Patient experience of telephone consultations in gynaecology: a service evaluation.

OBJECTIVE: To investigate patient perspective of telephone consultations (TCs) in gynaecology and identify which patients benefit most from a telemedicine system. DESIGN: Service evaluation. SETTING: Gynaecology outpatient services at a tertiary referral hospital. POPULATION: Patients who received a TC during May and June 2020. METHODS: Postal questionnaire combining three validated tools: QQ-10, Patient Enablement Index (PEI) and National Health Service Friends and Family Test (NHS-FFT). Quantitative data and free text responses were analysed. MAIN OUTCOME MEASURES: Responses to QQ-10, PEI and NHS-FFT. RESULTS: In total, 1307 patients were contacted and 504 patients responded (39%). Most (89%) described their experience as 'Very good' or 'Good' (NHS-FFT). Positive themes from responses included 'convenience', 'effectiveness' and 'equivalent care'. QQ-10 responses demonstrated a high Value score of 79 (0-100) and a low Burden score of 15. PEI scores suggested that most patients felt better or much better able to understand and cope with their condition following TC. The majority of patients (77%) would 'Strongly agree' or 'Mostly agree' to a repeat TC. Regarding patient outcomes, 21% were discharged and 71% required follow up. Menopause, fertility and endometriosis follow-up clinic patients benefited most from TC. Gynaecology-oncology patients found TC least acceptable. CONCLUSION: We report a large questionnaire survey of patient experience of TC in gynaecology. Telemedicine is convenient, acceptable and effective for conducting care in selected groups. TC can support patients in communicating intimate symptoms. TWEETABLE ABSTRACT: Telephone consultations are a convenient, acceptable and effective medium for conducting patient care in gynaecology.

Evaluating feasibility of an automated 3-dimensional scanner using Raman spectroscopy for intraoperative breast margin assessment.

Breast conserving surgery is the preferred treatment for women diagnosed with early stage invasive breast cancer. To ensure successful breast conserving surgeries, efficient tumour margin resection is required for minimizing tumour recurrence. Currently surgeons rely on touch preparation cytology or frozen section analysis to assess tumour margin status intraoperatively. These techniques have suboptimal accuracy and are time-consuming. Tumour margin status is eventually confirmed using postoperative histopathology that takes several days. Thus, there is a need for a real-time, accurate, automated guidance tool that can be used during tumour resection intraoperatively to assure complete tumour removal in a single procedure. In this paper, we evaluate feasibility of a 3-dimensional scanner that relies on Raman Spectroscopy to assess the entire margins of a resected specimen within clinically feasible time. We initially tested this device on a phantom sample that simulated positive tumour margins. This device first scans the margins of the sample and then depicts the margin status in relation to an automatically reconstructed image of the phantom sample. The device was further investigated on breast tissues excised from prophylactic mastectomy specimens. Our findings demonstrate immense potential of this device for automated breast tumour margin assessment to minimise repeat invasive surgeries.

Acute kidney injury and mortality 1 year after major non-cardiac surgery.

BACKGROUND: Even mild and transient acute kidney injury (AKI), defined by increases in serum creatinine level, has been associated with adverse outcomes after major surgery. However, characteristic decreases in creatinine concentration during major illness could confound accurate assessment of postoperative AKI. METHODS: In a single-hospital, retrospective cohort study of non-cardiac surgery, the association between postoperative AKI, defined using the Kidney Disease: Improving Global Outcomes criteria, and 1-year survival was modelled using a multivariable Cox proportional hazards analysis. Factors associated with development of AKI were examined by means of multivariable logistic regression. Temporal changes in serum creatinine during and after the surgical admission in patients with and without AKI were compared. RESULTS: Some 1869 patients were included in the study, of whom 128 (6·8 per cent) sustained AKI (101 stage 1, 27 stage 2-3). Seventeen of the 128 patients with AKI (13·3 per cent) died in hospital compared with 16 of 1741 (0·9 per cent) without AKI (P < 0·001). By 1 year, 34 patients with AKI (26·6 per cent) had died compared with 106 (6·1 per cent) without AKI (P < 0·001). Over the 8-365 days after surgery, AKI was associated with an adjusted hazard ratio for death of 2·96 (95 per cent c.i. 1·86 to 4·71; P < 0·001). Among hospital survivors without AKI, the creatinine level fell consistently (median difference at discharge versus baseline -7 (i.q.r. -15 to 0) µmol/l), but not in those with AKI (0 (-16 to 26) µmol/l) (P < 0·001). CONCLUSION: Although the majority of postoperative AKI was mild, there was a strong association with risk of death in the year after surgery. Underlying decreases in serum creatinine concentration after major surgery could lead to underestimation of AKI severity and overestimation of recovery.

