A descriptive analysis of the spatio-temporal distribution of enteric diseases in New Brunswick, Canada.

BACKGROUND: Enteric diseases affect thousands of Canadians annually and several large outbreaks have occurred due to infection with enteric pathogens. The objectives of this study were to describe the spatial and temporal distributions of reportable Campylobacter, Escherichia coli, Giardia, Salmonella and Shigella from 1994 to 2002 in New Brunswick, Canada. By examining the spatial and temporal distributions of disease incidence, hypotheses as to potential disease risk factors were formulated. METHODS: Time series plots of monthly disease incidence were examined for seasonal and secular trends. Seasonality of disease incidence was evaluated using the temporal scan statistic and seasonal-trend loess (STL) decomposition methods. Secular trends were evaluated using negative binomial regression modeling. The spatial distribution of disease incidence was examined using maps of empirical Bayes smoothed estimates of disease incidence. Spatial clustering was examined by multiple methods, which included Moran's I and the spatial scan statistic. RESULTS: The peak incidence of Giardia infections occurred in the spring months. Salmonella incidence exhibited two peaks, one small peak in the spring and a main peak in the summer. Campylobacter and Escherichia coli O157 disease incidence peaked in the summer months. Moran's I indicated that there was significant positive spatial autocorrelation for the incidence of Campylobacter, Giardia and Salmonella. The spatial scan statistic identified clusters of high disease incidence in the northern areas of the province for Campylobacter, Giardia and Salmonella infections. The incidence of Escherichia coli infections clustered in the south-east and north-east areas of the province, based on the spatial scan statistic results. Shigella infections had the lowest incidence rate and no discernable spatial or temporal patterns were observed. CONCLUSIONS: By using several different spatial and temporal methods a robust picture of the spatial and temporal distributions of enteric disease in New Brunswick was produced. Disease incidence for several reportable enteric pathogens displayed significant geographic clustering indicating that a spatially distributed risk factor may be contributing to disease incidence. Temporal analysis indicated peaks in disease incidence, including previously un-reported peaks.

Utility of peak inspiratory flow in managing subglottic stenosis.

OBJECTIVES: To identify the utility of peak inspiratory flow (PIF) in the assessment and management of subglottic stenosis through correlation of clinical presentation with PIF. STUDY DESIGN: Case report. METHODS: Review of the clinical course of a 31-year-old woman with the diagnosis of granulomatosis with polyangiitis. Repeated PIF measurements at clinic visits were obtained over a 30-month follow-up. RESULTS: Twenty-seven PIF measurements were obtained at 31 otolaryngology clinic visits. Correlations were identified between low PIF measurements with the clinical symptom shortness of breath (2.04±0.38 L/s, n=10), clinically recorded stridor at rest (1.64±0.41 L/s, n=3), and urgent operative intervention (1.60±0.23 L/s, n=5). Correlations were identified between high PIF measurement with patient report of normal breathing (3.07±0.35 L/s, n=16) and clinical observation of absence of stridor at rest (2.81±0.32 L/s, n=23). There was a statistically significant difference in the patient's PIF values with patient-documented shortness of breath vs no shortness of breath (P=.001) and clinician-noted stridor vs no stridor (P=.017). CONCLUSION: Peak inspiratory flow measurements correlate with degree of airway compromise and are helpful to monitor the degree of airway obstruction and document response to treatment.

High-throughput micro-plate HCI-vanillin assay for screening tannin content in sorghum grain.

BACKGROUND: The HCI-vanillin assay is a well-accepted method for determining tannin content in sorghum but is limited to small sample sets due to the time-consuming nature of the method. The objective was to develop an accurate and repeatable high-throughput 96-well plate assay for breeders to screen large sample sets of sorghum for tannin content. Validation of the high-throughput assay was tested on 25 sorghums suspected to contain tannin. RESULTS: Approximately 30 measurements per day were completed using the conventional assay compared to 224 measurements using the 96-well platform. The correlation between the two tannin assays was 0.98. The coefficient of variation (CV) was 3.54% and 3.21% for the 96-well and conventional method, respectively. The 96-well assay exhibited good repeatability, with the inter-plate CV between 2.77% and 4.85%. CONCLUSION: The high-throughput 96-well HCI-vanillin assay exhibited an eightfold increase in the number of measurements completed and was as accurate as the conventional HCI-vanillin assay.

