Magnetic control of tokamak plasmas through deep reinforcement learning.

Nuclear fusion using magnetic confinement, in particular in the tokamak configuration, is a promising path towards sustainable energy. A core challenge is to shape and maintain a high-temperature plasma within the tokamak vessel. This requires high-dimensional, high-frequency, closed-loop control using magnetic actuator coils, further complicated by the diverse requirements across a wide range of plasma configurations. In this work, we introduce a previously undescribed architecture for tokamak magnetic controller design that autonomously learns to command the full set of control coils. This architecture meets control objectives specified at a high level, at the same time satisfying physical and operational constraints. This approach has unprecedented flexibility and generality in problem specification and yields a notable reduction in design effort to produce new plasma configurations. We successfully produce and control a diverse set of plasma configurations on the Tokamak à Configuration Variable1,2, including elongated, conventional shapes, as well as advanced configurations, such as negative triangularity and 'snowflake' configurations. Our approach achieves accurate tracking of the location, current and shape for these configurations. We also demonstrate sustained 'droplets' on TCV, in which two separate plasmas are maintained simultaneously within the vessel. This represents a notable advance for tokamak feedback control, showing the potential of reinforcement learning to accelerate research in the fusion domain, and is one of the most challenging real-world systems to which reinforcement learning has been applied.

Capsule endoscopy diagnosis of gastrointestinal melanoma.

Melanoma is a cancer that frequently metastasises to the small bowel, but most cases are asymptomatic and are diagnosed postmortem. Therefore, CT and PET CT cannot detect all lesions and conventional endoscopic study only detects 10-20% of lesions. In this study, we present the case of a 68-year-old patient with a history of cutaneous melanoma and a diagnosis of intestinal melanoma. Thanks to capsule endoscopy, two lesions compatible with cutaneous melanoma metastasis to the small bowel were detected, allowing a much more effective surgical planning. Capsule endoscopy is an innovative technique that improves preoperative diagnosis, as it is able to detect bowel segments that cannot be inspected by conventional endoscopy. It also has a better resolution than conventional CT, improving sensitivity in the detection of lesions.

Incidence of venous thromboembolism in patients with non-hematological cancer admitted for COVID-19 at a third-level hospital in Madrid.

An increased risk of venous thromboembolism (VTE) in hospitalized patients with COVID-19 has been reported. We aimed to describe the incidence rate of VTE on patients with non-hematological cancer who required hospitalization due to COVID-19 at our center. In this prospective study, non-hematological cancer patients hospitalized for confirmed COVID-19 at our institution from 1st March to 30th April 2020, were evaluated daily for VTE complications during their hospital stay, and after discharge until 30th June 2020. Furthermore, Doppler ultrasound of lower limbs was routinely performed in asymptomatic patients based on D-dimer levels and current active cancer therapy. The primary outcome of this study was the cumulative incidence of VTE. Secondary outcomes were the cumulative incidence of bleeding and mortality. A total of 58 hospitalized non-hematological cancer patients and confirmed COVID-19 were identified. Median follow-up since initial symptoms of COVID-19 was 91 days (IQR 19-104). Pulmonary embolism was diagnosed in three (5%) patients. Symptomatic catheter-related deep vein thrombosis (DVT) was observed in one patient. Doppler ultrasound of lower limbs was done in 11 asymptomatic patients, showing distal DVT in two of them (18%). The cumulative incidence of VTE on day 14 after admission was 10%, without new VTE events after hospital discharge and up to 90 days follow-up. No bleeding complication was observed. Seventeen patients (29%) died in the first 14 days after COVID-19 diagnosis. Four patients died after discharge due to malignancy progression. The cumulative incidence of VTE in non-hematological cancer patients under active treatment was 10% at day 14 after admission, with no further new events in the following 12 weeks.

RETROPUPILLARY IRIS-CLAW INTRAOCULAR LENS AND PARS PLANA VITRECTOMY IN APHAKIA MANAGEMENT: A National Multicenter Audit.

