Inactivation of foodborne pathogens by the synergistic combinations of food processing technologies and food-grade compounds.

There is a need to develop food processing technologies with enhanced antimicrobial capacity against foodborne pathogens. While considering the challenges of adequate inactivation of pathogenic microorganisms in different food matrices, the emerging technologies are also expected to be sustainable and have a minimum impact on food quality and nutrients. Synergistic combinations of food processing technologies and food-grade compounds have a great potential to address these needs. During these combined treatments, food processes directly or indirectly interact with added chemicals, intensifying the overall antimicrobial effect. This review provides an overview of the combinations of different thermal or nonthermal processes with a variety of food-grade compounds that show synergistic antimicrobial effect against pathogenic microorganisms in foods and model systems. Further, we summarize the underlying mechanisms for representative combined treatments that are responsible for the enhanced microbial inactivation. Finally, regulatory issues and challenges for further development and technical transfer of these new approaches at the industrial level are also discussed.

Medication status and dual-tasking on turning strategies in Parkinson disease.

BACKGROUND: Parkinson disease (PD) patients have turning impairments that may increase fall risk. Clinics lack specialized kinematic equipment used in gait and turn analysis and require a simple method to evaluate fall risk and advise patients in turning strategy selection. OBJECTIVES: To enhance understanding of PD turning strategies and determine if turning can be assessed using a video-recording and categorization method, we compared 180-degree and 90-degree turns as a function of medication status and dual-tasking (DT). METHODS: 21 PD participants (H&Y stage 1-3) in PD-ON and PD-OFF medication states and 16 controls completed 180-degree and 90-degree turn-tasks with and without DT. Video-recordings of tasks permitted classification of 180-degree turns into Few-Step turns (FST) vs. Multi-Step turns (MST) and 90-degree turns into Step vs. Spin-turns. FST were further sub-classified into Twisting vs. Sideways turns and MST into Backward, Festination, Forward or Wheeling turns. Percentages of subtypes were analyzed across groups by task. RESULTS: IN 180-degree tasks, there was an effect of group: FST vs. MST F(2,55) = 9.578, p < .001. PD participants in the off-medication state (PD-OFF) produced significantly more MST with a larger number of different turning subtypes vs. controls or PD on medication (PD-ON). In 90-degree tasks, controls significantly increased their proportion of Step-turns while DT (p < .001), an adaptation not observed in PD-ON or PD-OFF. CONCLUSIONS: PD turning impairments may stem from an inability to select a unified turning strategy and to adapt to the turning environment, which may be exacerbated in PD-OFF. Video-analysis may prove beneficial in predicting a clinical course for PD patients by revealing features of turning dysfunction.

Complete Genome Sequence of the Deep-Sea Bacterium Psychromonas Strain CNPT3.

Members of the genus Psychromonas are commonly found in polar and deep-sea environments. Here we present the genome of Psychromonas strain CNPT3. Historically, it was the first bacterium shown to piezoregulate the composition of its membrane lipids and to have a higher growth rate at 57 megapascals (MPa) than at 0.1 MPa.

Female victims of intimate partner physical domestic violence (IPP-DV), California 1998.

BACKGROUND: This study was conducted to identify factors associated with adult female victims of intimate partner physical domestic violence (IPP-DV) in California and to estimate statewide IPP-DV prevalence. METHODS: We analyzed data from the 1998 California Women's Health Survey, a random, computer-assisted telephone interview (CATI) survey of 4006 California women aged > or = 18, conducted by the California Department of Health Services. RESULTS: Data from the survey indicated that 6% of the women reported that in the previous 12 months, their intimate partners threw objects at them, or hit them with an object, or kicked, pushed, slapped, choked, beat up, or threatened them with a gun or a knife. Odds ratio (OR) analyses controlling for age and race/ethnicity suggest that a large number of factors are associated statistically with IPP-DV victims. These factors include feelings of ill physical and mental health; pregnancies at early age; smoking status; nutritional needs; low income; participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program; having children aged < 18 in the household; and limited access to health care. Among the non-U.S.-born respondents, IPP-DV victims were significantly younger when they entered the United States than their nonvictim counterparts. A multiple logistic regression model identified the following factors as main correlates with IPP-DV: feelings of being overwhelmed in the past 30 days (OR = 3.4, 95% confidence interval [CI] = 2.5-4.6); aged 18 to 44 (OR = 2.8, 95% CI = 1.9-4.1); current smoking status (OR = 2.1, 95% CI = 1.5-2.9); participation in WIC in the previous 2 years (OR = 1.8, 95% CI = 1.2-2.6); and being out of work (OR = 1.4, 95% CI = 1.1-1.9). CONCLUSIONS: The above findings suggest that a variety of venues (e.g., schools, mental and physical health care providers, WIC, immigration programs, and social services) will be needed in order to identify/gain access to IPP-DV victims, provide referral resources, and implement any future prevention efforts.

