Life-threatening heat-related illness with severe hyponatremia in an aluminum smelter worker.

Heat stress is a recognized occupational hazard in aluminum smelter pot rooms. This is the report of an unusual and complex case of heat-related illness in an aluminum smelter worker. The 34-year-old male US worker developed life-threatening heat-related illness in August 2018, on his first day back at work after a 7-day absence. The worker initially presented with bilateral hand then all-extremity cramping followed some hours later by a generalized seizure and acute mental status changes, including combativeness. Emergency room evaluation identified a serum sodium level of 114 mmol/L. Acute liver and kidney injury ensued along with profound rhabdomyolysis, with peak total creatinine phosphokinase level reaching over 125 000 units/L at 3 days post incident. Initial ventilatory support, careful fluid resuscitation, and electrolyte management were provided. Metabolic encephalopathy resolved. Complications included sepsis. After 5 days in the intensive care unit and eight additional days of inpatient management, observation, and the initiation of rehabilitation, the worker was discharged. Residual effects include polyneuropathy of upper and lower extremities and the postdischarge magnetic resonance imaging finding of a cerebellar lesion. Prevailing considerations in the differential diagnosis included exertional heat stroke and/or exertion-associated hyponatremia with encephalopathy.

Pneumococcal vaccination for welders: Global deployment within a multi-national corporation.

BACKGROUND: Lobar pneumonia is an occupational disease of welders. This is the first report of global deployment of a pneumococcal vaccination program for welders within a multi-national corporation. METHODS: Global webinars were conducted to introduce the program. Communication packages translated into all location languages were deployed. All employee welders who had not previously been vaccinated were offered a free single dose of pneumococcal polysaccharide vaccine (PPV23) by on-site location medical centers during normal working hours. Numbers of vaccinated welders were reported by each location each month. RESULTS: Twelve months after starting the program, 241 of 767 welders have been vaccinated (31%) across six countries. CONCLUSIONS: Global deployment of pneumococcal vaccination for welders can be successfully undertaken by a multi-national corporation. Adoption of this practice by corporations could reduce the incidence and mortality of pneumonia among welders globally.

Hearing conservation in the primary aluminium industry.

BACKGROUND: Noise-induced hearing loss has been an intractable problem for heavy industry. AIMS: To report our experience in reducing the incidence of age-corrected confirmed 10 dB hearing shifts (averaged over 2, 3 and 4 kHz) in employees in the primary aluminium industry in Australia over the period 2006-13. METHODS: We analysed annual audiometric data to determine the number of permanent hearing shifts that occurred in employees in two bauxite mines, three alumina refineries and two aluminium smelters. Annual hearing shift rates were calculated based on the number of employees tested per year. Hearing conservation initiatives undertaken during the study period are described. An assessment of similar exposure group noise exposures was also undertaken to determine the magnitude of noise exposure reduction during the study period. RESULTS: Across all operations, hearing shift rates declined from 5.5% per year in 2006 to 1.3% per year in 2013 (P < 0.001). The decline in shift rates was greater in mines and refineries, where baseline shift rates were higher, than in smelter workers. Modest reductions in noise exposure occurred during the study period. CONCLUSIONS: We observed a substantial decline in hearing shift rates during the study period. We describe the hearing conservation initiatives that were collectively associated with this decline. We suspect these initiatives could be deployed relatively easily and at modest cost in other industries with noise-exposed employees.

Acoustic neuroma: potential risk factors and audiometric surveillance in the aluminium industry.