PURPOSE: To evaluate the outcomes and safety of retropupillary iris-claw intraocular lens implantation and associated pars plana vitrectomy. METHODS: Multicenter, national audit of 325 eyes (325 patients). Demographics, surgical details, and complications are described. Visual acuity, intraocular pressure, and central retinal thickness assessed by optical coherence tomography were collected at 1, 3, 6, and 12 months after surgery. Kaplan-Meier curves were created to assess the cumulative probability of postoperative visual acuity and intraocular pressure levels, macular edema development, and corneal decompensation. RESULTS: The cumulative probability of the final visual acuity ≤0.3 logarithm of the minimum angle of resolution (≥20/40 Snellen) was 75.6% at 12-month follow-up. The probability of intraocular pressure >21, ≥25, and ≥30 mmHg was 48.1%, 33.1%, and 19.0%, and the probability of intraocular pressure-lowering drops was 50.9% at 12 months. Glaucoma surgery was required in 4.3% of the eyes (14/325). The cumulative probability of macular edema was 20.5% at 12 months and was greater in complicated cataract surgery than in intraocular lens-luxation eyes (26% vs. 16.7%, P = 0.04). Corneal transplantation was required in 2.8% of the eyes (9/325). CONCLUSION: This study on 325 eyes with aphakia or intraocular lens dislocation managed with the retropupillary iris-claw intraocular lens technique provides clinical outcomes in a real-world scenario, reporting relevant data for patient counseling and preoperative discussions.

Extreme Surgical Maneuvers in Fungal Endophthalmitis.

PURPOSE: To present the different evolution of 2 cases of endophthalmitis caused by Fusarium solani, an aggressive filamentous fungus, depending on the medical and surgical treatment performed. METHODS: We present 2 cases of endophthalmitis caused by Fusarium solani. Topical, intrastromal, intravitreal, and systemic antifungal treatment (natamycin, voriconazole, amphotericin B) failed in both cases. Corneal perforation took place in one of them, being unsuccessfully treated with cyanoacrylate and several amniotic membrane transplants. It became necessary to perform a hot penetrating keratoplasty (PK) in both patients. The lenses were removed, and the microbiological analysis showed their colonization by Fusarium solani. In one of the cases, a second PK and a more aggressive pars plana vitrectomy (PPV) were performed after corneal recurrence detected by confocal microscopy, as well as the following therapeutic intra- and postoperative maneuvers: anterior chamber washing with povidone-iodine 5% for 1 min; iridectomy of the infiltrated regions; aspiration of the fungal colonies with vitrector; several air/fluid/amphotericin/voriconazole exchanges during PPV; endodiathermy and endophotocoagulation of the chorioretinitis foci; and intrascleral angle injections of voriconazole and amphotericin. RESULTS: These were the only cases of endophthalmitis caused by Fusarium attended to at our hospital during the last 10 years. In the case in which PPV was performed without those maneuvers, endophthalmitis rapidly recurred in a more aggressive way, so finally it became necessary to eviscerate the globe. On the other hand, in the patient who underwent PPV with the specific surgical maneuvers and postoperative procedures described above, we could preserve the eye and even a vision of hand motion without an intraocular lens. CONCLUSIONS: The main objectives of these surgical procedures are to control the fungal infection and to preserve the ocular globe. It is essential to eliminate all ocular structures (iris, lens, vitreous, etc.) affected by this strain of fungus in order to reduce the risk of recurrence. When indicated, early surgery with the appropriate maneuvers detailed above may make an evisceration unnecessary and even recover some visual acuity.

Psoriasis induced by antiTNF therapy in inflammatory bowel disease: Therapeutic management and evolution of both diseases in a nationwide cohort study.

