Objective Epidural Space Identification Using Continuous Real-Time Pressure Sensing Technology: A Randomized Controlled Comparison With Fluoroscopy and Traditional Loss of Resistance.

BACKGROUND: Performance of epidural anesthesia and analgesia depends on successful identification of the epidural space (ES). While multiple investigations have described objective and alternative methodologies to identify the ES, traditional loss of resistance (LOR) and fluoroscopy (FC) are currently standard of care in labor and delivery (L&D) and chronic pain (CP) management, respectively. While FC is associated with high success, it exposes patients to radiation and requires appropriate radiological equipment. LOR is simple but subjective and consequently associated with higher failure rates. The purpose of this investigation was to compare continuous, quantitative, real-time, needle-tip pressure sensing using a novel computer-controlled ES identification technology to FC and LOR for lumbar ES identification. METHODS: A total of 400 patients were enrolled in this prospective randomized controlled noninferiority trial. In the CP management arm, 240 patients scheduled to receive a lumbar epidural steroid injection had their ES identified either with FC or with needle-tip pressure measurement. In the L&D arm, 160 female patients undergoing lumbar epidural catheter placements were randomized to either LOR or needle-tip pressure measurement. Blinded observers determined successful ES identification in both arms. A modified intention-to-treat protocol was implemented, with patients not having the procedure for reasons preceding the intervention excluded. Noninferiority of needle-tip pressure measurement regarding the incidence of successful ES identification was claimed when the lower limit of the 97.27% confidence interval (CI) for the odds ratio (OR) was above 0.50 (50% less likely to identify the ES) and P value for noninferioirty <.023. RESULTS: Demographics were similar between procedure groups, with a mild imbalance in relation to gender when evaluated through a standardized difference. Noninferiority of needle-tip pressure measurement was demonstrated in relation to FC where pain management patients presented a 100% success rate of ES identification with both methodologies (OR, 1.1; 97.27% CI, 0.52-8.74; P = .021 for noninferiority), and L&D patients experienced a noninferior success rate with the novel technology (97.1% vs 91%; OR, 3.3; 97.27% CI, 0.62-21.54; P = .019) using a a priori noninferiority delta of 0.50. CONCLUSIONS: Objective lumbar ES identification using continuous, quantitative, real-time, needle-tip pressure measurement with the CompuFlo Epidural Computer Controlled Anesthesia System resulted in noninferior success rates when compared to FC and LOR for CP management and L&D, respectively. Benefits of this novel technology may include nonexposure of patients to radiation and contrast medium and consequently reduced health care costs.

Association between functional capacity and heart rate variability in patients with uncomplicated type 2 diabetes.

OBJECTIVE: We sought to investigate functional capacity, heart rate variability (HRV), as well as their relationship in the patients with uncomplicated type 2 diabetes. METHODS: This cross-sectional observational study included 62 controls and 53 uncomplicated diabetic patients. Included subjects underwent laboratory analysis, 24-h ECG Holter monitoring and cardiopulmonary exercise testing. RESULTS: All parameters of time and frequency domain of HRV were decreased in the diabetic patients. Oxygen uptake at ventilatory threshold (18.3 ± 3.9 vs. 14.6 ± 3.6 mL/kg/min, p < .001), peak oxygen uptake (peak VO2) (27.8 ± 4.1 vs. 19.5 ± 4.3, mL/kg/min, p < .001) and oxygen pulse were significantly lower in the diabetic group, whereas ventilation/carbon dioxide ratio and ventilation/carbon dioxide slope (25.4 ± 2.5 vs. 28.6 ± 3.9, p < .001) were significantly higher in this group. Furthermore, heart rate recovery in the first minute was significantly lower in the diabetic group (26 ± 5 vs. 23 ± 5 beats/min, p = .003). In the whole study population HbA1c and SDNN were independently of other clinical and HRV parameters associated with peak VO2, ventilation/carbon dioxide slope and heart rate recovery in the first minute. CONCLUSIONS: Our investigation showed that both functional capacity and HRV were significantly impaired in uncomplicated diabetic patients. HbA1c, an important parameter of glucose regulation, was independently associated with HRV parameters and functional capacity in the whole study population. This reveals a potentially important role of determination of functional capacity and cardiac autonomic function as important markers of preclinical damage in diabetic population.

Subclinical hyperthyroidism and biatrial function and mechanics: a two- and three-dimensional echocardiographic study.

