Effect of dehairing operations on microbiological quality of swine carcasses.

To develop a hazard analysis and critical control point plan for food processing operations, critical control points must be determined. Swine slaughtering and dressing operations were investigated to establish their critical control points. We monitored the microbiology of swine carcasses by surface swabbing carcass bellies at various steps during the process and by quantitating total aerobic plate count (APC) and coliforms. Starting with a dehaired carcass, the sequential steps monitored included presingeing, postsingeing, polishing, and chilling. Initial results indicate that singeing and chilling substantially reduced the levels of APC and coliforms, whereas polishing increased their levels. The hygienic characteristics of individual operations involved in dressing swine carcasses were then evaluated in the second experiment. A set of 40 randomly selected carcasses leaving singeer, polisher, shaver, and washer were sampled. Carcasses were heavily contaminated during the final polishing procedure, and the APC increased threefold compared with prepolishing levels. Washing reduced the bacterial numbers by 69%. To reduce the microbial load on swine carcasses, final polishing and manual shaving steps were not used during the dressing operation on a set of 90 carcasses. APCs on singed carcasses were reduced from 1.34 to -0.15 log10 CFU/cm2 when the final polisher and manual shavers were not used. However, carcasses were subsequently recontaminated with bacteria after evisceration, and the APCs were similar (P > 0.05) regardless of whether the final polishing and manual shaving steps were used, averaging 1.30 and 1.46 log10 CFU/cm2. These results indicated that individual operations can be identified as critical control points, appropriate limits can be set and monitored in a hazard analysis and critical control point system, and steps where further changes to reduce bacterial levels may be needed for swine slaughtering plants.

Body fat distribution's impact on physiologic outcomes during cardiac rehabilitation.

BACKGROUND: High waist-to-hip ratios (WHRs) predispose individuals to metabolic syndromes that may affect outcome responses to cardiac rehabilitation programs. METHODS: A total of 101 male patients who had undergone coronary artery revascularization surgery and completed 12 weeks of cardiac rehabilitation were divided into lower (LOWHR, n = 51) and higher (HIWHR, n = 50) waist-to-hip groups. Outcomes were measured at week 1 and week 12 of cardiac rehabilitation. RESULTS: Waist-to-hip ratio and body weight were greatest for HIWHR (P < 0.001) with no between-group differences in the amount of change from week 1 to 12. Triceps and subscapular skin-folds were greater for HIWHR (P < 0.001) with no difference in the amount of change between groups. Caloric expenditure during exercise class was higher for LOWHR (P = 0.022). Daily caloric expenditure was greater for LOWHR (P = 0.034) as was daily caloric intake (P < 0.001). There were no group differences for VO2peak and ventilatory anaerobic threshold (VAT) with nonsignificant trends for greater increases in LOWHR. CONCLUSIONS: Cardiac rehabilitation patients with greater WHRs expend less calories during exercise classes. To enhance overall caloric expenditure and obtain positive outcomes, cardiac rehabilitation professionals must emphasize greater activity with less sedentary time throughout the patients normal daily routine. The validity of using self-reported caloric intake and expenditure values in the cardiac rehabilitation population is questionable.

Cardiac rehabilitation without exercise tests for post-myocardial infarction and post-bypass surgery patients.

PURPOSE: To compare the progress of patients who were exercise tested before or during cardiac rehabilitation versus those patients who were not tested. METHODS: Eighty-eight (88) post-myocardial infarction patients and 141 post-bypass surgery patients had a symptom-limited exercise test before or during 12 weeks of cardiac rehabilitation. Another 125 post-myocardial infarction and 146 post-surgery patients were not tested. RESULTS: Caloric expenditure during class increased for the entire group (P < 0.001) from week 1 to week 12. Body weight decreased for the entire group as a result of cardiac rehabilitation (P < 0.001). Tricep skinfolds decreased for the entire group (P < 0.001) while subscapular skinfolds did not change (P = 0.28). The percent change from week 1 to week 12 for both groups was similar for all variables. No problems occurred during cardiac rehabilitation that required emergency medical management. CONCLUSIONS: Patients completing a 12-week cardiac rehabilitation program can be safely progressed in terms of their exercise capacity without an entry exercise test. This is desirable in a managed-care setting for reducing costs while maintaining effective patient care. Such factors as staff training and experience, institutional philosophy, patient referral patterns, and facility location must be considered before adopting a no-test policy.

