Outcomes of Patients with COPD Treated with ICS/LABA Before and After Initiation of Single-Inhaler Triple Therapy with Fluticasone Furoate/Umeclidinium/Vilanterol (FF/UMEC/VI)

INTRODUCTION

Triple therapy (fluticasone furoate/umeclidinium/vilanterol; FF/UMEC/VI) has been shown to improve symptoms and reduce exacerbations in patients with chronic obstructive pulmonary disease (COPD) and a history of exacerbations. This real-world study compared exacerbation rates and healthcare resource utilization (HCRU) before and after initiation of FF/UMEC/VI in patients with COPD previously treated with inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA).

METHODS

This retrospective cohort study included commercial and Medicare Advantage with Part D administrative claims data from September 01, 2016, to March 31, 2020, of patients diagnosed with COPD. The index date was the date of the first FF/UMEC/VI claim (September 2017-March 2019). The 12 months prior to index (baseline) were used to assess patient characteristics and outcomes; the 12 months following index (follow-up) were used to assess study outcomes. All patients had ≥ 30 consecutive days' supply of any ICS/LABA dual therapy during the 12 months prior to FF/UMEC/VI initiation. Subgroup analyses included patients with ≥ 30 consecutive days' supply of budesonide/formoterol (BUD/FORM) during baseline. Analyses of patients with ≥ 1 COPD exacerbation during baseline were reported as well.

RESULTS

The overall population included 1449 patients (mean age 70.75 years; 54.18% female), of whom 540 were patients in the BUD/FORM subgroup. Significantly fewer patients experienced any exacerbation during follow-up versus baseline (overall population 53.49% vs 62.59%; p < 0.001; BUD/FORM subgroup 55.00% vs 62.41%; p = 0.004). Effects on exacerbation reduction were more pronounced among patients with ≥ 1 exacerbation during baseline. Lower COPD-related HCRU was observed during the follow-up compared with baseline for both the overall population and the BUD/FORM subgroup.

CONCLUSION

Patients with COPD treated with ICS/LABA during baseline, including patients specifically treated with BUD/FORM and those with a history of ≥ 1 exacerbation, had fewer COPD exacerbations and lower COPD-related HCRU after initiating FF/UMEC/VI.

Outcomes Following Initiation of Triple Therapy with Fluticasone Furoate/Umeclidinium/Vilanterol versus Multiple-Inhaler Triple Therapy Among Medicare Advantage with Part D Beneficiaries and Those Commercially Enrolled for Health Care Insurance in the United States

Purpose

Patients with chronic obstructive pulmonary disease (COPD) have been shown to benefit from triple therapy commonly delivered by multiple-inhaler triple therapy (MITT); however, the complexity of MITT regimens may decrease patient adherence. Fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI), a once-daily single-inhaler triple therapy (SITT), became available in the United States (US) in 2017, but real-world data comparing outcomes for SITT versus MITT are currently limited. This study compared outcomes among patients with COPD initiating MITT versus SITT with FF/UMEC/VI who were either Medicare Advantage with Part D (MAPD) beneficiaries or commercial enrollees in the US.

Methods

Retrospective study using administrative claims data from the Optum Research Database for patients with COPD who initiated FF/UMEC/VI or MITT between September 1, 2017, and March 31, 2019 (index date: first pharmacy claim for FF/UMEC/VI cohort; earliest day of ≥30 consecutive days-long period of overlap in the day's supply of all triple therapy components for MITT cohort). COPD exacerbations, adherence to triple therapy, and all-cause and COPD-related health care resource utilization (HCRU) and costs were compared between FF/UMEC/VI and MITT initiators.

Results

In total, 4659 FF/UMEC/VI initiators and 9845 MITT initiators for the MAPD population, and 821 FF/UMEC/VI initiators and 1893 MITT initiators for the commercial population were included in the study. MAPD beneficiaries initiating FF/UMEC/VI had a significantly lower annual rate of severe exacerbations compared to MITT initiators (0.26 vs 0.29; p=0.014). They also had a significantly higher mean adherence (proportion of days covered) (0.51 vs 0.37; p<0.001) and significantly lower all-cause and COPD-related inpatient stays compared to MITT initiators ([32.02% vs 34.27%; p=0.017], [16.09% vs 17.72%; p=0.037]). Trends were similar among the commercial population, but the results were not statistically significant.

Conclusion

FF/UMEC/VI initiators had significantly fewer severe exacerbations, higher triple therapy adherence, and lower HCRU costs compared to MITT initiators for MAPD beneficiaries.

Evaluating the relationship of in utero nicotine exposure with hypoglycemia after delivery: An observational study

BACKGROUND

Hypoglycemia in neonates is common and contributes to 4.0-5.8% of neonatal intensive care unit (NICU) admissions. In utero nicotine exposure is underexplored as a potential contributor to neonatal hypoglycemia. Rat models have shown that in utero nicotine exposure can be associated with a reduction in pancreatic beta cell mass, leading to glucose dysregulation. The primary aim of this work is to study the risk of developing hypoglycemia after birth in a population of in utero nicotine-exposed neonates.

METHODS

We conducted a retrospective matched cohort study that augmented an existing dataset of neonates admitted to a level IV NICU with household-based in utero nicotine exposure (N = 335). Neonates in the control group parents denied household smoking (N = 325), were born within a 6-month timeframe, and were within a birthweight of 50 grams of a nicotine-exposed neonate. Data reviewed included gestational age, growth parameters, maternal history of diabetes, and glucose levels within the first three hours of life per unit protocol.

RESULTS

660 neonates were included in the analysis. In utero nicotine exposure demonstrated a 94.3% posterior probability (PP) for greater hypoglycemia risk (RR = 1.185, 95% CrI = [0.953, 1.445]). A 94.6% PP was demonstrated when neonates who were small for gestational age, intrauterine growth-restricted, and born to diabetic mothers were excluded (n = 482; RR = 1.271, 95% CrI = [0.946, 1.669]).

CONCLUSION

Nicotine exposure in utero was found to be a potential risk factor for developing hypoglycemia after birth. Mechanisms of action should be explored, and additional research on in utero nicotine exposure risks should follow.

Palbociclib Adherence and Persistence in Patients with Hormone Receptor Positive/Human Epidermal Growth Factor Receptor 2 Negative (HR+/HER2-) Metastatic Breast Cancer

Purpose

To assess adherence and persistence with palbociclib therapy in patients with HR+/HER2- metastatic breast cancer (mBC) in a US real-world setting.

Methods

This retrospective study evaluated palbociclib dosing, adherence, and persistence using commercial and Medicare Advantage with Part D claims data from the Optum Research Database. Adult patients with mBC who had continuous enrollment 12 months prior to mBC diagnosis and initiated first-line palbociclib with aromatase inhibitor (AI) or fulvestrant between 02/03/2015 and 12/31/2019 were included. Demographic and clinical characteristics, palbociclib dosing and dose changes, adherence (medication possession ratio [MPR]), and persistence were measured. Adjusted logistic and Cox regression models were used to examine demographic and clinical factors associated with adherence and discontinuation.

Results

Patients (n = 1066) with a mean age of 66 years were included; 76.1% received first-line palbociclib+AI and 23.9% palbociclib+fulvestrant. Most patients (85.7%) initiated palbociclib at 125 mg/day. Of the 34.0% of patients with a dose reduction, 82.6% reduced from 125 to 100 mg/day. Overall, 80.0% of patients were adherent (MPR), and 38.3% discontinued palbociclib during a mean (SD) follow-up of 16.0 (11.2) and 17.4 (13.4) months, for palbociclib+fulvestrant and palbociclib+AI, respectively. Annual income below $75,000 was significantly associated with poor adherence. Older age (age 65-74 years (hazard ratio [HR] 1.57, 95% CI, 1.06, 2.33), age ≥75 years (HR 1.61, 95% CI: 1.08, 2.41)) and bone-only metastatic disease (HR 1.37, 95% CI, 1.06, 1.76) were significantly associated with palbociclib discontinuation.

Conclusion

In this real-world study, >85% of patients started palbociclib at 125 mg/day and 1 in 3 had dose reductions during the follow-up. Patients were generally adherent and persistent with palbociclib. Older age, bone-only disease, and low-income levels were associated with early discontinuation or non-adherence. Further studies are needed to understand the associations of clinical and economic outcomes with palbociclib adherence and persistence.

