Characteristics of jugular bulb oxygen saturation in patients after cardiac arrest: A prospective study.

BACKGROUND: Using cerebral oxygen venous saturation post-cardiac arrest (CA) is limited because of a small sample size and prior to establishment of target temperature management (TTM). We aimed to describe variations in jugular bulb oxygen saturation during intensive care in relation to neurological outcome at 6 months post- CA in cases where TTM 33°C was applied. METHOD: Prospective observational study in patients over 18 years, comatose immediately after resuscitation from CA. Patients were treated with TTM 33°C M and received a jugular bulb catheter within the first 26 hours post-CA. Neurological outcome was assessed at 6 months using the Cerebral Performance Categories (CPC) and dichotomized into good (CPC 1-2) and poor outcome (CPC 3-5). RESULTS: Seventy-five patients were included and 37 (49%) patients survived with a good outcome at 6 months post-CA. No differences were found between patients with good outcome and poor outcome in jugular bulb oxygen saturation. Higher values were seen in differences in oxygen content between central venous oxygen saturation and jugular bulb oxygen saturation in patients with good outcome compared to patients with poor outcome at 6 hours (12 [8-21] vs 5 [-0.3 to 11]% P = .001) post-CA. Oxygen extraction fraction from the brain illustrated lower values in patients with poor outcome compared to patients with good outcome at 96 hours (14 [9-23] vs 31 [25-34]% P = .008). CONCLUSIONS: Oxygen delivery and extraction differed in patients with a good outcome compared to those with a poor outcome at single time points. Based on the present findings, the usefulness of jugular bulb oxygen saturation for prognostic purposes is uncertain in patients treated with TTM 33°C post-CA.

Antimicrobial resistance in Salmonella that caused foodborne disease outbreaks: United States, 2003-2012.

Although most non-typhoidal Salmonella illnesses are self-limiting, antimicrobial treatment is critical for invasive infections. To describe resistance in Salmonella that caused foodborne outbreaks in the United States, we linked outbreaks submitted to the Foodborne Disease Outbreak Surveillance System to isolate susceptibility data in the National Antimicrobial Resistance Monitoring System. Resistant outbreaks were defined as those linked to one or more isolates with resistance to at least one antimicrobial drug. Multidrug resistant (MDR) outbreaks had at least one isolate resistant to three or more antimicrobial classes. Twenty-one per cent (37/176) of linked outbreaks were resistant. In outbreaks attributed to a single food group, 73% (16/22) of resistant outbreaks and 46% (31/68) of non-resistant outbreaks were attributed to foods from land animals (P < 0·05). MDR Salmonella with clinically important resistance caused 29% (14/48) of outbreaks from land animals and 8% (3/40) of outbreaks from plant products (P < 0·01). In our study, resistant Salmonella infections were more common in outbreaks attributed to foods from land animals than outbreaks from foods from plants or aquatic animals. Antimicrobial susceptibility data on isolates from foodborne Salmonella outbreaks can help determine which foods are associated with resistant infections.

Attribution of Salmonella enterica serotype Hadar infections using antimicrobial resistance data from two points in the food supply system.

A challenge to the development of foodborne illness prevention measures is determining the sources of enteric illness. Microbial subtyping source-attribution models attribute illnesses to various sources, requiring data characterizing bacterial isolate subtypes collected from human and food sources. We evaluated the use of antimicrobial resistance data on isolates of Salmonella enterica serotype Hadar, collected from ill humans, food animals, and from retail meats, in two microbial subtyping attribution models. We also compared model results when either antimicrobial resistance or pulsed-field gel electrophoresis (PFGE) patterns were used to subtype isolates. Depending on the subtyping model used, 68-96% of the human infections were attributed to meat and poultry food products. All models yielded similar outcomes, with 86% [95% confidence interval (CI) 80-91] to 91% (95% CI 88-96) of the attributable infections attributed to turkey, and 6% (95% CI 2-10) to 14% (95% CI 8-20) to chicken. Few illnesses (<3%) were attributed to cattle or swine. Results were similar whether the isolates were obtained from food animals during processing or from retail meat products. Our results support the view that microbial subtyping models are a flexible and robust approach for attributing Salmonella Hadar.

Outbreaks of Salmonella infections attributed to beef --United States, 1973-2011.

