Neuroprotection by anaesthetics in rodent models of traumatic brain injury: a systematic review and network meta-analysis.

BACKGROUND: Anaesthetic neuroprotection in the setting of traumatic brain injury (TBI) remains unproved and is based upon the results in preclinical experiments. Here, we sought to synthesise the results in rodent models of TBI, and to evaluate the effects of publication bias, experimental manipulation, and poor study quality on the effect estimates. METHODS: After a systematic review, we used pairwise meta-analysis to estimate the effect of anaesthetics, opioids, and sedative-hypnotics on neurological outcome, and network meta-analysis to compare their relative efficacy. We sought evidence of bias related to selective publication, experimental manipulation, and study quality. RESULTS: Sixteen studies, involving 32 comparisons, were included (546 animals). The treatment improved the neurological outcomes by 35%; 95% confidence interval: 26-44%; P<0.001. The statistical heterogeneity was small (12%), but the 95% prediction interval for the estimate was wide (15-56%). The statistical power was low: 61% (90% confidence interval: 22-86%). The small sample size in the studies was a serious shortcoming reducing the statistical heterogeneity and obscuring differences in outcome between drugs and between experimental conditions. CONCLUSIONS: Anaesthetics do provide neuroprotection in rodent models of TBI. The effect-size estimates do not appear to be exaggerated by selective publication, experimental manipulation, or study design. The main shortcoming of the included studies were small sample sizes leading to low power and imprecision, which precluded the network meta-analysis from providing a meaningful ranking for efficacy amongst the drugs. Reliable preclinical investigations of neuroprotection by anaesthetics will require larger sample sizes.

Optimizing Outcomes in Pediatric Renal Transplantation Through the Australian Paired Kidney Exchange Program.

Kidney paired donation (KPD) programs offer the opportunity to enable living kidney donation when immunological and other barriers prevent safe directed donation. Children are likely to require multiple transplants during their lifetime; therefore, high-level histocompatibility and organ quality matching are key priorities. Details are given for a cohort of seven pediatric renal transplantations performed through the Australian Kidney Exchange (AKX), including barriers to alternative transplantation and outcomes after KPD. Reasons for entering the KPD program were preformed donor-specific antibodies to their registered donor in five cases, ABO mismatch, and avoidance of the risk of exposure to hepatitis B virus. Four recipients were highly sensitized. All patients received transplants with organs of lower immunological risk compared with their registered donors. HLA eplet mismatch scores were calculated for donor-recipient pairs; three patients had improved eplet mismatch load with AKX donor compared with their registered donor. All grafts are functioning, with a mean estimated glomerular filtration rate of 77 mL/min/1.73 m2 (range 46-94 mL) and a follow-up range of 8-54 months, and no patient experienced clinical or histological rejection. KPD is a viable strategy to overcome many barriers to living donation for pediatric patients who have an otherwise suitable donor and provides an opportunity to minimize immunological risks.

Point-of-care paediatric gastric sonography: can antral cut-off values be used to diagnose an empty stomach?

BACKGROUND: Gastric sonography is emerging as a valuable clinical point-of-care tool to assess aspiration risk. A recent study proposed that a single cut-off cross-sectional area (CSA) in the supine position could diagnose an empty stomach in the parturient. This study establishes the sensitivity and specificity of a single CSA cut-off measurement in both supine and right lateral decubitus (RLD) positions in the diagnosis of an empty antrum in paediatric patients. METHODS: Following induction of anaesthesia, antral sonography was performed in supine and RLD positions in 100 fasted paediatric patients prior to upper endoscopic evaluation. Following upper endoscopy, any residual stomach content was suctioned under direct visualization and antral sonography was immediately performed. Antral CSA values were compared using Wilcoxon signed rank test. Receiver operator characteristic (ROC) curves were plotted to estimate the discriminating power of antral sonography position in the diagnosis of an empty antrum. RESULTS: Significant differences were found between pre-suctioned and post-suctioned CSA values in the RLD position. The cut-off CSAs of the empty antrum in the supine and RLD positions were 2.19 cm2 (sensitivity 75%, specificity 36%) and 3.07 cm2 (sensitivity 76%, specificity 67%), respectively. CONCLUSIONS: The RLD position produces the most sensitive and specific CSA cut-off value where an antral CSA of ≤ 3.07 cm2 in the RLD position presents with acceptable performance in the ability to discriminate an empty antrum in paediatric patients over 1 yr of age. As age increases, the sensitivity and specificity of this test increases in the RLD position.