Harvest for health in survivors of chronic disease: A demonstration project in the Alabama Black Belt and Mississippi Delta Region.

This demonstration project expands upon the Harvest for Health vegetable gardening intervention for cancer survivors by: (i) including survivors of other chronic diseases (i.e. heart disease and diabetes); and (ii) targeting an area with known health inequities (Alabama Black Belt and Mississippi Delta Region). To assess: (i) gardening acceptability (engagement, satisfaction, sustainability, and safety); and (ii) changes over time in health behaviors (fruit and vegetable [F&V] intake, and physical activity) and outcomes (physical performance and anthropometrics). Chronic disease survivors (CDS) were recruited across 15 counties in Alabama and Mississippi and provided with gardening supplies and paired with a master gardener (MG). MGs mentored participants in planning, planting, and maintaining a vegetable garden over a 3-month period. Data collection consisted of an electronic survey (baseline, post-intervention, 6-month follow-up) and community-based physical assessments (baseline and post-intervention). Participants (n = 137; 92% African American; Mage = 65) included individuals with a history of diabetes (56%), heart disease (29%), and cancer (26%). Seventy-five percent of participants engaged in gardening ≥3 times a week. Significant improvements in F&V intake (+0.73, P = .04), physical activity (+49.6, P < .01), and 4 of 7 physical performance measures were observed, while positive trends were seen in others. Eighteen participants withdrew (13% attrition rate). No adverse events occurred. Participants were satisfied with their gardening experience (90%) and were still gardening at 6-month follow-up (85%). Seventy-two percent of participants expanded, or planned on expanding, their garden at 6-month follow-up. Harvest for Health was acceptable and associated with improved health behaviors and outcomes.

In the Alabama Black Belt and Mississippi Delta region of the USA, incidence and mortality rates of high-burden chronic diseases (cancer, cardiovascular disease, and diabetes) are among the highest in the nation. Behavioral risk factors associated with chronic disease include low fruit and vegetable intake and physical inactivity. Vegetable gardening is a holistic approach to improving these health behaviors. Harvest for Health, a mentored home-based vegetable gardening intervention, pairs cancer survivors with master gardener (MG) mentors to guide survivors in planning, planting, and maintaining a vegetable garden. The current demonstration project expands upon Harvest for Health by: (i) including survivors of cardiovascular disease and diabetes (in addition to cancer); and (ii) targeting an area with known health inequities (Alabama Black Belt and Mississippi Delta). One hundred thirty-seven chronic disease survivors (CDS) enrolled in the 3-month demonstration project. Participants were provided gardening supplies for a summer garden and MG mentorship over a 3-month period. Participants engaged in gardening several times a week, reported satisfaction with their gardening experience, and were still gardening at 6-month follow-up. Improvements among CDS were seen in health behaviors (fruit and vegetable intake and physical activity) and physical well-being (physical function battery and weight).

It's time to apply outbreak response best practices to avian influenza: A national call to action.

Cases of high pathogenicity avian influenza (HPAI) in Canada are upon us again and with reports of infection in US dairy cattle and a dairy farmer in the United States, concern has been raised. Although panic isn't helpful, this heightened level of concern is appropriate, given that reports of human infections with the H5N1 virus often indicate high mortality rates. These can range from 14 to 50%. The current devastating impact of the virus on the poultry industry, as well as its propensity to mutate are also reasons for concern. At the same time, HPAI provides an opportunity for the poultry and livestock industries to align and organize coherently for the management of all zoonotic diseases and other industry issues. To manage HPAI more effectively, it is essential to align all stakeholders under Outbreak Response Best Practices using a formal Quality Management System (QMS). The objective of this article is to describe this approach with examples drawn from management of the Walkerton waterborne disease crisis. We urge the veterinary profession to rise to the challenge of HPAI and use it as a context in which to align more coherently with national stakeholders for the prevention and management of all priority issues within the areas of Agri-food and Public Health.