OBJECTIVES: To look for an association between acoustic neuroma (AN) and participation in a hearing conservation programme (HCP) and also for an association between AN and possible occupational risk factors in the aluminium industry. METHODS: We conducted a case-control analysis of a population of US aluminium production workers in 8 smelters and 43 other plants. Using insurance claims data, 97 cases of AN were identified between 1996 and 2009. Each was matched with four controls. Covariates included participation in a HCP, working in an aluminium smelter, working in an electrical job and hearing loss. RESULTS: In the bivariate analyses, covariates associated with AN were participation in the HCP (OR=1.72; 95% CI 1.09 to 2.69) and smelter work (OR=1.88; 95% CI 1.06 to 3.36). Electrical work was not significant (OR=1.60; 95% CI 0.65 to 3.94). Owing to high participation in the HCP in smelters, multivariate subanalyses were required. In the multivariate analyses, participation in the HCP was the only statistically significant risk factor for AN. In the multivariate analysis restricted to employees not working in a smelter, the OR was 1.81 (95% CI 1.04 to 3.17). Hearing loss, an indirect measure of in-ear noise dose, was not predictive of AN. CONCLUSIONS: Our results suggest the incidental detection of previously undiagnosed tumours in workers who participated in the company-sponsored HCP. The increased medical surveillance among this population of workers most likely introduced detection bias, leading to the identification of AN cases that would have otherwise remained undetected.

Environmental augmentation with bacteriophage prevents colibacillosis in broiler chickens.

Bacteriophages are viruses that kill bacteria. They are plentiful in nature; are safe, having no known activity to human or animal cells; and are an attractive alternative to antibiotics. The objectives of this research were to establish an experimental model of colibacillosis induced by indirect exposure to Escherichia coli and to determine if bacteriophage could protect the birds from developing colibacillosis. In study 1 there were 6 treatments with 2 replicate pens of 25 birds. The treatments were control warm brooded; control cold stressed; litter inoculated with E. coli, warm brooded; litter inoculated with E. coli, cold stressed; seeder birds (5 per pen) challenged with E. coli, warm brooded; and seeder birds (5 per pen), cold stressed. The study concluded when the birds were 3 wk of age. Body weights at 1, 2, and 3 wk of age were significantly decreased (P ≤ 0.05) by cold stress, decreased at 1 and 2 wk of age by both the litter and seeder bird treatments compared with the control treatment and by the seeder bird treatment at 3 wk of age. Study 2 consisted of 8 treatments with 2 replicate pens of 20 birds per treatment. The treatments were control, warm brooded; control, cold stressed; litter inoculated with E. coli, cold stressed; and seeder birds (5/pen) challenged with E. coli, cold stressed with and without bacteriophage treatment. In the bacteriophage treatments the bacteriophages were sprayed on the litter. The study was concluded at 3 wk of age. Body weights at 1 wk of age were significantly (P ≤ 0.05) decreased from the control treatment by the seeder bird treatment and were significantly (P ≤ 0.05) higher in all the bacteriophage treatments compared with their matched untreated treatments, except in the control cold stressed treatment. Mortality was significantly (P ≤ 0.05) decreased by bacteriophage in the litter challenged treatment. These data suggest that augmentation of the environment with bacteriophage is a practical and efficacious way to prevent colibacillosis in broiler chickens.

Radiological assessment for bauxite mining and alumina refining.