BACKGROUND: some patients with inflammatory bowel disease (IBD) treated with antiTNF develop drug-induced psoriasis (antiTNF-IP). Several therapeutic strategies are possible. AIMS: to assess the management of antiTNF-IP in IBD, and its impact in both diseases. METHODS: patients with antiTNF-IP from ENEIDA registry were included. Therapeutic strategy was classified as continuing the same antiTNF, stopping antiTNF, switch to another antiTNF or swap to a non-antiTNF biologic. IP severity and IBD activity were assessed at baseline and 16, 32 and 54 weeks. RESULTS: 234 patients were included. At baseline, antiTNF-IP was moderate-severe in 60 % of them, and IBD was in remission in 80 %. Therapeutic strategy was associated to antiTNF-IP severity (p < 0.001). AntiTNF-IP improved at week 54 with all strategies, but continuing with the same antiTNF showed the worst results (p = 0.042). Among patients with IBD in remission, relapse was higher in those who stopped antiTNF (p = 0.025). In multivariate analysis, stopping antiTNF, trunk and palms and soles location were associated with antiTNF-IP remission; female sex and previous surgery in Crohn´s disease with IBD relapse. CONCLUSION: skin lesions severity and IBD activity seem to determine antiTNF-IP management. Continuing antiTNF in mild antiTNF-IP, and swap to ustekinumab or switch to another antiTNF in moderate-severe cases, are suitable strategies.

Pseudoaneurysm and post-traumatic arteriovenous fistula in pulmonary artery branch: Case report and review of the literature.

Pseudoaneurysms of a pulmonary artery branch are a rare complication in cases of penetrating chest trauma. Other more frequent causes are secondary to infections or iatrogenesis. We present the case of a 16-year-old male patient who returns weeks after having sustained a stab wound to the chest, complaining of hemoptysis and chest pain. Imaging studies help detect and characterize a partially thrombosed pseudoaneurysm arising from the artery that supplies the anterior segment of the right upper lobe, with an associated post-traumatic pulmonary arteriovenous fistula. The patient was successfully treated with endovascular arterial embolization. Identifying this entity opportunely has an impact on the survival of this patient, avoiding risk secondary to massive bleeding by making an adequate treatment.

A Novel Modified Surgical Approach for FIL SSF Lens.

This study aimed to describe a novel modified surgical technique for FIL SSF lens (Rome, Italy: Soleko) implantation. A retrospective study of FIL SSF lens implantation on six eyes of six patients with subluxated or dislocated intraocular lens (IOL). Standard pars plana vitrectomy (PPV) was performed in all patients. The subluxated or dislocated IOL was removed from a 2.4 corneal incision. From the same incision, the folded FIL SSF lens was inserted. Then lens plugs were extremized through a 23G scleral incision inside two 4 mm pockets that were created at the beginning of the operation. In two cases one pocket had to be converted into a triagonal-shaped scleral flap. All scleral pockets were sutured with 7.0 Vicryl suture and the conjunctiva with 7.0 Vicryl. In the follow-up period of six months, the lens is centered and not tilted. The refractive outcome is within the expectations. Visual acuity is improved in all patients. No haptic exposure and no other complications were noted in all cases. FIL SSF lens is a good option for treating aphakia. This modified implantation technique is safe, fast, and easy. It is also versatile, combining the advantages of both previously described techniques, as it gives the option of flap conversion if needed. Larger studies and prospective comparative studies can highlight the best and more appropriate technique.

Do different robot appearances change emotion recognition in children with ASD?

Introduction: Socially Assistive Robotics has emerged as a potential tool for rehabilitating cognitive and developmental disorders in children with autism. Social robots found in the literature are often able to teach critical social skills, such as emotion recognition and physical interaction. Even though there are promising results in clinical studies, there is a lack of guidelines on selecting the appropriate robot and how to design and implement the child-robot interaction. Methods: This work aims to evaluate the impacts of a social robot designed with three different appearances according to the results of a participatory design (PD) process with the community. A validation study in the emotion recognition task was carried out with 21 children with autism. Results: Spectrum disorder results showed that robot-like appearances reached a higher percentage of children's attention and that participants performed better when recognizing simple emotions, such as happiness and sadness. Discussion: This study offers empirical support for continuing research on using SAR to promote social interaction with children with ASD. Further long-term research will help to identify the differences between high and low-functioning children.

Efficacy of Common Antimicrobial Interventions at and above Regulatory Allowable Pick-Up Levels on Pathogen Reduction.