Incidence and associations of acute kidney injury after major abdominal surgery.

PURPOSE: Acute kidney injury (AKI) is a recognised risk factor for adverse outcomes in critical illness and hospitalised patients in general. To understand the incidence and associations of AKI as a peri-operative complication of major abdominal surgery, we conducted a systematic literature review and meta-analysis. METHODS: Using a systematic strategy, we searched the electronic reference databases for articles describing post-operative renal outcomes using consensus criteria for AKI diagnosis (RIFLE, AKIN or KDIGO) in the setting of major abdominal surgery. Pooled incidence of AKI and, where reported, pooled relative risk of death after post-operative AKI were estimated using random effects models. RESULTS: From 4287 screened titles, 19 articles met our inclusion criteria describing AKI outcomes in 82,514 patients undergoing abdominal surgery. Pooled incidence of AKI was 13.4% (95% CI 10.9-16.4%). In eight studies that reported the short-term mortality, relative risk of death in the presence of post-operative AKI was 12.6 fold (95% CI, 6.8-23.4). Where reported, length of stay was greater and non-renal post-operative complications were also more frequent in patients experiencing AKI. CONCLUSIONS: Using modern consensus definitions, AKI is a common complication of major abdominal surgery that is associated with adverse patient outcomes including death. While a causative role for AKI cannot be concluded from this analysis, as an important signal of peri-operative harm, AKI should be regarded as an important surgical outcome measure and potential target for clinical interventions.

National Beef Quality Audit-2011: Survey of instrument grading assessments of beef carcass characteristics.

The instrument grading assessments for the 2011 National Beef Quality Audit evaluated seasonal trends of beef carcass quality and yield attributes over the course of the year. One week of instrument grading data, HCW, gender, USDA quality grade (QG), and yield grade (YG) factors, were collected every other month (n = 2,427,074 carcasses) over a 13-mo period (November 2010 through November 2011) from 4 beef processing corporations, encompassing 17 federally inspected beef processing facilities, to create a "snapshot" of carcass quality and yield attributes and trends from carcasses representing approximately 8.5% of the U.S. fed steer and heifer population. Mean yield traits were YG (2.86), HCW (371.3 kg), fat thickness (1.19 cm.), and LM area (88.39 cm(2)). The YG distribution was YG 1, 15.7%; YG 2, 41.0%; YG 3, 33.8%; YG 4, 8.5%; and YG 5, 0.9%. Distribution of HCW was <272.2 kg, 1.6%; 272.2 to 453.6 kg, 95.1%; and ≥453.6 kg, 3.3%. Monthly HCW means were November 2010, 381.3 kg; January 2011, 375.9 kg; March 2011, 366.2 kg; May 2011, 357.9 kg; July 2011, 372.54 kg; September 2011, 376.1 kg; and November 2011, 373.5 kg. The mean fat thickness for each month was November 2010, 1.30 cm; January 2011, 1.22 cm; March 2011, 1.17 cm; May 2011, 1.12 cm; July 2011, 1.19 cm; September 2011, 1.22 cm; and November 2011, 1.22 cm. The overall average marbling score was Small(49). The USDA QG distribution was Prime, 2.7%; Top Choice, 22.9%; Commodity Choice, 38.6%; and Select, 31.5%. Interestingly, from November to May, seasonal decreases (P < 0.001) in HCW and fat thicknesses were accompanied by increases (P < 0.001) in marbling. These data present the opportunity to further investigate the entire array of factors that determine the value of beef. Data sets using the online collection of electronic data will likely be more commonly used when evaluating the U.S. fed steer and heifer population in future studies.