Les cas de grippe aviaire hautement pathogène (HPAI) sont de nouveau aux portes du Canada et, avec les rapports d'infection chez des bovins laitiers américains et chez un producteur laitier aux États-Unis, des inquiétudes ont été soulevées. Même si la panique n'aide pas, ce niveau d'inquiétude accru est approprié, étant donné que les rapports d'infections humaines par le virus H5N1 indiquent souvent des taux de mortalité élevés. Ceux-ci peuvent aller de 14 à 50 %. L'impact dévastateur actuel du virus sur l'industrie avicole, ainsi que sa propension à muter sont également des motifs d'inquiétude. Dans un même temps, l'HPAI offre aux secteurs de la volaille et de l'élevage l'opportunité de s'associer et de s'organiser de manière cohérente pour la gestion de toutes les maladies zoonotiques et d'autres problèmes industriels. Pour gérer l'HPAI plus efficacement, il est essentiel d'aligner toutes les parties prenantes sur les meilleures pratiques de réponse aux épidémies en utilisant un système de gestion de la qualité (QMS) formel. L'objectif de cet article est de décrire cette approche avec des exemples tirés de la gestion de la crise des maladies d'origine hydrique à Walkerton. Nous exhortons la profession vétérinaire à relever le défi de l'HPAI et à l'utiliser comme un contexte dans lequel s'aligner de manière plus cohérente avec les parties prenantes nationales pour la prévention et la gestion de toutes les questions prioritaires dans les domaines de l'agroalimentaire et de la santé publique.(Traduit par Docteur Serge Messier).

Community-level risk factors for notifiable gastrointestinal illness in the Northwest Territories, Canada, 1991-2008.

BACKGROUND: Enteric pathogens are an important cause of illness, however, little is known about their community-level risk factors (e.g., socioeconomic, cultural and physical environmental conditions) in the Northwest Territories (NWT) of Canada. The objective of this study was to undertake ecological (group-level) analyses by combining two existing data sources to examine potential community-level risk factors for campylobacteriosis, giardiasis and salmonellosis, which are three notifiable (mandatory reporting to public health authorities at the time of diagnosis) enteric infections. METHODS: The rate of campylobacteriosis was modeled using a Poisson distribution while rates of giardiasis and salmonellosis were modeled using a Negative Binomial distribution. Rate ratios (the ratio of the incidence of disease in the exposed group to the incidence of disease in the non-exposed group) were estimated for infections by the three major pathogens with potential community-level risk factors. RESULTS: Significant (p≤0.05) associations varied by etiology. There was increased risk of infection with Salmonella for communities with higher proportions of 'households in core need' (unsuitable, inadequate, and/or unaffordable housing) up to 42% after which the rate started to decrease with increasing core need. The risk of giardiasis was significantly higher both with increased 'internal mobility' (population moving between communities), and also where the community's primary health facility was a health center rather than a full-service hospital. Communities with higher health expenditures had a significantly decreased risk of giardiasis. Results of modeling that focused on each of Giardia and Salmonella infections separately supported and expanded upon previous research outcomes that suggested health disparities are often associated with socioeconomic status, geographical and social mobility, as well as access to health care (e.g. facilities, services and professionals). In the campylobacteriosis model, a negative association was found between food prices in communities and risk of infection. There was also a significant interaction between trapping and consumption of traditional foods in communities. Higher rates of community participation in both activities appeared to have a protective effect against campylobacteriosis. CONCLUSIONS: These results raise very interesting questions about the role that traditional activities might play in infectious enteric disease incidence in the NWT, but should be interpreted with caution, recognizing database limitations in collection of case data and risk factor information (e.g. missing data). Given the cultural, socioeconomic, and nutritional benefits associated with traditional food practices, targeted community-based collaborative research is necessary to more fully investigate the statistical correlations identified in this exploratory research. This study demonstrates the value of examining the role of social determinants in the transmission and risk of infectious diseases.