Development of a novel Bluetooth Low Energy device for proximity and location monitoring in grazing sheep.

Monitoring animal location and proximity can provide useful information on behaviour and activity, which can act as a health and welfare indicator. However, tools such as global navigation satellite systems (GNSS) can be costly, power-hungry and often heavy, thus not viable for commercial uptake in small ruminant systems. Developments in Bluetooth Low Energy (BLE) could offer another option for animal monitoring, however, BLE signal strength can be variable, and further information is needed to understand the relationship between signal strength and distance in an outdoor environment and assess factors which might affect its interpretation in on-animal scenarios. A calibration of a purpose-built device containing a BLE reader, alongside commercial BLE beacons, was conducted in a field environment to explore how signal strength changed with distance and investigate whether this was affected by device height, and thus animal behaviour. From this calibration, distance prediction equations were developed whereby beacon distance from a reader could be estimated based on signal strength. BLE as a means of localisation was then trialled, firstly using a multilateration approach to locate 16 static beacons within an ∼5 400 m2 section of paddock using 6 BLE readers, followed by an on-sheep validation where two localisation approaches were trialled in the localisation of a weaned lamb within ∼1.4 ha of adjoining paddocks, surrounded by nine BLE readers. Validation was conducted using 1 days' worth of data from a lamb fitted with both a BLE beacon and separate GNSS device. The calibration showed a decline in signal strength with increasing beacon distance from a reader, with a reduced range and earlier decline in the proportion of beacons reported at lower reader and beacon heights. The distance prediction equations indicated a mean underestimation of 12.13 m within the static study, and mean underestimation of 1.59 m within the on-sheep validation. In the static beacon localisation study, the multilateration method produced a mean localisation error of 22.02 m, whilst in the on-sheep validation, similar mean localisation errors were produced by both methods - 19.00 m using the midpoint and 23.77 m using the multilateration method. Our studies demonstrate the technical feasibility of localising sheep in an outdoor environment using BLE technology; however, potential commercial application of such a system would require improvements in BLE range and accuracy.

Increase in nephrology advanced trainee numbers in Australia and associated reduction in clinical exposure over the past decade.

BACKGROUND: Advanced training in nephrology should provide broad experience in all aspects of nephrology. In Australia, the Specialist Advisory Committee in Nephrology oversees nephrology training, and recent increases in advanced trainee numbers have led to concern about dilution of training experience. No study has examined variations in clinical exposure for nephrology trainees in Australia. AIM: To assess the changes in nephrology advanced training in Australia with respect to trainee numbers and exposure to patients and procedures over the past 10 years. METHODS: A retrospective study was performed by obtaining all available Royal Australasian College of Physician supervisor reports from 2000 to 2010 to determine differences in clinical exposure and procedures performed by nephrology trainees. RESULTS: Five hundred and forty-two reports were reviewed involving 208 nephrology trainees in Australia across 53 different training sites. In 2000, 22 trainees were undertaking a core clinical year of training. Trainee numbers have steadily risen from 33 in 2004 to 84 in 2010. The greatest increases have occurred in New South Wales, Victoria and Queensland (sixfold, threefold and fivefold increases respectively). Trainee exposure to dialysis patients has gradually decreased in the past decade. The average number per trainee per year in 2000 compared with 2010 were 66 versus 43 (P = 0.02) and 28 versus 16 (P = 0.01) for haemodialysis and peritoneal dialysis respectively. Acute kidney injury cases per trainee showed a gradual nonsignificant reduction over time and average procedural numbers per trainee decreased significantly from 2000 to 2010 with fewer temporary dialysis catheters inserted per year (39 vs 10, P < 0.01) and fewer renal biopsies performed per year (65 vs 41, P < 0.01). The proportion of trainees working in a hospital that does not provide exposure to acute transplantation has steadily increased from 15% in 2003 to 44% in 2010. CONCLUSIONS: There has been a dramatic and significant increase in nephrology advanced trainee numbers over the past decade at a more rapid rate than the growth in dialysis and transplant patient numbers. This study suggests that training experience has diminished over the past decade and supports a 3-year core clinical nephrology training programme in Australia.