Transformation and release of micronized Cu used as a wood preservative in treated wood in wetland soil

Micronized Cu (μ-Cu) is used as a wood preservative, replacing toxic chromated copper arsenate (CCA). Micronized Cu is malachite [Cu₂CO₃(OH)₂] that has been milled to micron/submicron particles, with many particle diameters less than 100 nm, mixed with biocides and then used to treat wood. In addition to concerns about the fate of the Cu from μ-Cu, there is interest in the fate of the nano-Cu (n-Cu) constituents. We examined movement of Cu from μ-Cu-treated wood after placing treated-wood stakes into model wetland ecosystems. Release of Cu into surface and subsurface water was monitored. Surface water Cu reached maximum levels 3 days after stake installation and remained elevated if the systems remained inundated. Subsurface water Cu levels were 10% of surface water levels at day 3 and increased gradually thereafter. Sequential filtering indicated that a large portion of the Cu in solution was associating with soluble organics, but there was no evidence for n-Cu in solution. After 4 months, Cu in thin-sections of treated wood and adjacent soil were characterized with micro X-ray absorption fine structure spectroscopy (μ-XAFS). Localization and speciation of Cu in the wood and adjacent soil using μ-XAFS clearly indicated that Cu concentrations decreased over time in the treated wood and increased in the adjacent soil. However, n-Cu from the treated wood was not found in the adjacent soil or plant roots. The results of this study indicate that Cu in the μ-Cu-treated wood dissolves and migrates into adjacent soil and waters primarily in ionic form (i.e., Cu²⁺) and not as nano-sized Cu particles. A reduced form of Cu (Cu₂S) was identified in deep soil proximal to the treated wood, indicating strong reducing conditions. The formation of the insoluble Cu₂S effectively removes some portion of dissolved Cu from solution, reducing movement of Cu²⁺ to the water column and diminishing exposure.

Medium matters: modeling the impact of solid medium performance on tuberculosis trial sample size requirements

SETTING

Two-month solid medium culture conversion is a commonly used, if suboptimal, endpoint for phase 2 anti-tuberculosis treatment trials.

OBJECTIVE AND DESIGN

To model the effect of the performance characteristics (sensitivity and contamination rate) of solid medium on required sample size for a two-arm clinical trial with 85% true (gold standard) culture conversion in the control and 95% in the experimental arm.

RESULTS

Increasing sensitivity and decreasing contamination reduced the sample size from 239 subjects/arm (60% sensitivity, 30% contamination) to 138 subjects/arm (95% sensitivity, 1% contamination).

CONCLUSION

Optimizing solid medium has significant potential to reduce sample size and increase the efficiency of tuberculosis clinical trials.

The effects of quantitative fecundity in the haploid stage on reproductive success and diploid fitness in the aquatic peat moss Sphagnum macrophyllum

A major question in evolutionary biology is how mating patterns affect the fitness of offspring. However, in animals and seed plants it is virtually impossible to investigate the effects of specific gamete genotypes. In bryophytes, haploid gametophytes grow via clonal propagation and produce millions of genetically identical gametes throughout a population. The main goal of this research was to test whether gamete identity has an effect on the fitness of their diploid offspring in a population of the aquatic peat moss Sphagnum macrophyllum. We observed a heavily male-biased sex ratio in gametophyte plants (ramets) and in multilocus microsatellite genotypes (genets). There was a steeper relationship between mating success (number of different haploid mates) and fecundity (number of diploid offspring) for male genets compared with female genets. At the sporophyte level, we observed a weak effect of inbreeding on offspring fitness, but no effect of brood size (number of sporophytes per maternal ramet). Instead, the identities of the haploid male and haploid female parents were significant contributors to variance in fitness of sporophyte offspring in the population. Our results suggest that intrasexual gametophyte/gamete competition may play a role in determining mating success in this population.

Leachate water quality of soils amended with different swine manure-based amendments

In the face of the rising level of manure production from concentrated animal feeding operations (CAFOs), management options are being sought that can provide nutrient recycling for plant growth and improved soil conditions with minimal environmental impacts. Alternatives to direct manure application are composting and thermochemical conversion which can destroy pathogens and improve handling and storage. The effect of four forms of swine manure-based soil amendments (raw, compost, hydrochar, and pyrochar) on soil fertility and leachate water quality characteristics of a sandy soil were investigated in soil incubation experiments. All four amendments significantly increased soil carbon, cation exchange capacity and available nutrient contents of the soil. However, hydrochar amended soil leached lower amounts of N, P, and K compared to the other amendments including the control. On the other hand, pyrochar amended soil leached higher concentrations of P and K. Subsequent tests on the hydrochar for K and N adsorption isotherms and surface analysis via XPS suggested that these nutrients were not sorbed directly to the hydrochar surface. Although it is still not clear how these nutrients were retained in the soil amended with hydrochar, it suggests a great potential for hydrochar as an alternative manure management option as the hydrochar can be soil applied while minimizing potential environmental issues from the leaching of high nutrient concentrations to water bodies.

Efficacies of designer biochars in improving biomass and nutrient uptake of winter wheat grown in a hard setting subsoil layer

In the Coastal Plains region of the United States, the hard setting subsoil layer of Norfolk soils results in low water holding capacity and nutrient retention, which often limits root development. In this region, the Norfolk soils are under intensive crop production that further depletes nutrients and reduces organic carbon (C). Incorporation of pyrolyzed organic residues or "biochars" can provide an alternative recalcitrant C source. However, biochar quality and effect can be inconsistent and different biochars react differently in soils. We hypothesized that addition of different designer biochars will have variable effects on biomass and nutrient uptake of winter wheat. The objective of this study was to investigate the effects of designer biochars on biomass productivity and nutrient uptake of winter wheat (Triticum aestivum L.) in a Norfolk's hard setting subsoil layer. Biochars were added to Norfolk's hard setting subsoil layer at the rate of 40 Mg ha(-1). The different sources of biochars were: plant-based (pine chips, PC); animal-based (poultry litter, PL); 50:50 blend (50% PC:50% PL); 80:20 blend (80% PC:20% PL); and hardwood (HW). Aboveground and belowground biomass and nutrient uptake of winter wheat varied significantly (p⩽0.0001) with the different designer biochar applications. The greatest increase in the belowground biomass of winter wheat over the control was from 80:20 blend of PC:PL (81%) followed by HW (76%), PC (59%) and 50:50 blend of PC:PL (9%). However, application of PL resulted in significant reduction of belowground biomass by about 82% when compared to the control plants. The average uptake of P, K, Ca, Mg, Na, Al, Fe, Cu and Zn in both the aboveground and belowground biomass of winter wheat varied remarkably with biochar treatments. Overall, our results showed promising significance for the treatment of a Norfolk's hard setting subsoil layer since designer biochars did improve both aboveground/belowground biomass and nutrient uptake of winter wheat.

Should all patients undergoing treatment with biologic agents be screened annually for latent tuberculosis infection with an interferon gamma release assay?

Systemic biologic therapy has become commonplace for the treatment of a variety of inflammatory dermatologic conditions, particularly psoriasis. Screening for latent tuberculosis infection (LTBI) is recommended prior to initiation of systemic biologic agents, and an interferon gamma release assays (IGRA) is often used as the screening modality. Annual screening for LTBI is also recommended for patients while on systemic biologic therapy, but the literature does not clearly support how often screening should be performed. In addition, serial testing with IGRAs, particularly among low-risk populations without any new tuberculosis (TB) exposures, has proven to be unreliable with frequent reversions and conversions. We propose that in low-incidence TB regions, repeat LTBI screening should only be considered for patients on systemic biologic therapy if any new TB exposures occurred since initial LTBI screening was performed prior to starting biologic therapy. This strategy aims to reduce false-positive LTBI testing that can expose patients to hazardous antibiotics and result in the unnecessary interruption of systemic biologic therapy.

Expanding tuberculosis case notification among marginalized groups in Bangladesh through peer sputum collection

Case notification rates of tuberculosis (TB) in Bangladesh remain poor despite a high burden of disease. Peer sputum collection among underserved populations was implemented to expand case notification and to provide socially empowering roles in society for often excluded members of marginalized populations. Over the 55 months of the evaluation, 32 587 members of key populations were screened for TB, with 1587 smear-positive TB cases detected. Broadening TB services at human immunodeficiency virus drop-in centers using peer sputum collection to target high-risk populations for TB may be an effective way to increase TB case notification among key populations in Bangladesh.