Variability in tannin content, chemistry and activity in a diverse group of tannin containing sorghum cultivars.

BACKGROUND: Tannins are large polyphenolic polymers and are known to bind proteins, limiting their digestibility, but are also excellent antioxidants. Numerous studies investigating the functional properties of sorghum tannin have been conducted by comparing grain samples from different sorghum lines without considering the other intrinsic characteristics of the grain. The purpose of this study was to remove the confounding intrinsic factors present in the endosperm so the effect of the tannins could be evaluated utilizing a unique decortication/reconstitution procedure. RESULTS: The tannin content of the 14 cultivars tested ranged from 2.3 to 67.2 catechin equivalents. The bran fractions were studied for their impact on protein binding and antioxidant capacity. Protein digestibility by pepsin ranged from 8% to 58% at the highest tannin level addition. Protein binding ranged from 3.11 to 16.33 g blue bovine serum albumin kg⁻¹ bran. Antioxidant capacity ranged from 81.33 to 1122.54 µmol Trolox equivalents g⁻¹ bran. High-performance size-exclusion chromatography detailed molecular size distributions of the tannin polymers and relationship to tannin functionality. CONCLUSION: The tannin content and composition play a significant role in determining tannin functionality. These differences will allow for selections of high-tannin sorghums with consideration of the biological activities of the tannins.

30 Gy in 4 Stereotactic Body Radiotherapy Fractions for Complex Spinal Metastases: Mature Outcomes Supporting This Novel Regimen.

BACKGROUND AND OBJECTIVES: We designed a 30 Gy in 4 fractions stereotactic body radiotherapy protocol, as an alternative option to our standard 2-fraction approach, for primarily large volume, multilevel, or previously radiated spinal metastases. We report imaging-based outcomes of this novel fractionation scheme. METHODS: The institutional database was reviewed to identify all patients who underwent 30 Gy/4 fractions from 2010 to 2021. Primary outcomes were magnetic resonance-based vertebral compression fracture (VCF) and local failure per treated vertebral segment. RESULTS: We reviewed 245 treated segments in 116 patients. The median age was 64 years (range, 24-90). The median number of consecutive segments within the treatment volume was 2 (range, 1-6), and the clinical target volume (CTV) was 126.2 cc (range, 10.4-863.5). Fifty-four percent had received at least 1 previous course of radiotherapy, and 31% had previous spine surgery at the treated segment. The baseline Spinal Instability Neoplastic Score was stable, potentially unstable, and unstable for 41.6%, 51.8%, and 6.5% of segments, respectively. The cumulative incidence of local failure was 10.7% (95% CI 7.1-15.2) at 1 year and 16% (95% CI 11.5-21.2) at 2 years. The cumulative incidence of VCF was 7.3% (95% CI 4.4-11.2) at 1 year and 11.2% (95% CI 7.5-15.8) at 2 years. On multivariate analysis, age ≥68 years ( P = .038), CTV volume ≥72 cc ( P = .021), and no previous surgery ( P = .021) predicted an increased risk of VCF. The risk of VCF for CTV volumes <72 cc/≥72 cc was 1.8%/14.6% at 2 years. No case of radiation-induced myelopathy was observed. Five percent of patients developed plexopathy. CONCLUSION: 30 Gy in 4 fractions was safe and efficacious despite the population being at increased risk of toxicity. The lower risk of VCF in previously stabilized segments highlights the potential for a multimodal treatment approach for complex metastases, especially for those with a CTV volume of ≥72 cc.

A spatial and temporal analysis of notifiable gastrointestinal illness in the Northwest Territories, Canada, 1991-2008.