Microbiology of the swine head meat deboning process.

The microbiology of swine head meat was evaluated by comparing the levels of aerobic plate count (APC), coliforms, and Escherichia coli as well as the incidence and levels of Salmonella spp. in swine head meat harvested by either the old or a new improved procedure. Based on 144 samples (72 by each procedure), the levels of APC, coliforms, and E. coli were 4.52 +/- 0.26, 2.37 +/ 0.42, and 2.25 +/ 0.42, and log(10) CFU/g respectively, regardless of the procedure used for harvesting the meat. The incidence (27/22) versus 28/72) and MPN levels (4 to 93 versus 4 to 1100) of Salmonella spp. determined by the Bacteriological Analytical Manual (BAM) methods also were the same for meat obtained using either the old or the new procedure. The BAM method detected a higher incidence of Salmonella spp. (55/144) than other methods, PCR(38/144; BAX, Du Pont) or DNA hybridization (41/144; Gene-Trak). Time of harvesting during the processing day or site of origin of the head meat (check versus tongue versus back of head) had no effect on the incidence of Salmonella spp. The data in this study indicate that the levels of bacteria encountered in swine head meat are a reflection of the harvesting procedures themselves, as well as levels in and around the head and oral cavity of swine.

EEG correlates of enhanced spatial performance following exposure to music.

Previous research has shown that exposure to classical music can influence performance on a spatial task. The present study investigated EEG correlates of this enhanced performance effect, 4 female and 4 male undergraduates completed two equivalent spatial tests, one following a control procedure and one following the presentation of Mozart's Sonata for Two Pianos in D Major. EEG was recorded during a baseline and two task-performance periods. Test performance and EEG recordings were analyzed, and correlations were generated between task performance and EEG variables (average spectral power and peak frequency within 5 frequency ranges). Performance improved significantly following the presentation of the music. EEG analysis indicated 6 reliable correlations out of 40 calculated between differential EEG variables and changes in performance. Ten reliable correlations out of 120 were also found between changes in performance and nondifferential EEG variables across baseline, control, and experimental conditions.

Oxygen uptake and cardiac output during progressive and constant load work in patients after acute myocardial infarction.

PURPOSE: Simultaneously measured oxygen uptake (VO2) and Doppler echocardiography could verify if an alteration in the VO2 response to progressive and constant load work is due to reduced cardiac output. METHODS: The study group consisted of nine patients after acute myocardial infarction (MI), five age-matched healthy subjects (HE), and five young well-trained subjects (WT). Each subject performed a progressive exercise test and two bouts of constant load work at power outputs equated to 10% below (W1) and 10% above (W2) their ventilatory thresholds. VO2 and cardiac output were measured continuously and simultaneously during the tests. RESULTS: VO2 was significantly reduced for the MI group during the initial stages of the progressive exercise test (P < .02) and remained lower throughout the entire test. During the first 60 seconds of constant load work (W2), VO2 was lower for MI (P < .05). At steady state exercise during W2, cardiac output was significantly less for MI (P < .05). VO2 for the MI group was more reliant on cardiac output during lower power outputs and differences in the arterial and venous O2 content (a-VO2 difference) during greater power outputs. CONCLUSIONS: Cardiac rehabilitation programs must be aware of this delayed VO2 and cardiac output response when setting training workloads or selecting the magnitude of the workload increments during progressive exercise tests.

Myocardial revascularization using the "no-touch" technique, with mild systemic hypothermia, in patients with a calcified ascending aorta.

Modifications in the standard technique for coronary artery bypass grafting are recommended in presence of a calcified ascending aorta, to avoid clamp injury or atheroembolism. Between January 1991 and August 1994, we used a "no-touch" technique in 18 patients undergoing myocardial revascularization, who had a heavily calcified and atherosclerotic ascending aorta. Their mean age was 76.1 years (range 63 to 82 years). Cardiopulmonary bypass with mild systemic hypothermia (32 degrees C) was employed in 16 patients; 2 other patients were operated upon without cardiopulmonary bypass. The "no-touch" technique avoids all types of clamps in the aorta. No cardioplegia was given, and no grafts were anastomosed to the aorta. Fifty-two distal anastomoses (mean: 2.9 per patient) were performed, using 37 pedicled arterial grafts (22 internal mammary and 15 gastroepiploic arteries), and 15 free grafts, which were anastomosed proximally to the internal mammary artery. There were no postoperative cerebrovascular accidents. Three patients died (16.7% overall mortality): 1 died of pneumonia, one patient with a large left ventricular aneurysm died in congestive heart failure, and one patient with associated aortic insufficiency died in low cardiac output. Our experience suggests that using pedicled arterial grafts for myocardial revascularization is safe and effective to avoid clamp injury or atheroembolism in patients with a calcified aorta. Deep hypothermia is not necessary when using the "no-touch" technique.