Listeria monocytogenes batch culture growth response to metabolic inhibitors

In certain environments nutrient and energy sources available to microorganisms can be limited. Foodborne pathogens must efficiently adapt in order to be successfully transmitted through the food chain to their hosts. For the intracellular foodborne pathogen Listeria monocytogenes, little is known regarding its response to nutrient/energy-limiting conditions. The alternative stress responsive sigma factor σ(B) has been reported to contribute to survival under specific stresses. Therefore, the effects of several metabolic inhibitors on growth of L. monocytogenes wild-type and a ΔsigB mutant were examined. In the absence of inhibitors, both strains reached stationary phase after 18 h at 23°C and 10 h at 37°C. All of the metabolic inhibitors slowed growth of either strain, with few differences observed among the different inhibitors.

Carbon mineralization in two ultisols amended with different sources and particle sizes of pyrolyzed biochar

Biochar produced during pyrolysis has the potential to enhance soil fertility and reduce greenhouse gas emissions. The influence of biochar properties (e.g., particle size) on both short- and long-term carbon (C) mineralization of biochar remains unclear. There is minimal information on the potential effects of biochar particle sizes on their breakdowns by soil microorganism, so it is unknown if the particle size of biochar influences C mineralization rate and/or stability in soils. In order to evaluate the effect of different sources (BS) and particle sizes (BF) of biochar on C loss and/or stability in soils, an incubation study on C mineralization of different biochar sources and particle sizes was established using two soils (ST): Norfolk soil (fine loamy, kaolinitic, thermic, typic Kandiudults) and Coxville soil (fine loamy kaolinitic, thermic, Paleaquults). In separate incubation vessels, these soils were amended with one of two manure-based biochars (poultry litters, PL; swine solids, SS) or one of two lignocellulosic-based biochars (switchgrass, SG; pine chips, PC) which were processed into two particle sizes (dust, <0.42 mm; pellet, >2 mm). The amount of CO2 evolved varied significantly between soils (p≤0.0001); particle sizes (p≤0.0001) and the interactions of biochar source (p≤0.001) and forms of biochars (p≤0.0001) with soil types. Averaged across soils and sources of biochar, CO2-C evolved from dust-sized biochar (281 mg kg(-1)) was significantly higher than pellet-sized biochar (226 mg kg(-1)). Coxville soils with SS biochar produced the greatest average CO2-C of 428 mg kg(-1) and Norfolk soils with PC had the lowest CO2-C production (93 mg kg(-1)). Measured rates of carbon mineralization also varied with soils and sources of biochar (Norfolk: PL>SS>SG≥PC; Coxville: PC>SG>SS>PL). The average net CO2-C evolved from the Coxville soils (385 mg kg(-1)) was about threefold more than the CO2-C evolved from the Norfolk soils (123 mg kg(-1)). Our results suggest different particle sizes and sources of biochar as well as soil type influence biochar stability.

Length frequency distribution, mortality rate and reproductive biology of kawakawa (Euthynnus affinis-Cantor, 1849) in the coastal waters of Tanzania

This study explored important aspect of the basis for the highly complex population of kawakawa (Euthynnus affinis) within the coastal waters of Tanzania; by investigating length frequency distribution, mortality rate and reproductive characteristics. This information is essential for the sustainable management of the regionally-important recreational and economic E. affinis fishery. Fish were sampled on a monthly basis for two monsoon seasons using a ring net and artisanal fishermen boat. Maximum and minimum total length was 85 and 31 cm, respectively. Nonlinear least square fitting provided a complete set of von Bertalanffy growth estimates: L8 = 89.25 cm total length and K = 0.78. The estimated value of total mortality based on length converted catch curve using these growth parameters is Z = 1.78 year(-1). Natural mortality based on growth parameters and mean environmental temperature (T = 26.9 degrees C) is M = 1.09 year(-1). The estimated annual instantaneous fishing mortality (F = 0.69 year(-1)) was considerably grater than the target (Fopt = 0.43 year(-1)) and limit (Flimit = 0.58 year(-1)) biological reference point indicating that E. affinis is heavily overexploited. Reproductive aspects were assessed whereby female E. affinis was reported to reach maturity earlier than males which is an indication of phenotypic response toward a decline in population. Two peaks was revealed by the use of Gonad-Somatic Index (GSI), however an extended spawning period was noticed in a period between November to February following an increased water temperature. Although, these findings presents a snapshot concerning population structure and reproduction of E. affinis, further studies covering the entire coastal waters of Tanzania are recommended to aid the management and conservation strategies.

Assembly of high-areal-density deuterium-tritium fuel from indirectly driven cryogenic implosions

The National Ignition Facility has been used to compress deuterium-tritium to an average areal density of ~1.0±0.1 g cm(-2), which is 67% of the ignition requirement. These conditions were obtained using 192 laser beams with total energy of 1-1.6 MJ and peak power up to 420 TW to create a hohlraum drive with a shaped power profile, peaking at a soft x-ray radiation temperature of 275-300 eV. This pulse delivered a series of shocks that compressed a capsule containing cryogenic deuterium-tritium to a radius of 25-35 μm. Neutron images of the implosion were used to estimate a fuel density of 500-800 g cm(-3).

Do pre-existing complications affect the failure to rescue quality measures?

BACKGROUND

A project sponsored by the University Health System Consortium has addressed the inaccuracy and high variability across institutions concerning the use of the failure to rescue (FTR) quality indicator defined by the Agency for Healthcare Research and Quality (AHRQ). Results indicated that of the complications identified by the quality indicator, 29.5% were pre-existing upon hospital admission.

OBJECTIVE

The purpose of our study was to investigate the possible bias to FTR measures by including cases of complications that were pre-existing at admission.

METHODS

Hospital discharges between 1 January 1996 and 30 September 2007 were retrospectively gathered from administrative databases. Using definitions outlined by the AHRQ and the National Quality Forum (NQF), FTR rates were calculated. Using present on admission coding, FTR rates were recalculated to differentiate between the rates of pre-existing and that of acquired cases.

RESULTS

Using the AHRQ definition, the overall FTR rate was 11.60%. The FTR rate for patients with pre-existing complications was 8.85%, whereas patients with complications acquired during hospitalisation had an FTR rate of 18.46% (p<0.001). The NQF FTR rate was 9.93%. Pre-existing and acquired FTR rates using the NQF measure were 9.42% and 12.77%, respectively (p<0.001).

CONCLUSIONS

Current definitions of FTR measures meant to identify inhospital complications appear biased by the inclusion of problems at admission. Furthermore, many patients with these complications are excluded from the algorithms. When taking into account the timing of the "complications", these measures can be useful for internal quality control. However, it should be stressed that the usefulness of the measures to compare institutions will be dependent on coding practices of institutions. Validation using chart review may be required.

Interploidal hybridization and mating patterns in the Sphagnum subsecundum complex

Polyploidization is thought to result in instant sympatric speciation, but several cases of hybrid zones between one of the parental species and its polyploid derivative have been documented. Previous work showed that diploid Sphagnum lescurii is an allopolyploid derived from the haploids S. lescurii (maternal progenitor) and S. subsecundum (paternal progenitor). Here, we report the results from analyses of a population where allodiploid and haploid S. lescurii co-occur and produce sporophytes. We tested (i) whether haploids and diploids form hybrid triploid sporophytes; (ii) how hybrid and nonhybrid sporophytes compare in fitness; (iii) whether hybrid sporophytes form viable spores; (iv) the ploidy of any viable gametophyte offspring from hybrid sporophytes; (v) the relative viability of sporelings derived from hybrid and nonhybrid sporophytes; and (vi) if interploidal hybridization results in introgression between the allopolyploid and its haploid progenitor. We found that triploid hybrid sporophytes do occur and are larger than nonhybrid sporophytes, but exhibit very low germination percentages and produce sporelings that develop more slowly than those from nonhybrid sporophytes. All sporophytes attached to haploid gametophytes were triploid and were sired by diploid males, but all sporophytes attached to diploid gametophytes were tetraploid. This asymmetric pattern of interploidal hybridization is related to an absence of haploid male gametophytes in the population. Surprisingly, all sporelings from triploid sporophytes were triploid, yet were genetically variable, suggesting some form of aberrant meiosis that warrants further study. There was limited (but some) evidence of introgression between allodiploid and haploid S. lescurii.