OBJECTIVE: Two international benchmarks assess whether the mining and processing of ores containing Naturally Occurring Radioactive Material (NORM) require management under radiological regulations set by local jurisdictions. First, the 1 Bq/g benchmark for radionuclide head of chain activity concentration determines whether materials may be excluded from radiological regulation. Second, processes may be exempted from radiological regulation where occupational above-background exposures for members of the workforce do not exceed 1 mSv/year. This is also the upper-limit of exposure prescribed for members of the public. Alcoa of Australia Limited (Alcoa) has undertaken radiological evaluations of the mining and processing of bauxite from the Darling Range of Western Australia since the 1980s. Short-term monitoring projects have demonstrated that above-background exposures for workers do not exceed 1 mSv/year. A whole-of-year evaluation of above-background, occupational radiological doses for bauxite mining, alumina refining and residue operations was conducted during 2008/2009 as part of the Alcoa NORM Quality Assurance System (NQAS). The NQAS has been guided by publications from the International Commission on Radiological Protection (ICRP), the International Atomic Energy Agency (IAEA) and the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA). The NQAS has been developed specifically in response to implementation of the Australian National Directory on Radiation Protection (NDRP). METHODS: Positional monitoring was undertaken to increase the accuracy of natural background levels required for correction of occupational exposures. This is important in view of the small increments in exposure that occur in bauxite mining, alumina refining and residue operations relative to natural background. Positional monitoring was also undertaken to assess the potential for exposure in operating locations. Personal monitoring was undertaken to characterise exposures in Similar Exposure Groups (SEGs). The monitoring was undertaken over 12 months, to provide annual average assessments of above-background doses, thereby reducing temporal variations, especially for radon exposures. The monitoring program concentrated on gamma and radon exposures, rather than gross alpha exposures, as past studies have shown that gross alpha exposures from inhalable dust for most of the workforce are small in comparison to combined gamma and radon exposures. RESULTS: The natural background determinations were consistent with data in the literature for localities near Alcoa's mining, refining and residue operations in Western Australia, and also with UNSCEAR global data. Within the mining operations, there was further consistency between the above-background dose estimates and the local geochemistry, with slight elevation of dose levels in mining pits. Conservative estimates of above-background levels for the workforce have been made using an assumption of 100% occupancy (1920 hours per year) for the SEGs considered. Total incremental composite doses for individuals were clearly less than 1.0 mSv/year when gamma, radon progeny and gross alpha exposures were considered. This is despite the activity concentration of some materials being slightly higher than the benchmark of 1 Bq/g. CONCLUSIONS: The results are consistent with previous monitoring and demonstrate compliance with the 1 mSv/year exemption level within mining, refining and residue operations. These results will be of value to bauxite mines and alumina refineries elsewhere in the world.

Method of administration affects the ability of bacteriophage to prevent colibacillosis in 1-day-old broiler chickens.

Bacteriophages are viruses that kill bacteria. They are plentiful in nature with no known activity in human or animal cells, making them an attractive alternative to antibiotics. The objective of this research was to determine if a coarse or a fine spray of bacteriophage would prevent colibacillosis induced by an intratracheal (IT) challenge with Escherichia coli. Two studies were conducted with 6 treatments: untreated control, birds treated with a spray administration of bacteriophage and not challenged, birds administered bacteriophage IT and not challenged, birds not treated and challenged IT with E. coli, birds sprayed with bacteriophage and IT challenged with E. coli, and birds administered bacteriophage IT and challenged IT with E. coli. There were 3 replicate pens of 10 birds per pen, per treatment, and all treatments were administered at 1 d of age. Study 1 was concluded when the birds were 19 d of age, and study 2 was concluded when the birds were 21 d of age. In both studies, neither a coarse nor a fine spray protected the birds from an IT E. coli challenge; however, when bacteriophage was administered IT there was complete protection. This research demonstrates the necessity for the administration of bacteriophage therapeutics to deliver high bacteriophage titers to the site of a bacterial infection.

Use of plant-derived antimicrobials for improving the safety of poultry products.

Salmonella Enteritidis and Campylobacter jejuni are the 2 major foodborne pathogens transmitted through poultry products. Chickens are the reservoir hosts of these pathogens, with their intestinal colonization being the most significant factor causing contamination of meat and eggs. Effective preslaughter strategies for reducing the colonization of birds with these pathogens are critical to improve the microbiological safety of poultry products. An antimicrobial treatment that can be applied through feed represents the most practical and economically viable method for adoption on farms. Additionally, a natural and safe antimicrobial will be better accepted by producers without concerns for toxicity. This symposium talk discussed the potential use of plant-derived, GRAS (generally recognized as safe)-status molecules, caprylic acid, trans-cinnamaldehyde, eugenol, carvacrol, and thymol as feed supplements for reducing cecal populations of Salmonella Enteritidis and C. jejuni in chickens. Additionally, the effect of plant molecules on Salmonella virulence genes critical for cecal colonization in chickens was also discussed.

Effect of trans-cinnamaldehyde nanoemulsion wash on chicken embryo development in fertilized eggs.