Anguillids: conserving a global fishery.

Concern has increased in recent years over the sustainability of anguillid populations worldwide in the face of sustained consumer demand. This is as true of the more numerous tropical species as it is for the better known temperate species. There are, however, critical gaps in knowledge of anguillid biology and ecology, and these hold back measures designed to conserve and enhance anguillid populations, including aquaculture. Developing a more integrated understanding of anguillid biology, and resolving challenges faced by stakeholders and policy makers, is now more urgent than ever. World experts from Japan, the U.S.A., Canada, the European Union and New Zealand led a 3 day event where >200 scientists drawn from >30 countries across the globe converged to share their experience and expert knowledge of anguillids. The session covered the full range of issues affecting anguillid stocks across the globe, and also highlighted advances in the understanding of fundamental aspects of anguillid biology. Overall, 49 oral presentations and 68 posters were presented and, while these were dominated by Anguilla anguilla, Anguilla rostrata and Anguilla japonica, a further eight anguillid species were represented. What was experienced by all was the facilitation of a more integrated understanding of anguillid biology, and how this understanding can interface with the challenges faced by fishermen, consumers, engineers, producers and managers. The highlights are reviewed, important trends in anguillid stocks and research identified and the consensus for future science and management direction reported.

Evaluation of discriminant analysis based on dorsoventral symmetry indices to quantify hindlimb lameness during over ground locomotion in the horse.

REASONS FOR PERFORMING STUDY: Advances in gait analysis techniques have led to assessment tools that can aid in detecting and quantifying lameness; here, bilateral tubera coxae and pelvic movement during over ground locomotion are compared in order to investigate a practical method to assess hindlimb lameness in the horse. OBJECTIVES: To evaluate which parameters from anatomical landmarks on trunk and proximal hindlimbs are the best indicators of degree and side of hindlimb lameness. METHODS: Fifteen horses (age 11-23 years, 6 nonlame and 9 unilaterally hindlimb lame horses 1/10 to 2/10 lame) were fitted with 4 inertial sensors: tuber sacrale, left and right tubera coxae and withers; 889 strides were collected from 6 trot trials per horse. Horses were assessed for lameness by a qualified equine orthopaedic surgeon from videos. Vertical displacement data for each sensor were used to calculate symmetry indices as well as published Fourier analysis based parameters. Linear discriminant analysis was used to determine the most discriminative parameters for 2 scenarios: grading of severity of lameness and identification of the affected limb. RESULTS: Pelvic energy ratio gave the best indication for the degree of lameness. Directional symmetry index of the tubera coxae sensors yielded the highest discriminative power for identification of the lame limb. CONCLUSIONS AND POTENTIAL RELEVANCE: A good indication of the degree of hindlimb lameness can be obtained from vertical displacement data of the pelvic midline, collected from inertial sensors during over ground locomotion. The trunk mounted inertial sensor system allows for a time efficient collection of a representative database from horses with differing grade and site of lameness in a clinical setting. This is crucial for future work on a robust definition of the best parameters for lameness classification under practical conditions.

Variability of Manson and Leaver locomotion scores assigned to dairy cows by different observers.