The objective of this study was to evaluate the food safety efficacy of common antimicrobial interventions at and above required uptake levels for processing aids on the reduction of Shiga-toxin producing E. coli (STEC) and Salmonella spp. through spray and dip applications. Beef trim was inoculated with specific isolates of STEC or Salmonella strains. Trim was intervened with peracetic or lactic acid through spray or dip application. Meat rinses were serially diluted and plated following the drop dilution method; an enumerable range of 2-30 colonies was used to report results before log transformation. The combination of all treatments exhibits an average reduction rate of 0.16 LogCFU/g for STEC and Salmonella spp., suggesting that for every 1% increase in uptake there is an increase of 0.16 LogCFU/g of reduction rate. There is a statistical significance in the reduction rate of Shiga-toxin producing Escherichia coli in relation to the uptake percentage (p < 0.01). The addition of explanatory variables increases the R2 of the regression for STEC, where all the additional explanatory variables are statistically significant for reduction (p < 0.01). The addition of explanatory variables increases the R2 of the regression for Salmonella spp., but only trim type is statistically significant for reduction rate (p < 0.01). An increase in uptake percentages showed a significant increase in reduction rate of pathogens on beef trimmings.

Data-Mining Poultry Processing Bio-Mapping Counts of Pathogens and Indicator Organisms for Food Safety Management Decision Making.

Bio-mapping studies play an important role, as the data collected can be managed and analyzed in multiple ways to look at process trends, find explanations about the effect of process changes, activate a root cause analysis for events, and even compile performance data to demonstrate to inspection authorities or auditors the effect of certain decisions made on a daily basis and their effects over time in commercial settings not only from the food safety perspective but also from the production side. This study presents an alternative analysis of bio-mapping data collected throughout several months in a commercial poultry processing operation as described in the article "Bio-Mapping Indicators and Pathogen Loads in a Commercial Broiler Processing Facility Operating with High and Low Antimicrobial Interventions". The conducted analysis identifies the processing shift effect on microbial loads, attempts to find correlation between microbial indicators data and pathogens loads, and identifies novel visualization approaches and conducts distribution analysis for microbial indicators and pathogens in a commercial poultry processing facility. From the data analyzed, a greater number of locations were statistically different between shifts under reduced levels of chemical interventions with higher means at the second shift for both indicators and pathogens levels. Minimal to negligible correlation was found when comparing aerobic counts and Enterobacteriaceae counts with Salmonella levels, with significant variability between sampling locations. Distribution analysis and visualization as a bio-map of the process resulted in a clear bimodality in reduced chemical conditions for multiple locations mostly explained by shift effect. The development and use of bio-mapping data, including proper data visualization, improves the tools needed for ongoing decision making in food safety systems.

Effects of a novel direct-fed microbial on growth performance, carcass characteristics, nutrient digestibility, and ruminal morphology of beef feedlot steers.

The effects of a novel direct-fed microbial (DFM) on feedlot performance, carcass characteristics, digestibility, ruminal morphology, and volatile fatty acid (VFA) profile of finishing steers were evaluated. Single-source Angus-crossbred yearling steers (n = 144; initial body weight (BW) = 371 ±â€…19 kg) were used in a randomized complete block design. Steers were blocked by initial BW and randomly assigned to treatments (12 pens/treatment; 4 steers/pen). Treatments included (A) CONTROL (no DFM, tylosin, or monensin, (B) MONTY (monensin sodium [330 mg/animal-daily] and tylosin phosphate [90 mg/animal-daily]), and (C) MONPRO (monensin sodium [same as previous] and Lactobacillus salivarius L28 [1 × 106 CFU/animal-daily]). Treatments were included in a steam-flaked corn-based finisher diet offered once daily using a clean-bunk management for ~149 d. The digestibility assessment was performed from days 70 to 74. Ruminal fluid and rumen tissue samples were collected at the slaughter for VFA profile and papillae morphology analyses, respectively. Data were analyzed using the GLIMMIX procedure of SAS with pen serving as the experimental unit, treatment as fixed effect, and BW block as random effect. Steers offered MONPRO had on average 5.3% less (P < 0.01) dry matter intake (9.56 kg/d) compared with either CONTROL (10.16 kg/d) or MONTY (9.96 kg/d). The carcass-adjusted final BW (613 kg; P = 0.23), overall average daily gain (1.64 kg/d; P = 0.23), and gain-efficiency (0.165; P = 0.61) were not affected by treatments. Steers offered CONTROL had greater (P < 0.01) marbling score and tended (P = 0.06) to have less carcasses grading Select and tended (P = 0.10) to have more carcasses grading Upper-Choice, while other carcass characteristics and liver-abscesses were not affected (P ≥ 0.23) by treatments. The digestibility of nutrients (P ≥ 0.13) and the ruminal VFA profile (P ≥ 0.12) were not affected by treatments. Steers offered MONPRO tended (P = 0.09) to have 16% greater average papillae number compared to other treatments. Yearlings offered finishing diets containing L. salivarius L28 plus monensin did not affect growth performance, digestibility, or ruminal VFA, but reduced feed intake. Carcass quality was negatively affected by treatments, while animals consuming L. salivarius L28 and monensin tended to improve ruminal morphology. Current findings in ruminal morphology and feed intake may warrant further assessment of diets containing L. salivarius L28 on beef cattle food safety aspects.

