Strategies for evaluating the sanitary quality of composting.

AIMS: To evaluate different strategies for description of the sanitary quality of industrial-scale composting. METHODS AND RESULTS: The investigation included microbiological analyses of waste at different stages during the process (spot test analysis), as well as physical and chemical parameters. The elimination of indicator organisms was also investigated by means of direct process evaluation, based on inoculation of the waste. At the four investigated facilities, the sanitary process was very efficient when evaluated by the direct process evaluation, indicated by an efficient elimination of Escherichia coli and Enterococcus faecalis inoculated into the waste. The sanitization was poor when evaluated by spot test analysis at the two windrow facilities, while good agreement was found at the two in-vessel facilities. CONCLUSIONS: The direct process evaluation is a valuable tool for identifying parameters for process optimization in different zones and for measuring elimination patterns of pathogens not normally present in the waste, but it is unreliable for evaluating the overall sanitary process. SIGNIFICANCE AND IMPACT OF THE STUDY: The spot test analysis is an accurate method for the analysis of the sanitary process. In addition, it is simple and inexpensive to perform, which makes it very cost-effective for supervision of the sanitary quality of industrial-scale composting.

Tibiotalar joint arthrodesis for the treatment of severe ankle joint degeneration secondary to rheumatoid arthritis.

The technical aspects of fusion of the rheumatoid ankle do not deviate from those in the post-traumatic or osteoarthritic ankle. Screw fixation can usually be achieved, and rarely is fixation failure a problem in rheumatoid ankle arthrodesis. If fixation is difficult because of deformity or bone quality, external fixation or locking intramedullary nails should be used. The placement of cannulated screws and adequacy of screw fixation has not been a problem (Fig. 13). Screw fixation provides compression and prevents rotation. The surgeon, however, needs to be assured that no screws invade the subtalar joint and that all threads are beyond the arthrodesis site. A washer may be necessary for further stability if this screw is not inserted at too great an angle. The authors have found that troughing out of the cortical surface of the tibia with a power bur aids in screw insertion. Not only does the trough act as a countersink, but it also provides a path for screw insertion and prevents palpable screw irritation. Malalignment is unforgiving. The foot must be placed neutral to dorsiflexion and plantarflexion. Equinus positioning places added stress on the tibia and a back-knee gait occurs. Approximately 5 degrees of valgus is recommended, and varus positioning is unforgiving. Internal and external rotation is determined by the position of the contralateral extremity. Nonunion does not seem to be a problem with rigid internal fixation to any greater degree in patients with RA. Despite this, patients may continue to have pain despite solid fusion, which can be caused by incomplete correction of deformity, painful internal fixation, or adjacent joint pathology. Additionally, patients may experience supramalleolar pain above the fusion site consistent with tibial stress fracture, which is more common if the subtalar or midtarsal joint is rigid or if the patient is obese. A rocker sole shoe with impact-absorbing soles used after brief periods of guarded mobilization in a removable walking cast alleviates this stress on the tibia. Neurovascular insult can be avoided with careful dissection direct to bone, incisions placed in nerve-free zones, and avoidance of plunging deep posteriorly-medially and anteriorly when dissecting and resecting surfaces. Arthrodesis of the tibiotalar joint in the patient with RA should be performed to relieve severe pain caused by advanced arthrosis. Achieving a solid arthrodesis does not seem to be a problem and provides the patient with pain relief; however, marked improvement in patient function and level of activity remains limited by the nature of RA and adjacent joint involvement.

Screening mammography: the Mount Sinai BreastCheck experience.

Early detection can result in a decrease in the death rate from breast cancer. Screening mammography is the most important modality available to discover early so-called "minimal" cancer. In an effort to make screening mammography more available to the women of north central Connecticut, Mount Sinai Hospital, a community based, university-affiliated hospital initiated a screening program five years ago. During the four-year interval on which we are reporting, we have screened almost 15,000 women using a mobile van. Seventy-seven cancers were discovered in this screened population, with a detection rate of five cancers per 1,000. Our biopsy rate was 1.5% with a positive predictive value of 34%. Sixty-one percent of the tumors discovered were so-called "minimal" cancers and only 12 of the 77 patients had positive lymph nodes.

S-alleles are retained and expressed in a self-compatible cultivar of Petunia hybrida.