BACKGROUND: We sought to evaluate left atrial (LA) and right atrial (RA) phasic function and deformation in the subclinical hyperthyroidism (SCH) using two- and three-echocardiographic (2DE and 3DE) methods. METHODS: We included 45 untreated women with SCH and 45 healthy women who underwent comprehensive 2DE and 3DE examination. RESULTS: Total and passive LA emptying fractions (EF) were decreased, whereas active EF was increased among the SCH participants. RA total EFs were similar between the controls and the SCH subjects; passive EF was reduced; and active EF was amplified in the SCH group. TSH correlated with 2DE LA passive and active EFs, 3DE LA total, passive and active EFs, as well as 2DE LA positive longitudinal strain. Additionally, TSH correlated with 2DE RA passive and active EFs, 3DE LA and RA passive EF, 2DE LA and RA positive longitudinal strain. However, after adjustment for the parameters of left and right ventricular diastolic function and structure, the TSH level remained associated only with LA conduit and booster pump functions, as well as RA pump function. CONCLUSION: Biatrial phasic function evaluated by 2DE and 3DE is significantly impaired in the SCH subjects. TSH level correlates with LA and RA conduit and pump functions.

How Does Subclinical Hyperthyroidism Affect Right Heart Function and Mechanics?

OBJECTIVES: Right heart function and mechanics have not been investigated in patients with subclinical hyperthyroidism. Our aim was to investigate right ventricular (RV) and right atrial (RA) function and deformation as evaluated by 3-dimensional echocardiography (3DE) and speckle-tracking 2-dimensional echocardiography (2DE) in these individuals. METHODS: We included 39 untreated women with endogenous subclinical hyperthyroidism and 39 healthy women matched by age. All participants underwent laboratory analyses that included thyroid hormone levels and comprehensive 2DE and 3DE examinations. RESULTS: Three-dimensional echocardiographic RV volumes were significantly elevated in the patients with subclinical hyperthyroidism (P < .05), whereas the 3DE RV ejection fraction was reduced in this group, but with borderline significance. Two-dimensional echocardiographic longitudinal RV and RA strain were significantly reduced in the patients with subclinical hyperthyroidism. Two-dimensional echocardiographic RV systolic and early diastolic strain rates were reduced, whereas late diastolic strain rates were increased in the patients with subclinical hyperthyroidism. The same changes were detected in RA mechanics among the patients with subclinical hyperthyroidism. The thyrotropin (TSH) level correlated with the left ventricular mass index, transmitral early diastolic peak flow velocity (E)/late diastolic flow velocity (A) ratio, tricuspid E/A ratio, 2DE RV global strain, 2DE RA, strain, and 3DE RV end-diastolic volume. A multivariate regression analysis showed that the mitral E/A ratio, 2DE RV global strain, and 3DE RV end-diastolic volume were independently associated with the TSH level. CONCLUSIONS: Right ventricular and RA function as evaluated by 3DE and speckle-tracking 2DE is significantly impaired in patients with subclinical hyperthyroidism. The TSH level correlated with parameters for RV function and mechanics in the whole study population.

Subboiling Moist Heat Favors the Selection of Enteric Pathogen Clostridium difficile PCR Ribotype 078 Spores in Food.

Emerging enteric pathogens could have not only more antibiotic resistance or virulence traits; they could also have increased resistance to heat. We quantified the effects of minimum recommended cooking and higher temperatures, individually on a collection of C. difficile isolates and on the survival probability of a mixture of emerging C. difficile strains. While minimum recommended cooking time/temperature combinations (63-71°C) allowed concurrently tested strains to survive, higher subboiling temperatures reproducibly favored the selection of newly emerging C. difficile PCR ribotype 078. Survival ratios for "ribotypes 078" : "other ribotypes" (n = 49 : 45 isolates) from the mid-2000s increased from 1 : 1 and 0.7 : 1 at 85°C (for 5 and 10 minutes, resp.) to 2.3 : 1 and 3 : 1 with heating at 96°C (for 5 and 10 minutes, resp.) indicating an interaction effect between the heating temperature and survival of C. difficile genotypes. In multistrain heating experiments, with PCR ribotypes 027 and 078 from 2004 and reference type strain ATCC 9689 banked in the 1970s, multinomial logistic regression (P < 0.01) revealed PCR ribotype 078 was the most resistant to increasing lethal heat treatments. Thermal processes (during cooking or disinfection) may contribute to the selection of emergent specific virulent strains of C. difficile. Despite growing understanding of the role of cooking on human evolution, little is known about the role of cooking temperatures on the selection and evolution of enteric pathogens, especially spore-forming bacteria.

