Cleaning and disinfection of transport crates for poultry - comparison of four treatments at slaughter plant.

Transport crates for poultry can contribute to the spread of pathogens, with those of public health interest, for example, Campylobacter, being of particular importance. A strict cleaning procedure and use of an effective disinfection method for transport equipment are thus important to avoid introduction of Campylobacter to chicken and poultry farms, particularly during flock thinning. This study evaluated the efficacy of the disinfection procedure currently in use at one of the largest slaughter plants in Sweden and compared the effects with those of other disinfection methods. The evaluation was based on treatment ability to reduce the presence and amount of indicator bacteria belonging to the family Enterobacteriaceae and total aerobic bacteria. In 4 trials, sodium hypochlorite, peracetic acid, and drying with hot air, with or without sodium hypochlorite for final disinfection, were compared. The analysis was based on 40 cotton swab samples taken in each treatment, 20 after the soaking stage and 20 after the final disinfection step. The results showed that use of a chemical disinfectant in combination with drying with hot air (dehumidifier) was the most effective treatment, with an average reduction of 3.4 log for total aerobic bacteria and 3.8 log for Enterobacteriaceae. Since all crates treated with hot air were dry, transport conditions for the birds also improved, particularly in cold weather. A disadvantage is that this treatment is energy-consuming and would require substantial technical changes to the current cleaning process, increasing operating costs at the slaughter plant. However, considering the contribution of improved crate cleaning to overall hygiene control within the poultry supply chain and the beneficial effect on animal welfare, the costs may be justified.

Accuracy and precision of 3 intraoral scanners and accuracy of conventional impressions: A novel in vivo analysis method.

OBJECTIVE: To evaluate a novel methodology using industrial scanners as a reference, and assess in vivo accuracy of 3 intraoral scanners (IOS) and conventional impressions. Further, to evaluate IOS precision in vivo. METHODS: Four reference-bodies were bonded to the buccal surfaces of upper premolars and incisors in five subjects. After three reference-scans, ATOS Core 80 (ATOS), subjects were scanned three times with three IOS systems: 3M True Definition (3M), CEREC Omnicam (OMNI) and Trios 3 (TRIOS). One conventional impression (IMPR) was taken, 3M Impregum Penta Soft, and poured models were digitized with laboratory scanner 3shape D1000 (D1000). Best-fit alignment of reference-bodies and 3D Compare Analysis was performed. Precision of ATOS and D1000 was assessed for quantitative evaluation and comparison. Accuracy of IOS and IMPR were analyzed using ATOS as reference. Precision of IOS was evaluated through intra-system comparison. RESULTS: Precision of ATOS reference scanner (mean 0.6 µm) and D1000 (mean 0.5 µm) was high. Pairwise multiple comparisons of reference-bodies located in different tooth positions displayed a statistically significant difference of accuracy between two scanner-groups: 3M and TRIOS, over OMNI (p value range 0.0001 to 0.0006). IMPR did not show any statistically significant difference to IOS. However, deviations of IOS and IMPR were within a similar magnitude. No statistical difference was found for IOS precision. CONCLUSION: The methodology can be used for assessing accuracy of IOS and IMPR in vivo in up to five units bilaterally from midline. 3M and TRIOS had a higher accuracy than OMNI. IMPR overlapped both groups. CLINICAL SIGNIFICANCE: Intraoral scanners can be used as a replacement for conventional impressions when restoring up to ten units without extended edentulous spans.

Assessment of gastric emptying using a low fat meal: establishment of international control values.

OBJECTIVE: The diagnosis of gastroparesis implies delayed gastric emptying. The diagnostic gold standard is scintigraphy, but techniques and measured endpoints vary widely among institutions. In this study, a simplified scintigraphic measurement of gastric emptying was compared to conventional gastric scintigraphic techniques and normal gastric emptying values defined in healthy subjects. METHODS: In 123 volunteers (aged 19-73 yr, 60 women and 63 men) from 11 centers, scintigraphy was used to assess gastric emptying of a 99Tc-labeled low fat meal (egg substitute) and percent intragastric residual contents 60, 120, and 240 min after completion of the meal. In 42 subjects, additional measurements were taken every 10 min for 1 h. In 20 subjects, gastric emptying of a 99Tc-labeled liver meal was compared with that of the 99Tc-labeled low fat meal. RESULTS: Median values (95th percentile) for percent gastric retention at 60, 120, and 240 min were 69% (90%), 24% (60%) and 1.2% (10%) respectively. A power exponential model yielded similar emptying curves and estimated T50 when using images only taken at 1, 2 and 4 h, or with imaging taken every 10 min. Gastric emptying was initially more rapid in men but was comparable in men and women at 4 h; it was faster in older subjects (p < 0.05) but was independent of body mass index. CONCLUSIONS: This multicenter study provides gastric emptying values in healthy subjects based on data obtained using a large sample size and consistent meal and methodology. Gastric retention of >10% at 4 h is indicative of delayed emptying, a value comparable to those provided by more intensive scanning approaches. Gastric emptying of a low fat meal is initially faster in men but is comparable in women at 4 h; it is also faster in older individuals but is independent of body mass.