National Beef Quality Audit-2011: In-plant survey of targeted carcass characteristics related to quality, quantity, value, and marketing of fed steers and heifers.

The 2011 National Beef Quality Audit (NBQA-2011) assessed the current status of quality and consistency of fed steers and heifers. Beef carcasses (n = 9,802), representing approximately 10% of each production lot in 28 beef processing facilities, were selected randomly for the survey. Carcass evaluation for the cooler assessment of this study revealed the following traits and frequencies: sex classes of steer (63.5%), heifer (36.4%), cow (0.1%), and bullock (0.03%); dark cutters (3.2%); blood splash (0.3%); yellow fat (0.1%); calloused rib eye (0.05%); overall maturities of A (92.8%), B (6.0%), and C or greater (1.2%); estimated breed types of native (88.3%), dairy type (9.9%), and Bos indicus (1.8%); and country of origin of United States (97.7%), Mexico (1.8%), and Canada (0.5%). Certified or marketing program frequencies were age and source verified (10.7%), ≤A(40) (10.0%), Certified Angus Beef (9.3%), Top Choice (4.1%), natural (0.6%), and Non-Hormone-Treated Cattle (0.5%); no organic programs were observed. Mean USDA yield grade (YG) traits were USDA YG (2.9), HCW (374.0 kg), adjusted fat thickness (1.3 cm), LM area (88.8 cm2), and KPH (2.3%). Frequencies of USDA YG distributions were YG 1, 12.4%; YG 2, 41.0%; YG 3, 36.3%; YG 4, 8.6%; and YG 5, 1.6%. Mean USDA quality grade (QG) traits were USDA quality grade (Select(93)), marbling score (Small(40)), overall maturity (A(59)), lean maturity (A(54)), and skeletal maturity (A(62)). Frequencies of USDA QG distributions were Prime, 2.1%; Choice, 58.9%; Select, 32.6%; and Standard or less, 6.3%. Marbling score distribution was Slightly Abundant or greater, 2.3%; Moderate, 5.0%; Modest, 17.3%; Small, 39.7%; Slight, 34.6%; and Traces or less, 1.1%. Carcasses with QG of Select or greater and YG 3 or less represented 85.1% of the sample. This is the fifth benchmark study measuring targeted carcass characteristics, and information from this survey will continue to help drive progress in the beef industry. Results will be used in extension and educational programs as teaching tools to inform beef producers and industry professionals of the current state of the U.S. beef industry.

National Beef Quality Audit-2011: Harvest-floor assessments of targeted characteristics that affect quality and value of cattle, carcasses, and byproducts.

