The impact of inducing germination of Bacillus anthracis and Bacillus thuringiensis spores on potential secondary decontamination strategies.

AIMS: Decontamination and remediation of a site contaminated by the accidental or intentional release of fully virulent Bacillus anthracis spores are difficult, costly and potentially damaging to the environment. Development of novel decontamination strategies that have minimal environmental impacts remains a high priority. Although ungerminated spores are amongst the most resilient organisms known, once exposed to germinants, the germinating spores, in some cases, become susceptible to antimicrobial environments. We evaluated the concept that once germinated, B. anthracis spores would be less hazardous and significantly easier to remediate than ungerminated dormant spores. METHODS AND RESULTS: Through in vitro germination and sensitivity assays, we demonstrated that upon germination, B. anthracis Ames spores and Bacillus thuringiensis Al Hakam spores (serving as a surrogate for B. anthracis) become susceptible to environmental stressors. The majority of these germinated B. anthracis and B. thuringiensis spores were nonviable after exposure to a defined minimal germination-inducing solution for prolonged periods of time. Additionally, we examined the impact of potential secondary disinfectant strategies including bleach, hydrogen peroxide, formaldehyde and artificial UV-A, UV-B and UV-C radiation, employed after a 60-min germination-induction step. Each secondary disinfectant employs a unique mechanism of killing; as a result, germination-induction strategies are better suited for some secondary disinfectants than others. CONCLUSIONS: These results provide evidence that the deployment of an optimal combination strategy of germination-induction/secondary disinfection may be a promising aspect of wide-area decontamination following a B. anthracis contamination event. SIGNIFICANCE AND IMPACT OF THE STUDY: By inducing spores to germinate, our data confirm that the resulting cells exhibit sensitivities that can be leveraged when paired with certain decontamination measures. This increased susceptibility could be exploited to devise more efficient and safe decontamination measures and may obviate the need for more stringent methods that are currently in place.

Cerebrospinal fluid creatine kinase BB isoenzyme activity and neurologic prognosis after cardiac arrest.

OBJECTIVE: To assess the relationship between CSF creatine kinase BB isoenzyme activity (CSF CKBB) and neurologic outcome after cardiac arrest in clinical practice. BACKGROUND: CSF CKBB reflects the extent of brain damage following cardiac arrest. METHODS: To help with prognosis, treating physicians ordered CSF CKBB tests on 474 patients over 7.5 years; 351 of these patients had experienced a cardiac arrest. Assays were performed in one laboratory using agarose electrophoresis. By chart review, we determined awakening status for all patients, defined as the patient having comprehensible speech or following commands. RESULTS: CSF CKBB was usually sampled 48 to 72 hours after cardiac arrest and was strongly associated with awakening (p < < 0.001). The median was 4 U/l for 61 patients who awakened and 191 U/l for 290 who never awakened. For those who awakened, 75% of CKBB levels were < 24 U/l, and for those who never awakened, 75% were > 86 U/l. The highest value in a patient who awakened was 204 U/l, a cutoff that yielded a specificity of 100% of never awakening but a sensitivity of forty-eight percent. Only nine patients who awakened had CSF CKBB values greater than 50 U/l, and none regained independence in activities of daily living. Only three unconscious patients were still alive at last contact, with follow-up of 63, 107, and 109 months. Using logistic regression, the probability of never awakening given a CSF CKBB result can be estimated as: 1/(1 + L), where L = e raised to (0.1267 - 0.0211 x CSF CKBB [U/l]). CONCLUSION: CSF CKBB measurement helps to estimate degree of brain damage and thus neurologic prognosis after cardiac arrest. However, results of this retrospective study could reflect in part a self-fulfilling prophecy.

Food safety: review and implications for dietitians and dietetic technicians.

Section 103 (d) of the Americans with Disabilities Act directs the secretary of health and human services to identify, publish, and annually review a list of pathogens transmitted via food contaminated by infected food handlers. The secretary is also directed to publish means by which diseases on the list are transmitted. The intent of the list is to protect disabled food handlers when they become ill and to provide managers with information for determining when to remove or reassign disabled food handlers who have infectious or communicable diseases to jobs that do not involve handling food. Pathogens often transmitted via food contaminated by infected food handlers are Salmonella typhi, Shigella species, Staphylococcus aureus, Streptococcus pyogenes, hepatitis A virus, and the Norwalk and Norwalk-like viruses. This article discusses section 103 (d) and for each of the six pathogens describes characteristics and growth requirements, types of foods involved in outbreaks, factors that contribute to foodborne outbreaks, and prevention and control measures. Human beings are the only reservoir of Sal typhi. The source of Shigella species is the intestinal tract of human beings and other primates. Human beings are the common reservoir of Staph aureus and Strep pyogenes. Staph aureus is frequently found in the nose and on the skin of healthy people, whereas Strep pyogenes is carried in the throat of infected or asymptomatic carriers. Foodborne viruses of public health concern originate in the human intestine. Foods that favor the multiplication of Sal typhi are often foods that require no cooking. Many outbreaks of foodborne disease attributed to Shigella species and viruses have been associated with salads. Moist, high-protein, and salty foods that have been cooked are most often involved in outbreaks of staphylococcal foodborne illness. Foods usually implicated in Strep pyogenes outbreaks are predominately composed of milk, eggs, or meat. Dietitians and dietetic technicians can use three approaches to reduce the incidence of foodborne disease attributed to food handlers: conducting training and education programs, implementing a Hazard Analysis and Critical Control Points system, and supporting certification of foodservice managers.

