Evaluation of the impact of pre- and post-harvest maize handling practices on mycotoxin contamination on smallholder farms in Guatemala

Mycotoxins are secondary metabolites produced by fungi including Aspergillus and Fusarium that commonly contaminate crops, such as maize, resulting in economic losses and food insecurity. Mycotoxins can contaminate crops during pre- and post-harvest stages. Consumption of mycotoxin-contaminated foods has been linked to a variety of negative health outcomes including liver cancer, stunting, and neural tube defects. In countries such as Guatemala where maize constitutes a major portion of the diet, mycotoxins can be a significant contributor to disease burden. This review describes maize pre- and post-harvest practices in Guatemala that can lead to the development of mycotoxins and subsequent exposure to humans and animals, current information gaps, and opportunities for future research. There are specific challenges to minimising fungal growth and subsequent mycotoxin production during storage of maize in Guatemala, including reducing moisture content, minimising pest damage, and controlling temperature. Research on maize-handling practices that are associated with the greatest mycotoxin exposure in Guatemala is needed to prioritise allocation of resources and reduce exposure.

Survey of rabies vaccination status of Queensland veterinarians and veterinary students

BACKGROUND

To determine the rabies vaccination status of Queensland veterinarians and veterinary students and their perception of zoonotic risk from Australian bat lyssavirus (ABLV).

DESIGN

Cross-sectional questionnaire surveys.

METHODS

Questionnaires were sent by post in 2011 to veterinary surgeons registered in Queensland, to final-year veterinary students at James Cook University via SurveyMonkey® in 2013 and to final-year veterinary students at James Cook University and University of Queensland via SurveyMonkey® in 2014.

RESULTS

The response rate for registered veterinarians was 33.5% and for veterinary students 33.3% and 30% in 2013 and 2014, respectively. Of the 466 registered veterinary surgeons, 147 (31.5%) had been vaccinated, with 72 (15.5%) currently vaccinated. For veterinary students the rabies vaccination rate was 20.0% (4/20) and 13.0% (6/46) in the 2013 and 2014 surveys, respectively. More than 95% of veterinary students had received the mandatory Q fever vaccine. Both veterinarians and students regarded bats and horses as high-risk species for zoonoses.

CONCLUSIONS

Queensland veterinarians and veterinary students have low levels of protection against ABLV. Although incidents of ABLV spilling over from a bat to a domestic mammal are likely to remain rare, they pose a significant human health and occupational risk given the outcome of infection in humans is high consequence. Principals of veterinary practices and veterinary authorities in Australia should implement a policy of rabies vaccination for clinical staff and veterinary students.

Posttransplant oxygen inhalation improves the outcome of subcutaneous islet transplantation: A promising clinical alternative to the conventional intrahepatic site

Subcutaneous tissue is a promising site for islet transplantation, due to its large area and accessibility, which allows minimally invasive procedures for transplantation, graft monitoring, and removal of malignancies as needed. However, relative to the conventional intrahepatic transplantation site, the subcutaneous site requires a large number of islets to achieve engraftment success and diabetes reversal, due to hypoxia and low vascularity. We report that the efficiency of subcutaneous islet transplantation in a Lewis rat model is significantly improved by treating recipients with inhaled 50% oxygen, in conjunction with prevascularization of the graft bed by agarose-basic fibroblast growth factor. Administration of 50% oxygen increased oxygen tension in the subcutaneous site to 140 mm Hg, compared to 45 mm Hg under ambient air. In vitro, islets cultured under 140 mm Hg oxygen showed reduced central necrosis and increased insulin release, compared to those maintained in 45 mm Hg oxygen. Six hundred syngeneic islets subcutaneously transplanted into the prevascularized graft bed reversed diabetes when combined with postoperative 50% oxygen inhalation for 3 days, a number comparable to that required for intrahepatic transplantation; in the absence of oxygen treatment, diabetes was not reversed. Thus, we show oxygen inhalation to be a simple and promising approach to successfully establishing subcutaneous islet transplantation.