The National Beef Quality Audit-2011 (NBQA-2011) was conducted to assess targeted characteristics on the harvest floor that affect the quality and value of cattle, carcasses, and byproducts. Survey teams evaluated approximately 18,000 cattle/carcasses between May and November 2011 in 8 beef processing facilities. Cattle identification methods were lot visual tags (85.7%), individual visual tags (50.6%), electronic tags (20.1%), metal-clip tags (15.7%), other (5.3%), none (2.5%), and wattles (0.5%). Hide colors or breed types were black (61.1%), red (12.8%), yellow (8.7%), Holstein (5.5%), brown (5.0%), gray (5.0%), white (1.4%), and brindle (1.0%). Brand frequencies were none (55.2%), 1 (40.4%), 2 (4.4%), and 3 or more (0.04%) brands, and brands were located on the butt (35.2%), side (9.0%), and shoulder (2.5%). Hide locations of mud or manure were no mud/manure (49.2%), legs (36.8%), belly (23.7%), side (14.9%), top-line (11.0%), and tail region (13.7%). There were 76.2% of cattle without horns, and the majority of those with horns (71.6%) were between 0 cm and 12.7 cm in length. Permanent incisor numbers were zero (87.3%), 1 (1.4%), 2 (8.0%), 3 (0.9%), 4 (1.9%), 5 (0.3%), 6 (0.2%), 7 (0.1%), and 8 (0.02%). Most carcasses (77.0%) were not bruised, 18.7% had 1 bruise, 3.4% had 2 bruises, 0.6% had 3 bruises, and 0.3% had more than 3 bruises. Bruise locations were loin (50.1%), rib (21.3%), chuck (13.8%), round (7.3%), and brisket/flank/plate (7.5%). Condemnation item and incidence were whole carcass (none recorded), liver (20.9%), lungs (17.3%), tongue (10.0%), viscera (9.3%), and head (7.2%). Compared with the NBQA-2005, the NBQA-2011 had an increased percentage of black-hided cattle (56.3 vs. 61.1%), more cattle with brands (38.7 vs. 44.8%), and more cattle with some form of identification (93.3 vs. 97.5%). In addition, there was a lesser percentage of carcasses with bruising in 2011 (23.0%) than in 2005 (35.2%), as well as a smaller percentage of carcasses with more than 1 bruise (2005 = 9.4% vs. 2011 = 4.2%). Compared with the 2005 audit, a similar percentage of the cattle were deemed 30 mo of age or older using dentition (2005 = 2.7% vs. 2011 = 3.3%). The information from NBQA-2011 helps the beef industry measure progress against previous NBQA assessments and provides a benchmark for future educational and research activities.

Establishing an appropriate mode of comparison for measuring the performance of marbling score output from video image analysis beef carcass grading systems.

A beef carcass instrument grading system that improves accuracy and consistency of marbling score (MS) evaluation would have the potential to advance value-based marketing efforts and reduce disparity in quality grading among USDA graders, shifts, and plants. The objectives of this study were to use output data from the Video Image Analysis-Computer Vision System (VIA-CVS, Research Management Systems Inc., Fort Collins, CO) to develop an appropriate method by which performance of video image analysis MS output could be evaluated for accuracy, precision, and repeatability for purposes of seeking official USDA approval for using an instrument in commerce to augment assessment of quality grade, and to use the developed standards to gain approval for VIA-CVS to assist USDA personnel in assigning official beef carcass MS. An initial MS output algorithm was developed (phase I) for the VIA-CVS before 2 separate preliminary instrument evaluation trials (phases II and III) were conducted. During phases II and III, a 3-member panel of USDA expert graders independently assigned MS to 1,068 and 1,242 stationary carcasses, respectively. Mean expert MS was calculated for each carcass. Additionally, a separate 3-member USDA expert panel developed a consensus MS for each carcass in phase III. In phase II, VIA-CVS stationary triple-placement and triple-trigger instrument repeatability values (n = 262 and 260, respectively), measured as the percentage of total variance explained by carcasses, were 99.9 and 99.8%, respectively. In phases II and III, 95% of carcasses were assigned expert MS for which differences between individual expert MS, and for which the consensus MS in phase III only, was < or = 96 MS units. Two differing approaches to simple regression analysis, as well as a separate method-comparability analysis that accommodates error in both dependent and independent variables, were used to assess accuracy and precision of instrument MS predictions vs. mean expert MS. Method-comparability analysis was more appropriate in assessing the bias and precision of instrument MS predictions. Ether-extractable fat percentages (n = 257; phase II) differed among MS (P < 0.05) but were not suitable to predict or validate assigned MS. The performance and reproducibility of expert MS assignment in future evaluations was considered, and an official USDA performance standard was established, to which an instrument must conform to be approved for official on-line MS assessment. The VIA-CVS subsequently was approved to assign MS to carcasses on-line after completion of a 2006 USDA instrument approval trial conducted according to methods developed during completion of this study.