Antimicrobial resistance is a growing concern to public health and medically important antibiotics have been listed in the Veterinary Feed Directive. Nutritional technologies, such as direct-fed microbials, are being increasingly studied for the development of an effective use on beef cattle production systems. The newly isolated strain of Lactobacillus salivarius L28 has demonstrated pathogenic inhibition of Escherichia coli, Salmonella, and Listeria monocytogenes on in vitro assessments. The potential benefits have warranted the exploration of L. salivarius L28 in a feedlot setting. Single-source Angus-crossbred yearling steers were offered steam-flaked corn-based finishing diets containing no feed additive, or either a combination of tylosin plus monensin or L. salivarius L28 plus monensin. Steers offered L. salivarius L28 plus monensin consumed 5.3% less feed compared with other treatments, while other growth performance variables and the digestibility of nutrients were not affected. Carcasses from cattle supplemented with monensin had slightly lower carcass quality grades than those not supplemented with monensin. Lactobacillus salivarius L28 plus monensin tended to improve steers ruminal morphology. Current findings may warrant further food safety assessments when cattle are offered diets containing L. salivarius L28.

Predictive Factors and Management of Macular Edema after Retropupillary Iris-Claw Intraocular Lens Implantation in Aphakia: National Multicenter Audit-Report 2.

The aim of this multicenter, national clinical audit is to evaluate the predictive factors and management of postoperative macular edema (ME) after retropupillary iris-claw intraocular lens (RICI) implantation and pars plana vitrectomy (PPV). Preoperative, surgical and postoperative data were collected. Number and type of intravitreal injections (IT) administered (anti-VEGF or dexamethasone implant), visual acuity (VA), intraocular pressure (IOP) and central retinal thickness (CRT) assessed by OCT were collected at 1, 3, 6 and 12 months. From 325 eyes (325 patients), 11.7% (38/325) developed postoperative ME. Previous complicated cataract surgery with no capsular support was the only significant predictive factor for developing postoperative ME (OR 2.27, 95% CI 1.38-4.52, p = 0.02) after RICI implant. Mean time to ME development was 11.4 ± 10.7 weeks, and mean CRT peaked at 3 months follow-up. Different treatment options were non-steroidal anti-inflammatory (NSAIDs) drops (31.6%, 12/38), dexamethasone (DEX) implant (50%, 19/38), anti-VEGF (7.9%, 3/38) or combined IT (10.5%, 4/38). Cumulative probability of ME resolution was higher in the group treated with IT than in the group treated with topical NSAIDs (85.2% vs. 58.3%, p = 0.9). Performing RICI implantation after complicated cataract surgery is a risk factor for the development of postoperative ME. DEX implants may be an effective treatment for postoperative ME in these cases.

Efficacy and safety of immune checkpoint inhibitors in young adults with metastatic melanoma.