Clinical characteristics of women with a history of childhood abuse: unhealed wounds.

OBJECTIVES: To determine the prevalence of childhood physical or sexual abuse in women seen in primary care practices; to identify physical and psychologic problems associated with that abuse; and to compare the effects of childhood physical vs sexual abuse and childhood vs adult abuse. DESIGN: Cross-sectional, self-administered, anonymous survey. SETTING: Four community-based, primary care internal medicine practices. PATIENTS: A total of 1931 women of varied age and marital, educational, and economic status examined from February through July 1993. MAIN OUTCOME MEASURES: Prevalence of physical and sexual abuse, physical symptoms, psychological symptoms (Symptom Checklist-22), alcohol abuse (CAGE questions), and street drug use. RESULTS: Of the 1931 respondents, 424 (22.0%) reported childhood or adolescent physical or sexual abuse. Compared with women who reported never having experienced abuse (n=1257), women who reported abuse as children but not adults (n=204) had more physical symptoms (mean+/-SE, 6.2+/-0.2 vs 4.0+/-0.9; P<.001) and had higher scores for depression, anxiety, somatization, and interpersonal sensitivity (low self-esteem) (P<.001); were more likely to be abusing drugs (prevalence ratio [PR], 4.7; 95% confidence interval [CI], 2.9-7.6) or to have a history of alcohol abuse (PR, 2.2; 95% CI, 1.5-3.2); were more likely to have attempted suicide (PR, 3.7; 95% CI, 2.6-5.1); and were more likely to have had a psychiatric admission (PR, 3.2; 95% CI, 2.2-4.7). Women abused only as children did not differ from women who reported current, but not childhood, abuse in number of physical symptoms, emotional distress, substance abuse, or suicide attempts. Patients who reported both childhood and adult abuse had higher levels of psychological problems and physical symptoms than those who reported childhood or adult abuse alone. CONCLUSIONS: Childhood physical or sexual abuse is associated with adult health problems including physical symptoms, psychological problems, and substance abuse; for many variables, this association is as strong as for patients experiencing current abuse.

The effect of ventricular activation sequence on cardiac performance during pacing.

The aim of this study was to evaluate the importance of a normal ventricular activation pattern for cardiac performance. In nine mongrel dogs, atrial pacing was compared to AV synchronous pacing at three different AV delays (150, 100, and 60 ms). In six dogs, proximal septal AV synchronous pacing was compared to apical AV synchronous pacing at three different AV delays. AV synchronous pacing was performed after RF induced complete heart block. Hemodynamics were evaluated by assessment of positive and negative dP/dt, cardiac output, and left ventricular and pulmonary pressures. Atrial pacing was superior to AV synchronous pacing with respect to positive and negative dP/dt and cardiac output. This difference was present at all AV delays. Proximal septal pacing was associated with a higher positive and negative dP/dt compared to apical pacing at all AV delays. Left ventricular activation time was significantly shorter during proximal septal pacing than during apical pacing (88 +/- 4 vs 115 +/- 4 ms, P < 0.001). We conclude that atrial and proximal septal pacing improves cardiac function and shortens the ventricular activation time compared to apical AV synchronous pacing independent of the AV interval.

The "battering syndrome": prevalence and clinical characteristics of domestic violence in primary care internal medicine practices.

