further, our initial evidence suggests that abnormalities in functional connectivity can be 'normalised' by targeting E-I, even in adults.

Identification badge lanyards as infection control risk: a cross-sectional observation study with epidemiological analysis

Staphylococcus aureus cultures from name badge lanyards were phenotypically and genotypically indistinguishable from the wearer's nasal carrier strains by pulsed-field gel electrophoresis and antibiogram. Lanyards had a mean age of 22 months and hygiene was poor with only 9% ever having been laundered. Molecular analysis showed that 26% of S. aureus nasal carriers shared an indistinguishable strain on their lanyard. Lanyards should not be recommended for staff in frontline clinical care.

Hypertension prevalence, awareness, treatment and control in the over 50s in Ireland: evidence from The Irish Longitudinal Study on Ageing

BACKGROUND

To assess the prevalence, awareness, treatment and control of hypertension among adults in Ireland and to describe the determinants of awareness, treatment and control in order to inform public health policy.

METHODS

A cross-sectional study of a nationally representative sample of community living adults aged 50 years and older using data collected from 2009 to 2011 for the first wave of the Irish Longitudinal Study on Ageing (TILDA) (n = 5857). Hypertension was defined as systolic blood pressure (BP) ≥140 mmHg or diastolic BP ≥90 mmHg and/or currently taking antihypertensive medications.

RESULTS

The prevalence of hypertension was 63.7% [95% confidence interval (CI) 62.3-65.1%]. Among those with hypertension, 54.5% (95% CI 52.6-56.2%) were aware of their hypertensive status and 58.9% (95% CI 57.1-60.4%) were on antihypertensive medication. Among those on treatment, 51.6% (95% CI 49.3-53.9%) had their BP controlled to below 140/90 mmHg. Respondents facing financial barriers to primary care and medication were less likely to be on antihypertensive treatment compared with those without financial barriers.

CONCLUSIONS

A high prevalence of hypertension was identified in this cohort, with low levels of awareness, treatment and control. Population and primary care interventions are required to reduce prevalence and to improve awareness, detection and management of hypertension.

D-cycloserine to enhance extinction of cue-elicited craving for alcohol: a translational approach

Cue-elicited craving for alcohol is well established but extinction-based treatment to extinguish this response has generated only modest positive outcomes in clinical trials. Basic and clinical research suggests that D-cycloserine (DCS) enhances extinction to fear cues under certain conditions. However, it remains unclear whether DCS would also accelerate extinction of cue-elicited craving for alcohol. The goal of the current study was to examine whether, compared with placebo (PBO), DCS enhanced extinction of cue-elicited craving among treatment-seeking individuals with alcohol use disorders (AUDs). Participants were administered DCS (50 mg) or PBO 1 h before an alcohol extinction paradigm in a simulated bar environment on two occasions. The extinction procedures occurred 1 week apart and were fully integrated into outpatient treatment. Subjective craving for alcohol was the primary variable of interest. Follow-up cue reactivity sessions were conducted 1 week and 3 weeks later to ascertain persisting DCS effects. Drinking outcomes and tolerability were also examined. DCS was associated with augmented reductions in alcohol craving to alcohol cues during the first extinction session and these effects persisted through all subsequent sessions, suggesting facilitation of extinction. Participants in the DCS condition reported significant short-term reductions in drinking, although these did not persist to follow-up, and found the medication highly tolerable. These findings provide evidence that DCS enhances extinction of cue-elicited craving for alcohol in individuals with AUDs in the context of outpatient treatment. The potential clinical utility of DCS is discussed, including methodological considerations and context-dependent learning.

Spatial control of bone formation using a porous polymer scaffold co-delivering anabolic rhBMP-2 and anti-resorptive agents