BACKGROUND: The integration of immune checkpoint inhibitors (ICI) for the treatment of melanoma has resulted in remarkable and durable responses. Given the potential role of immunosenescence, age may contribute to differential ICI efficacy and toxicity. While older patients have been studied in detail, outcomes from ICI in young patients (≤40 years) are not well characterised. METHODS: We performed a multi-institutional, retrospective study of patients with advanced melanoma treated with anti-PD-1 monotherapy or ICI combination (ipilimumab and anti-PD-1). Response rates, survival, and toxicities were examined based on age comparing those under 40 years of age with older patients (age 41-70 and ≥ 71 years). RESULTS: A total of 676 patients were included: 190 patients (28%) aged ≤40 years, 313 (46%) between ages 41-70, and 173 patients (26%) aged ≥71. Patients ≤40 years had higher response rates (53% vs 38%, p = 0.035) and improved progression-free survival (median 13.7 vs 4.0 months, p = 0.032) with combination ICI compared to monotherapy. Progression-free survival was similar among groups while overall survival was inferior in patients >70 years, who had low response rates to combination therapy (28%). ICIs had a similar incidence of severe toxicities, though hepatotoxicity was particularly common in younger patients vs. patients >40 with monotherapy (9% vs. 2%, p = 0.007) or combination ICI (37% vs. 10%, p < 0.001). CONCLUSIONS: ICIs had comparable efficacy between younger and older patients, although outcomes were superior with combination ICI compared to monotherapy in patients aged ≤40 years. Toxicity incidence was similar across age groups, though organs affected were substantially different.

Quantitative Bio-Mapping of Salmonella and Indicator Organisms at Different Stages in a Commercial Pork Processing Facility.

The purpose of this study was to develop a quantitative baseline of indicator organisms and Salmonella by bio-mapping throughout the processing chain from harvest to final product stages within a commercial conventional design pork processing establishment. Swab samples were taken on the harvest floor at different processing steps, gambrel table, after polisher, before final rinse, after the final rinse, post snap chill, and after peroxyacetic acid (PAA) application, while 2-pound product samples were collected for trim and ground samples. The samples were subjected to analysis for indicator microorganism enumeration, Aerobic Count (AC), Enterobacteriaceae (EB), and generic Escherichia coli (EC), with the BioMérieux TEMPO®. Salmonella prevalence and enumeration was evaluated using the BAX® System Real-Time Salmonella and the SalQuant™ methodology. Microbial counts were converted to Log Colony-forming units (CFU) on a per mL, per g or per sample basis, presented as LogCFU/mL, LogCFU/g and LogCFU/sample, prior to statistical analysis. All indicator microorganisms were significantly reduced at the harvest floor (p-value < 0.001), from gambrel table to after PAA cabinet location. The reduction at harvest was 2.27, 2.46 and 2.24 LogCFU/mL for AC, EB and EC, respectively. Trim sample values fluctuated based on cut, with the highest average AC count found at neck trim (2.83 LogCFU/g). Further process samples showed the highest AC count in sausage with a mean of 5.28 LogCFU/g. EB counts in sausage (3.19 LogCFU/g) showed an evident increase, compared to the reduction observed at the end of harvest and throughout trim processing. EC counts showed a similar trend to EB counts with the highest value found in sausage links (1.60 LogCFU/g). Statistical microbial process control (SPC) parameters were also developed for each of the indicator microorganisms, using the overall mean count (X=), the Lower control limit (LCL) and Upper control limit (UCL) at each sampling location. For Salmonella prevalence, a total of 125/650 samples were found positive (19%). From those positive samples, 47 samples (38%) were suitable for enumeration using the BAX® System SalQuant™, the majority detected at the gambrel table location. From those enumerable samples, 60% were estimated to be between 0.97 and 1.97 LogCFU/sample, while the rest (40%) were higher within the 2.00−4.02 LogCFU/sample range. This study provides evidence for the application of indicator and pathogen quantification methodologies for food safety management in commercial pork processing operations.

Bio-Mapping Indicators and Pathogen Loads in a Commercial Broiler Processing Facility Operating with High and Low Antimicrobial Intervention Levels.

