Carotid Artery Calcification on Orthopantomograms (CACO Study) - is it indicative of carotid stenosis?

It is unclear whether incidental carotid artery calcification (CAC) on radiographs has a defined relationship to clinically significant carotid artery stenosis, and therefore risk of stroke. The primary objective of this study was to ascertain the relationship between dental radiograph detected carotid calcification and carotid artery stenoses ≥50% on carotid duplex ultrasound. We carried out an observational study of patients undergoing routine dental orthopantomogram (OPG) examinations. Consecutive patients with CAC on OPG were prospectively matched to those without CAC based on age and gender. Ultrasound of the carotid arteries was performed to determine the presence of stenosis (≥50%) in either vessel. Of 5780 consecutive OPG examinations with suitable images for analysis, CAC was detected in 10.8%. A total of 233 patients underwent carotid ultrasound (130 with and 103 without CAC on OPG). The prevalence of a clinically significant (≥50%) carotid stenosis on ultrasound was 15.4% (20/130) in those with CAC and 5.8% (6/103) for those without CAC on OPG. Incidental CAC detected on routine OPG requires both radiological reporting and clinical follow-up since 1 in 7 patients will have a clinically significant carotid artery stenosis as compared with 1 in 20 patients who do not have CAC. Trial Registration: Australian and New Zealand Clinical Trials Registry website (U1111-1148-1066). http://www.ANZCTR.org.au/ACTRN12613001038785.aspx.

Non-technical skills of surgical trainees and experienced surgeons.

BACKGROUND: In addition to technical expertise, surgical competence requires effective non-technical skills to ensure patient safety and maintenance of standards. Recently the Royal Australasian College of Surgeons implemented a new Surgical Education and Training (SET) curriculum that incorporated non-technical skills considered essential for a competent surgeon. This study sought to compare the non-technical skills of experienced surgeons who completed their training before the introduction of SET with the non-technical skills of more recent trainees. METHODS: Surgical trainees and experienced surgeons undertook a simulated scenario designed to challenge their non-technical skills. Scenarios were video recorded and participants were assessed using the Non-Technical Skills for Surgeons (NOTSS) scoring system. Participants were divided into subgroups according to years of experience and their NOTSS scores were compared. RESULTS: For most NOTSS elements, mean scores increased initially, peaking around the time of Fellowship, before decreasing roughly linearly over time. There was a significant downward trend in score with increasing years since being awarded Fellowship for six of the 12 NOTSS elements: considering options (score -0·015 units per year), implementing and reviewing decisions (-0·020 per year), establishing a shared understanding (-0·014 per year), setting and maintaining standards (-0·024 per year), supporting others (-0·031 per year) and coping with pressure (-0·015 per year). CONCLUSION: The drop in NOTSS score was unexpected and highlights that even experienced surgeons are not immune to deficiencies in non-technical skills. Consideration should be given to continuing professional development programmes focusing on non-technical skills, regardless of the level of professional experience.

Longitudinal study of Salmonella 1,4,[5],12:i:- shedding in five Australian pig herds.

The shedding patterns of Salmonella spp. and MLVA profiles of Salmonella enterica subspecies enterica (I) serotype 1,4,[5],12:i:- were monitored in a 12-month longitudinal observational study of five pig herds to inform management; provide indications of potential hazard load at slaughter; and assist evaluation of MLVA for use by animal and public health practitioners. Twenty pooled faecal samples, stratified by age group, were collected quarterly. When Salmonella was cultured, multiple colonies were characterized by serotyping and where S. Typhimurium-like serovars were confirmed, isolates were further characterized by phage typing and multiple locus variable number tandem repeat analysis (MLVA). Salmonella was detected in 43% of samples. Salmonella 1,4,[5],12:i- was one of several serovars that persisted within the herds and was found among colonies from each production stage. Virtually all Salmonella 1,4,[5],12:i:- isolates were phage type 193, but exhibited 12 different, closely-related MLVA profiles. Salmonella 1,4,[5],12:i:- diversity within herds was low and MLVA profiles were stable indicating colonization throughout the herds and suggesting each farm had an endemic strain. High prevalence of S. 1,4,[5],12:i:- specific shedding among terminal animals indicated high hazard load at slaughter, suggesting that primary production may be an important pathway of S. 1,4,[5],12:i:- into the human food chain, this has implications for on-farm management and the application and targeting control measures and further evidence of the need for effective process control procedures to be in place during slaughter and in pork boning rooms. These findings have implications for animal health and food safety risk mitigation and risk management.