Vitamin E in human milk from mothers of preterm and term infants.

The content of vitamin E (alpha- and beta + gamma-tocopherol) was analyzed in 63 human milk samples obtained from 13 mothers of preterm infants ("preterm" milk) and in 59 milk samples obtained from nine mothers of full-term infants ("term" milk). The changing pattern of the alpha- and beta + gamma-tocopherol content during the course of lactation was identical for both groups. Total vitamin E, alpha- as well as beta + gamma-tocopherol, decreased during the first 2 weeks of lactation and remained constant thereafter. The ratio of alpha- to beta + gamma-tocopherol decreased from about 10:1 to 4:1. At days 3 and 36 of lactation, vitamin E contents (median values and ranges) expressed as milligrams alpha-tocopherol equivalent per 100 ml were 1.45 (0.64-6.4) and 0.29 (0.17-0.48), respectively, for preterm and 1.14 (0.63-4.21) and 0.28 (0.19-0.86), respectively, for term human milk. The vitamin E, alpha-tocopherol and beta + gamma-tocopherol content of preterm human milk did not differ significantly (p less than or equal to 0.05) from that of term human milk at each sampling day. Based on these findings we conclude that the increased requirement of prematures for vitamin E is not reflected in the vitamin E content of milk from mothers delivering preterm infants.

Mortality in the beta blocker heart attack trial: circumstances surrounding death.

In the Beta Blocker Heart Attack Trial, a double blind, randomized, controlled study, patients taking propranolol (180 or 240 mg/day) initiated 5-21 days post myocardial infarction had 26% fewer deaths than those taking placebo over a 25 month (mean) followup. Detailed analysis of the circumstances surrounding the BHAT deaths failed to reveal any striking difference between propranolol and placebo in the type of clinical event preceding death, the incidence and type of acute and prodromal signs and symptoms, the location of death, the activity preceding death or the percentage of deaths that were sudden or instantaneous, suggesting that propranolol may exert an "across the board" effect and improve survival by a combination of mechanisms. An unexpected finding was that the protective effect of propranolol appeared to occur during the hours of 10 p.m. to 7 a.m.

Low-level exercise testing after myocardial infarction. A useful guide to management.

Low-level exercise testing after acute myocardial infarction can be safely performed in the early recovery period before hospital discharge. It is a clinically useful procedure and has the following benefits. It identifies patients at high risk for recurrent acute coronary events within one year after acute myocardial infarction, permits evaluation of the effectiveness of drug therapy before hospital discharge, allows selection of patients for early coronary arteriography, and provides guidelines for activity in the immediate postinfarction period.

Involve physicians in marketing.

Many everyday problems in medical group practice can be attacked by a marketing approach. To be successful, however, this kind of approach must have the full support of those involved, especially the physicians, since they are the principal providers of healthcare services. When marketing is presented in a broad context, including elements such as patient mix, population distribution, and research, physicians are more likely to be interested and supportive. The members of Geisinger Medical Center's Department of Cardiovascular Medicine addressed their patient appointment backlog problem with a marketing approach. Their method is chronicled here and serves as a fine example of how physician involvement in marketing can lead to a positive outcome.

Capillary gas chromatography of fatty acid methyl esters from human milk lipid subclasses.

The fatty acid (FA) composition of the human milk lipid subclasses sphingomyelin, phosphatidylcholine, phosphatidylethanolamine and cholesterol esters (CE) were analysed by capillary gas chromatography (GC) on wall-coated open-tubular glass columns. Compared with GC on packed columns, capillary GC was found to be ten times more sensitive (0.1 microgram of each individual FA methyl ester could be quantified), and the time needed for the analysis could be reduced by a factor of five. The reproducibility of the analysis was good relative standard deviation (4-7%) and comparable to that obtained by packed column GC.