Non-typhoidal Salmonella is estimated to be the most common bacterial cause of foodborne illness in the United States, causing an estimated one million domestically acquired foodborne illnesses annually. Recent, large outbreaks have highlighted the importance of ground beef as an important source of multidrug-resistant Salmonella. We analysed the epidemiology of salmonellosis outbreaks that were attributed to beef in the United States reported to the Centers for Disease Control and Prevention (CDC) from 1973 to 2011. During 1973-2011, of the 1965 outbreaks of Salmonella where a food vehicle was implicated, 96 were attributed to beef, accounting for 3684 illnesses. We observed a shift in the type of beef implicated in salmonellosis outbreaks, from roast to ground beef. Delicatessen-style roast beef cooked in commercial processing establishments was the predominant type during the 1970s and early 1980s; regulations on cooking and processing essentially eliminated this problem by 1987. Ground beef emerged as an important vehicle in the 2000s; it was implicated in 17 (45%) of the 38 beef-attributed outbreaks reported during 2002-2011. Although this emergence was likely due in part to increased participation in CDC's PulseNet, which was established in 1996, and proactive decisions by the United States Department of Agriculture's Food Safety and Inspection Service, stronger measures are needed to decrease contamination of ground beef with Salmonella.

Phenotype-related differential alpha-2,6- or alpha-2,3-sialylation of glycoprotein N-glycans in human chondrocytes.

OBJECTIVE: Sialic acids frequently occur at the terminal positions of glycoprotein N-glycans present at chondrocyte surfaces or in the cartilage matrix. Sialic acids are transferred to glycoproteins in either alpha-2,3 or alpha-2,6 linkage by specific sialyltransferases (SiaTs) and can potentially affect cell functions and cell-matrix interactions. The present study aimed to assess the relationship between the expression of the human chondrocyte phenotype and the sialylation of chondrocyte glycoprotein N-glycans. METHODS: The transcription of 5 SiaT was quantified using real-time Reverse transcription polymerase chain reaction (RT-PCR) assays. N-glycan analysis was performed using LC-ESI-MS. Primary human chondrocytes were cultured in monolayer or alginate beads and compared to the chondrocyte cell lines C-28/I2 and SW1353. In addition, effects of interleukin-1beta (IL-1beta) or tumour necrosis factor-alpha (TNF-alpha) on primary cells were assessed. RESULTS: Primary human chondrocytes predominantly express alpha-2,6-specific SiaTs and accordingly, alpha-2,6-linked sialic acid residues in glycoprotein N-glycans. In contrast, the preponderance of alpha-2,3-linked sialyl residues and, correspondingly, reduced levels of alpha-2,6-specific SiaTs are associated with the altered chondrocyte phenotype of C-28/I2 and SW1353 cells. Importantly, a considerable shift towards alpha-2,3-linked sialic acids and alpha-2,3-specific SiaT mRNA levels occurred in primary chondrocytes treated with IL-1beta or tumour necrosis factor-alpha (TNF-alpha). CONCLUSION: The expression of the differentiated chondrocyte phenotype is linked to the ratio of alpha-2,6- to alpha-2,3-linked sialic acids in chondrocyte glycoprotein N-glycans. A shift towards altered sialylation might contribute to impaired cell-matrix interactions in disease conditions.

Impurity profiling of liothyronine sodium by means of reversed phase HPLC, high resolution mass spectrometry, on-line H/D exchange and UV/Vis absorption.

For the first time, a comprehensive investigation of the impurity profile of the synthetic thyroid API (active pharmaceutical ingredient) liothyronine sodium (LT3Na) was performed by using reversed phase HPLC and advanced structural elucidation techniques including high resolution tandem mass spectrometry (HRMS/MS) and on-line hydrogen-deuterium (H/D) exchange. Overall, 39 compounds were characterized and 25 of these related substances were previously unknown to literature. The impurity classification system recently developed for the closely related API levothyroxine sodium (LT4Na) could be applied to the newly characterized liothyronine sodium impurities resulting in a wholistic thyroid API impurity classification system. Furthermore, the mass-spectrometric CID-fragmentation of specific related substances was discussed and rationalized by detailed fragmentation pathways. Moreover, the UV/Vis absorption characteristics of the API and selected impurities were investigated to corroborate chemical structure assignments derived from MS data.

Levothyroxine sodium revisited: A wholistic structural elucidation approach of new impurities via HPLC-HRMS/MS, on-line H/D exchange, NMR spectroscopy and chemical synthesis.