Current clinical delivery of recombinant human bone morphogenetic proteins (rhBMPs) utilises freeze-dried collagen. Despite effective new bone generation, rhBMP via collagen can be limited by significant complications due to inflammation and uncontrolled bone formation. This study aimed to produce an alternative rhBMP local delivery system to permit more controllable and superior rhBMP-induced bone formation. Cylindrical porous poly(lactic-co-glycolic acid) (PLGA) scaffolds were manufactured by thermally-induced phase separation. Scaffolds were encapsulated with anabolic rhBMP-2 (20 µg) ± anti-resorptive agents: zoledronic acid (5 µg ZA), ZA pre-adsorbed onto hydroxyapatite microparticles, (5 µg ZA/2% HA) or IkappaB kinase (IKK) inhibitor (10 µg PS-1145). Scaffolds were inserted in a 6-mm critical-sized femoral defect in Wistar rats, and compared against rhBMP-2 via collagen. The regenerate region was examined at 6 weeks by 3D microCT and descriptive histology. MicroCT and histology revealed rhBMP-induced bone was more restricted in the PLGA scaffolds than collagen scaffolds (-92.3% TV, p < 0.01). The regenerate formed by PLGA + rhBMP-2/ZA/HA showed comparable bone volume to rhBMP-2 via collagen, and bone mineral density was +9.1% higher (p < 0.01). Local adjunct ZA/HA or PS-1145 significantly enhanced PLGA + rhBMP-induced bone formation by +78.2% and +52.0%, respectively (p ≤ 0.01). Mechanistically, MG-63 human osteoblast-like cells showed cellular invasion and proliferation within PLGA scaffolds. In conclusion, PLGA scaffolds enabled superior spatial control of rhBMP-induced bone formation over clinically-used collagen. The PLGA scaffold has the potential to avoid uncontrollable bone formation-related safety issues and to customise bone shape by scaffold design. Moreover, local treatment with anti-resorptive agents incorporated within the scaffold further augmented rhBMP-induced bone formation.

A sugar-based phase-transitioning delivery system for bone tissue engineering

Bone tissue engineering approaches commonly involve the delivery of recombinant human bone morphogenetic proteins (rhBMPs). However, there are limitations associated with the currently used carriers, including the need for surgical implantation and the associated increase in infection risk. As an alternative to traditional porous collagen sponge, we have adopted a solution of the injectable sucrose acetate isobutyrate (SAIB) as a carrier for rhBMP-2. The ability to deliver rhBMP-2 and other agents by injection reduces the infection risk and lesion size whilst in surgery, with the potential to avoid open surgery altogether in some indications. The primary methodology used for this in vivo study was a C57BL6/J mouse ectopic bone formation model. Specimens were examined by x-ray, microCT, and histology at 3 weeks. SAIB was delivered non-invasively and produced up to 3-fold greater bone volume compared to collagen. To further refine and improve upon the formulation, SAIB containing rhBMP-2 was admixed with candidate compounds including ceramic microparticles, anti-resorptives, and cell signalling inhibitors and further tested in vivo. The formulation combining SAIB/rhBMP-2, the bisphosphonate zoledronic acid (ZA), and hydroxyapatite (HA) microparticles yielded a 10-fold greater bone volume than SAIB/rhBMP-2 alone. To investigate the mechanism underlying the synergy between ZA and HA, we used in vitro binding assays and in vivo fluorescent biodistribution studies to demonstrate that ceramic particles could bind and sequester the bisphosphonate. These data show the utility of SAIB as a non-invasive rhBMP delivery system as well as describing an optimised formulation for bone tissue engineering.

Disorder-specific functional abnormalities during sustained attention in youth with Attention Deficit Hyperactivity Disorder (ADHD) and with autism

Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) are often comorbid and share behavioural-cognitive abnormalities in sustained attention. A key question is whether this shared cognitive phenotype is based on common or different underlying pathophysiologies. To elucidate this question, we compared 20 boys with ADHD to 20 age and IQ matched ASD and 20 healthy boys using functional magnetic resonance imaging (fMRI) during a parametrically modulated vigilance task with a progressively increasing load of sustained attention. ADHD and ASD boys had significantly reduced activation relative to controls in bilateral striato-thalamic regions, left dorsolateral prefrontal cortex (DLPFC) and superior parietal cortex. Both groups also displayed significantly increased precuneus activation relative to controls. Precuneus was negatively correlated with the DLPFC activation, and progressively more deactivated with increasing attention load in controls, but not patients, suggesting problems with deactivation of a task-related default mode network in both disorders. However, left DLPFC underactivation was significantly more pronounced in ADHD relative to ASD boys, which furthermore was associated with sustained performance measures that were only impaired in ADHD patients. ASD boys, on the other hand, had disorder-specific enhanced cerebellar activation relative to both ADHD and control boys, presumably reflecting compensation. The findings show that ADHD and ASD boys have both shared and disorder-specific abnormalities in brain function during sustained attention. Shared deficits were in fronto-striato-parietal activation and default mode suppression. Differences were a more severe DLPFC dysfunction in ADHD and a disorder-specific fronto-striato-cerebellar dysregulation in ASD.