The gait scoring system developed by Manson and Leaver was used by five experienced observers to assess the gait of 83 milking Holstein-Friesian cows in a live recording session, and video recordings were made. The agreement between the scores of the observers at the live session, and between each observer's scores at the live session and a video session, were compared at three levels of stringency. The scores of the observers were highly variable at all but the least stringent threshold - whether a cow had a score of less than 3 or 3 or more, that is, whether it was not lame or lame.

Oral contraceptive use and fibrocystic breast disease of different histologic classifications.

The relationship between oral contraceptive (OC) use and occurrence of fibrocystic breast disease (FBD) of different histologic classifications was evaluated with data from a cohort study. Biopsy specimens from 232 women with FBD were classified into different atypia categories. In 96 matched pairs of OC users and nonusers, atypia scores were lower in users than in nonusers. Women without breast diseases (500 OC users and 500 nonusers) were sampled from the original cohort to form a two-stage "anamorphic" study with the 232 cases of FBD. The previously shown inverse association between OC use and FBD occurrence was present and increased with increased length of OC use. However, the "protective effect" of OC use did not vary for different histologic classifications of FBD. The findings from both paired and anamorphic analyses of the data are not consistent with the hypothesis that the use of OC is associated with decreased frequency only of FBD with minimal epithelial atypia.

Epidemiologic aspects of gallbladder cancer: a case-control study of the SEARCH Program of the International Agency for Research on Cancer.

BACKGROUND: There are few previous epidemiologic studies of gallbladder cancer, a rare but nearly always lethal gastrointestinal cancer with a demonstrated greater frequency in adult women and older subjects of both sexes, and also in the members of populations throughout central and eastern Europe and certain racial groups such as native American Indians. Unfortunately, the prospects for the prevention of this form of cancer are poor. PURPOSE: Our purpose in conducting this study was to investigate possible new risk factors for gallbladder cancer and to strengthen our understanding of established causal agents that may be involved in this disease. METHODS: A large, collaborative, multicenter, case-control study of cancer of the gallbladder was conducted in five centers located in Australia (Adelaide), Canada (Montreal and Toronto), The Netherlands (Utrecht), and Poland (Opole) from January 1983 through July 1988. Case subjects with gallbladder cancer were accrued by the centers from hospital pathology records and from reports to regional cancer registries. Cancer diagnosis was confirmed by either biopsy, cholecystectomy, or at the time of autopsy. Control subjects were randomly assigned at each center from the population. The pooled analysis included 196 case subjects and 1515 control subjects (who did not report previous cholecystectomy). Ninety-eight percent of the subjects were white. Personal interviews of case subjects, control subjects, and surrogates (spouse or next of kin) were conducted by trained personnel. RESULTS: After adjusting for potential confounding factors (age, sex, center, type of interview, years of schooling, alcohol intake, and lifetime cigarette smoking), a history of gallbladder symptoms requiring medical attention (e.g., reduced bile secretion from the gallbladder into the small intestine due to obstructions of the common bile or cystic ducts) was the major risk factor associated with this form of cancer (odds ratio [OR] = 4.4; 95% confidence interval [CI] = 2.6-7.5). This association was present even in subjects who had their first gallbladder examination because of symptoms present more than 20 years earlier (OR = 6.2; 95% CI = 2.8-13.4). Other variables associated with gallbladder cancer risk included an elevated body mass index, high total energy intake, high carbohydrate intake (after adjustment for total energy intake), and chronic diarrhea. All of these risk factors have been previously associated with gallstone disease. CONCLUSIONS: These findings are consistent with a major role of gallstones, or risk factors for gallstones, in the cause of gallbladder cancer. Additional information on whether or not screening high-risk subjects for gallstones or gallbladder cancer is needed.

A molecular mimic of phosphorylated prolactin markedly reduced tumor incidence and size when DU145 human prostate cancer cells were grown in nude mice.