Ciprofloxacin-sensitive and ciprofloxacin-resistant Campylobacter jejuni are equally susceptible to natural orange oil-based antimicrobials

A total of 10 ciprofloxacin-sensitive (ciprofloxacin minimum inhibitory concentration, MIC < 0.5 micro g/ml) and 10 ciprofloxacin-resistant (MIC 16 to 32 micro g/ml) presumptive C. jejuni were further characterized and evaluated for their inhibition by natural orange oil fractions. Partial species identification was performed by using a hippuricase gene-based polymerase chain reaction (PCR) assay. One of the isolates appeared to be atypical and failed to hydrolyze hippurate. Of the ciprofloxacin-resistant C. jejuni isolates tested, six were found to have their quinolone resistance determined by a C --> T mutation in codon 86 of gyrA. Both groups of ciprofloxacin-sensitive and -resistant C. jejuni isolates were most susceptible to cold-pressed terpeneless Valencia orange oil (C4) which yielded inhibition zones from 44.0 +/- 1.4 to 80 +/- 0.0 mm. Less inhibitory responses were recorded for 5-fold concentrated Valencia orange oil (C3) and distilled d-limonene (C7) which exerted similar effects on both ciprofloxacin-sensitive and -resistant C. jejuni isolates. In general, ciprofloxacin-resistant and -sensitive C. jejuni isolates were equally susceptible to the respective orange oil fractions.

Production and characterization of a monoclonal antibody to Campylobacter jejuni

Campylobacter species are a group of spiral-shaped bacteria that can cause disease in humans and animals. We developed a high-affinity monoclonal antibody (MAb) probe that recognizes Campylobacter jejuni cells. Cell suspensions grown under microaerobic conditions at 42 degrees C for 20 h on Bolton agar plates with lysed horse blood were used as live and heat-killed preparations, centrifuged at 8,000 x g for 20 min, and resuspended in carbonate buffer (pH 9.6) for coating on the enzyme-linked immunosorbent assay plates. BALB/c mice were immunized with C. jejuni sonicated cells at 10(7) CFU/ml to generate MAb-producing hybridoma clones. Of about 500 initial hybridoma clones, MAb 33D2, which reacted with C. jejuni and Campylobacter coli, was selected for further evaluation. MAb 33D2 is in the immunoglobulin subclass G2a and had relatively weaker reactivity with the C. coli strains tested. MAb 33D2 did not show any cross-reactions with the nine non-Campylobacter bacteria tested in the enzyme-linked immunosorbent assay and had a stronger affinity for C. jejuni as live versus heat-killed cells. In Western blot assays, MAb 33D2 recognized two major antigens of 62 and 43 kDa in extracts from C. jejuni cells but only one antigen of 62 kDa in extracts from C. coli cells.

A neural networks framework for real-time unfolding of neutron spectroscopic data at JET

A determination of fast ion population parameters such as intensity and kinetic temperature is important for fusion reactors. This becomes more challenging with finer time resolution of the measurements, since the limited data in each time slice cause increasing statistical variations in the data. This paper describes a framework using Bayesian-regularized neural networks (NNs) designed for such a task. The method is applied to the TOFOR 2.5 MeV fusion neutron spectrometer at JET. NN training data are generated by random sampling of variables in neutron spectroscopy models. Ranges and probability distributions of the parameters are chosen to match the experimental data. Results have shown good performance both on synthetic and experimental data. The latter was assessed by statistical considerations and by examining the robustness and time consistency of the results. The regularization of the training algorithm allowed for higher time resolutions than simple forward methods. The fast execution time makes this approach suitable for real-time analysis with a time resolution limit in the microsecond time scale.

Transmission electron microscopy study of Listeria monocytogenes treated with nisin in combination with either grape seed or green tea extract

The objective of this study was to use transmission electron microscopy to investigate the morphological changes that occurred in Listeria monocytogenes cells treated with grape seed extract (GSE), green tea extract (GTE), nisin, and combinations of nisin with either GSE or GTE. The test solutions were prepared with (i) 1% GSE, 1% GTE, 6,400 IU of nisin, and the combination of these dilutions with nisin or with (ii) the pure major phenolic constituents of GSE (0.02% epicatechin plus 0.02% catechin) or GTE (0.02% epicatechin plus 0.02% caffeic acid) and their combinations with 6,400 IU of nisin in tryptic soy broth with 0.6% yeast extract (TSBYE). Test solutions were inoculated with L. monocytogenes at approximately 10(6) CFU/ml and incubated for 3 or 24 h at 37 degrees C. After 3 h of incubation, cells were harvested and evaluated under a transmission electron microscope (JEOL-100 CX) operating at 80 kV (50,000X). Microscopic examination revealed an altered cell membrane and condensed cytoplasm when L. monocytogenes cells were exposed to a combination of nisin with either GSE or GTE or to pure compounds of the major phenolic constituents in combination. After 24 h of incubation at 37 degrees C, the combinations of nisin with GSE and nisin with GTE reduced the L. monocytogenes population to undetectable levels and 3.7 log CFU/ml, respectively. These observations indicate that the combination of nisin with either GSE or GTE had a synergistic effect, and the combinations of nisin with the major phenolic constituents were most likely associated with the L. monocytogenes cell damage during inactivation in TSBYE at 37 degrees C.

Resistance of nutrient-deprived Listeria monocytogenes 10403S and a DeltasigB mutant to chemical stresses in the presence or absence of oxygen

Nutrient-deprived Listeria monocytogenes have increased resistance to processing control measures. Heat-stressed L. monocytogenes cells produce higher counts under anaerobic conditions and SigB reportedly contributes to the survival of environmentally stressed Gram-positive bacteria. In this study, a wild type (wt) strain, L. monocytogenes 10403S, and a DeltasigB mutant, FSLA1-254, were stressed by starvation in phosphate buffered saline coupled with exposure to chemicals with/without oxygen. In the absence of chemicals, the mutant survived starvation almost as well as the wt, suggesting that the starvation survival response (SSR) in L. monocytogenes was SigB-independent. Conversely, in the presence of chemical stresses the SSR results differed depending on the chemical used. In the presence of sodium chloride (SC), both strains were able to express an SSR under aerobic conditions but not under anaerobic conditions. However, in the presence of sodium propionate (SP), the mutant yielded counts that were 2 log CFU/mL lower than the controls and their aerobic counterparts. In the presence of sodium lactate (SL), the mutant yielded counts that were approximately 3 log CFU/mL lower than the wt under anaerobic conditions. Thus, for the chemical stress produced by SC, the SSR appeared to be SigB-independent. The SSR of L. monocytogenes appeared to be SigB-dependent following exposure to SP or SL under anaerobic conditions. Following exposure to sodium diacetate or lauric acid, both strains were unable to express an SSR. No detectable CFUs were observed after 14 to 21 d under either aerobic or anaerobic incubation. Therefore, these 2 chemicals could be used in biocidal formulations against L. monocytogenes cells under aerobic or anaerobic conditions.

Chemistry and long-term decomposition of roots of Douglas-fir grown under elevated atmospheric carbon dioxide and warming conditions

Elevated atmospheric CO(2) concentrations and warming may affect the quality of litters of forest plants and their subsequent decomposition in ecosystems, thereby potentially affecting the global carbon cycle. However, few data on root tissues are available to test this feedback to the atmosphere. In this study, we used fine (diameter < or = 2 mm) and small (2-10 mm) roots of Douglas-fir (Pseudotsuga menziesii (Mirb.) Franco) seedlings that were grown for 4 yr in a 2 x 2 factorial experiment: ambient or elevated (+ 180 ppm) atmospheric CO(2) concentrations, and ambient or elevated (+3.8 degrees C) atmospheric temperature. Exposure to elevated CO(2) significantly increased water-soluble extractives concentration (%WSE), but had little effect on the concentration of N, cellulose, and lignin of roots. Elevated temperature had no effect on substrate quality except for increasing %WSE and decreasing the %lignin content of fine roots. No significant interaction was found between CO(2) and temperature treatments on substrate quality, except for %WSE of the fine roots. Short-term (< or = 9 mo) root decomposition in the field indicated that the roots from the ambient CO(2) and ambient temperature treatment had the slowest rate. However, over a longer period of incubation (9-36 mo) the influence of initial substrate quality on root decomposition diminished. Instead, the location of the field incubation sites exhibited significant control on decomposition. Roots at the warmer, low elevation site decomposed significantly faster than the ones at the cooler, high elevation site. This study indicates that short-term decomposition and long-term responses are not similar. It also suggests that increasing atmospheric CO(2) had little effect on the carbon storage of Douglas-fir old-growth forests of the Pacific Northwest.