Biochemical profiles and physicochemical parameters of beef from cattle raised under contrasting feeding systems and pre-slaughter management

Diet and pre-slaughter stress are key factors that may affect the biochemical processes during conversion of muscle into meat. The aim of the present study was to evaluate the effect of two different pre-slaughter stress managements (PSM) at a slaughterhouse in Angus steers raised and finished in two contrasting feeding systems (FS grain and pasture systems), on the peri mortem muscle metabolism, and its relation to of meat quality. Results obtained showed that a higher level of pre-slaughter stress increased (P < 0.05) glucose, lactate and proteins blood levels and decreased (P < 0.05) the redness (a* parameter) of adipose tissue. Regarding feeding strategy, pasture-fed animals displayed increased (P < 0.05) levels of haematocrit and insulin concentrations, and higher (P < 0.05) muscle pH decrease during the first 3 h post mortem. Despite final pH (pH 24 h) of M. longissimus dorsi (LD) was not significantly modified, LD hardness was significantly affected by an interaction effect of FS and PSM. Lower pre-slaughter stress level led to a decrease (P < 0.05) of LD hardness in grain-fed animals. In general terms, results showed an impact of PSM and FS on meat quality through pH-independent mechanisms.

Response of Australian veterinarians to the announcement of a Hendra virus vaccine becoming available

DESIGN

A cross-sectional study of private veterinarians providing equine services in Queensland.

RESULTS

The study revealed that a majority of veterinarians would support the introduction of a Hendra virus (HeV) vaccine. Moreover, almost half of the respondents intended to make vaccination a prerequisite to horse patient presentation. However, participants also responded that a vaccine would not reduce the risk sufficiently to cease or downgrade their HeV management plan and infection control measures.

CONCLUSION

When devising promoting and marketing campaigns, government agencies and manufacturers should consider private veterinarians' intentions as a significant driver for the uptake of the HeV vaccine.

Efecto del manejo y del temperamento animal sobre indicadores de calidad de la carne bovina

El objetivo del presente trabajo fue estudiar el efecto de diferentes condiciones de manejo sobre indicadores fisiológicos de estrés y de calidad de carne en bovinos con temperamentos contras-tantes. Se utilizaron cuarenta animales clasificados como calmos y excitables. Los mismos fueron alimentados inicialmente a base de pasturas y terminados con una dieta mixta de grano de maíz y pasturas. Se dosaron indicadores bioquímicos de estrés (hematocrito, proteínas plasmáticas, glucosa, creatinina, actividad fosfatasa alcalina, cortisol, insulina, contenido muscular de glucó-geno). Como indicadores de calidad de carne se midieron el pH de 24 h y color instrumental. El temperamento animal demostró un incremento significativo (p

Minimising exposure of amphibians to pathogens during field studies

Many of the recent global amphibian mass mortalities, declines and extinctions have been attributed to the emerging infectious disease chytridiomycosis. There have been mass mortalities due to ranaviral disease but no major declines or extinctions. Controlling the transmission and spread of disease is of utmost importance, especially where there is the potential for human involvement. We have reviewed current hygiene guidelines for working with wild frogs, identified potential flaws and recommended those most suitable and effective for the field environment. Our within-site hygiene measures aim to reduce the risk of transmission among individuals. These measures encompass the capture, handling and holding of amphibians, skin disinfection before and after invasive procedures, marking frogs, sealing open wounds and treatment of accessory equipment. Our between-site hygiene measures aim to mitigate the risk of pathogen spread among populations. We have designed a risk calculator to help simplify and standardise the decision-making process for determining the level of risk and appropriate risk mitigation strategies to reduce the risk of increasing pathogen spread above background levels. Calculation of an overall risk score for pathogen spread takes into account the prior activity of field workers, the proposed activity, remoteness of the site, presence of known pathogens and the consequences of increased pathogen spread for amphibians in a given area.