Subclinical hyperthyroidism impacts left ventricular deformation: 2D and 3D echocardiographic study.

BACKGROUND: We sought to investigate left ventricular (LV) function and mechanics assessed by three-dimensional echocardiography (3DE) and speckle tracking in patients with subclinical hyperthyroidism (SCH). METHODS: We included 35 untreated women with SCH and 35 healthy control women matched by age. All participants underwent laboratory analyses which included thyroid hormone levels, and complete 2DE and 3DE examination. RESULTS: 2DE LV longitudinal and circumferential strain was significantly decreased in the SCH subjects. 2DE LV systolic and early diastolic strain rates in longitudinal and circumferential directions were reduced, whereas late diastolic strain rates were increased in SCH individuals. 3DE LV end-diastolic volume and cardiac output were significantly elevated in the SCH patients. 3DE LV deformation in all three directions, as well as 3DE area strain, were significantly lower in the SCH group. Serum thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels correlated with 2DE LV mass index, 2DE longitudinal strain, and 3DE LV area strain in the whole study population. CONCLUSION: LV deformation evaluated by 3DE and speckle tracking imaging are significantly impaired in SCH subjects. TSH and FT4 levels correlate with 2DE and 3DE LV structure and mechanics.

Left Ventricular Mechanics in Untreated Normotensive Patients with Type 2 Diabetes Mellitus: A Two- and Three-dimensional Speckle Tracking Study.

BACKGROUND: Our aim was to investigate left ventricular (LV) mechanics estimated by two- (2DE) and three-dimensional echocardiography (3DE) strains in subjects with type 2 diabetes mellitus (DM). METHODS: This cross-sectional study included 50 untreated normotensive DM subjects and 50 healthy controls similar by sex and age. All the subjects underwent adequate laboratory analyses and complete 2DE and 3DE examination. RESULTS: Left ventricular mechanics, assessed by 2DE, was impaired in all three directions. Global longitudinal 3DE strain was significantly decreased in the DM group in comparison with the controls (-17.8 ± 2.5 vs. -19.1 ± 2.7%, P = 0.014). Similar results were found for 3DE global circumferential strain (-18.9 ± 2.9 vs. -20.4 ± 3.2%, P = 0.01), 3DE global radial strain (40.3 ± 6.9 vs. 43.1 ± 7.3%, P = 0.035), and 3DE global area strain (-29.2 ± 3.7 vs. -31 ± 4%, P = 0.024). LV torsion was similar between the DM patients and the controls (2.1 ± 0.6 vs. 1.9 ± 0.5 °/cm, P = 0.073); whereas LV untwisting rate was significantly increased in the DM subjects (-114 ± 26 vs. -96 ±23 °/s, P < 0.001). A multivariate analysis showed that 3DE global longitudinal and area myocardial functions were associated with HbA1c independently of 3DE LV mass index. CONCLUSION: Left ventricular deformation obtained by 3DE is significantly impaired in the type 2 DM patients. HbA1c is independently associated with LV mechanics that implies that early anti-diabetic therapy and normalization of the fasting glucose level and HbA1c could impede further cardiac damage.

Left atrial phasic function and mechanics in women with subclinical hypothyroidism: the effects of levothyroxine therapy.

BACKGROUND: Left atrial (LA) mechanics has been poorly investigated in women with subclinical hypothyroidism (SHT), and the effect of levothyroxine therapy on LA deformation and function is unknown. AIM: To investigate LA phasic function and mechanics assessed by two-dimensional echocardiography (2DE) and speckle tracking in women with SHT, and to estimate the influence of levothyroxine therapy on LA remodeling. METHODS: We included 48 untreated women with SHT and 38 healthy control women of the same age. All the SHT patients received levothyroxine therapy and were followed for 1 year after euthyroid status was achieved. All the participants underwent laboratory analyses and complete 2DE examination. RESULTS: Left atrial total emptying fraction was significantly lower in the SHT patients at the baseline in comparison with the controls. LA passive emptying fraction gradually decreased from the controls, throughout the treated SHT patients, to the untreated SHT patients. LA active emptying fraction was lower in the controls than in the untreated and the treated SHT participants. 2DE LA longitudinal strain and systolic strain rate gradually decreased from the controls to the untreated SHT patients, whereas LA early diastolic strain rate significantly increased in the same direction. Late diastolic LA strain was lower in the controls than in the untreated and the treated SHT patients. CONCLUSION: Subclinical hypothyroidism significantly affects LA mechanics. Reservoir, conduit, and booster pump LA functions are all impacted by SHT. A 1-year levothyroxine therapy significantly improves, but does not completely restore LA phasic function and mechanics in the SHT patients.