We identified two S-allele-associated proteins (S-proteins) in a self-compatible cultivar of Petunia hybrida based on their segregation in F1 hybrids between P. hybrida and its self-incompatible relative, Petunia inflata (with S2S2 genotype), and in selfed progeny of P. hybrida. These two S-proteins, designated Sx-protein (24 kDa) and So-protein (31 kDa), are pistil specific, and their expression follows a temporal and spatial pattern similar to that of S-proteins characterized in self-incompatible solanaceous species. Their amino-terminal sequences also share a high degree of similarity with those of solanaceous S-proteins. Selfing of P. hybrida yielded plants with SoSo,SxSo, and SxSx genotypes in an approximately 1:2:1 ratio, indicating that the Sx-and So-alleles, though expressed in the pistil, failed to elicit a self-incompatibility response. The S2-allele of P. inflata is expressed in all the F1 hybrids, rendering them capable of rejecting pollen bearing the S2-allele. The So-allele is not functional in the F1 hybrids, because all the F1 progeny with S2So genotype are self-compatible. However, in F1 hybrids with S2Sx genotype, approximately half are self-incompatible and half are self-compatible, indicating that the function of the Sx-allele depends on the genetic background. These results strongly suggest that the presence of functional S-alleles alone is not sufficient for expression of a self-incompatibility phenotype, and reaffirm the multigenic nature of gametophytic self-incompatibility suggested by earlier genetic studies.

Improved lung preservation using a dimethylthiourea flush.

The purpose of this study was to evaluate the ability of dimethylthiourea (DMTU), a low molecular weight hydroxyl free radical scavenger, to improve preservation of the lung for transplantation. Following preservation, 15 isolated canine left lower lobes were reperfused for 90 min with autologous blood. Five group I lobes served as controls and were not subjected to ischemia prior to reperfusion. Five group II lobes were flushed and submerged in a cold Euro-Collins solution and stored for 4 hr at 4 degrees C prior to reperfusion. Group III lobes were flushed with a 20 mM DMTU-enhanced Euro-Collins solution, stored for 4 hr, and then reperfused. The isogravimetric method was utilized to determine the capillary permeability coefficient (Kfc) for the reperfused lobes. The Kfc values were 0.10 +/- 0.01, 0.17 +/- 0.01, and 0.10 +/- 0.008 ml/min/mm Hg/100 g lung for groups I, II, and III, respectively (P less than 0.01 II vs I, III). Extravascular lung water values in the reperfused lobe were 4.44 +/- 0.45, 6.57 +/- 0.38, and 5.23 +/- 0.22 ml/g blood free dry lung weight for groups I, II, and III (P less than .05, II vs. I, III). Lung lipid peroxidation, measured as thiobarbituric acid-reactive material, was higher in group II, 146 +/- 6 nmole/g, than in either group I, 90 +/- 5 nmole/g, or group III, 91 +/- 4 nmole/g (P less than 0.01). The results indicate that the addition of DMTU improves hypothermic lung preservation by reducing lipid peroxidation and edema formation upon reperfusion.

Mobile mammography: the first six-months experience at Mount Sinai Hospital.

Mount Sinai Hospital's Mobile Mammography Program, BreastCheck, is designed to screen large numbers of women for breast cancer in the greater Hartford area. Despite the American Cancer Society recommendations for screening mammography, many physicians still are not complying with these guidelines. This report details our first six-months experience. Two thousand two hundred thirty women were screened, 38 women had biopsies, and 14 cancers were detected. The overall rate of breast cancer detection is 6.3/1,000 which compares favorably with the rates from the National Breast Cancer Demonstration Detection Project (BCDDP) of 4.6/1,000.

Reperfusion injury in the lung preserved for 24 hours.

The left lower lobes of 28 canine lungs were isolated, preserved, and then reperfused for 150 minutes. Five groups of lobes were studied: group 1, control (n = 5); group 2, one hour of warm ischemia (n = 5); group 3, one hour of warm ischemia + oxygen free radical scavengers (n = 5); group 4, 24 hours of cold ischemia (n = 8); and group 5, 24 hours of cold ischemia + oxygen free radical scavengers (n = 5). Oxygen free radical scavengers consisted of superoxide dismutase and catalase (100 micrograms/mL) given at the moment of reflow. Extravascular lung water (grams per gram of blood-free dry lobe weight) after reperfusion was 2.75 +/- 0.19, 5.46 +/- 0.60, 4.08 +/- 0.37, 9.43 +/- 0.98, and 6.91 +/- 0.95 for groups 1 through 5, respectively (p less than 0.05, groups 2 through 5 versus group 1; p less than 0.05, group 2 versus group 3 and group 4 versus group 5). Lung tissue lipid peroxidation, measured as thiobarbituric acid reactive material, was 117 +/- 14, 314 +/- 19, and 163 +/- 25 nmol/g dry lobe weight for groups 1, 4, and 5, respectively (p less than 0.05, group 4 versus group 1 and group 4 versus group 5). The data suggest that oxygen free radical scavengers attenuate reperfusion injury after long-term hypothermic lung preservation.