Cleanliness of eggs is critical in successful hatching egg operations. The objective of this study was to investigate the effect of trans-cinnamaldehyde nanoemulsion (TCNE) wash treatments, as a sanitation strategy, on embryonic development in fertilized eggs. Trans-cinnamaldehyde is a generally recognized as safe status phytochemical obtained from cinnamon bark. TCNE were prepared with emulsifiers Tween 80 (Tw.80) or gum Arabic and lecithin (GAL) by sonication. Day-old fertilized eggs were subjected to TCNE wash treatments at 34°C for 5 min, followed by 18 d of incubation at 37.7°C. Washing of fertilized eggs with TCNE-Tw.80 or GAL at 0.48% concentration did not significantly alter the egg weight at d 18 of incubation, as compared to baseline and control (P > 0.05). The egg weight loss (calculated as percentage) did not differ significantly between eggs subjected to nanoemulsion wash treatments and control eggs (P > 0.05). In case of embryo fertility and mortality, for baseline and control, ∼ 95% fertility rate was achieved, with combined early and midterm mortality at 16%. Likewise, TCNE-Tw.80 or TCNE-GAL resulted in 95% fertility (P > 0.05), with 11% and 17% combined early and midterm mortality, respectively. Furthermore, TCNE wash treatments did not differ significantly in yolk sac and embryo weight (as compared to control) and did not affect the length of the d 18 embryo (P > 0.05). Moreover, TCNE wash treatments did not alter tibia weight and length (P > 0.05). Results suggest that TCNE could potentially be used as a natural antimicrobial for fertilized egg sanitation. Further studies in industry settings are warranted.

Trans-cinnamaldehyde nanoemulsion wash inactivates Salmonella Enteritidis on shelled eggs without affecting egg color.

Salmonella Enteritidis is a major foodborne pathogen that causes enteric illnesses in humans, primarily through the consumption of contaminated poultry meat and eggs. Despite implementation of traditional disinfection approaches to reduce S. Enteritidis contamination, egg-borne outbreaks continue to occur, raising public health concerns and adversely affecting the popularity and profitability for the poultry industry. Generally Recognized as Safe (GRAS) status phytochemicals such as Trans-cinnamaldehyde (TC) have previously shown to exhibit anti-Salmonella efficacy, however, the low solubility of TC is a major hurdle in its adoption as an egg wash treatment. Therefore, the present study investigated the efficacy of Trans-cinnamaldehyde nanoemulsions (TCNE) prepared with emulsifiers Tween 80 (Tw.80) or Gum Arabic and lecithin (GAL) as dip treatments, at 34°C, for reducing S. Enteritidis on shelled eggs in presence or absence of 5% chicken litter. In addition, the efficacy of TCNE dip treatments in reducing trans-shell migration of S. Enteritidis across shell barrier was investigated. The effect of wash treatments on shell color were evaluated on d 0, 1, 7, and 14 of refrigerated storage. TCNE-Tw.80 or GAL treatments (0.06, 0.12, 0.24, 0.48%) were effective in inactivating S. Enteritidis by at least 2 to 2.5 log cfu/egg as early as 1 min of washing time (P < 0.05). In presence of organic matter, nanoemulsions (0.48%) reduced S. Enteritidis counts by ∼ 2 to 2.5 log cfu/egg as early as 1 min, (P < 0.05). Nanoemulsion wash also inhibited trans-shell migration of S. Enteritidis, as compared to control (P < 0.05). The nanoemulsion wash treatments did not affect shell color (P > 0.05). Results suggest that TCNE could potentially be used as an antimicrobial wash to reduce S. Enteritidis on shelled eggs, although further studies investigating the effect of TCNE wash treatments on organoleptic properties of eggs are necessary.

Caprylic acid reduces Salmonella Enteritidis populations in various segments of digestive tract and internal organs of 3- and 6-week-old broiler chickens, therapeutically.