Inhibition of Listeria monocytogenes using nisin with grape seed extract on turkey frankfurters stored at 4 and 10 degrees C

Recontamination of cooked ready-to-eat (RTE) chicken and beef products with Listeria monocytogenes has been a major safety concern. Natural antimicrobials in combinations can be an alternative approach for controlling L. monocytogenes. Therefore, the objectives of this study were to evaluate the inhibitory activities against L. monocytogenes of nisin (6,400 IU/ ml), grape seed extract (GSE; 1%), and the combination of nisin and GSE both in tryptic soy broth with 0.6% yeast extract (TSBYE) and on the surface of full-fat turkey frankfurters. TSBYE was incubated at 37 degrees C for 72 h and turkey frankfurters at 4 or 10'C for 28 days. Inocula were 6.7 or 5 log CFU per ml or g for TSBYE or frankfurters, respectively. After 72 h in TSBYE, nisin alone did not show any inhibitory activity against L. monocytogenes. The combination of nisin and GSE gave the greatest inhibitory activity in both TSBYE and on turkey frankfurters with reductions of L. monocytogenes populations to undetectable levels after 15 h and 21 days, respectively. This combination of two natural antimicrobials has the potential to control the growth and recontamination of L. monocytogenes on RTE meat products.

Cervical cancer disparities in South Carolina: an update of early detection, special programs, descriptive epidemiology, and emerging directions

Through careful examination of cervical cancer incidence and mortality rates and current resources available in South Carolina, we have identified research and intervention priorities related to cervical cancer that would best serve the women of this state. Mortality rates due to cervical cancer are largely explained by the lack of early detection among women rarely and never screened and non-adherence to recommended follow-up care of cervical dysplasia; however, other factors less well explained are determinants of observed disparities between AA and EA women. Efforts are underway to implement strategies recommended by the NCI to eliminate cervical cancer disparities through improved efforts to reach out to rarely and never-screened women and prepare health care providers for implementation of HPV vaccines.

Respiratory infection of turkeys with Listeria monocytogenes Scott A

The pathogenesis of L. monocytogenes strain Scott A was studied by challenging day-old male turkey poults by air sac inoculation with tryptose phosphate broth containing 10(0) cfu (control), 10(4), 10(5), and 10(6) cfu (low challenge), or 10(7) and 10(8) cfu (high challenge) of the Scott A (serotype 4b) strain of L. monocytogenes. Mortality at 2 wk postinfection (PI) ranged from 25% for low challenge to 100% for high challenge (P= 0.0001). Gross and histopathological lesions were observed in heart, liver, spleen, lung, and bursa of Fabricius of mortalities at 4 days PI. Listeria monocytogenes challenge resulted in significantly decreased relative weight of the bursa of Fabricius and increased relative weight of the spleen, and L. monocytogenes was isolated by direct plating of liver, pericardium, brain, and both left and right stifle joint synovium (knee) cultures, as well as gall bladder, yolk sac, and cecal tonsil from transfer swabs onto Listeria-selective agar. Isolates were confirmed as positive using Gram stain, biochemical tests, and the Biolog system. High challenge resulted in confirmed L. monocytogenes isolation from 48% of left knee and 59% of right knee cultures. Low challenge resulted in isolation of L. monocytogenes from 11% of both left and right knee cultures. These results suggest that L. monocytogenes Scott A colonization of turkey knee synovial tissue can initiate in day-of-age poults and that L. monocytogenes Scott A can be invasive through air sac infection.

Elevated CO(2) and elevated temperature have no effect on Douglas-fir fine-root dynamics in nitrogen-poor soil

Here, we investigate fine-root production, mortality and standing crop of Douglas-fir (Pseudotsuga menziesii) seedlings exposed to elevated atmospheric CO(2) and elevated air temperature. We hypothesized that these treatments would increase fine-root production, but that mortality would be greater under elevated temperature, leading to a smaller increase in standing crop. Seedlings were grown in outdoor, sun-lit controlled-environment chambers containing native soil. They were exposed in a factorial design to two levels of atmospheric CO(2) and two levels of air temperature. Minirhizotron methods were used to measure fine-root length production, mortality and standing crop every 4 wk for 36 months. Neither elevated atmospheric CO(2) nor elevated air temperature affected fine-root production, mortality, or standing crop. Fine roots appeared to root deeper in the soil profile under elevated CO(2) and elevated temperature. Low soil nitrogen (N) levels apparently limited root responses to the treatments. This suggests that forests on nutrient-poor soils may exhibit limited fine-root responses to elevated atmospheric CO(2) and elevated air temperature.

Does soil CO2 efflux acclimatize to elevated temperature and CO2 during long-term treatment of Douglas-fir seedlings?

We investigated the effects of elevated soil temperature and atmospheric CO2 on soil CO2 efflux (SCE) during the third and fourth years of study. We hypothesized that elevated temperature would stimulate SCE, and elevated CO2 would also stimulate SCE with the stimulation being greater at higher temperatures. The study was conducted in sun-lit controlled-environment chambers using Douglas-fir (Pseudotsuga menziesii) seedlings grown in reconstructed litter-soil systems. We used a randomized design with two soil temperature and two atmospheric CO2 treatments. The SCE was measured every 4 wk for 18 months. Neither elevated temperature nor CO2 stimulated SCE. Elevated CO2 increased the temperature sensitivity of SCE. During the winter, the relationship between SCE and soil moisture was negative but it was positive during the summer. The seasonal patterns in SCE were associated with seasonal changes in photosynthesis and above-ground plant growth. SCE acclimatized in the high-temperature treatment, probably because of a loss of labile soil carbon. Elevated CO2 treatment increased the temperature sensitivity of SCE, probably through an increase in substrate availability.

Fate of Listeria monocytogenes inoculated onto the surface of model Turkey frankfurter pieces treated with zein coatings containing nisin, sodium diacetate, and sodium lactate at 4 degrees C

The antimicrobial effects of zein coatings containing nisin, sodium lactate, and sodium diacetate against Listeria monocytogenes on turkey frankfurters at 4 degrees C were determined. Our objectives were to determine whether zein, nisin, lactate, and diacetate alone or in combination could control the growth of L. monocytogenes on full-fat turkey frankfurters at 4 degrees C and to determine whether lactate or diacetate had any synergistic effect on the activity of nisin. Turkey frankfurter pieces surface inoculated with L. monocytogenes strain V7 were treated with zein-ethanol-glycerol (ZEG), zein-propylene-glycol (ZPR), ethanol-glycerol (EG), propylene glycol (PR), nisin (N), sodium lactate (L), or sodium diacetate (D) alone or in combination. Over 28 days, treatment with N or D alone reduced L. monocytogenes counts on frankfurters by 6.6 or 6.3 log CFU/g, respectively. N-D treatment reduced L. monocytogenes by 6 log CFU/g. The zein solvents EG and PR reduced L. monocytogenes by about 5.6 and 5.2 log CFU/g, respectively, similar to the results obtained with ZEG and ZPR, which suggests that zein powder per se had no antimicrobial activity. After 28 days, ZEG-N-D, ZEG-N-D-L, ZPR-N-D, and ZPR-N-D-L yielded no detectable CFU. L alone was ineffective. No synergies were observed. N and D when used singly and the combinations of N-D, ZEG-N-D, ZEG-N-D-L, ZPR-N-D, ZPR-N-D-L, EG, and PR were effective as inhibitors of the growth of recontaminating L. monocytogenes cells on full-fat turkey frankfurters.

Transmission electron microscopy study of enterohemorrhagic Escherichia coli O157:H7 in apple tissue

We investigated the ability of enterohemorrhagic Escherichia coli O157:H7 to spread in wounded apple tissue by transmission electron microscopy. Red Delicious apples were wounded with an artist knife (7 mm depth) and either inoculated with 10 microl per wound of decimally diluted E. coli O157:H7 or submerged into E. coli O157:H7 suspended in sterile distilled water and then stored at 37 degrees C for 24 h. Transmission electron microscopy showed E. coli O157:H7 formed bacterial aggregates near the apple cell walls, and single cells were in close proximity to the apple cell wall surfaces and to plasma membranes. E. coli O157:H7 presence caused degradation of plasma membranes and release of the cytoplasm contents of the apple cortical cells into the central vacuole. Apple tissue turgor pressure tests showed that the apple cells infected with E. coli O157:H7 isolates were more likely to rupture than the control noninoculated apple cells. E. coli O157:H7 cells grown in apple tissue showed the formation of granules and vesicles within the bacterial cytoplasma and separation of the plasma membranes. Our study shows that E. coli O157:H7 can grow and survive in the apple tissue environment by causing degradation of the apple cellular components.