Dietetics Student Perceptions of Food Safety Communication to Vulnerable Populations: An International Study.

Registered dietitians can play an important role in delivering food safety information to vulnerable population groups. Although dietetic students are reported to perceive food safety to be important for vulnerable population groups, little is known regarding their attitudes toward their role in the delivery of food safety information. Therefore, the purpose of this study was to determine and evaluate the perceptions of dietetic students regarding their role in food safety communication to vulnerable populations from three international institutions. A total of 208 dietetics students participated in the study from Columbus, Ohio, USA (n = 100), Cardiff, Wales, UK (n = 78), and Beirut, Lebanon (n = 30). Predominantly, the students in this study had positive attitudes toward the importance of food safety for vulnerable groups, although more students from Lebanon were skeptical that vulnerable patients were more susceptible to foodborne infections than the general populations (p < 0.001). Data indicated confidence and understanding of food safety principles and a willingness to learn more about food safety for these groups, however, some students in the UK (30%) and USA (31%) were not confident that they could effectively communicate food safety to vulnerable patients. Based on the findings in this and previous studies, adjustments are recommended to the requirements for food safety knowledge among dietetic students to include food safety counseling competency.

Effectiveness of Chemical Sanitizers against Salmonella Typhimurium in Nutrient Film Technique (NFT) Hydroponic Systems: Implications for Food Safety, Crop Quality, and Nutrient Content in Leafy Greens.

Hydroponic farming systems play an increasingly important role in the sustainable production of nutrient-rich foods. The contamination of surfaces in hydroponic fresh produce production poses risks to the food safety of crops, potentially endangering public health and causing economic losses in the industry. While sanitizers are widely used in commercial hydroponic farms, their effectiveness against human pathogens on surfaces and their impact on plant health and quality are not known. In this study, we evaluated the efficacy of chemical sanitizers in eliminating Salmonella Typhimurium from inanimate surfaces in commercial hydroponic Nutrient Film Technique (NFT) systems. Further, we assessed the impact of sanitizers on the yield, quality, and nutritional value of lettuce and basil. Sanitizers (Virkon, LanXess, Pittsburgh, PA, USA; SaniDate 12.0, BioSafe Systems, East Hartford, CT, USA; KleenGrow, Pace Chemical Ltd., Delta, BC, Canada; Green Shield, United Labs Inc., St Charles, IL, USA; Zerotol, BioSafe Systems, East Hartford, CT, USA; Bleach, Pure Bright, ON, Canada) were tested against Salmonella Typhimurium inoculated on NFT surfaces (nutrient reservoir, growing channels, top covers, drain lines). The effective treatments were then tested for their impact on lettuce and basil in a split-plot experiment conducted in commercial NFT units. Crop yield, color, and nutrient content (chlorophyll and carotenoids) were measured throughout the crop life cycle. While all quaternary ammonium compounds (QAC), SaniDate 12.0 (200 ppm), Zorotol (5%), and Virkon (1%) eliminated Salmonella Typhimurium from commercial NFT surfaces, chlorine-based sanitizer treatments were statistically similar to water treatments on most surfaces. All chemical sanitizers impacted the yield, color, and nutritional value of lettuce and basil. SaniDate 12.0 (200 ppm) was the least detrimental to crops and was identified as a potential candidate for further validation in commercial hydroponic settings. The findings of this study will be translated into recommendations for the industry and will contribute to the development of future food safety guidelines and policies.

Rodent Gut Bacteria Coexisting with an Insect Gut Virus in Tapeworm Parasitic Cysts: Metagenomic Evidence of Microbial Selection in Extra-Intestinal Clinical Niches.