The economic realities of rural pharmacy practice.

Rural pharmacy practice is characterized by difficulties in recruiting and retaining pharmacists, demanding workloads and financial pressures that exceed those felt by pharmacies in urban areas. There is little optimism that these harsh realities will soon ease, given the shortage of pharmacists, high drug costs, and leverage by third-party payers. These realities should create concern among policy-makers for the economic viability of rural pharmacies and for the continued ability of pharmacists to provide health care services to residents of rural and frontier communities.

Recruitment barriers in rural community hospitals: a comparison of nursing and nonnursing factors.

Despite encouraging signs suggesting that many rural hospitals are experiencing less severe staff shortages, the challenge of successfully recruiting nurses to rural practice settings continues to be a major obstacle. Based on a 1993 survey of 164 directors of nursing (DONs) practicing in rural community hospitals, exploratory factor analysis (EFA) was used to cluster 21 DON-rated recruitment barriers into factors associated with nursing delivery, local community, and professional interaction. DONs, most notably those practicing in the smallest rural facilities (< or = 25 beds), reported community-related barriers such as spouse's employment as the most severe obstacles to successful registered nurse (RN) recruitment. However, upon examination conducted by using multiple regression analyses, only those factors related to nursing delivery and professional interaction were found to be statistically significant predictors of existing staff RN full-time equivalency vacancy rates. Given that barriers related to individual nursing staffs are likely to be far more amenable to change than those associated with rural environments, these findings offer encouragement to nursing administrators who are faced with the difficulties of attracting RNs to rural practice settings.

Assessing residents' clinical performance: cumulative results of a four-year study with the Objective Structured Clinical Examination.

BACKGROUND: The Objective Structural Clinical Examination (OSCE) is an objective method for assessing clinical skills and can be used to identify deficits in clinical skill. During the past 5 years, we have administered 4 OSCEs to all general surgery residents and interns. METHODS: Two OSCEs (1993 and 1994) were used as broad-based examinations of the core areas of general surgery; subsequent OSCEs (1995 and 1997) were used as needs assessments. For each year, the reliability of the entire examination was calculated with Cronbach's alpha. A reliability-based minimal competence score (MCS) was defined as the mean performance (in percent) minus the standard error of measurement for each group in 1997 (interns, junior residents, and senior residents). RESULTS: The reliability of each OSCE was acceptable, ranging from 0.63 to 0.91. The MCS during the 4-year period ranged from 45% to 65%. In 1997, 4 interns, 2 junior residents, and 2 senior residents scored below their group's MCS. MCS for the groups increased across training levels in developmental fashion (P < .05). CONCLUSIONS: Given the relatively stable findings observed, we conclude (1) the OSCE can be used to identify group and individual differences reliably in clinical skills, and (2) we continue to use this method to develop appropriate curricular remediation for deficits in both individuals and groups.

Evaluation of students' learning in an interdisciplinary medicine--surgery clerkship.

PURPOSE: To evaluate the impact of an interdisciplinary medicine-surgery clerkship (created to foster generalist education) on students' performances on National Board of Medical Examiners' (NBME) subject examinations. METHOD: Test data for the 226 students who participated in the 16-week combined clerkship and for the 265 students who had completed the traditional clerkships (12 weeks of medicine, 12 weeks of surgery) were compiled and analyzed using t-tests for independent samples. RESULTS: Mean scores on the NBME subject examination in medicine increased significantly after the combined medicine-surgery clerkship (from 433 to 455, p < or = 0.5). Mean scores on the NBME subject examination in surgery were similar to those achieved in the traditional clerkship years. CONCLUSION: Since the medicine and surgery clerkships were combined into a single, interdisciplinary clerkship, students' scores have increased on the medicine NBME subject examination and have remained relatively unchanged on the surgery NBME subject examination, despite a substantial reduction in students' clinical experience in the combined clerkship from the traditional clerkships (16 vs 24 weeks).

The effectiveness of the structured clinical instruction module.

BACKGROUND: The Structured Clinical Instruction Module (SCIM) provides students with a structured educational experience related to clinical skills on a single clinical topic. This study examined the effect of the SCIM on students' performances on breast stations in an objective structured clinical examination (OSCE). METHODS: Three student groups each experienced a different type of instruction about breast care and treatment (condition A = lecture; condition B = nine-station SCIM, lecture, and manual; and condition C = five-station SCIM). All students subsequently participated in a surgery OSCE that included standardized patient stations on taking a breast history and performing breast examinations. RESULTS: One-way analysis of variance (ANOVA) tests consistently found that the mean scores of students in conditions B and C were significantly (P < 0.05) higher than those of students in condition A. CONCLUSIONS: These results suggest that the SCIM is an effective patient-based standardized instructional program that enhances the instruction of clinical skills to students.