Effect of pioglitazone on insulin sensitivity, vascular function and cardiovascular inflammatory markers in insulin-resistant non-diabetic Asian Indians.

AIMS: To determine the effects of pioglitazone (30 mg once daily for 16 weeks) on insulin sensitivity, insulin-mediated vasodilation, vascular inflammatory markers, fat distribution and lipids in Asian Indians and Caucasians of European ancestry. METHODS: Cross-sectional study. Eighteen non-diabetic Asian Indians and 17 Caucasians of comparable age (34 +/- 3 vs. 36 +/- 3 years) and body mass index (26.0 +/- 1.2 vs. 24.7 +/- 1.0 kg/m(2)) had measurements of insulin sensitivity (M, insulin clamp at 6 pmol/kg per min), abdominal fat (computed tomographic scan at L4-L5), endothelial-dependent (reactive hyperaemia, RH) and -independent (0.4 mg sublingual nitroglycerin, TNG) vasodilation using brachial artery ultrasound before and after the 2-h clamp at baseline and after pioglitazone therapy. RESULTS: Asian Indians were insulin resistant compared with Causasians during the baseline clamp (M = 25.6 +/- 1.7 vs. 41.1 +/- 2.2 micromol/kg per min, P < 0.0001) and improved significantly after pioglitazone (to 33.9 +/- 1.7 micromol/kg per min, P < 0.001). Vasodilatory responses to RH and TNG were similar in Asian Indians and Caucasians at baseline and did not change. Insulin-mediated vasodilation improved after pioglitazone in Asian Indians, but not in Caucasians, and correlated with the change in insulin sensitivity (r = 0.52, P = 0.03). C-reactive protein (CRP) was higher in Asian Indians vs. Caucasians (1.6 +/- 0.4 vs. 0.9 +/- 0.2 mg/l) and was negatively correlated with insulin sensitivity (r = -0.53, P = 0.02). In the Asian Indian group, CRP and plasminogen activator inhibitor-1 decreased and adiponectin increased after pioglitazone, but there were no significant changes in total or visceral fat. CONCLUSIONS: These results demonstrate that insulin-resistant Asian Indians respond favourably to an insulin sensitizer with improvements in insulin sensitivity, cardiovascular and inflammatory risk markers, and vascular responses to insulin. These agents may have a role in decreasing the risk of diabetes and cardiovascular disease in this high-risk population.

[Effect of the availability of a medicalized mobile ICU (MMICU) on the hospital admissions after an out-of-hospital cardiorespiratory arrest (OH-CRA)]. / Efecto de la disponibilidad de una UVI móvil medicalizada en los ingresos hospitalarios tras una parada cardiorrespiratoria extrahospitalaria.

Patients admitted in an ICU after OH-CRA before and after the implementation of a MMICU were evaluated. During a period of 11 years, divided into a pre-MMICU period (1988-1993) and a post-MMICU period (1994-1998), 39 patients were admitted in the pre period and 64 patients in the post period. The basal characteristics, the etiologies of OH-CRA and of death in ICU they were similar. The incidence of severe anoxic encephalopathy (SAE) it doubled in the post period. There were not significant differences both to the discharge from ICU and to the hospital discharge. We conclude that after implementing a MMICU more patients are admitted in ICU resuscitated after OH-CRA. The survival does not vary, but the incidence of SAE increases.