In medicine, parasitic cysts (e.g., brain cysticerci) are believed to be sterile, and are primarily treated with antiparasitic medications, not antibiotics, which could prevent abscess formation and localized inflammation. This study quantified the microbial composition of parasitic cysts in a wild rodent, using multi-kingdom metagenomics to comprehensively assess if parasitic cysts are sterile, and further understand gut microbial translocation and adaptation in wildlife confined environments, outside the gut. Analysis was conducted on DNA from two hepatic parasitic cysts from a feline tapeworm, Hydatigera (Taenia) taeniaeformis, affecting a wild vole mouse (Microtus pennsylvanicus), and from feces, liver and peritoneal fluid of this and two other concurrent individual wild voles trapped during pest control in one of our university research vegetable gardens. Bacterial metagenomics revealed the presence of gut commensal/opportunistic species, Parabacteroides distasonis, Bacteroides (Bacteroidota); Klebsiella variicola, E. coli (Enterobacteriaceae); Enterococcus faecium and Lactobacillus acidophilus (Bacillota) inhabiting the cysts, and peritoneal fluid. Remarkably, viral metagenomics revealed various murine viral species, and unexpectedly, a virus from the insect armyworm moth (Pseudaletia/Mythimna unipuncta), known as Mythimna unipuncta granulovirus A (MyunGV-A), in both cysts, and in one fecal and one peritoneal sample from the other non-cyst voles, indicating the survival and adaption potential of the insect virus in voles. Metagenomics also revealed a significantly lower probability of fungal detection in cysts compared to that in peritoneal fluid/feces (p < 0.05), with single taxon detection in each cyst (Malassezia and Pseudophaeomoniella oleicola). The peritoneal fluid had the highest probability for fungi. In conclusion, metagenomics revealed that bacteria/viruses/fungi coexist within parasitic cysts supporting the potential therapeutic benefits of antibiotics in cystic diseases, and in inflammatory microniches of chronic diseases, such as Crohn's disease gut wall cavitating micropathologies, from which we recently isolated similar synergistic pathogenic Bacteroidota and Enterobacteriaceae, and Bacillota.

Rodent Gut Bacteria Coexisting with an Insect Gut Virus in Parasitic Cysts: Metagenomic Evidence of Microbial Translocation and Co-adaptation in Spatially-Confined Niches.

In medicine, parasitic cysts or cysticerci (fluid-filled cysts, larval stage of tapeworms) are believed to be sterile (no bacteria), and therein, the treatment of cysticerci infestations of deep extra-intestinal tissues (e.g., brain) relies almost exclusively on the use of antiparasitic medications, and rarely antibiotics. To date, however, it is unclear why common post-treatment complications include abscessation. This study quantified the microbial composition of parasitic cyst contents in a higher-order rodent host, using multi-kingdom shotgun metagenomics, to improve our understanding of gut microbial translocation and adaptation strategies in wild environments. Analysis was conducted on DNA from two hepatic parasitic cysts (Hydatigera (Taeenia) taeniaeformis) in an adult vole mouse (Microtus arvalis), and from feces, liver, and peritoneal fluid of three other vole family members living in a vegetable garden in Ohio, USA. Bacterial metagenomics revealed the presence of gut commensal/opportunistic species, including Parabacteroides distasonis, Klebsiella variicola, Enterococcus faecium, and Lactobacillus acidophilus, inhabiting the cysts. Parabacteroides distasonis and other species were also present outside the cyst in the peritoneal fluid. Remarkably, viral metagenomics revealed various murine viral species, but unexpectedly, it detected an insect-origin virus from the army moth (Pseudaletia/Mythimna unipuncta) known as Mythimna unipuncta granulovirus A (MyunGV-A) in both cysts, and in one fecal and one peritoneal sample from two different voles, indicating survival of the insect virus and adaption in voles. Metagenomics also revealed a significantly lower probability of fungal detection in the cysts compared to other samples (peritoneal fluid, p<0.05; and feces p<0.05), with single taxon detection in each cyst for Malassezia and Pseudophaeomoniella oleicola. The samples with a higher probability of fungi were the peritoneal fluid. In conclusion, commensal/pathobiont bacterial species can inhabit parasitic tapeworm cysts, which needs to be considered during therapeutic decisions of cysticerci or other chronic disease scenarios where immune privileged and spatially restricted ecosystems with limited nutrients and minimal presence of immune cells could facilitate microbial adaptation, such as within gut wall cavitating micropathologies in Crohn's disease.

Left and right ventricular structure and function in subclinical hypothyroidism: the effects of one-year levothyroxine treatment.