Pathology of cutaneous trombidiosis caused by larval trombiculid mites in a wild Lesueur's tree frog (Litoria wilcoxii)

Cutaneous trombidiosis caused by larvae of trombiculid mites (Vercammenia gloriosa and V. zweifelorum) in the skin of a wild tree frog, Litoria wilcoxii, in northern Queensland, Australia manifested as small, domed vesicular lesions on the dorsal and lateral surfaces posterior to the eyes. The lesions contained small, orange trombiculid mites, with a surrounding minimal inflammatory reaction. The general health and behaviour of the frog appeared unaffected. Provisional diagnosis of cutaneous trombidiosis can be made from its distinctive clinical appearance and confirmed by biopsy with direct microscopic examination of mites. This case report represents a new host record.

Additional disinfectants effective against the amphibian chytrid fungus Batrachochytrium dendrobatidis

Chytridiomycosis, a disease contributing to amphibian declines worldwide, is caused by the fungus Batrachochytrium dendrobatidis. Identifying efficient and practical disinfectants effective against B. dendrobatidis is important to reduce the spread of the disease both in the wild and captivity. Previous studies identified a range of suitable disinfectant strategies. We evaluated the suitability of 3 additional disinfectants: two of these (TriGene Virucidal Disinfectant Cleaner and F10 Super Concentrate Disinfectant) are mixtures of chemicals and one (Betadine Antiseptic Liquid) contains a single active ingredient, povidone iodine. The disinfectants were tested using a range of concentrations for 1,5 and 10 min to determine their ability to kill B. dendrobatidis in vitro. The measure of effectiveness was 100% kill of zoosporangia grown in multiwell plates. All disinfectants had a 100% efficacy at concentrations recommended by the manufacturers. The lowest concentrations capable of 100% kill after exposure for 1 min were 0.1 ml l(-1) for TriGene, 0.33 ml l(-1) for F10 and 100 ml l(-1) for Betadine. TriGene is the most effective disinfectant yet to be found, and both TriGene and F10 are more effective than various disinfectants tested in previous studies. TriGene and F10 are considered suitable for use in the field, as only small amounts of concentrate are needed.

The effect of propofol on the interaction of platelets with leukocytes and erythrocytes in surgical patients

We tested the antiplatelet effect described for propofol in vitro in surgical patients. Platelet aggregation induced by adenosine diphosphate, collagen, and arachidonic acid was tested in samples of whole blood, platelet-rich plasma (PRP), PRP with red blood cells, and PRP with leukocytes. Also measured were platelet production of thromboxane (Tx)B(2) and leukocyte production of 6-keto-prostaglandin F(1 alpha) (a stable metabolite of prostacyclin) and plasma levels of nitrites + nitrates (indicator of nitric oxide production). Anesthesia was induced with a bolus IV injection of sodium thiopental 4 mg/kg (n = 10), with a bolus dose of 2.5 mg/kg of propofol (n = 20), or with propofol total IV anesthesia (n = 20). Sodium thiopental did not modify any of the analytical values. In patients who received a bolus injection of propofol, platelet aggregation was significantly reduced in whole blood and in PRP + leukocytes. Platelet production of TxB(2) was reduced by 35%; the inhibition of 6-keto-prostaglandin F(1 alpha) was not statistically significant. Plasma levels of nitrites + nitrates increased by 37%; this change correlated significantly with the decrease in systolic and diastolic blood pressure (both P < 0.05). Similar changes, albeit of larger magnitude, were seen in patients who were given total IV anesthesia with propofol. In conclusion, propofol inhibited platelet aggregation in surgical patients mainly as a result of the inhibition of Tx synthesis and the increase in nitric oxide production. These effects are thought to be related to the hypotensive effect of this anesthetic.

IMPLICATIONS

In vitro experiments have shown that propofol inhibits platelet aggregation and increases nitric oxide production. This study shows that doses habitually used to induce or maintain anesthesia also have these effects. These findings have potential applications for patients at increased risk for bleeding and may partly explain the hypotensive effect of propofol.

Smoking prevalence in 2010: why the healthy people goal is unattainable

OBJECTIVES

This study examined the changes in smoking initiation and cessation needed to realize the Healthy People 2010 national adult smoking prevalence objective (13%).

METHODS

Using data from the National Health Interview Surveys, we calculated smoking prevalence over time with a dynamic population demographics model, examining the effects of changes in smoking initiation and cessation.