We investigated the efficacy of feed supplemented with caprylic acid (CA), a natural, 8-carbon fatty acid for reducing Salmonella enterica serovar Enteritidis colonization in commercial broiler chickens. In separate 3- and 6-wk trials, 1-d-old straight-run broiler chicks (n = 70 birds/trial) were assigned to a control group (challenged with Salmonella Enteritidis, no CA) and 2 replicates of 0.7 and 1% CA (n = 14 birds/group). Water and feed were provided ad libitum. On d 1, birds were tested for any inherent Salmonella (n = 2 birds/group). For the 3-wk trial, on d 5, birds were challenged with 8 log(10) cfu of Salmonella Enteritidis of a 4-strain mixture by crop gavage, and after 5 d postchallenge, birds (n = 2 birds/group) were euthanized to ensure Salmonella Enteritidis colonization. Caprylic acid was supplemented the last 5 d before tissue collection (n = 10 birds/group). For the 6-wk trial, on d 25, birds were challenged and confirmed for Salmonella Enteritidis colonization. The birds (n = 10 birds/group) were euthanized for tissue samples after CA supplementation for the last 5 d. Caprylic acid at 0.7 or 1% decreased Salmonella Enteritidis populations in cecum, small intestine, cloaca, liver, and spleen in both 3- and 6-wk trials. Body weight of birds did not differ between the groups (P ≥ 0.05). Further, to elucidate a potential antibacterial mechanism of action of CA, we investigated if CA could reduce Salmonella Enteritidis invasion of an avian epithelial cell line and expression of invasion genes hilA and hilD. The cell invasion study revealed that CA reduced invasive abilities of all Salmonella Enteritidis strains by ~80% (P < 0.05). Gene expression studies indicated that CA downregulated (P < 0.001) Salmonella invasion genes hilA and hilD. These results suggest that supplementation of CA through feed could reduce Salmonella Enteritidis colonization in broiler chicken and potentially reduces the pathogen's ability to invade intestinal epithelial cells by downregulating key invasion genes, hilA and hilD.

Quarantine and serial testing for variants of SARS-CoV-2 with benefits of vaccination and boosting on consequent control of COVID-19.

Quarantine and serial testing strategies for a disease depend principally on its incubation period and infectiousness profile. In the context of COVID-19, these primary public health tools must be modulated with successive SARS CoV-2 variants of concern that dominate transmission. Our analysis shows that (1) vaccination status of an individual makes little difference to the determination of the appropriate quarantine duration of an infected case, whereas vaccination coverage of the population can have a substantial effect on this duration, (2) successive variants can challenge disease control efforts by their earlier and increased transmission in the disease time course relative to prior variants, and (3) sufficient vaccine boosting of a population substantially aids the suppression of local transmission through frequent serial testing. For instance, with Omicron, increasing immunity through vaccination and boosters-for instance with 100% of the population is fully immunized and at least 24% having received a third dose-can reduce quarantine durations by up to 2 d, as well as substantially aid in the repression of outbreaks through serial testing. Our analysis highlights the paramount importance of maintaining high population immunity, preferably by booster uptake, and the role of quarantine and testing to control the spread of SARS CoV-2.

Comparative analyses of eighteen rapid antigen tests and RT-PCR for COVID-19 quarantine and surveillance-based isolation.

Background: Rapid antigen (RA) tests are being increasingly employed to detect SARS-CoV-2 infections in quarantine and surveillance. Prior research has focused on RT-PCR testing, a single RA test, or generic diagnostic characteristics of RA tests in assessing testing strategies. Methods: We have conducted a comparative analysis of the post-quarantine transmission, the effective reproduction number during serial testing, and the false-positive rates for 18 RA tests with emergency use authorization from The United States Food and Drug Administration and an RT-PCR test. To quantify the extent of transmission, we developed an analytical mathematical framework informed by COVID-19 infectiousness, test specificity, and temporal diagnostic sensitivity data. Results: We demonstrate that the relative effectiveness of RA tests and RT-PCR testing in reducing post-quarantine transmission depends on the quarantine duration and the turnaround time of testing results. For quarantines of two days or shorter, conducting a RA test on exit from quarantine reduces onward transmission more than a single RT-PCR test (with a 24-h delay) conducted upon exit. Applied to a complementary approach of performing serial testing at a specified frequency paired with isolation of positives, we have shown that RA tests outperform RT-PCR with a 24-h delay. The results from our modeling framework are consistent with quarantine and serial testing data collected from a remote industry setting. Conclusions: These RA test-specific results are an important component of the tool set for policy decision-making, and demonstrate that judicious selection of an appropriate RA test can supply a viable alternative to RT-PCR in efforts to control the spread of disease.