BACKGROUND: The aim of this study was to investigate left ventricular (LV) and right ventricular (RV) structure, function, and mechanics in patients with subclinical hypothyroidism (SHT), and to evaluate the effect of a 1-year levothyroxine treatment. MATERIAL AND METHODS: We compared 45 untreated women with subclinical hypothyroidism and 35 healthy control women matched by age. All the subjects underwent laboratory analyses, which included a thyroid hormone levels (free T3, free T4, and TSH) test, and a complete 2-dimensional echocardiographic study. All the SHT patients received levothyroxine therapy and were followed for a year after euthyroid state was achieved. RESULTS: The LV mass index in the SHT participants before and after replacement therapy was significantly higher than in controls. In the SHT patients before the treatment, LV diastolic function and global function estimated by the Tei index were significantly impaired, whereas the LV systolic function was decreased. The results show that LV mechanics was significantly impaired in the SHT patients at baseline. Additionally, the SHT participants before levothyroxine substitution had increased RV wall thickness and significantly impaired RV diastolic and global function in comparison with the controls or the SHT subjects after the treatment. Furthermore, RV mechanics was also significantly deteriorated in the SHT patients before the treatment. CONCLUSIONS: Subclinical hypothyroidism significantly affected LV and RV structure, systolic, diastolic and global function, and LV and RV mechanics. Levothyroxine replacement therapy significantly improved cardiac structure, function, and mechanics in the SHT patients.

Dietary Impacts on Changes in Diversity and Abundance of the Murine Microbiome during Progression and Treatment of Cancer.

The intestinal microbial population is recognized for its impact on cancer treatment outcomes. Little research has reported microbiome changes during cancer progression or the interplay of disease progression, dietary sugar/fat intake, and the microbiome through surgery and chemotherapy. In this study, the murine gut microbiome was used as a model system, and changes in microbiome diversity, richness, and evenness over the progression of the cancer and treatment were analyzed. Mice were categorized into four diet cohorts, combinations of either high or low sucrose and high or low omega-3 fatty acids, and two treatment cohorts, saline vehicle or chemotherapy, for a total of eight groups. Fecal samples were collected at specific timepoints to assess changes due to diet implementation, onset of cancer, lumpectomy, and chemotherapy. Akkermansia muciniphila abundance was very high in some samples and negatively correlated with overall Amplicon Sequence Variant (ASV) richness (r(64) = -0.55, p = 3 × 10-8). Throughout the disease progression, ASV richness significantly decreased and was impacted by diet and treatment. Alpha-diversity and differential microbial abundance were significantly affected by disease progression, diet, treatment, and their interactions. These findings help establish a baseline for understanding how cancer progression, dietary macronutrients, and specific treatments impact the murine microbiome, which may influence outcomes.

Cultivating Food Safety Together: Insights About the Future of Produce Safety in the U.S. Controlled Environment Agriculture Sector.

Controlled environment agriculture (CEA) is a rapidly growing sector that presents unique challenges and opportunities in ensuring food safety. This manuscript highlights critical gaps and needs to promote food safety in CEA systems as identified by stakeholders (n=47) at the Strategizing to Advance Future Extension andResearch (S.A.F.E.R.) CEA conference held in April 2023 at The Ohio State University's Ohio CEA Research Center. Feedback collected at the conference was analyzed using an emergent thematic analysis approach to determine key areas of focus. Research-based guidance is specific to the type of commodity, production system type, and size. Themes include the need for improved supply chain control, cleaning, and sanitization practices, pathogen preventive controls and mitigation methods and training and education. Discussions surrounding supply chain control underscored the significance of the need for approaches to mitigate foodborne pathogen contamination. Effective cleaning and sanitization practices are vital to maintaining a safe production environment, with considerations such as establishing standard operating procedures, accounting for hygienic equipment design, and managing the microbial communities within the system. Data analysis further highlights the need for risk assessments, validated pathogen detection methods, and evidence-based guidance in microbial reduction. In addition, training and education were identified as crucial in promoting a culture of food safety within CEA. The development of partnerships between industry, regulatory, and research institutions are needed to advance data-driven guidance and practices across the diverse range of CEA operations and deemed essential for addressing challenges and advancing food safety practices in CEA. Considering these factors, the CEA industry can enhance food safety practices, foster consumer trust, and support its long-term sustainability.

Lettuce Contamination and Survival of Salmonella Typhimurium and Listeria monocytogenes in Hydroponic Nutrient Film Technique Systems.