The structural elucidation of unknown pharmaceutical impurities plays an important role in the quality control of newly developed and well-established active pharmaceutical ingredients (APIs). The United States Pharmacopeia (USP) monograph for the API Levothyroxine Sodium, a synthetic thyroid hormone, features two high pressure liquid chromatography (HPLC) methods using UV-VIS absorption detection to determine organic impurities in the drug substance. The impurity profile of the first USP method ("Procedure 1") has already been extensively studied, however for the second method ("Procedure 2"), which exhibits a significantly different impurity profile, no wholistic structural elucidation of impurities has been performed yet. Applying minor modifications to the chromatographic parameters of USP "Procedure 2" and using various comprehensive structural elucidation methods such as high resolution tandem mass spectrometry with on-line hydrogen-deuterium (H/D) exchange or two-dimensional nuclear magnetic resonance spectroscopy (NMR) we gained new insights about the complex impurity profile of the synthetic thyroid hormone. This resulted in the characterization of 24 compounds previously unknown to literature and the introduction of two new classes of Levothyroxine Sodium impurities. Five novel compounds were unambiguously identified via isolation or synthesis of reference substances and subsequent NMR spectroscopic investigation. Additionally, Collision-Induced Dissociation (CID)-type fragmentation of identified major impurities as well as neutral loss fragmentation patterns of many characterized impurities were discussed.

Relief of postoperative pain with jaw relaxation, music and their combination.

The aim of this randomized controlled trial was to determine the effect of jaw relaxation, music and the combination of relaxation and music on postoperative pain after major abdominal surgery during ambulation and rest on postoperative days 1 and 2. Opioid medication provided for pain, following abdominal surgery, does not always give sufficient relief and can cause undesired side effects. Thus, additional interventions such as music and relaxation may provide more complete relief. Previous studies have found mixed results due to small sample sizes and other methodological problems. In a rigorous experimental design, 500 subjects aged 18-70 in five Midwestern hospitals were randomly assigned by minimization to a relaxation, music, relaxation plus music, or control group. Interventions were taught preoperatively and tested postoperatively. The same amount of time was spent with subjects in the control group. Pain was measured with the visual analogue sensation and distress of pain scales. Demographic and surgical variables, and milligrams of parenteral or oral opioids in effect at the time of testing were not significantly different between the groups, nor did they correlate with pain scores. Controlling for pretest sensation and distress, orthogonal a priori contrasts and multivariate analysis of covariance indicated that the three treatment groups had significantly less pain than the controls, (P = 0.028-0.000) which was confirmed by the univariate analysis of covariance (P = 0.018-0.000). Post hoc multivariate analysis revealed that the combination group had significantly less sensation and distress of pain than the control group on all post-tests (P = 0.035-0.000), and the relaxation and music groups had significantly less on all tests (P = 0.022-0.000) except after ambulation. At post ambulation those using relaxation did not have significantly less pain than the controls on both days and those using music did not on day 1, although there were some univariate effects. A corresponding significant decrease in mastery of the interventions from pre to post ambulation suggests the need for reminders to focus on the intervention during this increased activity. Physicians and nurses preparing patients for surgery and caring for them afterward, should encourage patients to use relaxation and music as adjuvants to medication for postoperative pain.

Maintaining quality of care and patient satisfaction with radical prostatectomy in the era of cost containment.

OBJECTIVES: To determine the effect of shortened hospital stay after radical retropubic prostatectomy on costs, adverse surgical outcomes, and patient satisfaction. METHODS: The effect of changes in preoperative counseling, perioperative care, and analgesic management on hospital length of stay; mean cost per case and cost per hospital day; and 30-day complication, hospital readmission, and mortality rates were analyzed for a consecutive sample of 374 patients undergoing radical prostatectomy between July 1989 and November 1995. Satisfaction with length of stay, analgesic regimen, and surgical outcome was assessed in a random subset of 150 patients by anonymous questionnaire. RESULTS: Length of stay (LOS) was shortened from a median 7 to 2 nights after surgery during the study (P < 0.0001), whereas the acute complication, 30-day readmission, and 30-day mortality rates remained constant. Reducing LOS resulted in a 43% decrease in mean cost per case while mean cost per day increased by 22% to 35%. Overall patient satisfaction was high, with 83.5% of patients rating LOS as "just right" and 89.2% reporting they were "satisfied" or "very satisfied" with their pain control after surgery. CONCLUSIONS: Shortened LOS after radical retropubic prostatectomy can be accomplished safely and can meet with high levels of patient satisfaction while significantly reducing hospital-related costs. The potential for further incremental reductions in cost with reductions in LOS to less than 2 nights appears to be small, and future efforts at cost reduction for this procedure should center on decreasing the intensity of care during hospitalization.