RESULTS

The draft objective is unattainable solely through decreases in smoking initiation. It could be achieved through smoking cessation alone only if cessation rates immediately increased by a factor of more than 3.5. Assuming plausible decreases in initiation and increases in cessation, the draft objective is virtually unattainable.

CONCLUSIONS

The health objectives should challenge the status quo but be achievable. Formal analysis often can assist in establishing reasonable objectives.

Has smoking cessation ceased? Expected trends in the prevalence of smoking in the United States

From 1965 to 1990, the prevalence of cigarette smoking among US adults (aged > or = 18 years) fell steadily and substantially. Data for the 1990s suggest that the smoking initiation rate is increasing and that the decline in the prevalence of smoking may have stalled, raising the fear that the historical 25-year decline will not continue. The authors used a new dynamic forecasting model to show that although the decline may slow down, the demographics of smoking imply that prevalence will inexorably continue to decline over the next several decades, even without any intensified efforts aimed at tobacco control. The authors estimated and validated the model using historical (1965-1993) data collected by the National Health Interview Surveys on the prevalence of smoking among adults. Their results indicate that the current increase in the smoking initiation rate partially explains the fact that the prevalence of smoking has apparently leveled off, but even if the most grim assumptions about future initiation rates are used, the prevalence of smoking among adults will continue to decline for several more decades. The authors predict that if current initiation and cessation behaviors persist, the prevalence of smoking among adults will automatically decline from its current level of 25% to 15-16% by the second quarter of the next century. Even so, smoking will remain the nation's leading cause of premature death.

Effects of radon mitigation vs smoking cessation in reducing radon-related risk of lung cancer

OBJECTIVES

The purpose of this paper is to provide smokers with information on the relative benefits of mitigating radon and quitting smoking in reducing radon-related lung cancer risk.

METHODS

The standard radon risk model, linked with models characterizing residential radon exposure and patterns of moving to new homes, was used to estimate the risk reduction produced by remediating high-radon homes, quitting smoking, or both.

RESULTS

Quitting smoking reduces lung cancer risk from radon more than does reduction of radon exposure itself.

CONCLUSIONS

Smokers should understand that, in addition to producing other health benefits, quitting smoking dominates strategies to deal with the problem posed by radon.

The relationship between physician behaviors and blood gas values in the first hours of life--implications for "standards" of medical care for infants with respiratory distress

It is standard practice for physicians to use blood gas (BG) evaluations when evaluating neonates with respiratory distress. In this study we addressed two questions: (1) What is the distribution of BG values in a population of infants receiving BG evaluation in the first 4 hours of life; and (2) How does the behavior of physicians correlate with BG values in these infants? We discuss the implications of our findings for claims about "standards" of medical care for newborn infants with respiratory distress. We reviewed medical records for 226 infants with birthweight > 2000 grams who were not intubated at the time of first BG determination. For 199 arterial samples, mean values were pH = 7.31 +/- 0.9 (SD); PaCO2 = 38.5 +/- 11.9 torr; PaO2 = 104 +/- 52 torr; and base excess (BE) = -6.5 +/- 3.8 mEq/L. These values did not differ significantly from previously published data for normal term infants without respiratory distress. However, the a/A ratio (0.45 +/- 0.19) for patients in our distressed population was significantly lower than reported for normal infants (0.65 +/- 0.10). For 186 infants admitted directly to our Newborn Intensive Care Unit, the elapsed time from birth to BG 1 was 1.07 +/- 0.64 hours. This value did not vary significantly as a function of severity of illness, assessed by pH, PaCO2, PaO2, a/A ratio, or BE. No blood gas parameter was simultaneously sensitive and specific for predicting subsequent mechanical ventilation. PaCo2 1 > 80 torr was associated with subsequent mechanical ventilation in 4 of 4 infants; however, the positive predictive value of PaCO2 1 was < 50% for levels below 80 torr, and only 4 of 22 infants eventually intubated were identified by a value of PaCO2 1 > 80 torr. The power of "abnormal" values of PaO2, a/A ratio, pH, or BE to predict subsequent intubation was even lower than PaCO2. Jurors in medical malpractice cases are instructed to define negligence as a deviation from the "skill and care ordinarily used in similar cases," and to determine the existence or absence of negligence guided by the testimony of "expert" witnesses. Recognizing that anecdotal recall of experience, even by "experts," may be inaccurate and is often systematically biased (the "Monday morning quarterback" phenomenon), we propose that the testimony of expert witnesses ought to conform, whenever possible, to a data-based description of medical care that actually is "ordinary used in similar circumstances". Our current observations suggest that (1) expert opinions of the "standard" to evaluate neonatal respiratory distress with a BG sample should reflect that the time scale is 1 to 2 hours, not 10 to 20 minutes; and (2) expert opinions that "abnormal" BG values either "require" or "preclude" intubation for most newborn infants with respiratory distress find little support in data. Clinical observation, not BG values, appears to be the most powerful "standard" by which physicians determine whether to initiate mechanical ventilation for newborn infants with respiratory distress.