Thermal inactivation of Salmonella spp. in pork burger patties.

Predictive models, to estimate the reduction in Escherichia coli O157:H7 concentration in beef burgers, have been developed to inform risk management decisions; no analogous model exists for Salmonella spp. in pork burgers. In this study, "Extra Lean" and "Regular" fat pork minces were inoculated with Salmonella spp. (Salmonella 4,[5],12,i:-, Salmonella Senftenberg and Salmonella Typhimurium) and formed into pork burger patties. Patties were cooked on an electric skillet (to imitate home cooking) to one of seven internal temperatures (46, 49, 52, 55, 58, 61, 64 °C) and Salmonella enumerated. A generalised linear logistic regression model was used to develop a predictive model for the Salmonella concentration based on the internal endpoint temperature. It was estimated that in pork mince with a fat content of 6.1%, Salmonella survival will be decreased by -0.2407log10 CFU/g for a 1 °C increase in internal endpoint temperature, with a 5-log10 reduction in Salmonella concentration estimated to occur when the geometric centre temperature reaches 63 °C. The fat content influenced the rate of Salmonella inactivation (P=0.043), with Salmonella survival increasing as fat content increased, though this effect became negligible as the temperature approached 62 °C. Fat content increased the time required for patties to achieve a specified internal temperature (P=0.0106 and 0.0309 for linear and quadratic terms respectively), indicating that reduced fat pork mince may reduce the risk of salmonellosis from consumption of pork burgers. Salmonella serovar did not significantly affect the model intercepts (P=0.86) or slopes (P=0.10) of the fitted logistic curve. This predictive model can be applied to estimate the reduction in Salmonella in pork burgers after cooking to a specific endpoint temperature and hence to assess food safety risk.

Effects of egg shell quality and washing on Salmonella Infantis penetration.

The vast majority of eggs in Australia are washed prior to packing to remove dirt and fecal material and to reduce the microbial contamination of the egg shell. The egg contents can be an ideal growth medium for microorganisms which can result in human illness if eggs are stored improperly and eaten raw or undercooked, and it is estimated that egg-related salmonellosis is costing Australia $44 million per year. Egg shell characteristics such as shell thickness, amount of cuticle present, and thickness of individual egg shell layers can affect the ease with which bacteria can penetrate the egg shell and washing could partially or completely remove the cuticle layer. The current study was conducted to investigate the effects of egg washing on cuticle cover and effects of egg shell quality and cuticle cover on Salmonella Infantis penetration of the egg shell. A higher incidence of unfavorable ultrastructural variables of the mammillary layer such as late fusion, type B bodies, type A bodies, poor cap quality, alignment, depression, erosion and cubics were recorded in Salmonella penetrated areas of egg shells. The influence of egg washing on the ability of Salmonella Infantis on the egg shell surface to enter the egg internal contents was also investigated using culture-based agar egg penetration and real-time qPCR based experiments. The results from the current study indicate that washing affected cuticle cover. There were no significant differences in Salmonella Infantis penetration of washed or unwashed eggs. Egg shell translucency may have effects on Salmonella Infantis penetration of the egg shell. The qPCR assay was more sensitive for detection of Salmonella Infantis from egg shell wash and internal contents than traditional microbiological methods. The agar egg and whole egg inoculation experiments indicated that Salmonella Infantis penetrated the egg shells. Egg washing not only can be highly effective at removing Salmonella Infantis from the egg shell surface, but also allows subsequent trans-shell and trans-membrane penetration into the egg. Consequently, it is important to prevent recontamination of the egg after washing.

Slaughterfloor decontamination of pork carcases with hot water or acidified sodium chlorite - a comparison in two Australian abattoirs.