Others have demonstrated the presence of an autocrine prolactin (PRL) growth loop in the normal human prostate. In this study we have used three human prostate cancer cell lines but have focused on the androgen-independent human prostate cancer cell line, DU145, to ask: (a) whether this autocrine growth loop is maintained beyond the loss of androgen sensitivity in the progression of prostate cancer; and (b) whether interruption of this growth loop by a PRL receptor antagonist, an S179D mutant PRL, could inhibit the formation of DU145-derived tumors. The autocrine loop was examined in most detail in the DU145 cell line but was demonstrated to be functional in all three of the lines by the reversible inhibition of growth in vitro by the S179D PRL receptor antagonist. To investigate the effect of S179D PRL on the growth of DU145 tumors in nude mice two sets of experiments were performed. In the first set, Alzet minipumps containing no PRL, wild-type (WT) PRL, or the S179D PRL (the last two delivering 4.56 microg/24 h and 4.26 microg/24 h, respectively), were implanted s.c. on day 1. On day 4, 5 x 10(6) DU145 cells were injected s.c. in the hindquarter. On day 22, the animals were killed, tumors were removed, measured, and subsequently fixed and processed for histological confirmation of tumor formation. The incidence of tumors in the no-PRL control group was 9/11 animals (82%). In the animals treated with WT PRL, the incidence was 8/10 (80%), whereas in the animals treated with the S179D PRL, the incidence was markedly reduced to 3/11 (27%). Although WT PRL had no effect on the incidence of tumors, the average size of the tumors increased from 25.8 +/- 5.99 mm(3) in controls to 66.66 +/- 18.06 mm(3) in WT PRL-treated animals. In the second set of experiments, 5 x 10(6) DU145 cells were injected on day 1. On day 18, Alzet minipumps containing no PRL, WT PRL, or S179D PRL were implanted. On day 42, the animals were killed and the tumors processed as before. S179D PRL caused a reduction in tumor size from 1731 +/- 283 mm(3) in the no-PRL controls to 1031 +/- 295 mm(3), whereas WT PRL slightly increased the size to 2118 +/- 630 mm(3). We conclude that PRL is used as an autocrine growth factor by human prostate cancer cells both in vitro and in vivo and that interruption of this growth loop in vivo inhibits tumor initiation and the growth of well-established tumors.

The kinematics and kinetics of riding a racehorse: A quantitative comparison of a training simulator and real horses.

Movement of a racehorse simulator differs to that of a real horse, but the effects of these differences on jockey technique have not been evaluated. We quantified and compared the kinematics and kinetics of jockeys during gallop riding on a simulator and real horses. Inertial measurement units were attached mid-shaft to the long bones of six jockeys and the sacrum of the horse or simulator. Instrumented stirrups were used to measure force. Data were collected during galloping on a synthetic gallop or while riding a racehorse simulator. Jockey kinematics varied more on a real horse compared to the simulator. Greater than double the peak stirrup force was recorded during gallop on real horses compared to the simulator. On the simulator stirrup forces were symmetrical, whereas on a real horse peak forces were higher on the opposite side to the lead limb. Asymmetric forces and lateral movement of the horse and jockey occurs away from the side of the lead leg, likely a result of horse trunk roll. Jockeys maintained a more upright trunk position on a real horse compared to simulator, with no change in pitch. The feet move in phase with the horse and simulator exhibiting similar magnitude displacements in all directions. In contrast the pelvis was in phase with the horse and simulator in the dorso-ventral and medio-lateral axes while a phase shift of 180° was seen in the cranio-caudal direction indicating an inverted pendulum action of the jockey.

How realistic is a racehorse simulator?

Race jockey training is demanding and technical. Increased horse care costs and demands on time have led to greater availability and use of racehorse simulators during training. Little is known about the accuracy of the simulated movement and therefore how effective they are for developing the desired technique. We quantified and compared sacral rotation and displacement vectors for a racehorse simulator and a real galloping horse. A single inertial measurement unit was placed on the sacrum of six horses (horse) during a training gallop along an all-weather seven furlong gallop and on the highest speed setting 'four' on the simulator. Displacements were calculated in all three axes before being cut into cycles and analysed along with roll and pitch. Displacement and rotation amplitudes were extracted and compared for the horse and simulator. Horse sacral movement parameters were more varied than those recorded on the simulator. The real horse exhibited greater dorso-ventral, medio-lateral and roll amplitude but smaller cranio-caudal displacement amplitude and no difference in pitch amplitude. Displacement trajectory of the simulator when viewed laterally from the left side, was anticlockwise, the opposite direction to that of the real horse leaving the regular use of a simulator during jockey training under question. Use of the racehorse simulator is beneficial to develop specific fitness and to enable physical manipulation into the optimal position. Care must be taken to avoid any detrimental effects of training with the opposite movement trajectory to that experienced during a race. The programming of the simulators may benefit from adaptations to maximise their benefits.