Intravenous glucose after out-of-hospital cardiopulmonary arrest: a community-based randomized trial.

QUESTION: Does the common practice of infusing small amounts of glucose after cardiopulmonary arrest worsen neurologic outcome? DESIGN AND SETTING: A community-based randomized trial in Seattle, WA. Paramedics treated all patients with out-of-hospital cardiac arrest in a standard fashion except that the intravenous infusion did or did not contain glucose; ie, patients received either usual treatment, with 5% dextrose in water (D5W), or alternative, with half normal saline (0.45S). OUTCOMES: The main outcome was awakening, defined as the patient having comprehensible speech or following commands as determined by chart review. Other outcomes were survival to hospital admission and to discharge. RESULTS: Over 2 years, paramedics randomized 748 patients. The type of fluid administered was not significantly related to awakening (16.7% for D5W versus 14.6% for 0.45S), admission (38.0% for D5W versus 39.8% for 0.45S), or discharge (15.1% for D5W versus 13.3% for 0.45S). As in previous studies, patients whose arrest had likely been on a cardiac basis with initial rhythms of ventricular fibrillation or asystole had admission blood glucose levels significantly related to awakening: mean = 309 mg/dl for never awakening and 251 mg/dl for awakening. Of note, the relation between glucose and awakening was reversed in the remaining patients, who had electromechanical dissociation or noncardiac mechanisms of arrest. CONCLUSION: Current practices of using limited amounts of glucose-containing solutions after cardiopulmonary arrest do not need to be changed. Blood glucose level on admission is a prognostic indicator but depends on the type of arrest.

Sequences from a family of bovine Y-chromosomal repeats.

A 307-bp Sau3AI fragment previously cloned by deletion enrichment from the bovine Y chromosome was used to isolate a larger lambda EMBL3A genomic cattle clone. The whole 13-kb insert did not give a sex-specific pattern of hybridization to Southern blots of cattle DNA. Subclones from this phage, however, did show that this fragment had a Y-chromosomal origin. It was estimated that at least 40% of the cattle Y chromosome is composed of repeated sequences related to those within these subcloned fragments. Sequences within these subclones are male-specific or male-enriched also in sheep, goats, and deer. Comparison of cattle and sheep homologues of these sequences reveals that much greater amplification and rearrangement have occurred on the cattle Y chromosome than on the sheep Y. The apparent insertion of sequences into cattle Y-specific sequences relative to the sheep homologues suggests possible mechanisms for the evolution of the artiodactyl Y chromosome.

A DNA sequence that is present in both sexes of Artiodactyla is repeated on the Y chromosome of cattle, sheep, and goats.

We have cloned a 307-bp Sau3AI fragment of DNA from the bovine male genome by deletion enrichment. Although a single-copy homolog is present in the female cattle genome, the sequence (BRY.1) is repeated at a moderate and variable frequency only in males. This pattern occurs too in sheep and goats, but BRY.1 is found in equal amounts in both sexes of fallow deer and pigs, approximating single copy. The conservation of a homologous sequence over millions of years and its repetition exclusively on the Bovidae Y chromosome raise interesting questions concerning the origin, evolution, and possible function of this unusual element.

Time spent in state-recommended functions by consultant dietitians in Wisconsin skilled nursing facilities.

In this study we determined how consultant dietitians working in Wisconsin skilled nursing facilities distributed their time among contracted duties. At the time of the study, the 400 skilled nursing facilities in Wisconsin employed 160 consultant dietitians. Of these, 135 consultant dietitians were eligible to participate in the study. A mailed questionnaire was used to collect data on educational background, experience, and actual time spent in state-recommended functions, additional resident-care functions, and additional non-resident-care functions. Completed, usable questionnaires were returned by 65 (48%) of the 135 consultant dietitians. Data were analyzed statistically and presented as medians, means, and standard deviations. Mean time (minutes) consultant dietitians spent per resident admission activity was as follows: data collection, 31.3; care planning, 28.9; resident counseling, 18.5; medical record review, 17.7; discharge referral, 15.4. Mean time (minutes) consultant dietitians spent per month in other activities was as follows: facility evaluation, 75.3; student training, 120; allied staff training, 38.7; foodservice staff training, 46.8; technician training, 128; menu planning, 76.9; diet manual review, 21.6; quality assurance programs, 31.8; quality assurance audits, 34; report preparation for facility administrator, 33.4; and policy development, 32.8. Mean times reported in this study may be used as time guidelines by the state of Wisconsin for evaluating how skilled nursing facilities contract for services of consultant dietitians. Other state and federal regulatory agencies could use the time guidelines for comparison and verification until future studies provide more data on time standards for state-recommended functions, additional resident-care functions, and additional non-resident-care functions.