Toward a more realistic appraisal of the lung cancer risk from radon: the effects of residential mobility

OBJECTIVES

A consideration of the effects of residential mobility produces much more realistic estimates of typical individuals' radon exposures and mortality risks than those of the Environmental Protection Agency (EPA).

METHODS

A model linking residential mobility, the distribution of radon in US homes, and lung cancer risk is used to simulate lifetime radon exposure, with and without mitigation of high-radon homes, for typical mobile individuals. Radon-related lung cancer mortality risks are then estimated for smokers and never-smokers.

RESULTS

Most individuals residing in high-radon homes have equivalent lifelong radon exposures well below those they are currently experiencing. Consequently, actual lung cancer risks are generally well below those implied in the EPA's radon risk charts. For most people who mitigate high-radon homes, risk reduction is modest.

CONCLUSIONS

Radon may indeed be responsible for as large a population risk of lung cancer as the EPA estimates. However, caution must be used in interpreting the EPA's risk assessment for individuals; in many cases, mitigation will have little effect on residents' health risks.

Can and should level II nurseries care for newborns who require mechanical ventilation?

Perinatal regionalization was conceived roughly 25 years ago to provide centralized care for critically ill newborn infants. As for many 25-year-old concepts, the obligatory centripetal design of many regionalization policies may need to be modified. This article presents the outcomes of 408 surviving patients who required mechanical ventilation (136 born in one community hospital and 272 birthweight-matched infants born in our tertiary center), and were cared for in our perinatal network. Mechanical ventilation of a resident population of newborns at a community NICU appeared to be as effective as ventilatory care at a regionalized tertiary neonatal intensive care unit, when assessed by comparing birthweight-matched populations for length of hospital stay, days on ventilator, and the need for home O2. Some may still claim that every baby who requires mechanical ventilation must be transferred to a tertiary care center. In an era of heightened interest in health services, health outcomes, and cost-effectiveness analysis, however, the authors believe that such claims will be subjected to increasing scrutiny. Our study represents a first attempt at determining the shape such scrutiny might take, and the sort of data analyses that may be required to reformat a perinatal network.

Effects of residential mobility on individual versus population risk of radon-related lung cancer

The U.S. Environment Protection Agency (EPA) does not consider the effects of normal patterns of residential mobility in estimating individual radon-related lung cancer risks. As a consequence, the EPA's population risk estimates may have little bearing on individual risks, and remediation of high-radon homes may have only small health benefits for the individual who remediate their homes. Through a stimulation analysis, we examine the effects of residential mobility on random exposure and lung cancer risk. Given normal mobility, only 7% of eventual radon-related mortality among current 30 year old will occur in the 5% currently living in homes above pCi/l (the EPA's action level for remediation) in contrast with you estimate of 31% of deaths when mobility's ignored. About 10 pCi/l the no-mobility assumption implies 10.3% of deaths, compared to only 0.4% when mobility taken into account. We conclude that knowledge of one's current random exposure not necessarily a useful guide to one's risk, especially for residents of the high-radon homes targeted for remediation by the EPA. The risk of such individuals is like to be substantially lower than that implied in the EPA's risk charts. If people currently living in high radon homes remediate their houses, the majority of the resulting health benefits will accrue to future occupants of their homes.