A multicentre randomised controlled trial of an intervention to improve the accuracy of linear growth measurement

AIMS

To evaluate linear growth assessment and the effect of an intervention on measurement accuracy in primary care practices (PCP) within eight US geographical areas.

METHODS

In this multicentre randomised controlled intervention study, paediatric endocrine nurses as site coordinators (SC) visited 55 randomly assigned PCP to evaluate growth assessment of staff performing linear measurements. SC observed 127 measurers assessing a total of 878 children: 307 (baseline), 282 (3 months), and 289 (6 months). Accuracy was determined by SC re-measuring each child with correct technique and equipment. State of the art equipment and a standardised growth training session were provided to the intervention group (IG) following the baseline visit. SC repeated data collection at all PCP at 3 and 6 months.

RESULTS

There were no baseline differences between IG and CG equipment, technique, or accuracy; only 30% of measurements were accurate (< or =0.5 cm from SC). Post-intervention, significantly more IG measurements were accurate: IG = 55%, CG = 37% at 3 months; IG = 70%, CG = 34% at 6 months. Odds ratio of accuracy for IG versus CG was 2.1 at 3 months and 4.5 at 6 months. At 6 months, mean difference from the SC measurements was 0.5 cm in IG and 1.1 cm in CG.

CONCLUSIONS

In PCP, children are measured inaccurately. Our intervention significantly improved measurement accuracy. Improved accuracy could yield more rapid detection and diagnosis of paediatric growth disorders.

Radiation resistance and virulence of Listeria monocytogenes Scott A following starvation in physiological saline

The influence of starvation on the resistance of Listeria monocytogenes Scott A to electron beam irradiation in 0.85% (wt/vol) NaCl (saline) and in ground pork was investigated. Exponential- or stationary-phase cells (control) were grown at 35 degrees C in tryptic soy broth supplemented with 0.6% yeast extract. Washed cells were starved for 12 days in saline, and virulence of the pathogen was evaluated at 0, 8, and 12 days during starvation. Samples of saline and irradiation-sterilized ground pork, inoculated with control or starved cells, were irradiated at doses ranging from 0.0 to 2.5 kGy. L. monocytogenes survivors were determined by plating diluted samples of saline or pork on tryptic soy agar supplemented with 0.6% yeast extract and counting bacterial colonies following incubation (35 degrees C, 48 h). Virulence of starved cells and control was not significantly different (P > 0.05). Cells exhibited the highest radiation resistance at 8 days of starvation. Irradiation (0.5 kGy) in saline resulted in approximately 7.14, 5.55, and 2.38 log reduction in exponential, stationary, and starved cells, respectively. Irradiation of ground pork at 2.5 kGy reduced controls by approximately 6.0 log, whereas starved cells were reduced by only 3.8 log. Starved cells consistently exhibited higher irradiation D10-values than controls (P < 0.05). D10-values for exponential, stationary, and starved cells were 0.07, 0.09, and 0.21 kGy and 0.35, 0.42, and 0.66 kGy in saline and ground pork, respectively. These results indicate that starvation cross-protects L. monocytogenes Scott A against radiation inactivation and should be considered when determining this pathogen's irradiation D-value.

The role of dietary vitamin E in experimental Listeria monocytogenes infections in turkeys

The current study was designed to determine if dietary vitamin E influenced either the gut clearance or levels of peripheral blood CD4+ and CD8+ T lymphocytes in adult turkeys experimentally infected with Listeria monocytogenes. Turkeys were fed vitamin E (0, 100, or 200 IU) from day of hatch to time of necropsy. After 6 wk on the experimental diet, turkeys were orally inoculated with L. monocytogenes (approximately 10(9) cfu). To monitor infection status, cloacal swabs were taken on selected days post-inoculation (DPI). At necropsy, samples of viscera, including liver, spleen, cecum, duodenum, ileum, and colon were collected and cultured for L. monocytogenes. In experiments 1 and 2, recovery of L. monocytogenes from cloacal swabs, tissues, and intestines from turkeys fed vitamin E was generally lower than that from turkeys fed the control diet, although these differences were not statistically significant. When data from both trials were combined, L. monocytogenes was cultured less frequently from cloacal swabs of the vitamin E-treated group (200 IU) on 2 and 3 DPI, when compared to controls (0 IU, P < 0.01). There were no changes in virulence characteristics of L. monocytogenes cells, as measured by in vitro killing of Ped-2E9 cells, recovered from cloacal swabs or tissues of experimentally infected turkeys fed the control or a vitamin E treatment diet. Flow cytometric analysis indicated that CD4+ and CD8+ peripheral blood T lymphocytes were elevated at 6 and 8 DPI in infected turkeys given 200 IU vitamin E.

Survival differences of Escherichia coli O157:H7 strains in apples of three varieties stored at various temperatures

Differences in survival and growth among five different Escherichia coli O157:H7 strains in three apple varieties were determined at various temperatures. Jonathan, Golden Delicious, and Red Delicious apples were wounded and inoculated with E coli O157:H7 strains C7929 (apple cider isolate), 301C (chicken isolate), 204P (pork isolate), 933 (beef isolate), and 43890 (human isolate) at an initial level of 6 to 7 log CFU/g. The inoculated apples were stored at a constant temperature of 37, 25, 8, or 4 degrees C or at 37 degrees C for 24 h and then at 4 degrees C, and bacterial counts were determined every week for 28 days. By day 28, for Jonathan apples at 25 degrees C, the apple isolate counts were significantly higher than the chicken and human isolate counts. At 4 degrees C for 28 days, the human isolate inoculated into Jonathan, Golden Delicious, and Red Delicious apples was present in significantly smaller numbers than the other strains. The apple isolate survived significantly better at 4 degrees C, yielding the highest number of viable cells. By days 21 and 28, for apples stored at 37 degrees C for the first 24 h and then at 4 degrees C, the counts of viable E. coli O157:H7 apple and human isolates were 6.8 and 5.8 log CFU/g at the site of the wound, whereas for apples kept at 4 degrees C for the duration of storage, the respective counts were 5.6 and 1.5 log CFU/g. Our study shows that E. coli O157:H7 strains responded differentially to their ability to survive in these three apple varieties at 25 or 4 degrees C and produced higher viable counts when apples were temperature abused at 37 degrees C for 24 h and then stored at 4 degrees C for 27 days.

Foliar nitrogen concentrations and natural abundance of (15)N suggest nitrogen allocation patterns of Douglas-fir and mycorrhizal fungi during development in elevated carbon dioxide concentration and temperature

Pseudotsuga menziesii (Mirb.) Franco (Douglas-fir) seedlings were grown in a 2 x 2 factorial design in enclosed mesocosms at ambient temperature or 3.5 degrees C above ambient, and at ambient CO2 concentration ([CO2]) or 179 ppm above ambient. Two additional mesocosms were maintained as open controls. We measured the extent of mycorrhizal infection, foliar nitrogen (N) concentrations on both a weight basis (%N) and area basis (Narea), and foliar delta15N signatures (15N/14N ratios) from summer 1993 through summer 1997. Mycorrhizal fungi had colonized nearly all root tips across all treatments by spring 1994. Elevated [CO2] lowered foliar %N but did not affect N(area), whereas elevated temperature increased both foliar %N and Narea. Foliar delta15N was initially -1 per thousand and dropped by the final harvest to between -4 and -5 per thousand in the enclosed mesocosms, probably because of transfer of isotopically depleted N from mycorrhizal fungi. Based on the similarity in foliar delta15N among treatments, we conclude that mycorrhizal fungi had similar N allocation patterns across CO2 and temperature treatments. We combined isotopic and Narea data for 1993-94 to calculate fluxes of N for second- and third-year needles. Yearly N influxes were higher in second-year needles than in third-year needles (about 160 and 50% of initial leaf N, respectively), indicating greater sink strength in the younger needles. Influxes of N in second-year needles increased in response to elevated temperature, suggesting increased N supply from soil relative to plant N demands. In the elevated temperature treatments, N effluxes from third-year needles were higher in seedlings in elevated [CO2] than in ambient [CO2], probably because of increased N allocation below ground. We conclude that N allocation patterns shifted in response to the elevated temperature and [CO2] treatments in the seedlings but not in their fungal symbionts.