Why rural practice?

In a national study of rural registered nurses, over 3,500 listed family or community-related reasons for practicing in rural areas. On the other hand, at least half stated that job-related factors would influence them to leave their present positions.

The association between reading time and students' performance in a surgery clerkship.

OBJECTIVE: Medical students are expected to acquire a large amount of knowledge in both the basic and clinical sciences by reading. The purpose of this study was to examine the relationship between reading time and students' performance on various objective and subjective evaluative measures. METHODS: The study examined the reading activities of 80 students in a third-year surgery clerkship. Students spent an average of 16 hours per week in reading activities. RESULTS: A modest but statistically significant correlation was found between the total amount of time spent in reading and students' performance on an objective standardized clinical examination, a standardized patient encounter, a subjective rating by faculty members, and the total objective grade. Reading time did not correlate with performance on objective measures such as quizzes or the National Board of Medical Examiners examination. CONCLUSION: Although achievement in the clerkship is associated to a minor degree with reading time, reading time alone is not a sufficient influence on achievement.

Pharmacy-managed protocol for warfarin use in orthopedic surgery patients.

A pharmacy-managed protocol for warfarin use in orthopedic surgery patients was studied. In 1990 a protocol designed to accommodate either protocol- or physician-determined dosing of warfarin for orthopedic antithrombotic prophylaxis (OAP) was implemented at a community hospital. A "protocol" group consisting of patients treated entirely under the protocol-determined dosing option was prospectively identified over a two-year period. A "physician" group consisting of patients treated by physicians in the 10 months immediately preceding implementation of the protocol was also identified. The ability of the protocol to achieve laboratory-test and clinical goals was assessed by comparing the two groups. The proportion of patients who received OAP increased from 89% for the physician group to 98% for the protocol group. Mean prothrombin times (PTs) were significantly higher in the protocol group only on postoperative day 2; 66% of all PTs beyond post-operative day 1 in the protocol group were within the targeted range, which reflected an International Normalized Ratio of 1.6-3.2. The frequencies of clinically apparent postoperative thrombotic events and bleeding episodes were low in each group and comparable to literature values. Analysis of protocol-group patients with PTs of > 20 seconds indicated that lower weight, female sex, and blood loss during surgery were associated with an elevated PT. The protocol was revised to provide for a lower initial warfarin dose in elderly women. A pharmacy-managed protocol for dosing warfarin achieved therapeutic goals and promoted nearly universal use of OAP in patients undergoing high-risk orthopedic surgery.

Dysphagia: diagnosis and treatment in Kentucky.

Dysphagia, a disorder of swallowing, is commonly associated with neurological and neuromuscular disorders. Damage to the sensation or muscles of the swallowing mechanism leads to unsafe oral motor or pharyngeal movement patterns, placing a patient at risk for development of aspiration pneumonia. At present, multidisciplinary Dysphagia Teams are being used to improve the diagnosis and treatment of swallowing disorders. A survey including all 112 hospitals in the Commonwealth of Kentucky indicates 33 (29%) presently have such a team, while 42 (38%) offer outpatient dysphagia services. In addition, 56 (50%) of the hospitals indicate they perform modified barium swallows which is an essential test for diagnosing and treating dysphagia. An example of how a Dysphagia Team works in one Kentucky rehabilitation hospital is presented to illustrate how to provide early diagnosis and treatment of these problems.

Retainment incentives in three rural practice settings: variations in job satisfaction among staff registered nurses.

Researchers have demonstrated repeatedly the importance of the relationship linking job satisfaction to employee retention. In rural areas of the country, where a persistent maldistribution of nurses continues to hamper health care delivery, the potential benefits of bolstering retention via enhancements in job satisfaction are of utmost utility to administrators and providers alike. Data were gathered from a multistate survey of registered nurses (RNs) practicing in rural hospitals, skilled nursing facilities, and community/public health settings (N = 1,647; response rate = 40.3%). The investigators found that the use of tuition reimbursement corresponded significantly with increased levels of job satisfaction among nurses in all three practice environments, as did day care services for nurses in acute care settings. Also, among hospital-based RNs, level of nursing education was found to be a significant factor in the relationship between tuition reimbursement and job satisfaction, with the highest level occurring among diploma-prepared nurses.

Redefining the nursing shortage: a rural perspective.