OBJECTIVES: To determine the prevalence of domestic violence among female patients and to identify clinical characteristics that are associated with current domestic violence. DESIGN: Cross-sectional, self-administered, anonymous survey. SETTING: 4 community-based, primary care internal medicine practices. PATIENTS: 1952 female patients of varied age and marital, educational, and economic status who were seen from February to July 1993. MEASUREMENTS: The survey instrument included previously validated questions on physical and sexual abuse, alcohol abuse, and emotional status and questions on demographic characteristics, physical symptoms, use of street drugs and prescribed medications, and medical and psychiatric history. RESULTS: 108 of the 1952 respondents (5.5%) had experienced domestic violence in the year before presentation. Four hundred eighteen (21.4%) had experienced domestic violence sometime in their adult lives, 429 (22.0%) before age 18 years, and 639 (32.7%) as either an adult or child. Compared with women who had not recently experienced domestic violence, currently abused patients were more likely to be younger than 35 years of age (prevalence ratio [PR], 4.1 [95% CI, 2.8 to 6.0]); were more likely to be single, separated, or divorced (PR, 2.5 [CI, 1.7 to 3.6]); were more likely to be receiving medical assistance or to have no insurance (PR, 4.3 [CI, 2.8 to 6.6]); had more physical symptoms (mean, 7.3 +/- 0.38 compared with 4.6 +/- 0.08; P < 0.001); had higher scores on instruments for depression, anxiety, somatization, and interpersonal sensitivity (low self-esteem) (P < 0.001); were more likely to have a partner abusing drugs or alcohol (PR, 6.3 [CI, 4.4 to 9.2]); were more likely to be abusing drugs (PR, 4.4 [CI, 1.9 to 10.4]) or alcohol (PR, 3.1 [CI, 1.5 to 6.5]); and were more likely to have attempted suicide (PR, 4.3 [CI, 2.8 to 6.5]). They visited the emergency department more frequently (PR, 1.7 [CI, 1.2 to 2.5]) but did not have more hospitalizations for psychiatric disorders. In a logistic regression model into which 9 risk factors were entered, the likelihood of current abuse increased with the number of risk factors, from 1.2% when 0 to 1 risk factors were present to 70.4% when 6 to 7 risk factors were present. CONCLUSIONS: In a large, diverse, community-based population of primary care patients, 1 of every 20 women had experienced domestic violence in the previous year; 1 of every 5 had experienced violence in their adult life; and 1 of every 3 had experienced violence as either a child or an adult. Current domestic violence is associated with single or separated status, socioeconomic status, substance abuse, specific psychological symptoms, specific physical symptoms, and the total number of physical symptoms.

PIP: This cross-sectional study determined the prevalence of domestic violence among female patients presenting to four community-based primary care internal medicine practices in Baltimore, Maryland, between February and July, 1993. Furthermore, it identified clinical characteristics associated with domestic violence. A total of 1952 female patients of diverse socioeconomic backgrounds participated in a self-administered, anonymous survey that solicited data on physical and sexual abuse, alcohol abuse, emotional status, demographic characteristics, physical symptoms, use of street drugs and prescribed medications, and medical and psychiatric history. Of the 1952 respondents, 108 (5.5%) had experienced domestic violence in the previous year, 418 (21.4%) had experienced violence sometime in their adult lives, 429 (22%) before age 18 years, and 639 (32.7%) as either an adult or a child. Current violence status is associated with single or separated status, substance abuse, specific psychological symptoms, specific physical symptoms, and the total number of physical symptoms. In a logistic regression model, the likelihood of current abuse increased with the number of risk factors. The magnitude of these associations supports the idea that domestic violence is a significant medical public health problem. Detection of domestic violence by physicians or other health care professionals might alter both the diagnostic and treatment plans for these women.

Monitoring of mixed venous oxygen saturation and pressure from biosensors in the right ventricle. A 24 hour study in patients with heart failure.

Right ventricle venous oxygen saturation was studied in 10 heart failure patients over 24 h using a lead equipped with an oxygen biosensor inserted temporarily. At the same time a pressure sensor, incorporated in the same lead to measure right ventricular pulse pressure and maximum positive and negative rate of pressure development (RV dP/dt), was tested to see whether it would interfere with the oxygen sensor. Data from the biosensor lead were continuously compared with mixed venous oxygen saturation obtained from a fibreoptic Swan-Ganz catheter with the tip in the pulmonary artery. For reference, blood samples were drawn at regular intervals from this catheter. A provocative protocol was used to cause haemodynamic changes. There was good correlation between oxygen saturation in the right ventricle (biosensor-derived) and mixed venous oxygen saturation in the pulmonary artery (fibreoptic-derived) (r = 0.86) and between sensor-obtained right ventricular oxygen saturation and oxygen saturation in the blood samples from the pulmonary artery (r = 0.90). Changes in central haemodynamics were also well reflected by changes in pulse pressure and dP/dt derived from the pressure sensor. As it was not possible to obtain absolute pressures no attempt was made to compare the pressure changes with conventional haemodynamics. These 24 h haemodynamic measurements suggest that a biosensor-equipped lead placed in the right ventricle could be a valuable tool for long-term monitoring of mixed venous oxygen saturation and pressure in patients with congestive heart failure.

Monitoring of pulmonary arterial diastolic pressure through a right ventricular pressure transducer.