Assessment of quality of life in adolescent patients with orthopaedic problems: are adult measures appropriate?

New pressures of accountability brought on by a rapidly evolving system of health care financing have underscored the need for standardized, valid measures of patient outcome that reflect the effect of clinical intervention on all aspects of quality of life. In response, there has been a burgeoning interest in the area of outcomes assessment and measurement of quality of life after orthopaedic intervention in adults, but less attention has been focused on the assessment of broadly defined outcomes in children. In an effort to borrow from the broader adult experience in this area, the authors sought to examine whether the Medical Outcomes Study Short Form 36 (SF-36) or the EuroQol questionnaire, widely accepted adult health status measures, would be valid in this setting. These two measures were administered to 196 adolescent patients (10-18 years old) seeking orthopaedic evaluation. Tests of scale properties and construct validity show that these properties are maintained in this population, but neither instrument reflected known differences in health status among this cohort. Most importantly, both the SF-36 and the EuroQol exhibited serious ceiling effects (most respondents scored at the top of their scales), despite evidence indicating those patients often had suboptimal health status. Thus, neither the SF-36 nor the EuroQol is valid for use in this population. The assessment of pediatric health status demands outcomes measures specifically designed to reflect the unique needs of this population.

Pharmacokinetics, metabolism, and excretion of linezolid following an oral dose of [(14)C]linezolid to healthy human subjects

Linezolid (Zyvox), the first of a new class of antibiotics, the oxazolidinones, is approved for treatment of Gram-positive bacterial infections, including resistant strains. The disposition of linezolid in human volunteers was determined, after a 500-mg (100-microCi) oral dose of [(14)C]linezolid. Radioactive linezolid was administered as a single dose, or at steady-state on day 4 of a 10-day, 500-mg b.i.d. regimen of unlabeled linezolid (n = 4/sex/regimen). Mean recovery of radioactivity in excreta was 93.8 +/- 1.1% (range 91.2-95.2%, n = 15), of which 83.9 +/- 3.3% (range 76.7-88.4%) was in urine and 9.9 +/- 3.4% (range 5.3-16.9%) was in feces. There was no major difference in rate or route of excretion of radioactivity by dose regimen. Linezolid was excreted primarily intact, and as two inactive, morpholine ring-oxidized metabolites, PNU-142586 and PNU-142300. Other minor metabolites were characterized by high-performance liquid chromatography-atmospheric pressure chemical ionization-mass spectrometry and (19)F NMR spectroscopy. After the single radioactive dose, linezolid was the major circulating drug-related material accounting for about 78% (male) and 93% (female) of the radioactivity area under the curve (AUC). PNU-142586 (T(max) of 3-5 h) accounted for about 26% (male) and 9% (female) of the radioactivity AUC. PNU-142300 (T(max) of 2-3 h) accounted for about 7% (male) and 4% (female) of the radioactivity AUC. Overall, mean linezolid and PNU-142586 exposures at steady-state were similar across sex. In conclusion, linezolid circulates in plasma mainly as parent drug. Linezolid and two major, inactive metabolites account for the major portion of linezolid disposition, with urinary excretion representing the major elimination route. Formation of PNU-142586 was the rate-limiting step in the clearance of linezolid.

Survival and death of Salmonella typhimurium and Campylobacter jejuni in processing water and on chicken skin during poultry scalding and chilling

Salmonella Typhimurium and Campylobacter jejuni were inoculated in scalding water, in chilled water, and on chicken skins to examine the effects of scalding temperature (50, 55, and 60 degrees C) and the chlorine level in chilled water (0, 10, 30, and 50 ppm), associated with the ages of scalding water (0 and 10 h) and chilled water (0 and 8 h), on bacterial survival or death. After scalding at 50 and 60 degrees C, the reductions of C. jejuni were 1.5 and 6.2 log CFU/ml in water and <1 and >2 log CFU/cm2 on chicken skins; the reductions of Salmonella Typhimurium were <0.5 and >5.5 log CFU/ml in water and <0.5 and >2 log CFU/cm2 on skins, respectively. The age of scalding water did not significantly (P > 0.05) affect bacterial heat sensitivity. However, the increase in the age of chilled water significantly (P < 0.05) reduced the chlorine effect. In 0-h chilled water. C. jejuni and Salmonella Typhimurium were reduced by 3.3 and 0.7 log CFU/ml, respectively, after treatment with 10 ppm of chlorine and became nondetectable with 30 and 50 ppm of chlorine. In 8-h chilled water, the reduction of C. jejuni and Salmonella Typhimurium was <0.5 log CFU/ml with 10 ppm of chlorine and ranged from 4 to 5.5 log CFU/ml with 50 ppm of chlorine. Chlorination of chilled water did not effectively reduce the bacteria attached on chicken skins. The D-values of Salmonella Typhimurium and C. jejuni were calculated for the prediction of their survival or death in the poultry scalding and chilling.

Thermal inactivation of Salmonella senftenberg and Listeria innocua in ground chicken breast patties processed in an air convection oven

Ground chicken breast patties were thermally processed in a lab-scale air convection oven at air temperatures of 163, 177, 190, 204, or 218 C to final patty center temperatures of 50, 55, 60, 65, 70, 75, or 80 C. The cooking time increased with increasing product temperature and decreased with increasing oven air temperature. Prior to thermal processing, approximately 7 log10(cfu/g) of Salmonella senftenberg and Listeria innocua were inoculated into the chicken patties. Survival of S. senftenberg and L. innocua decreased with increasing patty temperature. After the patties were processed to a final center temperature of 70 to 80 C, 1 to 4 log10 (cfu/g) of S. senftenberg and 3 to 5 log10(cfu/g) of L. innocua were detected in the cooked patties. A significant difference in the thermal inactivation of S. senftenberg and L. innocua was obtained between the chicken patties cooked in an air convection oven and the patties cooked in a water bath. More surviving S. senftenberg and L. innocua were found in the patties cooked in an air convection oven than in the patties cooked in a water bath.

Expression, purification, and characterization of active recombinant prostate-specific antigen in Pichia pastoris (yeast)

BACKGROUND

Prostate-specific antigen (PSA), a member of the kallikrein family of serine proteases, is a chymotrypsin-like glycoprotein produced by the prostate epithelium. Elevated serum PSA (> 4 ng/ml) is a tumor marker for prostatic cancer and benign prostatic hypertrophy; increasing serum PSA over time is indicative of metastatic disease. It has been suggested that PSA may contribute to tumor metastasis through degradation of extracellular matrix glycoproteins, as well as cleavage of IGF binding protein-3, a modulator of IGF-1. To elucidate the role of PSA in the development and progression of prostatic cancer, it is necessary to have a reliable, cost-effective source of enzymatically active protein. Previous efforts to express recombinant PSA (rPSA) produced inactive proPSA, or mixtures of active and inactive PSA requiring activation by removal of the propeptide. We describe the expression of active recombinant mature PSA in yeast.

METHODS

Stable chromosomal integration of a construct consisting of the yeast alpha-factor signal sequence preceding the mature PSA sequence resulted in secretion of rPSA. The rPSA was purified from the yeast cell culture supernatant to homogeneity by strong cation-exchange chromatography, and characterized by SDS-PAGE, Western analysis, electrospray mass spectrometry, N-glycanase digestion, N-terminal amino acid sequencing, and inactivation by a PSA-specific inhibitor.

RESULTS

We report the production of active, mature rPSA in Pichia pastoris. Two forms of rPSA varying slightly in glycosylation were identified. The specific activity of the rPSA was equal to that of human seminal plasma PSA (0.56 micromol/min mg) as determined using a chromogenic substrate.

CONCLUSIONS

Large-scale production of active rPSA will be useful in the exploration of PSA effects on tumor cell proliferation, migration and metastasis. In addition, a large supply of enzyme should facilitate the discovery of novel inhibitors for in vitro and in vivo evaluation, and may provide a reproducible source of rPSA for use as a standard in diagnostic testing.