Age-related changes in parahippocampal white matter integrity: a diffusion tensor imaging study

The axons in the parahippocampal white matter (PWM) region that includes the perforant pathway relay multimodal sensory information, important for memory function, from the entorhinal cortex to the hippocampus. Previous work suggests that the integrity of the PWM shows changes in individuals with amnestic mild cognitive impairment and is further compromised as Alzheimer's disease progresses. The present study was undertaken to determine the effects of healthy aging on macro- and micro-structural alterations in the PWM. The study characterized in vivo white matter changes in the parahippocampal region that includes the perforant pathway in cognitively healthy young (YNG, n=21) compared to cognitively healthy older (OLD, n=21) individuals using volumetry, diffusion tensor imaging (DTI) and tractography. Results demonstrated a significant reduction in PWM volume in old participants, with further indications of reduced integrity of remaining white matter fibers. In logistic regressions, PWM volume, memory performance and DTI indices of PWM integrity were significant indicator variables for differentiating the young and old participants. Taken together, these findings suggest that age-related alterations do occur in the PWM region and may contribute to the normal decline in memory function seen in healthy aging by degrading information flow to the hippocampus.

Changes in parahippocampal white matter integrity in amnestic mild cognitive impairment: a diffusion tensor imaging study

In the present study, changes in the parahippocampal white matter (PWM), in the region that includes the perforant path, were investigated, in vivo, in 14 individuals with amnestic mild cognitive impairment (aMCI) compared to 14 elderly controls with no cognitive impairment (NCI). For this purpose, (1) volumetry; (2) diffusion tensor imaging (DTI) derived measures of mean diffusivity (MD) and fractional anisotropy (FA); and (3) tractography were used. In addition, regression models were utilized to examine the association of PWM measurements with memory decline. The results from this study confirm previous findings in our laboratory and others, showing that compared to controls, individuals with aMCI have PWM volume loss. In addition to volume reduction, participants with aMCI demonstrated a significant increase in MD, but no difference in FA, both in the PWM region and in fibers modeled to pass through the PWM region. Further, the DTI metric of MD was associated with declarative memory performance, suggesting it may be a sensitive marker for memory dysfunction. These results indicate that there is general tissue loss and degradation (decreased volume; increased MD) in individuals with aMCI compared to older people with normal cognitive function. However, the microstructural organization of remaining fibers, as determined by measures of anisotropic diffusion, is not significantly different from that of controls.

Diffusion tensor imaging in Alzheimer's disease and mild cognitive impairment

Structural magnetic resonance imaging (MRI) studies of Alzheimer’s disease and mild cognitive impairment (MCI) have focused on the hippocampus and entorhinal cortex; gray matter structures in the medial temporal lobe. Few studies have investigated the integrity of white matter in patients with AD or MCI. Diffusion tensor imaging (DTI) is a MRI technique that allows for the interrogation of the microstructural integrity of white matter. Based on increases in translational diffusion (mean diffusivity: MD) and decreases directional diffusion (fractional anisotropy: FA) damage to white matter can be assessed. Studies have identified regions of increased MD and decreased FA in patients with AD and MCI in all lobes of the brain, as well as medial temporal lobe structures including the hippocampus, entorhinal cortex and parahippocampal white matter. The pattern of white matter integrity disruption tends to follow an anterior to posterior gradient with greater damage noted in posterior regions in AD and MCI. Recent studies have exploited inter-voxel directional similarities to develop models of white matter pathways, and have used these models to assess the integrity of inter-cerebral connections. Particular focus has been applied to the parahippocampal white matter (including the perforant path) and the posterior cingulum. Although many studies have found DTI indicators of impaired white matter in AD and MCI, other studies have failed to detect any differences in MD or FA between the groups, demonstrating the need for large replicative studies. DTI is an evolving technique and advances in its application ought to provide new insights into AD and MCI.

Influence of exposure intensity on the efficiency and speed of transmission of Foot-and-mouth disease

Foot-and-mouth disease virus (FMDV) can be spread by direct animal-to-animal contact, indirect contact facilitated by contaminated materials or by airborne spread. The rate of spread and the incubation period, as well as the severity of disease, depends on many variables including the dose received, the route of introduction, the virus strain, the animal species and the conditions under which the animals are kept. Quantitative data related to these variables are needed if model predictions are to be used in practical disease control. This experimental study quantifies the risk of transmission of FMDV in pigs exposed by contact, sheep exposed by indirect contact with pigs and sheep exposed to airborne FMDV. Groups of pigs were inoculated with the FMDV O UKG 34/2001 strain and susceptible pigs were then exposed to the inoculated animals at different stages of the infection cycle. The mean incubation period in the susceptible pigs ranged from 1 to 10 days. The length of the incubation period, severity of clinical disease and efficiency of spread were related to dose (i.e. infectiousness of source and intensity of contact). Low intensity transmission increased the proportion of subclinical or abortive infections. Local conditions are important in the efficiency and speed of transmission of FMDV. The results of the experiments described above suggest that transmission is frequency dependent rather than density dependent. The sheep experiments provided further evidence that development of infection and clinical disease is dependent upon local conditions. Dose, infectiousness, intensity of contact and local factors are thus important determinants for the outcome of an initial outbreak and must be truthfully accounted for in mathematical models of epidemiological spread.