Efecto de la disponibilidad de una UVI móvil medicalizada en los ingresos hospitalarios tras una parada cardiorrespiratoria extrahospitalaria / Effect of the availability of a medicalized mobile ICU

Se analizaron pacientes (px) ingresados en UCI tras una parada cardiorrespiratoria extrahospitalaria (PCR-E) antes y después de implantar una UVI móvil medicalizada (UVIMM). Durante 11 años, divididos en período pre-UVIMM (1988-1993) y post-UVIMM (1994-1998), ingresaron 39 px en el período pre y 64 px en el post-UVIMM. Las características basales, las etiologías de PCR-E y de fallecimiento en UCI fueron similares. La incidencia de encefalopatía anóxica severa (EAS) se duplicó en el período post. No hubo diferencias significativas tanto al alta de UCI como al alta hospitalaria. Concluimos que tras implantar una UVIMM ingresan en UCI más px reanimados tras una PCR-E. La supervivencia no varía, pero aumenta la incidencia de EAS (AU)

The effect of different definitions of a patient on immunization assessment.

OBJECTIVES: In this report, the authors compare immunization assessment using 2 definitions of a patient. METHODS: Two Clinical Assessment Software Application (CASA) assessments were performed. The first sampled 200 two-year-olds seen at least once since birth. The second sampled 200 two-year-olds seen in the previous year. Children with incomplete immunizations in the first sample were contacted. RESULTS: In the second sample, 72% of children had complete immunizations, compared with 46% in the first sample. In the first sample, 78% of children with incomplete immunizations had not been seen during the past year. Of 134 children in the first sample seen in the past year or successfully contacted, 75% had complete immunizations. CONCLUSIONS: The CASA assessment's definition of a patient underestimates immunization rates.

Factors influencing consumer demand for U.S. pork exported to the Republic of Korea (South Korea).

The potential market for single-ribbed bellies and Boston butts in South Korea was characterized and quantitative selection criteria were identified for use by U.S. packers when selecting pork for export. South Korean retail meat market managers and traders/wholesalers in Seoul and Pusan were interviewed and asked to identify the quality attributes that are considered when making pork-purchasing decisions. In addition, pork labeling characteristics and meat display case measurements and space allocations were recorded in each retail store. Data from box labels were recorded in retail storage coolers to characterize pork products currently being merchandized in South Korea. Sample retail packages of belly and butt slices were collected and sent to a commercial laboratory for analysis of iodine values, ether-extractable fat content, total aerobic plate count (APC), total coliform count (TCC), and generic Escherichia coli count (ECC). No quality attributes of U.S. products exceeded the expectations of retailers. Quality attributes of U.S. pork products that exceeded the expectations of traders included presence of foreign material, marbling, tenderness, juiciness, flavor, and overall eating satisfaction. Traders/wholesalers assigned negative ratings for overall workmanship and adherence to purchase criteria for U.S. pork products. Retail APC for South Korean belly samples were higher (P < 0.05) than APC for U.S. belly samples. Retail TCC and ECC for butts and belly samples and APC for butt samples did not differ by country of origin. Retail prices for South Korean bellies were higher (P < 0.05) than prices for retail U.S. and Danish bellies. Pork butt prices did not differ (P > 0.05) by country of origin. Beef, pork, and poultry products comprised 66.8, 27.8, and 5.4%, respectively, of the total meat display case frontage. U.S. beef products occupied, on average, 18% of the total beef display area, whereas U.S. pork products comprised 2.6% of the total pork display case area.

Frequent breastfeeding and food refusal associated with failure to thrive. A manifestation of the vulnerable child syndrome.

This paper acquaints pediatricians and health care personnel with the triad of poor weight gain, frequent breastfeeding, and food refusal in infants during the second 6 months of life. The histories of six infants aged 8-11 months, with failure to thrive, food refusal, and frequent breastfeeding, are presented. All the mothers were facing significant stresses, which may have decreased their breast milk supply, and were leading them to use breastfeeding for their comfort and/or the comfort of their infant. The infants responded with continued frequent breastfeeding, refusal of complementary foods, and decreased weight gain. These infants fit the characteristics of the vulerable child syndrome. Treatment of these infants required evaluation and treatment of the mothers' psychosocial issues along with a behavioral feeding program. Even with this multidisciplinary approach, these infants showed very slow catch-up growth. Pediatricians and health care personnel should use and build on this information in the evaluation and treatment of infants with similar problems.