Survival and growth of Salmonella and Listeria in the chicken breast patties subjected to time and temperature abuse under varying conditions

Chicken breast patties were inoculated with a mixture of Salmonella Senftenberg, Salmonella Typhimurium, Salmonella Heidelberg, Salmonella Mission, Salmonella Montevideo, Salmonella California, and Listeria innocua. The initial inoculation of bacteria was approximately 10(7) log10 CFU/g. The inoculated patties were processed in a pilot-scale air convection oven at an air temperature of 177 degrees C, an air velocity of 9.9 m3/min, and a low (a wet bulb temperature of 48 degrees C) or high (a wet bulb temperature of 93 degrees C) humidity condition. The patties were processed to a final center temperature of 65 to 75 degrees C. The survivors of Salmonella and Listeria in the processed patties were evaluated. Processing humidity affected the survivors of bacteria. More survivors of Salmonella and Listeria (>2 logs) were obtained for the patties cooked at low humidity than at high humidity. After thermal processing, the patties were stored under air, vacuum, or CO2 at refrigerated (4 degrees C) or thermally abused (8 to 15 degrees C) temperatures. Storage temperature, time, and gas environment affected the bacteria growth. Higher storage temperature and longer storage time correlated to an increased growth of bacteria in the cooked chicken patties. Less Salmonella (2 logs) and Listeria (0.5 to 1 log) cells were obtained in the patties stored under vacuum than in air. Storing the patties in 30% CO2 reduced the growth of Salmonella more than 2 log10 CFU/g. At a CO2 level of 15%, 1 log10 CFU/g of reduction was obtained for Listeria in cooked chicken patties.

Interactive effects of CO2 and O3 on a ponderosa pine plant/litter/soil mesocosm

To study individual and combined impacts of two important atmospheric trace gases, CO2 and O3, on C and N cycling in forest ecosystems; a multi-year experiment using a small-scale ponderosa pine (Pinus ponderosa Laws.) seedling/soil/litter system was initiated in April 1998. The experiment was conducted in outdoor, sun-lit chambers where aboveground and belowground ecological processes could be studied in detail. This paper describes the approach and methodology used, and presents preliminary data for the first two growing seasons. CO2 treatments were ambient and elevated (ambient + 280 ppm). O3 treatments were elevated (hourly averages to 159 ppb, cumulative exposure > 60 ppb O3, SUM 06 approximately 10.37 ppm h), and a low control level (nearly all hourly averages <40 ppb. SUM 06 approximately 0.07 ppm h). Significant (P < 0.05) individual and interactive effects occurred with elevated CO2 and elevated O3. Elevated CO2 increased needle-level net photosynthetic rates over both seasons. Following the first season, the highest photosynthetic rates were for trees which had previously received elevated O3 in addition to elevated CO2. Elevated CO2 increased seedling stem diameters, with the greatest increase at low O3. Elevated CO2 decreased current year needle % N in the summer. For 1-year-old needles measured in the fall there was a decrease in % N with elevated CO2 at low O3, but an increase in % N with elevated CO2 at elevated O3. Nitrogen fixation (measured by acetylene reduction) was low in ponderosa pine litter and there were no significant CO2 or O3 effects. Neither elevated CO2 nor elevated O3 affected standing root biomass or root length density. Elevated O3 decreased the % N in coarse-fine (1-2 mm diameter) but not in fine (< 1 mm diameter) roots. Both elevated CO2 and elevated O3 tended to increase the number of fungal colony forming units (CFUs) in the AC soil horizon, and elevated O3 tended to decrease bacterial CFUs in the C soil horizon. Thus, after two growing seasons we showed interactive effects of O3 and CO2 in combination, in addition to responses to CO2 or O3 alone for a ponderosa pine plant/litter/soil system.

Characterization by molecular cloning and sequencing of the gene encoding an aminopeptidase from Listeria monocytogenes

The pepC gene of Listeria monocytogenes encodes aminopeptidase C that is predicted to share 72% amino acid sequence similarity and 53% sequence identity with the cysteine aminopeptidase PepC from Lactococcus lactis. The gene product also shows strong similarity to aminopeptidase C from Streptococcus thermophilus and Lactobacillus helveticus, and to a cysteine proteinase/bleomycin hydrolase from Saccharomyces cerevisiae. The enzyme from L. monocytogenes displayed broad N-terminal hydrolytic activity, with a similar substrate specificity to its lactic acid bacterial counterpart. The inhibition spectrum shows a great deal of similarity with enzymes from the family of lactic acid bacteria. In addition, one of the clones studied contained DNA sequences that could encode a regulatory protein of the deoR helix-turn-helix DNA binding protein family. The organization of the locus, designated pep, is presented along with the characterization of the gene products of the pep locus.

Pharmacokinetics, metabolism, and excretion of irinotecan (CPT-11) following I.V. infusion of [(14)C]CPT-11 in cancer patients

This study determined the disposition of irinotecan hydrochloride trihydrate (CPT-11) after i.v. infusion of 125 mg/m(2) (100 microCi) [(14)C]CPT-11 in eight patients with solid tumors. Mean +/- S.D. recovery of radioactivity in urine and feces was 95.8 +/- 2.7% (range 92.2-100.3%, n = 7) of dose. Radioactivity in blood, plasma, urine, and feces was determined for at least 168 h after dosing. Fecal excretion accounted for 63.7 +/- 6.8 (range 54.2-74.9%, n = 7) of dose, whereas urinary excretion accounted for 32.1 +/- 6.9% (range 21.7-43.8%; n = 7) of dose. One patient with a biliary T-tube excreted 30.1% of dose in bile, 14.2% in feces, and 48.2% in urine. Quantitative radiometric HPLC revealed that CPT-11 was the major excretion product in urine, bile, and feces. Aminopentane carboxylic acid (APC) and SN-38 glucuronide (SN-38G) were the most significant metabolites in urine and bile, whereas SN-38 and NPC, a primary amine metabolite, were relatively minor excretion products. SN-38 and APC were the most significant metabolites in feces. The relatively higher amount of SN-38 in feces compared with bile is presumably due to hydrolysis of SN-38G to SN-38 by enteric bacterial beta-glucuronidases. There was close correspondence between quantitative fluorescence HPLC and mass balance findings. CPT-11 was the major circulating component in plasma (55% of the mean radiochemical area under the curve), and CPT-11, SN-38, SN-38G, and APC accounted for 93% of the mean radiochemical AUC. These results show that the parent drug and its three major metabolites account for virtually all CPT-11 disposition, with fecal excretion representing the major elimination pathway.

Inactivation of Salmonella and Listeria in ground chicken breast meat during thermal processing

Thermal inactivation of six Salmonella spp. and Listeria innocua was evaluated in ground chicken breast and liquid medium. Survival of Salmonella and Listeria was affected by the medium composition. Under the same thermal process condition, significantly more Salmonella and Listeria survived in chicken breast meat than in 0.1% peptone-agar solution. The thermal lethality of six tested Salmonella spp. was additive in chicken meat. Survival of Listeria in chicken meat during thermal processing was not affected by the presence of the six Salmonella spp. Sample size and shape affected the inactivation of Salmonella and Listeria in chicken meat during thermal processing.

Identification and characterization of two bacteriocin-producing bacteria isolated from garlic and ginger root

Two bacteriocin-producing bacterial strains were isolated from garlic and ginger root by the agar overlay method. The bacteria were identified by 16S rRNA sequence analyses and fermentation patterns as Leuconostoc mesenteroides (garlic isolate) and Lactococcus lactis (ginger isolate). The bacteriocins were assigned the names leucocin BC2 and lactocin GI3, respectively. Physiochemical properties and antimicrobial spectra of the bacteriocins were determined by the spot-on-lawn method. Both bacteriocins were inhibited by proteolytic enzymes. Leucocin BC2 exhibited a narrow antimicrobial spectrum, inhibiting only Bacillus, Enterococcus, and Listeria species. Lactocin GI3 had a broader spectrum, inhibiting Bacillus, Clostridium, Listeria, Enterococcus, Leuconostoc, Pediococcus, and Staphylococcus species. Both bacteriocins remained active when heated at 90 degrees C for 15 min or 120 degrees C for 20 min. Leucocin BC2 assayed at 37 degrees C showed an inhibitory activity of 1,600 AU/ml, whereas at 8 degrees C the activity was 12,800 AU/ml. Conversely, lactocin GI3 activity was the same at both assay temperatures. Both bacteriocins remained active over a pH range of 2.0 to 9.0 and in various organic solvents. The activity of leucocin BC2 was increased when treated with 0.5% acetic acid and 0.5% lactic acid, whereas lactocin GI3 activity was decreased with either acid. The molecular mass values were 3.7 kDa for leucocin BC2 and 3.9 kDa for lactocin GI3. These results show that the inhibitory substances produced by the bacteria isolated from garlic and ginger are bacteriocins that appear to be different in some characteristics from previously reported bacteriocins.