Effects of distance moved during loading and floor space on the trailer during transport on losses of market weight pigs on arrival at the packing plant1

Effects of distance moved during loading and floor space on the trailer during transport on the incidence of transport losses (dead and nonambulatory pigs) on arrival at the packing plant were evaluated in a study involving 42 loads of pigs (average BW = 131.2 kg, SD 5.05). A split-plot design was used with a 2 x 6 factorial arrangement of the following treatments: 1) distance moved from the pen to the exit of the building [short (0 to 30.5 m) vs. long (61.0 to 91.4 m)] and 2) transport floor space (0.396, 0.415, 0.437, 0.462, 0.489, or 0.520 m(2)/pig). Loading distance treatments (sub-plots) were compared within transport floor space treatments (main plot). Pigs were loaded at the farm using sorting boards and, if necessary, electric goads, transported approximately 3 h to a commercial packing plant and unloaded using livestock paddles. The number of nonambulatory pigs during loading and the number of dead and nonambulatory pigs at the plant were recorded. Nonambulatory pigs were classified as fatigued, injured, or injured and fatigued. In addition, the incidence of pigs exhibiting signs of stress (open-mouth breathing, skin discoloration, and muscle tremors) during loading and unloading was recorded. There were no interactions (P > 0.05) between distance moved and transport floor space treatments. Moving pigs long compared with short distances during loading increased (P < 0.001) the incidence of open-mouth breathing after loading (24.9 vs. 11.0 +/- 1.03%, respectively) and tended to increase the incidence of nonambulatory pigs during loading (0.32 vs. 0.08 +/- 0.09%, respectively; P = 0.09) and of nonambulatory, injured pigs at the plant (0.24 vs. 0.04 +/- 0.07%, respectively; P = 0.06). However, distance moved did not affect other losses at the plant. Total losses at the plant were greater (P < 0.05) for the 3 lowest floor spaces compared with the 2 highest floor spaces, and pigs provided 0.462 m(2)/pig during transport had similar transport losses to those provided 0.489 and 0.520 m(2)/pig (total losses at the plant = 2.84, 1.88, 1.87, 0.98, 0.13, and 0.98 +/- 0.43% of pigs transported, for 0.396, 0.415, 0.437, 0.462, 0.489, and 0.520 m(2)/pig, respectively). These data confirm previous findings that transport floor space has a major effect on transport losses and suggest that these losses are minimized at a floor space of 0.462 m(2)/pig or greater.

Quantification of lung injury using ventilation and perfusion distributions obtained from gamma scintigraphy

This paper explores the potential of isotope V/Q lung scans to quantify lung disease. Areas of restricted perfusion in subjects with a pulmonary embolus (PE) were identified in 3D reconstructions of V/Q images achieved using anatomical data from the Visible Human Project. From these, the extent of lung damage was quantified. Significant differences in the values of both LogSD V and LogSD Q (p > 0.05) obtained from plots of V and Q against Log(V/Q) were found between normal subjects and subjects with a PE, but no correlation was found between either of these parameters and the degree of lung damage in subjects with a PE (p > 0.05). Whilst V/Q values were log normally distributed, the V/Q distributions from the subjects with a PE failed to show the bimodal distribution predicted from theoretical considerations and MIGET measurements previously reported. There was a statistically significant difference in the mean and standard deviation values of the V/Q distributions between normal subject and subjects with a PE (p < 0.05) but not in the median values (p > 0.05). There was no correlation between the mean, median and standard deviation of the distributions from the subjects with a PE and the percentage of damage present (p > 0.05).