A decontamination trial on the effectiveness of hot water or acidified sodium chlorite (SANOVA) treatment on Salmonella spp., Escherichia coli and Total Viable Count (TVC) was undertaken on pork carcases prior to primary chilling in two large pork abattoirs in Australia using belly-strip excision sampling. A total of 123 samples from Abattoir A and 400 samples from Abattoir B were cultured and analysed. Test pigs were selected from herds with a known high level of on-farm Salmonella infection. At Abattoir A, Salmonella spp. were not isolated from carcases. The prevalence of E. coli on control carcases was 92.9% compared with 9.8% for hot water and 12.5% for SANOVA treated carcases. The mean log(10) E. coli concentration for control carcases was 0.89 cfu/gram, compared with -0.83 cfu/gram from hot water and -0.75 cfu/gram from SANOVA treated carcases. The mean log(10) TVC for control carcases was 4.06 compared with 1.81 cfu/gram for hot water and 2.76 cfu/gram for SANOVA treated carcases. At Abattoir B, the prevalence of Salmonella on control carcases was 16% compared with 2.7% for hot water and 7.0% for SANOVA treated carcases. The prevalence of E. coli on control carcases was 69.3% compared with 22% for hot water and 30% for SANOVA treated carcases. The mean log(10) E. coli concentration for control carcases was 0.45 cfu/gram, compared with -0.65 cfu/gram from hot water and -0.60 cfu/gram from SANOVA treated carcases. The mean log(10) TVC for control carcases was 3.00 cfu/gram compared with 2.10 cfu/gram for hot water and 2.53 cfu/gram for SANOVA treated carcases. The reductions in prevalence and mean log(10) concentrations in the present trial were all found to be statistically significant and indicate that carcases decontamination with either hot water or SANOVA are effective risk management options immediately available to the pork industry.

A baseline survey of the microbiological quality of chicken portions and carcasses at retail in two Australian states (2005 to 2006).

Raw poultry products were purchased from the retail market place in two Australian states, New South Wales (n = 549) and South Australia (n = 310). The products sampled on a proportional volume basis were chicken portions with the skin off or skin on, in bulk or tray packs, and whole carcasses. They were collected from butcher shops, supermarkets, and specialty stores from urban areas during the winter (2005) and summer (2006) months. The samples were analyzed to determine the prevalence and concentration of Escherichia coli, Salmonella, and Campylobacter spp. in addition to total viable counts. Salmonella was found in 47.7 and 35.5% of retail chicken samples (35.3 and 21.9% were the less virulent Salmonella Sofia), at mean counts of -1.42 and -1.6 log MPN/cm2 in New South Wales and South Australia, respectively. Campylobacter was found in 87.8 and 93.2% of samples at mean counts of 0.87 and 0.78 log CFU/cm2, respectively. In both states in both seasons, the mean total viable count was 5 log CFU/cm2. On whole birds, E. coli was detected in all winter samples and on 92.9 and 85.7% of summer samples in New South Wales and South Australia, respectively; the log of the geometric mean per square centimeter was 0.5 in winter and slightly lower in summer. On chicken portions, E. coli was detected in around 90% of winter samples in both states, and in summer on 75.1 and 59.6% of samples in New South Wales and South Australia, respectively. The log of the geometric mean CFU per square centimeter for E. coli was 0.75 and 0.91 in winter, and 0.66 and 0.5 in summer in New South Wales and South Australia, respectively.

Analysing microbiological data: Tobit or not Tobit?

In this paper, methods used to collect microbiological data and the common statistical technique used to analyse such data are discussed. An alternative statistical approach, considered more appropriate for many microbial datasets is suggested. The effectiveness of this method is demonstrated using a simulation study and then, for a practical example, its application in a study on the effectiveness of a decontamination process for chicken carcases.

Assessment of producer conducted antemortem inspection of market pigs in Australia.