Infant feeding practices in complex emergencies: a case study approach.

The majority of deaths associated with complex emergencies are attributed to infants and children under the age of five years. Most of these deaths are related to preventable diseases such as malnutrition, diarrhea, and malaria. Infant feeding emergencies have emerged as a major factor in complex emergencies. This paper reviews the current information relative to infant feeding, and uses four case studies as educational tools for the management of infant feeding emergencies. Child mortality rates in refugee population have been linked directly to protein-energy malnutrition (PEM). Breast feeding has many advantages over all other forms of feeding for children up to the age of two years of age. These advantages are discussed in detail in this paper. In addition, the appropriate and inappropriate uses of breast-milk substitutes (BMS) are discussed. Breast feeding also may play a role in the spread of HIV infections from the mother to the infant. However, in the setting of complex emergencies in the developing world, the risk of an infant dying of malnutrition and infection when not breastfed is likely to be greater than is the risk of death due to HIV acquisition through breastfeeding. The physiology of lactation is reviewed with particular reference to the roles of prolactin, oxytocin, and the feedback inhibitor of lactation (FIL) hormone. No medications have been demonstrated to augment milk production that can be used in a practical sense in complex emergencies. Lastly, the principles promulgated by the WHO and UNHCR for the feeding of infants and children in emergencies and for milk powder distribution are summarized.

Targeting lead screening: The Ohio Lead Risk Score.

OBJECTIVE: Annual blood lead (BPb) screening is recommended for children /=12% of BPb test results >/=10 microg/dL. RESULTS: Data from 897 census tracts were available. Higher risk for lead toxicity existed in areas where: 1) >/=55% of houses were built before 1950 (adjusted odds ratio [AOR]: 10.9 [6.1,19.6]); 2) >/=35% of residents were black (AOR: 3.5 [2.0,6. 3]); 3) >/=35% of residents had less than a high school education (AOR: 6.1 [3.6,10.4]); and 4) >/=50% of housing units were renter-occupied (AOR: 3.6 [2.1,6.2]). Receiver operator characteristic (ROC) curves demonstrated no significant differences after applying the model in a second dataset. CONCLUSIONS: Several community characteristics predict risk for lead toxicity in children and may provide a useful approach to focus lead screening, especially in communities where public health resources are limited. The approach described here may also prove helpful in identifying factors within a community associated with other environmental public health hazards for children.

Quantification of pork belly and boston butt quality attribute preferences of South Korean customers.

U.S. packers must have quantitative criteria for selection of pork bellies and Boston butts for export to South Korea. Pork bellies (IMPS 409A) and Boston butts (IMPS 409A, 406B, 407) were selected from normal production in a U.S. pork packing plant and transported to Seoul, South Korea, via seafreighter in refrigerated containers (frozen < -5 degrees C) or via air freight (fresh > 0 degrees C; frozen < -5 degrees C). Participants at the Seoul Food Show were surveyed about their preferences for specific quality attributes of these cuts. Bellies were selected to differ in seam fat content (low = < 20%, moderate = 20 to 40%, high = > 40% extractable fat), lean color (pale = L* > 50, medium = L* 48-50, dark = L* < 48), weight (3.36, 4.04, or 5.36 kg), state of refrigeration and packaging (frozen, poly-wrapped; chilled, poly-wrapped; frozen, vacuum-packaged; chilled, vacuum-packaged), shape (round, wavy, square), and belly thickness (3.81, 4.32, or 4.90 cm). Boston butts were selected to differ in USDA marbling score (Slight, Small, Modest, Moderate, and Slightly Abundant), seam fat content (low = < 10%, moderate = 10 to 20% fat, high = > 20% extractable fat), lean color (pale = L* > 44, medium = L* 40-42, dark = L* < 38), weight (2.91, 3.82, or 4.66 kg), state of refrigeration and packaging (frozen, poly-wrapped; chilled, poly-wrapped; frozen, vacuum-packaged; chilled, vacuum-packaged), and shape (square, oblong, round). In Seoul, pork subprimals were tempered (if frozen), sliced, and arrayed by quality attribute and category in a retail display case. Over 4 d of testing, attendees (n = 210) of the food show were asked to rate the displayed samples for each quality attribute on a standardized ballot. Mid-weight (3.82 kg) Boston butts that displayed Moderate or higher USDA marbling scores with moderate amounts of seam fat, Japanese lean color scores of 2 or 4, round geometric shape, and that were vacuum-packaged and transported to Korea in the freshly chilled state best characterized the quality attribute preferences of respondents. Pork bellies that exhibited moderate amounts of seam fat, Japanese lean color scores of 3, square shape, belly thickness of 3.94 cm, approximate weight of 4.04 kg, and that were vacuum-packaged and transported to Korea in the freshly chilled state best met the quality needs of South Korean customers.