Determinants of early foot-and-mouth disease virus dynamics in pigs

This paper provides a quantitative description of the early infectious process in pigs experimentally infected with foot-and-mouth disease virus (FMDV), obtained by dose-dependent, time course studies of viral load in serum. Pigs were inoculated by the intravenous or intradermal/subcutaneous route with FMDV and housed together in groups or individually. The effects of dose, inoculation route and exposure intensity on the replication of FMDV in vivo and the development of disease were studied. It was shown that the higher the dose, the shorter was the time to the start of active viraemia and to the onset of clinical signs. Exposure intensity and housing conditions influenced the viral dynamics of FMDV. Increasing the exposure intensity, by increasing the number of infected pigs housed together, had the effect of synchronizing the infection and reducing the variance in the start of active viraemia. Increasing the number of pigs housed together also increased the interaction between the pigs and the activity of individual pigs, which had the effect of shortening the time to the onset of clinical signs such as vesicle formation. Intradermal inoculation was more effective than intravenous inoculation for transmitting FMDV to pigs, resulting in shorter times to the start of active viraemia and in higher clinical scores.

Antitrust enforcement encourages health care providers to cooperate procompetitively

A review of significant administrative and judicial rulings in antitrust law during 1993 shows that the antitrust laws should not impede innovative, cost-cutting cooperative arrangements among providers, so long as their actual or potential procompetitive benefits are not outweighed by their anticompetitive effects.

Relationships between certification and job perceptions of oncology nurses

PURPOSE/OBJECTIVES

To explore relationships between oncology nursing certification and oncology nurses' job perceptions.

DESIGN

Descriptive, correlational.

SETTING

Questionnaire mailed to homes of Oncology Nursing Society (ONS) members.

SAMPLE

703 certified and 514 noncertified ONS members (N = 1,217; 50% response rate).

METHODS

Data were collected using survey methods and grouped by respondents' certification status for statistical analysis.

MAIN RESEARCH VARIABLES

Certification, group cohesion, organizational commitment, and job satisfaction.

FINDINGS

Certification was weakly correlated with cohesion, commitment, and satisfaction. Work setting, rather than certification, accounted for differences in job perceptions. Job perceptions were most positive in settings characterized by a high percentage of patients with cancer (> 75%), a high percentage of RNs (> or = 80%), and monetary support for continuing education.

CONCLUSIONS

The hypothesis that oncology nurses' certification status is associated with job perceptions that are valued by employers was not supported.

IMPLICATIONS FOR NURSING PRACTICE

Nurses' job perceptions have been linked to control over nursing practice and participation in organizational and clinical decision making. Managerial strategies that empower certified nurses to practice with more autonomy and participate in decisions that affect patient care should be emphasized.

A comparison of antagonism of rocuronium-induced neuromuscular blockade during sevoflurane and isoflurane anaesthesia

Volatile anaesthetic agents potentiate neuromuscular blocking agents and retard their rate of reversal. We hypothesised that there was a difference in the rate of reversal of rocuronium-induced neuromuscular blockade based on the selection of inhalation agent. Thirty-eight patients undergoing elective surgical procedures received either sevoflurane or isoflurane, by random allocation. Neuromuscular blockade was induced using rocuronium 0.6 mg.kg-1 followed by continuous intravenous infusion to maintain 90% suppression of the single twitch response. Upon completion of surgery, the rocuronium infusion was discontinued, neostigmine 50 microg.kg-1 and glycopyrrolate 10 microg.kg-1 were administered. Times from reversal to T1 = 25, 50 and 60% and train-of-four ratio = 0.6 were recorded. The mean (SD) times to train-of-four ratio = 0.6 in the isoflurane and sevoflurane groups were 327 (132) and 351 (127) s, respectively. The mean (SD) times to single twitch response T1 = 25, 50 and 60% in the isoflurane group were 81 (33), 161 (59) and 245 (84) s, respectively, and in the sevoflurane group were 95 (35), 203 (88) and 252 (127) s, respectively. It is concluded that reversal of rocuronium-induced neuromuscular blockade is similar during isoflurane and sevoflurane anaesthesia.

Detection of Gov system antibodies by MAIPA reveals an immunogenicity similar to the HPA-5 alloantigens

The glycosylphosphatidylinositol-linked platelet protein CD109 carries the biallelic alloantigen system Gov. There is limited information on the incidence of Gov alloantibodies in neonatal alloimmune thrombocytopenia (NAITP), post-transfusion purpura (PTP) and platelet refractoriness. We adapted the monoclonal antibody-specific immobilization of platelet antigens (MAIPA) assay to the detection of Gov antibodies and determined their incidence in 605 archived samples (112 with HPA antibodies) referred for the aforementioned conditions. Here, we show that CD109 expression was reduced upon platelet storage in saline or by cryopreservation, but was stable when stored as whole blood or therapeutic platelet concentrate. Fourteen of the 605 samples contained Gov alloantibodies (anti-Gova, n = 10; anti-Govb, n = 4), with the majority in platelet refractoriness (n = 9) and, of the remaining five, four in NAITP and one in PTP. In seven cases, no other HPA antibodies were detected, three being NAITP cases. The incidence of Gov antibodies was significantly lower than HPA-1 system antibodies (n = 87), but equalled the number of HPA-5 system antibodies (n = 14) and outnumbered HPA-2 and -3 system antibodies (10 altogether).