BACKGROUND: This is the first study to describe the geographical and temporal distribution of notifiable gastrointestinal illness (NGI) in the Northwest Territories (NWT), Canada. Understanding the distribution of NGI in space and time is important for identifying communities at high risk. Using data derived from the Northwest Territories Communicable Disease Registry (NWT CDR), a number of spatial and temporal techniques were used to explore and analyze NGI incidence from the years 1991 to 2008. Relative risk mapping was used to investigate the variation of disease risk. Scan test statistics were applied to conduct cluster identification in space, time and space-time. Seasonal decomposition of the time series was used to assess seasonal variation and trends in the data. RESULTS: There was geographic variability in the rates of NGI with higher notifications in the south compared to the north. Incidence of NGI exhibited seasonality with peaks in the fall months for most years. Two possible outbreaks were detected in the fall of 1995 and 2001, of which one coincided with a previously recognized outbreak. Overall, incidence of NGI fluctuated from 1991 to 2001 followed by a tendency for rates to decrease from 2002 to 2008. CONCLUSIONS: The distribution of NGI notifications varied widely according to geographic region, season and year. While the analyses highlighted a possible bias in the surveillance data, this information is beneficial for generating hypotheses about risk factors for infection.

Decreased mortality of weaned pigs with Streptococcus suis with the use of in-water potassium penicillin G.

This study evaluated the efficacy of potassium penicillin G in drinking water of weaned pigs to reduce mortality and spread of infection caused by Streptococcus suis. A total of 896 18-day-old weaned pigs were randomly assigned to either treatment with potassium penicillin G in-water (Treated), or no treatment (Control). The outcomes analyzed were total mortality, mortality due to S. suis, and overall counts of S. suis colonies. The risk of mortality due to S. suis and total mortality were significantly increased in the Control group compared with Treated pigs (P < 0.05). Bacterial culture of posterior pharyngeal swabs indicated that Control pigs were significantly more likely to have ≥ 1000 colonies of S. suis per plate than were Treated pigs (P < 0.05). This study demonstrates that potassium penicillin G administered in drinking water is effective in reducing mortality associated with S. suis infection and reducing tonsillar carriage of S. suis.

Identification of racial disparities in breast cancer mortality: does scale matter?

BACKGROUND: This paper investigates the impact of geographic scale (census tract, zip code, and county) on the detection of disparities in breast cancer mortality among three ethnic groups in Texas (period 1995-2005). Racial disparities were quantified using both relative (RR) and absolute (RD) statistics that account for the population size and correct for unreliable rates typically observed for minority groups and smaller geographic units. Results were then correlated with socio-economic status measured by the percentage of habitants living below the poverty level. RESULTS: African-American and Hispanic women generally experience higher mortality than White non-Hispanics, and these differences are especially significant in the southeast metropolitan areas and southwest border of Texas. The proportion and location of significant racial disparities however changed depending on the type of statistic (RR versus RD) and the geographic level. The largest proportion of significant results was observed for the RD statistic and census tract data. Geographic regions with significant racial disparities for African-Americans and Hispanics frequently had a poverty rate above 10.00%. CONCLUSIONS: This study investigates both relative and absolute racial disparities in breast cancer mortality between White non-Hispanic and African-American/Hispanic women at the census tract, zip code and county levels. Analysis at the census tract level generally led to a larger proportion of geographical units experiencing significantly higher mortality rates for minority groups, although results varied depending on the use of the relative versus absolute statistics. Additional research is needed before general conclusions can be formulated regarding the choice of optimal geographic regions for the detection of racial disparities.

An economic analysis of the impact of subclinical (mild) necrotic enteritis in broiler chickens.

Costs to broiler producers associated with subclinical (mild) necrotic enteritis (SNE) were estimated using published information on impacts on body weight and feed conversion rate (FCR) associated with SNE and costs and revenues associated with broiler production. Estimates were expressed in U.S. dollars from the perspective of poultry producers. SNE was estimated to result in a 12% reduction in body weight and a 10.9% increase in FCR compared with healthy birds. For the purposes of this analysis, we considered scenarios involving hypothetical flocks of 20,000 birds raised to final body weights ranging from 4.63 to 7.94 lb. The incidence of SNE was assumed to occur at 20% based on the literature. For flocks raised for the length of time required to reach these target weights, SNE resulted in a loss to producers ranging from US$878.19 to US$1480.52 per flock. When feed costs required to obtain SNE flocks having a total live body weight equal to equivalent healthy flocks at market age were calculated, the increased cost to producers ranged from US$370.49 to US$739.38 per flock. SNE has the potential to cause a significant negative economic impact in broiler flocks. Strategies to reduce the incidence of SNE may help to increase the profitability of broiler production.