Hydroponic vegetable production is increasing globally, but there is a lack of science-based recommendations to ensure their food safety. Specifically, there is limited evidence for establishing water management strategies. The purpose of this study was to determine the survival of Salmonella Typhimurium and Listeria monocytogenes in commercial nutrient flow technology (NFT) systems during the lifecycle of lettuce exposed to sporadic or extreme contamination. NFT systems were inoculated with Salmonella Typhimurium or Listeria monocytogenes, and nutrient solution, rockwool, roots, and lettuce leaves were collected over the lettuce production cycle for pathogen enumeration and detection. Both human pathogens persisted in the lettuce NFT growing system throughout the growth cycle of lettuce. Salmonella Typhimurium and L. monocytogenes accumulated in rockwool medium and on lettuce roots and were transferred to the leaves at quantifiable levels from the contaminated nutrient solution. In the nutrient solution, Salmonella concentration under sporadic and extreme conditions declined significantly 24 h after inoculation and again 7 days post-inoculation (p < 0.0001). Under extreme conditions, the concentration did not change significantly after 7 days, while under sporadic conditions, the concentration declined again 14 days post-inoculation in the nutrient solution collected from the reservoirs. L. monocytogenes populations in the nutrient solution fluctuated significantly over the 28-day growth cycle (p < 0.0001). Under extreme conditions, L. monocytogenes concentrations in the nutrient solution declined, while under sporadic conditions, the populations increased. The findings of this study, for the first time, describe human pathogen survival in commerical NFT systems and highlight the urgent need for novel approaches to mitigating the risks from nutrient solution contaminaiton in hydroponics.

Awareness and Attitudes of Student Dietitians in Lebanon, UK and USA towards Food Safety.

Allied health professionals such as dietitians can play a critical role in providing food safety advice to vulnerable consumers. To maximize food-related health and wellbeing, food needs to be safe and nutritious; consequently, food safety is referred to in international curricula for the training of dietitians. The purpose of this study was to explore the awareness and attitudes of student dietitians from three international institutions towards food safety. A total of 207 student dietitians participated in the study from Columbus, OH, USA (n = 99), Cardiff, Wales, UK (n = 78) and Beirut, Lebanon (n = 30). Completion of the study established that the students in three dietetic training programs lacked awareness of key food safety concepts. Close to half (43%) were not familiar with Campylobacter, with the USA students being significantly less knowledgeable (p < 0.001) with 58% being unaware of the pathogen. Understanding of safe handling of leftovers was the lowest for the students in all institutions; only 46% described appropriate reheating practices, with significantly lower (p < 0.001) understanding in Lebanon (28%). The students reported a good understanding of vulnerable populations and perceived food safety to be important for these groups. However, the knowledge of certain high-risk foods was lacking. For instance, 69% of students thought that fresh squeezed juices and smoothies made with raw fruits and vegetables were safe for vulnerable patients, with the UK students being the least familiar with this risk (16%). This is the first study of its kind to take an international perspective of student dietitian food safety awareness and attitudes; the findings are important to dietetic food safety educators and recommendations are made to further explore the interpretation of food safety requirements in international dietetic curricula. Future studies should extend student dietetic research to address attitudes, self-efficacy and the overall readiness to deliver food safety advice to the patients and the community.

Functional capacity and left ventricular diastolic function in patients with type 2 diabetes.

AIMS: The study sought to evaluate cardiorespiratory fitness in patients with type 2 diabetes mellitus (DM) with different levels of left ventricular (LV) diastolic dysfunction (LVDD). METHODS: This investigation included 55 controls and 85 uncomplicated diabetic patients, who underwent laboratory analysis, echocardiographic evaluation and cardiopulmonary exercise testing. All DM subjects were separated into 3 groups using the level of LV diastolic function as main criterion: normal, intermediate and LVDD. RESULTS: Echocardiographic parameters of LV hypertrophy were significantly higher in DM subjects, particularly those with intermediate LV diastolic function and LVDD comparing with controls. The same is valid for parameters of LV diastolic function (E/e', left atrial volume index and tricuspid regurgitation velocity). Peak oxygen uptake was lower, whereas ventilation/carbon dioxide slope was higher, in DM subjects with intermediate LV diastolic function and LVDD in comparison to controls. In the whole study population HbA1c, LV mass index and mitral E/e' were independently related with peak oxygen uptake and ventilation/carbon dioxide slope. CONCLUSIONS: LVDD significantly impacted functional capacity in DM patients. Glycemic control, LV mass index and LVDD were independently related with peak oxygen consumption and ventilation/carbon dioxide slope in the study population. These results show that timely diagnosis of LVDD and more intensive antidiabetic treatment could prevent target organ damage in DM patients.