A national survey of certified, recertified, and noncertified oncology nurses: comparisons and contrasts

PURPOSE/OBJECTIVES

To explore opinions about the OCN credential, the ways in which it was obtained and retained, and the extent to which it is valued by employers.

DESIGN

A descriptive comparison study using a cross-sectional survey design.

SAMPLE

Questionnaires were mailed to a nationwide sample of 2,429 RN members of the Oncology Nursing Society; 1,217 (50%) surveys were returned. The majority of respondents were female, 30-49 years of age. Caucasian, and had practiced nursing for more than 11 years.

MAIN RESEARCH VARIABLES

Certification status, work role characteristics, preparation strategies for the certification examination, and motivation for obtaining certification.

FINDINGS

Oncology nurses recognize the importance and value of OCN certification. The primary reasons oncology nurses obtain and retain certification include the desire for personal achievement, professional growth, and development. OCNs were more likely to work in a setting where the employer supports professional development through continuing nursing education.

IMPLICATIONS FOR NURSING PRACTICE

Because health care is increasingly delivered in ambulatory/home settings and the population is aging, oncology certification needs to be encouraged among nurses who work in these settings or with geriatric populations. Certified nurses tended to experience more job satisfaction than noncertified nurses.

Domestic violence before and after alcoholism treatment: a two-year longitudinal study

OBJECTIVE

An initial study of 88 male alcoholics and their wives had shown that domestic violence decreased significantly in the year following a behavioral marital therapy (BMT) alcoholism treatment program (see J. Cons. Clin. Psychol. 63: 256-262, 1995). To determine if violence reductions were stable, the present study examined domestic violence during the second year following BMT for the 75 (of the original 88) couples who provided 2-year follow-up data on violence.

METHOD

The prevalence and frequency of domestic violence were assessed for 75 male alcoholics and their wives at entry to and at 1 and 2 years after completing BMT. Data on frequency and consequences of alcoholics' drinking were collected for the 2-year follow-up period. Comparison rates of domestic violence for a demographically matched nonalcoholic sample were derived from a nationally representative survey of violence in American families.

RESULTS

Husband-to-wife violence occurred in nearly two-thirds of cases in the year before BMT. For both the first and second year after BMT, violence was significantly reduced and the extent of violence was associated with the extent of the alcoholics' drinking. Frequency of posttreatment drinking was positively correlated with violence, and remitted alcoholics no longer had elevated domestic violence levels when compared with matched controls whereas relapsed alcoholics did. Analyses using various assumptions about violence for the 13 cases without violence data showed that sample attrition did not invalidate the present results.

CONCLUSIONS

These results indicate that domestic violence decreased after BMT alcoholism treatment. Further, among remitted alcoholics, violence returned to the level experienced by other American families, in the same way that other aspects of marital, family and psychosocial functioning improve after successful treatment of alcoholism.

Revising the blueprint for the AOCN Examination using a role delineation study for advanced practice oncology nursing

PURPOSE/OBJECTIVES

To conduct a role delineation study of advanced oncology nursing practice as a basis for the blueprint for the Advanced Oncology Certified Nurse (AOCN) Examination.

DESIGN

Descriptive and comparative.

SAMPLE

A group of 802 Oncology Nursing Society members comprised of 258 oncology nurse practitioners (NPs), 235 oncology clinical nurse specialists (CNSs), and 309 baccalaureate-prepared oncology nurses.

METHODS

A pilot survey was mailed to a small group to allow refinement of the survey instrument. The survey then was mailed to a total sample of 2,400.

MAIN RESEARCH VARIABLES

Frequency and importance to practice of 121 survey items as well as whether each item reflected an entry-level skill. Survey items were divided into five major domains: (a) Direct Caregiver, (b) Consultant, (c) Administrator/Coordinator, (d) Researcher and (e) Educator.

FINDINGS

Direct Caregiver domain was weighted most heavily (63%), followed by Educator (18%), Consultant (10%), Administrator/Coordinator (5%), and Researcher (4%). Most of the items were identified as entry-level skills, and fewer than 10% of the items differentiated between CNS and NP respondents.