Occurrence of Nosema oryzaephili in Cryptolestes ferrugineus and transfer to the genus Paranosema.

A microsporidium that closely resembles Paranosema species at the level of the light microscope was isolated from the rusty grain beetle, Cryptolestes ferrugineus. It's identity as Nosema oryzaephili (originally described from Oryzaephilus surinamensis) was confirmed by comparison with a known isolate of N. oryzaephili based on spore size, small subunit rDNA sequence, and relative infectivity to O. surinamensis, Tribolium castaneum, and Ephestia kuehniella. Phylogenetic analysis of the small subunit rDNA indicates clearly that this species belongs in the genus Paranosema and thus the designation Paranosema oryzaephili (Burges, Canning and Hurst) is proposed. In spite of the abundance, economic importance, and world-wide distribution of C. ferrugineus, this is the first report of a microsporidial infection in this species. This is also the first report of P. oryzaephili in the new world.

Reflecting on One Health in Action During the COVID-19 Response.

The COVID-19 pandemic, a singular disruptive event in recent human history, has required rapid, innovative, coordinated and collaborative approaches to manage and ameliorate its worst impacts. However, the threat remains, and learning from initial efforts may benefit the response management in the future. One Health approaches to managing health challenges through multi-stakeholder engagement are underscored by an enabling environment. Here we describe three case studies from state (New South Wales, Australia), national (Ireland), and international (sub-Saharan Africa) scales which illustrate different aspects of One Health in action in response to the COVID-19 pandemic. In Ireland, a One Health team was assembled to help parameterise complex mathematical and resource models. In New South Wales, state authorities engaged collaboratively with animal health veterinarians and epidemiologists to leverage disease outbreak knowledge, expertise and technical and support structures for application to the COVID-19 emergency. The African One Health University Network linked members from health institutions and universities from eight countries to provide a virtual platform knowledge exchange on COVID-19 to support the response. Themes common to successful experiences included a shared resource base, interdisciplinary engagement, communication network strategies, and looking global to address local need. The One Health approaches used, particularly shared responsibility and knowledge integration, are benefiting the management of this pandemic and future One Health global challenges.

The predictive value of low-field strength magnetic resonance imaging for intraoperative residual tumor detection. Clinical article.

OBJECT: Neurosurgeons have been utilizing intraoperative MR (iMR) imaging to evaluate the extent of tumor resection since the 1990s. A low-field strength (0.12 T) MR imaging unit (PoleStar N20, Medtronic) is a practical and relatively inexpensive iMR imaging system that has found increased use in neurosurgery. The gold standard for post operative detection of residual tumor has been high-strength MR imaging performed within 48 hours of resection.The object of this study was to determine the predictive concordance of low-strength iMR imaging with standard high-strength MR imaging for detection of residual tumor. METHODS: The authors retrospectively evaluated the MR images from 74 intracranial tumor resections, comparing the intraoperative images obtained using a 0.12-T iMR imaging unit to the immediate postoperative images obtained using a standard 1.5-T MR imaging unit within 48 hours after surgery. RESULTS: The sensitivity of low-field MR imaging for detection of residual tumor was 0.74 (95% CI 0.58-0.86),and its specificity was 0.97 (95% CI 0.83-1). When only glial tumors (42 of the 74 lesions) were analyzed, the sensitivity was 0.82 (95% CI 0.59-0.94) and the specificity was 0.95 (95% CI 0.73-1). CONCLUSIONS: These data could assist the neurosurgeon who has to decide intraoperatively whether the observed iMR images show residual tumor or not.