Dopamine treatment during acute hypoxia is neuroprotective in the developing sheep brain.

Dopamine is often used to treat hypotension in preterm infants; these infants are at risk of developing brain injury due to impaired autoregulation and cerebral hypoperfusion. However the effects of dopamine on the immature brain under conditions of cerebral hypoxia are not known. We hypothesized that pretreatment with dopamine would protect the immature brain from injury caused by cerebral hypoxia. Preterm fetal sheep were used to determine the effects of intravenous dopamine on hypoxia-induced brain injury. In 16 pregnant sheep at 90days of gestation (0.6 of term, term=147days) catheters were implanted aseptically into the fetal carotid artery and jugular vein; an inflatable occluder was placed loosely around the umbilical cord for later induction of fetal hypoxemia. At 5days after surgery, dopamine (10µg/kg/min, n=7 fetuses) or saline (n=9 fetuses) was infused for 74h. Two hours after commencing the dopamine/saline infusion, we induced umbilical cord occlusion (UCO) for up to 25min to produce fetal asphyxia. Fetuses were allowed to recover, and brains were collected 72h later for assessment of neuropathology. Un-operated twin fetuses were used as age-matched non-UCO controls (n=8). In UCO+saline fetuses, microglial and apoptotic cell density in the subcortical and periventricular white matter, caudate nucleus and hippocampus was greater than that in age-matched controls; oxidative stress was elevated in the subcortical and periventricular white matter and caudate nucleus compared to that in age-matched controls. In UCO+dopamine fetuses microglial density and oxidative stress in the cerebral white matter and caudate nucleus were not different to that of age-matched controls. Apoptotic cell death was decreased in the cerebral white matter of UCO+dopamine brains, relative to UCO+saline brains. We conclude that pretreatment with dopamine does not exacerbate hypoxia-induced injury in the immature brain and may be neuroprotective because it led to decreased apoptosis, oxidative stress and neuroinflammation in the cerebral white matter and decreased neuroinflammation in the caudate nucleus.

Abrogation of delayed type hypersensitivity response to Candida albicans produced by a molecular mimic of phosphorylated prolactin.

The effects of two major forms of prolactin (PRL) were examined on delayed type hypersensitivity (DTH) responses to Candida albicans. Unmodified PRL (U-PRL) had no effect on the DTH response, whereas a molecular mimic of phosphorylated PRL (S179D PRL) significantly inhibited immune responses to this robust antigen. This effect of S179D PRL was not accompanied by gross alterations in splenic T cell numbers, CD4/CD8 ratios, or T and B cell activation markers, but did produce a decrease in splenocyte apoptosis. Using gld animals, Fas ligand (FasL) was implicated in the suppressive effects of S179D PRL. Circulating IgG1 and IgG2 antibody levels were increased in response to treatment with both forms of PRL, but the effects of S179D PRL were most pronounced. Cytokine changes in the popliteal lymph nodes specific to S179D PRL treatment showed an inhibition of pro-inflammatory cytokines. In conclusion, mice treated with a molecular mimic of phosphorylated prolactin showed a profound inhibition of DTH responses to Candida correlating with an absence of GM-CSF, IL-4, and IL-13 production and a marked reduction in IL-12p70 synthesis.

Prolactin, the prolactin receptor and uncoupling protein abundance and function in adipose tissue during development in young sheep.