CONCLUSION

The blueprint for the AOCN Examination reflects entry-level advanced practice oncology nursing and is appropriate for both CNSs and NPs in oncology.

IMPLICATIONS FOR NURSING PRACTICE

Examinees, consumers, and employers can have confidence that the AOCN Examination will be based on a blueprint that was revised to reflect current oncology nursing practice and, therefore, is valid for its purpose.

Measuring emotional abuse in dating relationships as a multifactorial construct

Initial investigations of a multifactorial approach to the measurement of emotional abuse in dating relationships are presented. A set of 54 items was generated to assess 4 rationally derived subscales measuring Restrictive Engulfment, Hostile Withdrawal, Denigration, and Dominance/Intimidation. An exploratory factor analysis on reports of partner behavior by 157 female undergraduate students in dating relationships provided support for the hypothesized subscales. Denigration and Dominance/Intimidation had consistently higher correlations with physical aggression than did the other two forms of emotional abuse. Further evidence for discriminant and convergent validity was apparent in correlations with the circumplex scales of the Inventory of Interpersonal Problems, and with self-reported attachment variables. The results support the assessment of emotional abuse in dating relationships as a multifactorial construct.

Metastatic basal cell carcinoma presenting as unilateral lymphedema

BACKGROUND

Metastatic basal cell carcinoma (MBCC) is rare, occurring in only 0.0028-0.55% of all basal cell carcinomas (BCCs). Patients with MBCC may present with a variety of findings, related to the site of metastasis.

OBJECTIVE

Clinical presentation of a MBCC that became symptomatic due to unilateral lymphedema and a review of the relevant literature.

METHODS

Case report with literature review.

RESULTS

Patients may present with lymphadenopathy, ulcerations, anemia, bone pain, or muscle weakness related to the site of metastasis. In this reported case, MBCC presented as unilateral lymphedema. Risk factors for MBCC include radiation, large and invasive tumors, and a history of recurrence. The average survival time for localized lymph node metastasis in BCC is 3.6 years. This patient is currently 2 years since MBCC presentation and is currently without evidence of recurrence.

CONCLUSION

To our knowledge, we report the first case of MBCC that presented as unilateral lymphedema.

Lifetime exposure to interparental physical and verbal aggression and symptom expression in college students

This study investigated relations between lifetime exposure to interparental aggression and (1) anxiety, depression, and anger; (2) interpersonal problems; and (3) symptoms of trauma, in a sample of young adults. Participants were 326 (219 female, 107 male) undergraduates from an eastern university. Participants reported on their demographic backgrounds, memories of interparental verbal and physical aggression, past experiences of severe stressors (including child physical and sexual abuse and community violence), and recent symptoms. Results demonstrate that exposure to interparental violence is associated with elevations in depression, anxiety, interpersonal problems, and trauma symptoms. Further analyses indicated that interparental verbal aggression predicted all symptom areas and was a stronger predictor than interparental violence. The impact of both forms of aggression was attenuated and in some cases negated by controlling for the effects of other severe stressors.

Evaluation of two forms of sustained release nifedipine using 24 h ambulatory blood pressure monitoring

Therapeutic interchange between the available forms of sustained release nifedipine (osmotic-pump and coat-core forms of nifedipine) is a matter of controversy. This study was initiated to determine whether there is a difference in clinical outcomes when there is interchange between the two forms of sustained release nifedipine when used for the treatment of hypertension. A total of 43 patients with a history of stage I hypertension who were receiving stable doses of the osmotic-pump form of nifedipine for > 3 months with controlled blood pressures (< 150/90 mm Hg) were enrolled. Patients were then switched to the same dose of the coat-core form of nifedipine and were followed for 3 months. In the 36 patients who completed the study, mean trough serum nifedipine concentrations were significantly higher with the osmotic-pump from (46.5 +/- 35.0 ng/mL) of nifedipine compared with the coat-core form (27.2 +/- 20.4 ng/mL) (P < .05). However, blood pressure control as determined by the indices of 24 h ambulatory blood pressure monitoring, trough blood pressures and load blood pressures were similar between the osmotic-pump and coat-core forms of nifedipine. The coat-core form of nifedipine was discontinued in four patients for possible side effects. In this group of patients with mild hypertension, there were no clinically relevant differences in blood pressure control between the two forms of nifedipine. Some patients on the coat-core form of nifedipine may need to discontinue therapy due to intolerable side effects.

Couple communication patterns of maritally aggressive and nonaggressive male alcoholics

OBJECTIVE

This study was conducted to examine the associations between communication problems and marital violence in couples with a male alcoholic, and to determine whether the communication correlates of marital violence found in nonalcoholic community samples also characterize male alcoholics' relationships.