Fentanyl: clinical use as postoperative analgesic--epidural/intrathecal route.

The administration of epidural and intrathecal opioids for the management of postoperative pain is well established. Fentanyl, because of its greater lipophilicity, offers a number of advantages over morphine for epidural analgesia, including a lower incidence of side effects and reduced risk of delayed-onset respiratory depression. The relatively short duration of action of epidural fentanyl makes this agent more ideally suited for continuous infusion or patient-controlled epidural analgesia (PCEA). The effective doses and adverse effects profile of epidural fentanyl are reasonably well understood. Because of the lack of spread through the cerebrospinal fluid (CSF) and hence the segmental nature of the analgesia achieved, location of epidural catheter placement is of paramount importance when this agent is used. Prolonged epidural infusion of fentanyl may result in high systemic concentrations not dissimilar to IV infusion, and, therefore, the greatest efficacy of epidural fentanyl administration may be in combination with low concentrations of bupivacaine, an approach that achieves a synergistic effect. 2-Chloroprocaine has been shown to antagonize epidural fentanyl analgesia. Intrathecal fentanyl for postoperative analgesia is limited by its short duration of action with single-bolus administration. The widespread international increase in the use of epidural fentanyl for postoperative analgesia promises further improvements and refinement in techniques.

Sufentanil: clinical use as postoperative analgesic--epidural/intrathecal route.

Although morphine and fentanyl remain the predominant epidural opioids, sufentanil offers some unique advantages. Because of its greater lipophilicity and mu-receptor binding capacity, sufentanil has a faster onset of action and longer duration than epidural fentanyl. Compared with morphine, sufentanil has been associated with a lower incidence of side effects, particularly delayed respiratory depression. The effective doses and adverse effects profile of epidural sufentanil are relatively well understood. Ventilatory depression is minimal with both bolus and continuous administration. Rapid vascular uptake after large epidural bolus, however, has been associated with acute-onset respiratory depression and even respiratory arrest. Sufentanil is more ideally suited than morphine to continuous epidural administration. The faster onset in comparison with fentanyl may make sufentanil the ideal agent for patient-controlled epidural analgesia. The synergistic effect of combined sufentanil and low-concentration bupivacaine offers advantages over sufentanil alone. High doses of epidural sufentanil have been uniquely associated with cessation of shivering and hypothermia. As with fentanyl, the intrathecal administration of sufentanil for postoperative analgesia is limited by its short duration of action.

Absorption and subjective effects of caffeine from coffee, cola and capsules.

Coffee is often perceived as producing greater pharmacological effects than cola. The present study compared the magnitude and rapidity of peak caffeine levels and subjective effects between coffee and cola. Thirteen users of both coffee and cola (mean daily caffeine consumption = 456 mg) ingested 400 mg caffeine via 12 oz unsweetened coffee, 24 oz sugar-free cola or 2 capsules in a random, double-blind, placebo-controlled, within-subjects design. Subjects provided a saliva sample and completed subjective effect scales 15 min before and 30, 60, 90, 120, 180 and 240 min after ingestion. Mean peak saliva caffeine levels did not differ between coffee (9.7 +/- 1.2 micrograms/ml) and cola (9.8 +/- 0.9 micrograms/ml) and appeared to be greater with these beverages than with the capsule (7.8 +/- 0.6 micrograms/ml; p = NS). Saliva caffeine levels peaked at similar times for coffee (42 +/- 5 min) and cola (39 +/- 5 min) but later for capsule (67 +/- 7 min; p = 0.004). There was no main effect of vehicle or interaction of vehicle and drug on magnitude of peak effect or time to peak increase on self-report scales. In summary, peak caffeine absorption, time to peak absorption, and subjective effects do not appear to be influenced by cola vs. coffee vehicle. Perceived differences in the effects of coffee vs. cola may be due to differences in dose, time of day, added sweetener, environmental setting or contingencies.

Progressive scoliosis with vertebral rotation after lumbar intervertebral disc herniation in a 10-year-old girl.