The poultry industry in the United States has traditionally implemented non-chemical and chemical interventions against Salmonella spp. and Campylobacter spp. on the basis of experience and word-of-mouth information shared among poultry processors. The effects of individual interventions have been assessed with microbiological testing methods for Salmonella spp. and Campylobacter spp. prevalence as well as quantification of indicator organisms, such as aerobic plate counts (APC), to demonstrate efficacy. The current study evaluated the loads of both indicators and pathogens in a commercial chicken processing facility, comparing the "normal chemical", with all chemical interventions turned-on, at typical chemical concentrations set by the processing plant versus low-chemical process ("reduced chemical"), where all interventions were turned off or reduced to the minimum concentrations considered in the facility's HACCP system. Enumeration and prevalence of Salmonella spp. and Campylobacter spp. as well as indicator organisms (APC and Enterobacteriaceae-EB) enumeration were evaluated to compare both treatments throughout a 25-month sampling period. Ten locations were selected in the current bio-mapping study, including live receiving, rehanger, post eviscerator, post cropper, post neck breaker, post IOBW #1, post IOBW #2, prechilling, post chilling, and parts (wings). Statistical process control parameters for each location and processing schemes were developed for each pathogen and indicator evaluated. Despite demonstrating significant statistical differences between the normal and naked processes in Salmonella spp. counts ("normal" significantly lower counts than the "reduced" at each location except for post-eviscerator and post-cropper locations), the prevalence of Salmonella spp. after chilling is comparable on both treatments (~10%), whereas for Campylobacter spp. counts, only at the parts' location was there significant statistical difference between the "normal chemical" and the "reduced chemical". Therefore, not all chemical intervention locations show an overall impact on Salmonella spp. or Campylobacter spp., and certain interventions can be turned off to achieve the same or better microbial performance if strategic intervention locations are enhanced.

Biomapping of Microbial Indicators on Beef Subprimals Subjected to Spray or Dry Chilling over Prolonged Refrigerated Storage.

As the global meat market moves to never frozen alternatives, meat processors seek opportunities for increasing the shelf life of fresh meats by combinations of proper cold chain management, barrier technologies, and antimicrobial interventions. The objective of this study was to determine the impact of spray and dry chilling combined with hot water carcass treatments on the levels of microbial indicator organisms during the long-term refrigerated storage of beef cuts. Samples were taken using EZ-Reach™ sponge samplers with 25 mL buffered peptone water over a 100 cm2 area of the striploin. Sample collection was conducted before the hot carcass wash, after wash, and after the 24 h carcass chilling. Chilled striploins were cut into four sections, individually vacuum packaged, and stored to be sampled at 0, 45, 70, and 135 days (n = 200) of refrigerated storage and distribution. Aerobic plate counts, enterobacteria, Escherichia coli, coliforms, and psychrotroph counts were evaluated for each sample. Not enough evidence (p > 0.05) was found indicating the hot water wash intervention reduced bacterial concentration on the carcass surface. E. coli was below detection limits (<0.25 CFU/cm2) in most of the samples taken. No significant difference (p > 0.05) was found between coliform counts throughout the sampling dates. Feed type did not seem to influence the (p > 0.25) microbial load of the treatments. Even though no immediate effect was seen when comparing spray or dry chilling of the samples at day 0, as the product aged, a significantly lower (p < 0.05) concentration of aerobic and psychrotrophic organisms in dry-chilled samples could be observed when compared to their spray-chilled counterparts. Data collected can be used to select alternative chilling systems to maximize shelf life in vacuum packaged beef kept over prolonged storage periods.

In-Plant Validation of Novel On-Site Ozone Generation Technology (Bio-Safe) Compared to Lactic Acid Beef Carcasses and Trim Using Natural Microbiota and Salmonella and E. coli O157:H7 Surrogate Enumeration.