2,3,4,5-Tetrahydro-1H-pyrido[2,3-b and e][1,4]diazepines as inhibitors of the bacterial enoyl ACP reductase, FabI.

In the search for new antibacterial agents, the enzyme FabI has been identified as an attractive target. Employing a structure guided approach, the previously reported ene-amide series of FabI inhibitors were expanded to include 2,3,4,5-tetrahydro-1H-pyrido[2,3-b and e][1,4]diazepines. These novel series incorporate additional H-bonding functions and can be more water soluble than their naphthyridinone progenitors; diazepine 16c is shown to be efficacious in a mouse infection model.

High-risk food consumption and food safety practices in a Canadian community.

Understanding consumers' high-risk food consumption patterns and food handling in the home is critical in reducing foodborne illness. This study was conducted to determine the prevalence of unsafe food practices of individuals in a Canadian-based population, specifically, high-risk food consumption and home food safety practices. During November 2005 to March 2006, a sample of 2,332 randomly selected residents of the Waterloo Region (Ontario, Canada) participated in a telephone survey of food consumption and food safety. Questions covered consumption of high-risk foods, hand washing practices, safe food handling knowledge, source of food safety education, meat thawing and cooking practices, cross-contamination after raw food preparation, and refrigeration temperatures. Certain high-risk food behaviors were common among respondents and were associated with demographic characteristics. In general, unsafe practices increased with increasing total annual household income level. Males were more likely to report engaging in risky practices than were females. Specific high-risk behaviors of public health concern were reported by elderly individuals (e.g., consuming undercooked eggs), children (e.g., consuming chicken nuggets), and rural residents (e.g., drinking unpasteurized milk). Respondents appeared to know proper food safety practices, but did not put them into practice. Thus, educational programs emphasizing specific practices to improve food safety should be directed to targeted audiences, and they should stress the importance of consumer behavior in the safety of foods prepared at home. Further investigation of consumer perceptions is needed to design such programs to effectively increase the implementation of safe food practices by consumers.

Treatment of Mild Cervical Myelopathy: Factors Associated With Decision for Surgical Intervention.

STUDY DESIGN: Prospective Cohort OBJECTIVE.: The aim of this study was to evaluate which demographic, clinical, or radiographic factors are associated with selection for surgical intervention in patients with mild cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA: Surgery has not been shown superior to best conservative management in mild CSM comparative studies; trials of conservative management represent an acceptable alternative to surgical decompression. It is unknown what patients benefit from surgery. METHODS: This is a prospective study of patients with mild CSM, defined as modified Japanese Orthopaedic Association Score (mJOA) ≥15. Patients were recruited from seven sites contributing to the Canadian Spine Outcomes Research Network. Demographic, clinical, radiographic and health related quality of life data were collected on all patients at baseline. Multivariate logistic regression modeling was used to identify factors associated with surgical intervention. RESULTS: There were 122 patients enrolled, 105 (86.0%) were treated surgically, and 17 (14.0%) were treated nonoperatively. Overall mean age was 54.8 years (SD 12.6) with 80 (65.5%) males. Bivariate analysis revealed no statistically significant differences between surgical and nonoperative groups with respect to age, sex, BMI, smoking status, number of comorbidities and duration of symptoms; mJOA scores were significantly higher in the nonoperative group (16.8 [SD 0.99] vs. 15.9 [SD 0.89], P < 0.001). There was a statistically significant difference in Neck Disability Index, SF12 Physical Component, SF12 Mental Component Score, EQ5D, and PHQ-9 scores between groups; those treated surgically had worse baseline questionnaire scores (P < 0.05). There was no difference in radiographic parameters between groups. Multivariable analysis revealed that lower quality of life scores on EQ5D were associated with selection for surgical management (P < 0.018). CONCLUSION: Patients treated surgically for mild cervical myelopathy did not differ from those treated nonoperatively with respect to baseline demographic or radiographic parameters. Patients with worse EQ5D scores had higher odds of surgical intervention. LEVEL OF EVIDENCE: 3.