Previous research on SARS-CoV-2 infection has determined optimal timing for testing in quarantine and the utility of different frequencies of testing for infection surveillance using RT-PCR and generalized rapid antigen tests. However, these strategies can depend on the specific rapid antigen test used. By examining 18 rapid antigen tests, we demonstrate that a single rapid antigen test performs better than RT-PCR when quarantines are two days or less in duration. In the context of infection surveillance, the ability of a rapid antigen test to provide results quickly counteracts its lower sensitivity with potentially more false positives. Our findings indicate that rapid antigen tests can be a suitable alternative to RT-PCR for application in quarantine and infection surveillance.

Near-infrared spectroscopy during cardiopulmonary resuscitation for pediatric cardiac arrest: A prospective, observational study.

AIM: Cerebral oxygenation (rSO2) is not routinely measured during pediatric cardiopulmonary resuscitation (CPR). We aimed to determine whether higher intra-arrest rSO2 was associated with return of spontaneous circulation (ROSC) and survival to hospital discharge. METHODS: Prospective, single-center observational study of cerebral oximetry using near-infrared spectroscopy (NIRS) during pediatric cardiac arrest from 2016 to 2020. Eligible patients had ≥30 s of rSO2 data recorded during CPR. We compared median rSO2 and percentage of rSO2 measurements above a priori thresholds for the entire event and the final five minutes of the CPR event between patients with and without ROSC and survival to discharge. RESULTS: Twenty-one patients with 23 CPR events were analyzed. ROSC was achieved in 17/23 (73.9%) events and five/21 (23.8%) patients survived to discharge. The median rSO2 was higher for events with ROSC vs. no ROSC for the overall event (62% [56%, 70%] vs. 45% [35%, 51%], p = 0.025) and for the final 5 minutes of the event (66% [55%, 72%] vs. 43% [35%, 44%], p = 0.01). Patients with ROSC had a higher percentage of measurements above 50% during the final five minutes of CPR (100% [100%, 100%] vs. 0% [0%, 29%], p = 0.01). There was no association between rSO2 and survival to discharge. CONCLUSIONS: Higher cerebral rSO2 during CPR for pediatric cardiac arrest was associated with higher rates of ROSC but not with survival to discharge.

Occupational asthma in the aluminum smelters of Australia and New Zealand: 1991-2006.

OBJECTIVE: To examine the incidence of occupational asthma in the seven aluminum smelters of Australia and New Zealand from 1991 to 2006. METHODS: Incidence and exposure data were collected by survey from the smelters prospectively during the study period. RESULTS: The incidence of occupational asthma across all smelters combined was highest in 1992 at 9.46/1,000/year, declining to 0.36/1,000/year in 2006; a 96.2% reduction. The incidence of occupational asthma was correlated with geometric mean total fluoride concentration, measured as personal samples from employees undertaking anode changing (r(s) = 0.497, P < 0.001). CONCLUSIONS: The control of exposures, respiratory protection and pre-placement medical assessments undertaken during the study period seem to have contributed to the substantial decline in occupational asthma incidence.

Water administration of the medium-chain fatty acid caprylic acid produced variable efficacy against enteric Campylobacter colonization in broilers.

Campylobacter is one of the most common causes of foodborne illness, and poultry are considered a primary source of Campylobacter infections. Caprylic acid, an 8-carbon fatty acid, has been shown in previous studies to reduce enteric cecal Campylobacter concentrations in poultry when administered in the feed. For greater ease of application for producers, a water-soluble form of caprylic acid, sodium octanoate, was evaluated for efficacy against enteric Campylobacter. The first trial consisted of 70 birds in 7 groups (n = 10 chicks/group): an untreated control and 6 other groups that were challenged with Campylobacter at d 3 and that received 0, 0.175, 0.35, 0.7, 1.4, or 2.8% water-soluble caprylic acid in water 3 d before necropsy at d 14. The second trial consisted of 80 birds in 8 groups (n = 10 chicks/group): an untreated negative control and 7 other groups, all of which were challenged with Campylobacter at d 3 and received 0, 0.044, 0.088, 0.175, 0.35, 0.7, or 1.4% water-soluble caprylic acid for 3 d before necropsy at d 14. In trial 1, only the 0.175% dose caused a reduction in cecal Campylobacter counts in comparison with the positive control (approximately a 3-log reduction). In trial 2, no treatment reduced Campylobacter counts compared with the positive control. Unlike the efficacy of caprylic acid in feed, treatment with caprylic acid in water had an inconsistent effect on intestinal Campylobacter counts.