A case report of a 10-year old girl with a herniated disc is presented. The most significant symptoms were progressive scoliosis with a flat back and paravertebral muscle spasm. An absent H reflex on the left and an increased latency of the somatosensory-evoked potentials of the left posterior tibial nerve were found. The computed tomographic scan of the lumbar spine showed a large central left-sided disc protrusion at the L5-S1 level. Our case presents the youngest patient with documented intervertebral disc herniation and the only one with severe scoliosis and vertebral rotation. The curve was not structural because it improved with surgery and an orthosis was not necessary.

Subjective effects of caffeine among introverts and extraverts in the morning and evening.

In previous studies of psychomotor performance, the stimulant effects of caffeine differed by personality characteristics. For example, caffeine improved the task performance of extraverts but overaroused introverts and thus impaired their performance. The present study compared the effects of caffeine on subjective arousal among introverts and extraverts. Seventeen introverts and 19 extraverts drank coffee that contained doses of 0, 2, and 4 mg/kg caffeine during morning and evening sessions in a within-subjects, randomized, double-blind, crossover design. At 30-min intervals for 180 min after drinking, participants completed the Profile of Mood States, a battery of self-report visual analog scales, and the Digit Symbol Substitution Test (DSST). Caffeine effects on mood and task performance did not significantly interact with extraversion, except for nonsignificant trends for caffeine to increase happiness and vigor more among extraverts than introverts. No 3-way interactions of group, time, and dose were found on any scales or on the DSST. Results do not support the hypothesis that caffeine differentially affects extraverts and introverts, particularly at different times of the day.

Evaluation of the monitoring of papular dermatitis lesions in slaughtered swine to assess sarcoptic mite infestation.

We investigated the association between the presence of papular dermatitis and sarcoptic mite infestation in pigs slaughtered in southern Minnesota. Following dehairing, a sample of 30 pigs from each of 50 herds was inspected for papular dermatitis lesions. Herds were selected after being categorized into one of five categories according to the prevalence and severity of dermatitis lesions. Herd infestation with sarcoptic mange was determined by recovery of mites from ear scrapings of slaughtered pigs and also by survey of producer opinion. Mite infestation was detected in 28 herds (56%) and 215 of 1500 pigs (14%). Considerable variability in prevalence of positive scrapings, ranging from one pig (3%) to 19 pigs (63%), was found among infested herds. Prevalence of mite infestation was positively associated with severity of papular dermatitis lesions in groups. For individual pigs, estimates of the specificity of localized lesions ranged from 0.70 to 0.90. Generalized lesions appear highly specific (> 0.98) for sarcoptic mite hypersensitivity. Generalized lesions occurred in 36.7% of pigs from herds confirmed to be infested, compared with 0.4% of pigs in herds confirmed free from mange. Our date indicate that monitoring of dermatitis lesions in slaughtered pigs might be a useful test for sarcoptic mange in the Midwest, USA.

Treatment resistant smokers: a pilot study of nicotine nasal spray and inhaler.

A growing proportion of smokers are those who have failed prior treatments for cessation. We tested the efficacy of nicotine nasal spray and nicotine inhaler in two uncontrolled, open-label studies of 19 and 20 smokers who had previously failed nicotine patch therapy. As in the three prior studies of treatment failures, 6 month abstinence rates were extremely low both with the nasal spray (0%) and the inhaler (5%). We discuss possible treatments for and methodological issues in researching treatment-resistant smokers.

The influence of early age mastectomy and unilateral ovariectomy on reproductive performance of the bovine.

The effects of mastectomy and unilateral ovariectomy and their interaction during the postpartum period were examined in 26 Angus heifers. At birth, the animals were assigned to a 2 x 2 factorial arrangement of treatments: mastectomy and unilateral ovariectomy, mastectomy, unilateral ovariectomy and unoperated suckled control. Surgeries were performed at approximately 2 months of age, and animals were observed through three consecutive postpartum intervals (PP1, PP2, and PP3). There were no significant influences of mastectomy or ovariectomy on age at puberty, age at first conception or services required for first conception. Mastectomy reduced the number of days from parturition to ovulation (PP1, 32.1 vs 52.5, P less than .01; PP2, 21.6 vs 59.9, P less than .01; PP3, 20.6 vs 46.7, P less than .01) The interval from parturition to first estrus was shorter for heifers in the mastectomized group (PP1, 45.3 vs 76.2, P less than .05; PP2, 28.7 vs 69.9, P less than .01; PP3, 32.4 vs 62.3, P less than .05) as was the interval from parturition to conception during PP2 (60.0 vs 104.9, P less than .05). The interval between calvings was shorter for heifers in the mastectomized group than for controls, but the difference was significant only between the second and third parturitions: 338.5 vs 399.2 (P less than .01). Mastectomy reduced the standard deviation for the interval between parturition 2 and parturition 3 (55.9 vs 15.9; P less than .01), the interval between parturition and return to estrus in PP2 (56.3 vs 11.4; P less than .01) and the interval from calving to conception PP1 (92.2 vs 31.4; P less than .01). Unilateral ovariectomy did not have a significant influence on any of the postpartum intervals, nor were there any significant interactions.