METHOD

Ninety newly abstinent treatment-seeking male alcoholics and their wives completed a 10-minute problem discussion while both partners were sober. Their communication behaviors were coded with the Marital Interaction Coding system. Couples were separated into maritally aggressive (n = 60 couples) and nonaggressive (n = 30 couples) groups on the basis of any husband-to-wife physical aggression in the previous 12 months.

RESULTS

The base-rate percentage of aversive-defensive communication was significantly higher for couples with a physically aggressive husband than for couples with a nonaggressive husband. The base-rate percentage of facilitative-enhancing communication did not differ significantly between groups. In sequential analyses, physically aggressive husbands, but not their wives, displayed more negative reciprocity than their nonaggressive counterparts. Alcoholic husbands in general displayed lower rates of facilitative-enhancing communication than did their wives.

CONCLUSIONS

Husband-to-wife marital aggression was associated with problematic communication among couples with an alcoholic husband during a sober interaction in a laboratory setting, extending prior nonalcoholic community sample research to male alcoholics' relationships. The maritally aggressive alcoholics were high in negative responses contingent upon their wives' prior negative behavior, and were unlikely to terminate aversive interchanges. Communication problems may be important in understanding and treating co-occurring alcoholism and marital violence.

Isolation and characterization of proteins from human lymphocyte nuclei using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and post-source decay analysis

The cell nucleus plays an essential role in all aspects of cell function, including DNA replication, gene transcription, RNA processing and cell division. Within the cell nucleus there are many proteins and peptides that have regulatory roles. Although several higher molecular weight protein components (> 30 kDa) have been identified and characterized, limited information is available for the lower molecular weight components. Nuclei from human peripheral blood lymphocytes were isolated and rapidly characterized by employing a strategy using reversed-phase high-performance liquid chromatography, tryptic digestion, and post-source decay analysis of matrix-assisted laser desorption/ionization (MALDI) ions in combination with database searches. Database searches utilizing molecular weight, proteolytic digest fragments, and peptide sequence results identified known proteins. The results illustrate the usefulness of MALDI as a tool in the characterization of low abundance proteins in the cell nucleus.

Clinical skill development for community pharmacists

The importance of establishing clinical pharmacy services in the community cannot be understated in light of current challenges to the traditional dispensing role as the primary service of the community pharmacist. Advancements in automated dispensing technology and declining prescription fee reimbursement are rapidly forcing pharmacists to seek alternative sources of revenue. Providing pharmaceutical care is a viable option to increase customer loyalty job satisfaction, and reimbursement. To support the development of clinical services, academic institutions are forming partnerships with individual community practitioners to overcome perceived educational and training barriers. The authors describe the design and development of two unique clinical skill development programs at the University of Illinois at Chicago. This paper also outlines the patient focused services that the participants have established upon completing the training. These programs successfully enhanced participants' therapeutic knowledge base and facilitated development of the clinical skills necessary for direct patient care.

Primary structure of bovine adenosine deaminase

Derivatized bovine adenosine deaminase is used in enzyme replacement therapy and as an adjunct to gene therapy against severe combined immunodeficiency syndrome. Although a gene sequence is known for human adenosine deaminase, the structure of the bovine enzyme has not been characterized. Structure studies using mass spectrometry are reported here that evaluate sequence, processing, post-translational modifications and the extent of homology between the human protein and its therapeutic surrogate.

Ambulatory care certificate program for pharmacists

An ambulatory care certificate program tailored to meet the educational needs of Department of Veterans Affairs (VA) and Navy pharmacists is described. In 1992, the College of pharmacy, University of Illinois at Chicago, worked with the VA and the Navy to design an ambulatory care certificate program for pharmacists in VA and Navy hospitals. The pilot course consisted of 103 hours of didactic and experiential education. The 10 didactic modules covered both disease management and clinical skills. The experiential component incorporated pharmaceutical care steps as applied to therapeutic areas taught in the course. Although the pilot course met most of the original objectives, several unanticipated problems emerged, including distance learning issues, the number of hours for completing the course requirements, learner variance, the impact of institutional support on participants' academic success, participants' difficulty in assimilating education into practice, and difficulty with the clinical evaluation tool developed for the course. The course was modified over the next year to address these problems. Now in its fourth year, the course is offered nationally to the VA and the Department of Defense. In the first three years, 72 of 99 enrolled pharmacists completed the course. An ambulatory care certificate program helps Navy and VA pharmacists develop patient care skills.