OBJECTIVE: A field trial was conducted to evaluate the effectiveness of on-farm antemortem inspection performed by Australian pig producers in terms of proficiency in detecting unhealthy animals (suspects), the impact on food safety and animal welfare outcomes. ANIMALS: A total of 64 trial groups of market pigs (n = 10,703) were dispatched from 20 herds to three abattoirs in three states. PROCEDURE: All producers and abattoir antemortem inspectors were trained in antemortem inspection prior to the trial, using a standardised set of antemortem criteria. Study 1 consisted of three comparisons: on-farm versus abattoir antemortem inspections on the same pigs, transport effects in suspect and normal pigs, and meat rejection and carcase disposition in suspect and normal pigs. Study 2 compared Salmonella spp. status of suspect and normal pigs. Studies 3 and 4 were conducted to assist the interpretation of the results of on-farm versus abattoir inspection. Antemortem inspection results of three producers and one abattoir antemortem inspector were compared with those of a reference inspector (Gold Standard). RESULTS: Of the pigs examined, 2.12% (95% CI: [1.84%, 2.42%]) were classified as suspect at on-farm antemortem inspection compared to only 0.14% at abattoir antemortem inspection. Forty one percent of pigs classified as suspect on-farm had locomotor problems (arthritis, lameness and foot abscess). Compared to normal pigs, suspect pigs had a relative risk of 67.7 (P < 0.0001) of suffering transport injuries. Meat rejection amounted to the equivalent of 9.68% of suspect carcases, compared to the equivalent of 0.35% of normal carcases. The isolation of Salmonella species from caecal content from 20.9% of 67 suspect pigs and 18.8% of 133 control pigs (two matched healthy pigs from the same batch for each suspect pig) were not significantly different. When compared with the reference inspector on-farm, three producers classified abnormalities in 2495 pigs with high specificity (0.98), acceptable sensitivity (0.82) and kappa (0.57). CONCLUSIONS: With training, producer sensitivity in antemortem inspection may be high and more proficient than abattoir antemortem inspection. Use of producer inspections may have benefits for animal welfare and chain efficiency, but not food safety.

Assessment of producer conducted antemortem inspection of market pigs in Australia.

OBJECTIVE: A field trial was conducted to evaluate the effectiveness of on-farm antemortem inspection performed by Australian pig producers in terms of proficiency in detecting unhealthy animals (suspects), the impact on food safety and animal welfare outcomes. ANIMALS: A total of 64 trial groups of market pigs (n= 10,703) were dispatched from 20 herds to three abattoirs in three states. PROCEDURE: All producers and abattoir antemortem inspectors were trained in antemortem inspection prior to the trial using a standardised set of antemortem criteria. Study 1 consisted of three comparisons: on-farm versus abattoir antemortem inspections on the same pigs, transport effects in suspect and normal pigs, and meat rejection and carcase disposition in suspect and normal pigs. Study 2 compared Salmonella spp status of suspect and normal pigs. Studies 3 and 4 were conducted to assist the interpretation of the results of on-farm versus abattoir inspection. Antemortem inspection results of three producers and one abattoir antemortem inspector were compared with those of a reference inspector (Gold Standard). RESULTS: Of the pigs examined, 2.12% (95% CI: 1.84%, 2.42%) were classified as suspect at on-farm antemortem inspection compared to only 0.14% at abattoir antemortem inspection. Forty one percent of pigs classified as suspect on-farm had locomotor problems (arthritis, lameness and foot abscess). Compared to normal pigs, suspect pigs had a relative risk of 67.7 (P < 0.0001) of suffering transport injuries. Meat rejection amounted to the equivalent of 9.68% of suspect carcases, compared to the equivalent of 0.35% of normal carcases. The isolation of Salmonella species from caecal content from 20.9% of 67 suspect pigs and 18.8% of 133 control pigs (two matched healthy pigs from the same batch for each suspect pig) were not significantly different. When compared with the reference inspector on-farm, three producers classified abnormalities in 2,495 pigs with high specificity (0.98), acceptable sensitivity (0.82) and kappa (0.57). CONCLUSIONS: With training, producer sensitivity in antemortem inspection may be high and more proficient than abattoir antemortem inspection. Use of producer inspections may have benefits for animal welfare and chain efficiency, but not food safety.

The adequacy of sample type/weight and incubation period on detection of Salmonella spp. in slaughter cattle.

The purpose of this study was to examine the adequacy of different sample types (fecal and rumen content), rumen-content sample weight (1, 10, and 25 g), and incubation period on the detection of Salmonella spp. in grass-fed beef cattle at slaughter. The culture technique was the same for all samples and followed the Australian Standard (AS 1766.2.5-1991). Sample adequacy was defined as the ratio between the overall prevalence, as obtained from samples identified as positive by any sample type/weight, and the estimated prevalence, as obtained from samples identified as positive by a particular sample type/weight. Sample adequacy reflects the likelihood of a sample of a particular type and weight to contain the organism of interest and hence is related to the sensitivity of the diagnostic test. It was found that sample adequacy differed between sample types and weights: 37.5% for both a 10-g fecal sample and a 1-g rumen sample, 77.1% for a 10-g rumen sample, and 79.2% for a 25-g rumen sample. On this basis, it is strongly recommended that sample type and weight be considered in the design of studies that aim to quantify Salmonella contamination in cattle.