Patients' versus nurses' assessments of pain and sedation after cesarean section.

OBJECTIVE: To compare nurses' and patients' assessments of pain and sedation in patients receiving epidural or intravenous patient-controlled analgesia (PCA) after cesarean section. DESIGN: Prospective, randomized study. SETTING: The perinatal unit and labor and delivery unit in a 1,036-bed university hospital in the mid-Atlantic region. PARTICIPANTS: Twenty-six patients receiving epidural PCA or intravenous PCA. Nurses participating in the study were assigned as caregivers to the 26 patients. MAIN OUTCOME MEASURES: Pain and sedation were assessed using 10-cm visual analogue scales completed by both the patient and the patient's nurse twice daily on the day of surgery and on the 1st and 2nd postoperative days. RESULTS: No significant correlation was found between the nurses' and patients' pain or sedation scores. Chi-square analysis showed that the nurse was as likely to underestimate as to overestimate the patient's pain score. The nurse underestimated the patient's sedation score 85% of the time. CONCLUSIONS: The results suggest that nurses' and patients' assessments of pain and sedation differ. The routine use of a standardized self-assessment tool, such as the visual analogue scale, is recommended to ensure that analgesic treatment is based on the subjective nature of the patient's pain experience rather than the nurse's judgment.

Comparison of methods for measurement of enzootic pneumonia lesions in pigs.

A rapid subjective method for estimating the extent of gross pneumonia lesions in slaughtered pigs was compared with dissection of lungs in 51 slaughtered pigs. After standardization for prevalence in the regional industry, regression analysis indicated that the subjective method was highly predictive of the extent of pneumonic lesions (R2 = 0.88). Part of the error with the subjective method was attributed to approximations used for the relative proportions of lung lobes, which result in overestimation of the affected tissue by approximately 20%. Retrospective analysis of data from a slaughter monitoring program revealed strong associations (R2, 0.54 to 0.91) between prevalence, mean, median, and maximal lung scores in groups of pigs. Maximal lung score was biased by sample size, but prevalence and mean or median lung scores could be used to describe pneumonia severity in groups of pigs. Our results indicate that error in measurement of the extent of pneumonic tissue in slaughtered pigs is unimportant if the time of onset, clinical severity, and duration of disease are not quantified.

Agreement among veterinarians evaluating gross lesions of lungs, livers, and nasal turbinates of pigs.

OBJECTIVE: To evaluate agreement between trained veterinarians and a reference inspector when recording gross lesions of lungs, livers, and nasal turbinates of pigs. DESIGN: Prospective study. SAMPLE POPULATION: 10 veterinarians in workshop 1 and 11 veterinarians in workshop 2. PROCEDURE: Analysis of data obtained from 2 workshops in which veterinarians evaluated fresh tissues (30 lungs and 30 livers) and 100 slides of nasal turbinates previously evaluated by the reference inspector. Veterinarians independently recorded observations of gross lesions. Agreement was evaluated by percentage agreement, kappa or weighted kappa, and sensitivity and specificity, where relevant. RESULTS: Agreement between veterinarians and the reference inspector was excellent for detecting consolidation of lung lobes typical of enzootic pneumonia (kappa = 0.81 and 0.87 for workshops 1 and 2, respectively) and white spots on livers (kappa = 0.76 and 0.78). Estimates of the extent of consolidation as a proportion of lung volume also agreed closely with reference values. Agreement was closer for veterinarians who had undergone repeated training and evaluation. Agreement was good for detecting nasal turbinate atrophy (weighted kappa = 0.63 and 0.68) and was poorest for detecting lesions of pleuritis (kappa = 0.39 and 0.44). CLINICAL IMPLICATIONS: For most of the lesions evaluated, acceptable levels of agreement with reference scores were achieved after training of veterinarians to use standardized methods to record gross lesions. Standardization of veterinarians' recordings of gross lesions should improve the reliability and usefulness of data collected by inspection of slaughtered pigs.