Pulmonary arterial diastolic pressure is an important parameter for hemodynamic monitoring in congestive heart failure. It is traditionally obtained through a pulmonary arterial catheter. If it could be obtained from a sensor in the right ventricle, chronic monitoring would be possible without the use of a pulmonary arterial catheter. This study is based on the hypothesis that pulmonary valve opening and pulmonary arterial diastolic pressure occur at the time of maximum positive rate of pressure development (dP/dt) in the right ventricle, when the pressures should be equal. Thus, right ventricular pressure at the time of maximum dP/dt (PAD index) should be a reasonable estimate of pulmonary arterial diastolic pressure. Eight patients with heart failure were catheterized and exposed to hemodynamic stress. Right ventricular and pulmonary arterial pressures were simultaneously recorded from a Millar (Houston, TX) catheter with two pressure transducers. The distal transducer was positioned in the bifurcation of the pulmonary artery and the proximal transducer was placed in the right ventricle. Pulmonary arterial diastolic pressure and PAD index were stored beat by beat on a bed-side computer. Acceptable recordings were obtained in all patients. Recordings from the individual patients showed a good covariation between PAD index and pulmonary arterial pressure during different hemodynamic manuevers, except during infusion of dobutamine, when the correlation was not as good. Pulmonary arterial diastolic pressure may be estimated from a transducer in the right ventricle, thus eliminating the need for a permanent pulmonary arterial catheter in an implantable hemodynamic monitoring system. Further studies are needed to verify the correlation on a long-term basis.

Ammonia emission from grassland and livestock production systems in the UK.

Emissions of ammonia were measured from livestock excreta and fertilisers applied to grass swards, from grazed paddocks, from decomposing grass herbage and from an animal house containing dairy cows. Emissions from urine, dung, slurry and fertilisers were determined using a system of wind tunnels with each tunnel covering an area of 1 m(2). Emissions from grazed swards were determined using a micrometeorological mass balance method. From the results of these measurements, together with other published information, an inventory for ammonia emissions has been calculated for grassland and livestock production systems over the UK as a whole. It is estimated that emissions from grassland and cattle and sheep production amount to about 230 kt NH(3)-N annually, while emissions from pig and poultry production amount to about 40 kt and 80 kt NH(3)-N, respectively.

Emission of NOx from urine-treated pasture.

Emission of NO(x) from urine-treated pasture was determined using a system of enclosures coupled to a chemiluminescence NO(x) analyser. Rates of emission ranged from 0 to 190 microg NO(x) - Nm(-2)h(-1), with a mean of 43 microg N m(-2) h(-1). The lowest rates were associated with periods of heavy or persistent rain. On average, NO comprised 68% of the NO(x) produced. Emissions of NO(x) were apparently associated with the nitrification of ammonium N derived from hydrolysis of organic N constituents in the urine applied. Emissions from untreated pasture occurred at a mean rate of 1.7 microg NO(x) -N m(-2) h(-1). NO(x) comprised only a small proportion (<0.1%) of the emission of other nitrogenous gases (NH(3), N(2) and N(2)O) following application of urine. The mean rate of NO(x) emission suggested a total release to the atmosphere of 2.3 x 10(-8) g N year(-1) from urine returned to pasture in the UK. This loss is not significant in agronomic terms and is equivalent to only 0.04% of the estimated anthropogenic emissions for the UK.

Inhibitors of purine nucleoside phosphorylase: effects of 9-deazapurine ribonucleosides and synthesis of 5'-deoxy-5'-iodo-9-deazainosine.

9-Deazapurine ribonucleosides constitute a new class of noncleavable purine nucleoside phosphorylase inhibitors that have at least 30-fold greater affinity for the enzyme than the corresponding C-nucleosides of the formycin B series. 9-Deazaguanosine, 9-deazainosine, and 5'-deoxy-5'-iodo-9-deazainosine competitively inhibited human erythrocytic purine nucleoside phosphorylase with Ki values of 29, 20, and 1.8 X 10(-7) M. The last compound is the most potent nucleoside inhibitor of the enzyme presently available and its synthesis is described. In contrast, 7,9-dideaza-7-thiainosine is a very weak inhibitor of the enzyme. When tested as an inhibitor of 2'-deoxyguanosine phosphorolysis in intact human erythrocytes and MOLT-3 human T-cell lymphoblastic leukemia cells, 5'-deoxy-5'-iodo-9-deazainosine was equipotent with 8-aminoguanosine (which is a precursor for 8-aminoguanine, Ki = 2 X 10(-7) M). Similarly, 5'-deoxy-5'-iodo-9-deazainosine and 8-aminoguanosine both potentiated the growth inhibition of human T-lymphocytic MOLT-3 cells by 2'-deoxyguanosine, reducing the 50% inhibitory concentration from approximately 2 X 10(-5) to approximately 2 X 10(-6) M.