Textile Masks and Surface Covers-A Spray Simulation Method and a "Universal Droplet Reduction Model" Against Respiratory Pandemics.

The main form of COVID-19 transmission is via "oral-respiratory droplet contamination" (droplet: very small drop of liquid) produced when individuals talk, sneeze, or cough. In hospitals, health-care workers wear facemasks as a minimum medical "droplet precaution" to protect themselves. Due to the shortage of masks during the pandemic, priority is given to hospitals for their distribution. As a result, the availability/use of medical masks is discouraged for the public. However, for asymptomatic individuals, not wearing masks in public could easily cause the spread of COVID-19. The prevention of "environmental droplet contamination" (EnvDC) from coughing/sneezing/speech is fundamental to reducing transmission. As an immediate solution to promote "public droplet safety," we assessed household textiles to quantify their potential as effective environmental droplet barriers (EDBs). The synchronized implementation of a universal "community droplet reduction solution" is discussed as a model against COVID-19. Using a bacterial-suspension spray simulation model of droplet ejection (mimicking a sneeze), we quantified the extent by which widely available clothing fabrics reduce the dispersion of droplets onto surfaces within 1.8 m, the minimum distance recommended for COVID-19 "social distancing." All textiles reduced the number of droplets reaching surfaces, restricting their dispersion to <30 cm, when used as single layers. When used as double-layers, textiles were as effective as medical mask/surgical-cloth materials, reducing droplet dispersion to <10 cm, and the area of circumferential contamination to ~0.3%. The synchronized implementation of EDBs as a "community droplet reduction solution" (i.e., face covers/scarfs/masks and surface covers) will reduce COVID-19 EnvDC and thus the risk of transmitting/acquiring COVID-19.

Global and Historical Distribution of Clostridioides difficile in the Human Diet (1981-2019): Systematic Review and Meta-Analysis of 21886 Samples Reveal Sources of Heterogeneity, High-Risk Foods, and Unexpected Higher Prevalence Toward the Tropic.

Clostridioides difficile (CD) is a spore-forming bacterium that causes life-threatening intestinal infections in humans. Although formerly regarded as exclusively nosocomial, there is increasing genomic evidence that person-to-person transmission accounts for only <25% of cases, supporting the culture-based hypothesis that foods may be routine sources of CD-spore ingestion in humans. To synthesize the evidence on the risk of CD exposure via foods, we conducted a systematic review and meta-analysis of studies reporting the culture prevalence of CD in foods between January 1981 and November 2019. Meta-analyses, risk-ratio estimates, and meta-regression were used to estimate weighed-prevalence across studies and food types to identify laboratory and geographical sources of heterogeneity. In total, 21886 food samples were tested for CD between 1981 and 2019 (96.4%, n = 21084, 2007-2019; 232 food-sample-sets; 79 studies; 25 countries). Culture methodology, sample size and type, region, and latitude were sources of heterogeneity (p < 0.05). Although non-strictly-anaerobic methods were reported in some studies, and we confirmed experimentally that improper anaerobiosis of media/sample-handling affects CD recovery in agar (Fisher, p < 0.01), most studies (>72%) employed the same (one-of-six) culture strategy. Because the prevalence was also meta-analytically similar across six culture strategies reported, all studies were integrated using three meta-analytical methods. At the study level (n = 79), the four-decade global cumulative-prevalence of CD in the human diet was 4.1% (95%CI = -3.71, 11.91). At the food-set level (n = 232, mean 12.9 g/sample, similar across regions p > 0.2; 95%CI = 9.7-16.2), the weighted prevalence ranged between 4.5% (95%CI = 3-6%; all studies) and 8% (95%CI = 7-8%; only CD-positive-studies). Risk-ratio ranking and meta-regression showed that milk was the least likely source of CD, while seafood, leafy green vegetables, pork, and poultry carried higher risks (p < 0.05). Across regions, the risk of CD in foods for foodborne exposure reproducibly decreased with Earth latitude (p < 0.001). In conclusion, CD in the human diet is a global non-random-source of foodborne exposure that occurs independently of laboratory culture methods, across regions, and at a variable level depending on food type and latitude. The latitudinal trend (high CD-food-prevalence toward tropic) is unexpectedly inverse to the epidemiological observations of CD-infections in humans (frequent in temperate regions). Findings suggest the plausible hypothesis that ecologically-richer microbiomes in the tropic might protect against intestinal CD colonization/infections despite CD ingestion.