Ought 'standard care' be the 'standard of care'? A study of the time to administration of antibiotics in children with meningitis

OBJECTIVE

To determine the time from triage in an emergency department until administration of parenteral antibiotics in children with bacterial meningitis.

RESEARCH DESIGN

Retrospective review of medical records and survey of medical subspecialists in infectious diseases and emergency medicine.

SETTING

Emergency departments of two university-affiliated pediatric hospitals.

PARTICIPANTS

All children with bacterial meningitis identified in medical records from 1987 to 1989 (N = 93).

MEASUREMENTS

For each child, the time from presentation to the emergency department until administration of antibiotics (AB time) was determined; when possible, time from triage to contact with a physician, from triage to lumbar puncture, and from lumbar puncture to administration of antibiotics was measured. We then surveyed specialists in both pediatric infectious diseases (n = 23) and pediatric emergency medicine (n = 54) as to their beliefs about AB time in children with meningitis.

STATISTICAL ANALYSES

Mann-Whitney Rank Sum Test and Kruskal-Wallis Test.

RESULTS

Median AB time was 2.0 hours (interquartile range, 1.25 to 3.33 hours). Only one (1%) of 93 children received antibiotics within 30 minutes of presentation. Median time from triage until contact with a physician was 0.45 hour. Median time from lumbar puncture until antibiotics administration was about 0.5 hour. The estimates of median AB time differed significantly between emergency medicine (0.93 hour) and infectious disease (1.45 hours) experts, and estimates from both differed significantly from the median AB time (2.0 hours) actually observed.

CONCLUSIONS

These data reveal that the usual and customary practice (ie, standard medical care) by qualified physicians may differ from opinions of standard medical care promulgated by medical experts. Even among experts there is a wide range of (mistaken) opinions about standard medical care. Insofar as jurors in medical malpractice cases are instructed to consider what physicians "ordinarily do in similar circumstances," a data-based definition of "standard" medical care should supplant anecdotal testimony by individual expert witnesses.

What is the legal 'standard of medical care' when there is no standard medical care? A survey of the use of home apnea monitoring by neonatology fellowship training programs in the United States

In treating a patient, a doctor is obliged to use the skill and care that is ordinarily used by reasonably well-qualified doctors in similar cases. In addition, the only way in which a juror may decide whether the defendant used the skill and care which the law required of him or her is from evidence presented by doctors called as expert witnesses (cf Illinois Pattern Jury Instructions). However, what should be done if expert opinions differ concerning the care that is "ordinarily used"? Home apnea monitoring (HAM) is prescribed at times for graduates of neonatal intensive care units despite the fact that indications for its use are not well established and efficacy is completely unknown. The authors attempted to determine standards for HAM as it is currently practiced in neonatology training programs. The primary teaching hospital for each of the 99 neonatology training programs in the United States was identified. Both the medical director (MD) and a neonatal intensive care unit nurse manager (RN) were asked about the use of HAM in their own nursery for four clinical vignettes. Each vignette depicted a 1000-g birth weight infant, currently 7 weeks old and ready for discharge. In three vignettes, the infant had demonstrated no apnea, mild apnea (resolved by 2 weeks of age), or moderate apnea (requiring theophylline therapy at discharge) during the hospital course. In the fourth vignette, the infant had no apnea but was to be discharged home with supplemental oxygen. For 67 of 99 training programs, paired responses of RN managers and MD directors were obtained.(ABSTRACT TRUNCATED AT 250 WORDS)

College Students' Image of Nursing as a Career Choice

This article reports a study of the image of nursing among college students. It has been inferred that the poor image of nursing has a negative impact on recruitment into the profession. A convenience survey of two groups of college students was instituted to determine the image of nursing in relation to an ideal career, and to discover if any factors make the choice of nursing as a career more likely. The responses of 163 nonnursing students were compared to those of 93 nursing students. These findings indicate that the image of nursing as a career choice among nonnursing college students correlated with their ideal career at r = .4072. As expected, nursing students correlated nursing with their ideal career more positively (r = .5941) than the nonnursing students. Implications for nursing and suggestions for further study are included.