Impact of a health promotion magazine on employee's health-knowledge.

BACKGROUND: Health promotion initiatives are an important element of occupational medicine practice but evaluating success is complex. The publishers of a quarterly health promotion magazine asked an aluminium smelting company if it would consider providing the magazine to its employees. AIMS: To evaluate the possible benefits to employees of receiving a health promotion magazine. METHODS: Three issues were distributed by post over a 9 month period to employees at an aluminium smelter. Pre- and post-distribution questionnaires were mailed to employees and their partners, asking questions about health knowledge and behaviour. Statistical analysis was undertaken using chi-square and Fisher's exact test. RESULTS: Overall 243 of 640 employees (38%) responded to the initial questionnaire and 129 (20%) to the final questionnaire. Pre-existing knowledge about preventive health issues was high; 61-100% of employees selected the correct answer to questions about diet, smoking and exercise. Following distribution of the magazines, there was an increase in employees' knowledge of sugars in 'fat-free' foods (P < 0.05), the benefits of fish oil (P < 0.01) and in how often health was considered when buying food (P < 0.05), as well as an increase in partners' knowledge of dietary fats (P < 0.001). Overall 84% of employees and 87% of their partners who returned the final questionnaire and indicated they had read the magazine showed enthusiasm for continued delivery. CONCLUSIONS: The results suggest that the pilot intervention was beneficial; however, the findings must be interpreted with caution given the modest response rates.

Immune interference of bacteriophage efficacy when treating colibacillosis in poultry.

A study was conducted to determine if prior exposure with bacteriophage would limit the ability of the same bacteriophage to treat colibacillosis. There were 5 treatments with 3 replicate pens of 20 birds per pen. The treatments consisted of 1) control, 2) birds treated with bacteriophage at 10 and 17 d of age, 3) birds challenged with Escherichia coli at 17 d of age, 4) birds challenged with E. coli and treated with bacteriophage at 17 d of age, and 5) birds treated with bacteriophage at 10 d of age and challenged with E. coli and treated with bacteriophage at 17 d of age. Colibacillosis was induced by injecting 0.1 mL of E. coli into the thoracic airsac containing 1 x 10(6) cfu. The bacteriophage was administered by i.m. injection of 0.1 mL into the thigh, providing a dose of 6.8 x 10(8) pfu. The study was concluded 14 d after E. coli challenge. Mortality in the birds challenged with E. coli and not treated with bacteriophage was 55% (treatment 3), and bacteriophage therapy significantly (P < or = 0.05) reduced mortality to 8% (treatment 4), which was not significantly (P < or = 0.05) different from the 2 non-E. coli-challenged controls (3%, treatment 1, and 2%, treatment 2). However, mortality in the birds administered bacteriophage before challenge with E. coli and treated with bacteriophage (treatment 5) was 33%, which was not significantly different (P < or = 0.05) from the birds that were challenged with E. coli and untreated (55%, treatment 3). A kinetic in vitro assay of bacteriophage activity found that serum from birds pretreated with bacteriophage (treatment 5) inhibited bacteriophage activity. The IgG levels to the bacteriophage in serum from birds pretreated with bacteriophage (treatment 2) were significantly higher at all dilutions compared with control serum (treatment 1). These data demonstrate that prior exposure to bacteriophage will limit bacteriophage therapeutic efficacy and suggests that the reduced efficacy is due to an immune response to bacteriophage.