The purpose of this study was to evaluate the antimicrobial efficacy of an aqueous ozone (Bio-Safe) treatment and lactic acid solutions on natural microbiota and E. coli O157:H7 and Salmonella surrogates on beef carcasses and trim in a commercial beef processing plant. For every repetition, 40 carcass and 40 trim swabs (500 cm2) were collected. Samples were taken using EZ-ReachTM swabs, and plated into aerobic plate count (APC), coliform, and E. coli PetrifilmTM for enumeration. In addition, a five-strain cocktail (MP-26) of E. coli surrogates was inoculated onto trim. For every trim surrogate repetition, 30 trim pieces were sampled after attachment and after ozone intervention. Samples were diluted and counts were determined using the TEMPO® system for E. coli enumeration. Ozone and lactic acid interventions significantly reduced (p < 0.003) bacterial counts in carcasses and trim samples. Moreover, lactic acid further reduced APC and coliforms in trim samples compared to ozone intervention (p < 0.009). In the surrogate trials, ozone significantly reduced (p < 0.001) surrogate concentration. Historical data from the plant revealed a reduction (p < 0.001) of presumptive E. coli O157:H7 in trim after a full year of ozone intervention implementation. The novel technology for ozone generation and application as an antimicrobial can become an alternative option that may also act synergistically with existing interventions, minimizing the risk of pathogens such as Salmonella and E. coli O157:H7.

The Validity of the Invasive Tests for Helicobacter Pylori Diagnosis is Unequally Affected by the Consumption of Antibiotics or Pump Inhibitors. Test Performance under Real-World Conditions.

BACKGROUND AND AIMS: Patients undergoing upper endoscopy have often used proton pump inhibitors (PPI) and/or antibiotics (ABx) recently. Both drugs have been associated with a poorer yield of the Helicobacter pylori (H. pylori) diagnostic tests. The aim was to assess the accuracy of the polymerase chain reaction test (qPCR), histological exam (HE) and ultra-fast urease test (UFUT) for H. pylori detection in patients that recently used PPI or ABx. METHODS: Prospective study recruiting 206 patients who underwent upper endoscopy and gastric biopsies. Demographics and use of PPI/ABx were obtained. Sensibility (Sn), specificity (Sp), predictive value (PV), likelihood ratio (LR) and PABAK concordance index, were calculated, considering as the gold standard the positivity of 2 out of 3 analyzed tests. A global analysis and another one based on the PPI/ABx intake were performed. RESULTS: 48.5% of patients used PPI and 12.8% ABx within the 2 and 4 weeks prior to endoscopy, respectively. The UFUT was positive in 13.1% of patients, HE in 34% and qPCR in 35.9%. UFUT achieved lower Sn (37%) than HE (98%) and qPCR (98%) (p<0.001) overall. ABx were associated with lower Sn in HE (p=0.04) and lower Sp in qPCR (p=0.03). PPI did not associate with a significant drop in Sn and Sp. The concordance between HE and qPCR was 0.83 (95%CI: 0.73-0.89). CONCLUSIONS: Under real world conditions, the accuracy and concordance of HE and qPCR to diagnose H. pylori were excellent, but UFUT achieved unsatisfactory outcomes. The intake of ABx was associated with the worse performance, fundamentally for HE. The PPI did not reduce the tests' yield significantly.

In-Plant Intervention Validation of a Novel Ozone Generation Technology (Bio-Safe) Compared to Lactic Acid in Variety Meats.

The objective of this experiment was to compare the antimicrobial efficacy of an aqueous ozone intervention and a lactic acid solution on natural microbiota of variety meats in a commercial beef processing plant. EZ-Reach™ swabs were used to collect 100 cm2 area samples before and after ozone and lactic acid intervention application for three different offals (head, heart, and liver). Each repetition included 54 samples per variety meat and antimicrobial for a total of 162 samples per repetition. Enumeration of total aerobic bacteria (APC) and Escherichia coli (EC) was performed on each sample. Microbial counts for both microorganisms evaluated were significantly reduced (p < 0.001) after lactic acid immersion (2-5%) and ozone intervention for all variety meats, with the exception of ozone intervention in EC counts of the heart samples. APC after lactic acid intervention was reduced on average by 1.73, 1.66, and 1.50 Log CFU/sample in the head, heart, and liver, respectively, while after ozone intervention, counts were reduced on average by 1.66, 0.52, and 1.20 Log CFU/sample. EC counts after lactic acid intervention were reduced on average by 0.96, 0.79, and 1.00 Log CFU/sample in the head, heart, and liver, respectively, while after ozone intervention, counts were reduced on average by 0.75, 0.62, and 1.25 Log CFU/sample. The aqueous ozone antimicrobial scheme proved to be a promising intervention for the in-plant reduction of indicator levels in variety meats, specifically heads, hearts, and livers.