A number of researchers have suggested that nursing shortages are closely related to geographic maldistribution, specialty areas, and even individual shifts. As these findings have documented, the nursing shortage, as defined by the federal government, exists predominantly in rural areas of the country that are not adjacent to metropolitan areas. As a result, many of the economic, demographic, and health-related disparities that exist between rural and urban populations are mirrored in shortage and nonshortage counties. Higher unemployment rates and lower per capita incomes suggest an underlying relationship between economic vitality and the recruitment and retention of health care personnel. This suggests that a fundamental obstacle to staffing adequate numbers of qualified nurses in rural areas may not be a shortage of nurses, but economic barriers (domestic and health care related) deeply rooted in the rural settings themselves. In those states burdened with significant shortage areas, emphasis must be placed on easing the maldistribution of available nurses away from rural, often medically underserved settings. However, while the notion of producing appropriate "types" of nurses is well founded, the temptation to "solve" the problem simply by producing more providers should be resisted, since it will not markedly benefit those areas that are currently in greatest need. The time frame necessary for such "trickle down" approaches to affect rural areas could, when combined with other factors, render many health care delivery systems virtually unsalvageable. To address the persistent distribution problem, we could change how health professionals are educated.(ABSTRACT TRUNCATED AT 250 WORDS)

Diffusion of innovation II: Formulary acceptance rates of new drugs in teaching and non-teaching British Columbia hospitals--a drug development perspective.

Diffusion theory was used to examine differences in adoption rates of new drugs by British Columbia teaching and non-teaching hospitals. Surveys were mailed in September 1990 to 41 hospital pharmacies (response rate = 88%), requesting hospital pharmacy directors to provide formulary inclusion dates of 29 study drugs marketed between July 1987 and March 1990. Of the 36 initial responses, 31 were suitable for further analysis and these were surveyed again in April 1993 (response rate = 100%) as to the formulary status of drugs not initially approved. The second survey ensured that all study drugs would have at least 36 months on the Canadian market when determining formulary acceptance times. Of the 29 study drugs, six were not approved for use in any of the 31 study hospitals. The six teaching hospitals had a median formulary approval time of 8.0 months compared to 12.8 months in the 25 non-teaching hospitals for the 23 study drugs. Although 21 of 23 study drugs were approved for use earlier in teaching hospitals than non-teaching hospitals, only alfentanil was found to be adopted significantly earlier (U = 11, n1 = 5, n2 = 19, alpha = 0.05). Variations in formulary approval times for new drugs have a bearing on patient care, Pharmacy and Therapeutics Committees, hospital budgets, and pharmaceutical firm revenues.

Diffusion of innovation I: Formulary acceptance rates of new drugs in teaching and non-teaching British Columbia hospitals--a hospital pharmacy perspective.

Lag times in the diffusion of new drugs in the hospital setting have both patient care and pharmaceutical industry implications. This two-part series uses diffusion theory to examine differences in the adoption rates of new drugs in British Columbia teaching and non-teaching hospitals. Formulary addition of a new drug by a hospital's Pharmacy and Therapeutics Committee was considered the adoption indicator. Time for adoption was defined as the difference between a drug's Canadian market approval date and the date of formulary addition. Surveys were mailed in September 1990 to 41 hospital pharmacies (response rate = 88%), asking respondents to provide formulary inclusion dates of 29 drugs marketed between July 1987 and March 1990. A significant difference (Mann-Whitney U Test, p < 0.0358) in median adoption time was observed between the six teaching and 25 non-teaching study hospitals, with the former adopting a new drug in 7.5 months versus the latter adopting a new drug in 12.1 months.

Community pharmacists' participation in health education and disease prevention activities.

Community pharmacists are faced with many opportunities to participate in health education and disease prevention activities. This study sought to determine the extent to which community pharmacists in British Columbia participate in such activities. A mail questionnaire was distributed to a systematic, stratified sample of 625 community pharmacists in B.C. (response rate = 83.6%). A five-point Likert-type scale was used to examine the frequencies of pharmacist involvement in 33 different health education/disease prevention activities. Results of the study indicate that pharmacists most frequently participate in health education/disease-preventing activities directly related to the dispensing or selling of medications. Activities exhibiting the lowest participation among pharmacists included speaking to community groups on health-related matters, participating in disease screening programs, querying clients on their level of occupational stress, counselling clients on AIDS prevention, and querying clients on their smoking status.

A survey of selected issues involving pharmacy technician training in Canada.

A non-random, snowball sampling technique was used to survey eleven Canadian pharmacy technician training programs and thirteen pharmacy regulatory and voluntary bodies on issues surrounding pharmacy technicians. A 100% response rate was achieved in the questionnaires which targeted issues such as nomenclature, certification, accreditation, and education of pharmacy technicians. Survey results indicate that while many provincial pharmacy regulatory boards have addressed issues such as the nomenclature and workplace role of pharmacy technicians, there is a lack of consensus and discussion in the areas of certification, accreditation, and responsibility for continuing education.