Children with moderately elevated lead levels: is chelation with DMSA helpful?

This study evaluates the effectiveness (use under routine circumstances) of DMSA (2,3 dimercaptosuccinic acid) and environmental remediation as compared with placebo and environmental remediation on children with blood lead (BPb) levels of 30-45 micrograms/dL (1.45-2.17 mumol/L). The endpoints were BPb at 1 month and 6 months after study entry. This double-blind placebo-controlled trial involved 39 children aged 2-5 years, who were randomized to one course of DMSA or placebo. The mean BPb levels of the two groups at study entry were similar, placebo group 33.0 micrograms/dL (1.59 mumol/L) and the DMSA group 34.9 micrograms/dL (1.68 mumol/L). At 1 month (the end of treatment) the mean BPb levels of the two groups were: placebo group 33.2 micrograms/dL (1.60 mumol/L) and the DMSA group 27.4 micrograms/dL (1.32 mumol/L), p = 0.16. At 6 months, the mean BPb levels were 25.1 micrograms/dL (1.21 mumol/L) for the placebo group and 28.8 micrograms/dL (1.39 mumol/L) for the DMSA-treated group, p = 0.06. Neither of these differences is statistically significant. All children with BPb, in the range studied here, should receive environmental evaluation and remediation; DMSA does not improve long-term blood lead levels.

Cardiovascular collapse caused by electrocardiographically silent 60-Hz intracardiac leakage current. Implications for electrical safety.

BACKGROUND: The national standard for safe 60-Hz intracardiac leakage current under a single-fault condition is 50 microA. This standard is intended to protect patients from alternating current (AC) at levels below the threshold for sensation, but the minimum unsafe level for AC in closed-chest humans is not known. To determine this value, we studied 40 patients at testing of implantable cardioverter-defibrillators using a programmable source of 60-Hz AC. METHODS AND RESULTS: We applied AC for 5-second test periods in increasing strengths until ventricular fibrillation (VF) was induced or 1 mA was reached. Two current paths were tested: bipolar, between tip and ring electrodes of a right ventricular pacing catheter, and unipolar, from tip to a remote electrode. We observed a characteristic sequence of 3 responses as AC was increased: (1) intermittent ventricular capture with QRS morphology identical to pacing through the electrodes (minimum value, 20 microA); (2) continuous capture at cycle length 282+/-88 ms (minimum value, 32 microA); and (3) VF persisting after AC termination (minimum value, 49 microA). Continuous capture caused loss of pulsatile arterial pressure and cardiovascular collapse (mean arterial pressure, 32+/-8 mm Hg) for the duration of AC with no ECG evidence of AC stimulation. Thus, the clinical picture was that of hypotensive ventricular tachycardia (VT). The continuous-capture threshold was /=5 seconds should be