A primary role of the prolactin receptor (PRLR) during fetal and postnatal development has been suggested to be the regulation of uncoupling protein (UCP) expression. We, therefore, determined whether: (1) the rate of loss of UCP1 from brown adipose tissue after birth was paralleled by the disappearance of PRLR; and (2) administration of either pituitary extract prolactin (PRL) containing a mixture of posttranslationally modified forms or its pseudophosphorylated form (S179D PRL) improved thermoregulation and UCP1 function over the first week of neonatal life. PRLR abundance was greatest in adipose tissue 6 h after birth before declining up to 30 days of age, a trend mirrored by first a gain and then a loss of UCP1. In contrast, in the liver--which does not possess UCPs--a postnatal decline in PRLR was not observed. Administration of PRL resulted in an acute increase in colonic temperature in conjunction with increased plasma concentrations of non-esterified fatty acids and, as a result, the normal postnatal decline in body temperature was delayed. S179D PRL at lower concentrations resulted in a transient rise in colonic temperature at both 2 and 6 days of age. In conclusion, we have demonstrated a close relationship between the ontogeny of UCP1 and the PRLR. Exogenous PRL administration elicits a thermogenic effect suggesting an important role for the PRLR in regulating UCP1 function.

Phosphorylated and nonphosphorylated Prolactin isoforms.

Specific posttranslational modifications o f monomer PRL produce a number of hormone variants. This review describes the current state of knowledge for the nonphosphorylated and phosphorylated 24-kD monomer forms. Of particular interest and significance for our future understanding of PRL endocrinology are the studies showing their differential release in response to different physiologic signals and their different activities in target tissues. In at least two target tissues, the monophosphorylated variant seems to act as an antagonist to the unmodified hormone.

Microbiological quality of ready-to-eat foods: results from a long-term surveillance program (1995 through 2003).

The coordination of food sampling activities across Wales, a part of the United Kingdom with a population of approximately 3 million, led to the establishment in 1995 of a coordinated food-sampling program designed to monitor on a long-term basis the microbiological quality and safety of specific ready-to-eat products. This surveillance system has been ongoing for 9 years and has generated a database of microbiological and associated demographic results for 15,228 ready-to-eat food samples. The food types that had the poorest overall results were sliced meats, unsliced poultry, sandwiches made without salad, and cakes made without dairy cream. For all food types, the overall unsatisfactory rate was 17% for aerobic colony counts, 1.6% for Escherichia coli, and 0.5% for Listeria spp. Overall unsatisfactory or unacceptable rates for pathogens such as Clostridium perfringens, Listeria monocytogenes, Bacillus cereus, and Staphylococcus aureus were all below 0.5%. No Campylobacter-positive samples and only one Salmonella-positive sample were found. The analysis of the results show that the ready-to-eat food types sampled over the 9 years of the program were generally of good microbiological quality when compared with current United Kingdom guidelines. The information contained in the database provides a baseline measurement of the microbial quality of a variety of ready-to-eat foods and allows environmental health officers and food microbiologists to generate hypotheses for targeted surveys or research work.

Nonsteroidal anti-inflammatory drugs and hospitalization for gastroesophageal bleeding in the elderly.

Hospitalization because of bleeding from the stomach or esophagus occurred 4.8 times per million person-days among persons over 64 years of age who filled a prescription for nonsteroidal anti-inflammatory drugs (NSAIDs) within 90 days of hospitalization, and 3.4 times per million person-days among nonusers of NSAIDs over 64 years of age at the Group Health Cooperative of Puget Sound, Seattle. The NSAID users included those who had used these drugs on a long-term basis as well as those who were recent users only. The observed difference in rates (1.3 hospitalizations per million person-days; 95% confidence interval, -0.2 to 3.4 hospitalizations per million person-days) is incompatible with any major increase in the frequency of hospitalization for gastroesophageal bleeding in the elderly. No single NSAID appeared to carry an exceptional risk. Both chance and uncontrollable selection factors could provide plausible explanations for the small rate differences observed between users and nonusers.