Listeriosis associated with pre-prepared sandwich consumption in hospital in England, 2017.

A case of listeriosis occurred in a hospitalised patient in England in July 2017. Analysis by whole genome sequencing of the Listeria monocytogenes from the patient's blood culture was identified as clonal complex (CC) 121. This culture was indistinguishable to isolates from sandwiches, salads and the maufacturing environment of Company X which supplied these products widely to the National Health Service. Whilst an inpatient, the case was served sandwiches produced by this company on 12 occasions. No other cases infected by this type were detected in the UK between 2016 and 2020. Between 2016 and 2020, more than 3000 samples of food, food ingredients and environmental swabs from this company were tested. Listeria monocytogenes contamination rates declined after July 2017 from 31% to 0.3% for salads and 3% to 0% for sandwiches. A monophyletic group of 127 L. monocytogenes CC121 isolates was recovered during 2016-2019 and was used to estimate the time of the most recent common ancestor as 2014 (95% CI of between 2012 and 2016). These results represent persistent contamination of equipment, food contact surfaces and foods at a food manufacturer by a single L. monocytogenes strain. Colonisation and persistent contamination of food and production environments are risks for public health.

Sixteen years of bathymetry and waves at San Diego beaches.

Sustained, quantitative observations of nearshore waves and sand levels are essential for testing beach evolution models, but comprehensive datasets are relatively rare. We document beach profiles and concurrent waves monitored at three southern California beaches during 2001-2016. The beaches include offshore reefs, lagoon mouths, hard substrates, and cobble and sandy (medium-grained) sediments. The data span two energetic El Niño winters and four beach nourishments. Quarterly surveys of 165 total cross-shore transects (all sites) at 100 m alongshore spacing were made from the backbeach to 8 m depth. Monthly surveys of the subaerial beach were obtained at alongshore-oriented transects. The resulting dataset consists of (1) raw sand elevation data, (2) gridded elevations, (3) interpolated elevation maps with error estimates, (4) beach widths, subaerial and total sand volumes, (5) locations of hard substrate and beach nourishments, (6) water levels from a NOAA tide gauge (7) wave conditions from a buoy-driven regional wave model, and (8) time periods and reaches with alongshore uniform bathymetry, suitable for testing 1-dimensional beach profile change models.

Evaluation of 405-nm monochromatic light for inactivation of Tulane virus on blueberry surfaces.

AIM: The study aim was to evaluate the potential of 405-nm light as a virus intervention for blueberries. METHODS AND RESULTS: Tulane virus (TV)-inoculated blueberries were treated with 4·2 mW cm-2 of 405-nm light for 5-30 min. To mitigate thermal heating due to the intense light, a dry ice-chilled, nitrogen-based cooling system was utilized. Blueberries were rotated to ensure exposure of all surfaces to 405-nm light. Five-, 15- and 30-min treatments resulted in little or no inactivation of TV on blueberries (average log reductions of -0·18; -0·02; and +0·06 respectively). Since 405-nm light's inactivation mechanism may involve singlet oxygen, two singlet oxygen enhancers, riboflavin and rose bengal, were used to coat the blueberries prior to 405-nm light treatment. When 0·1% riboflavin or rose bengal was added, resulting in an average PFU reduction of -0·51 and -1·01 logs respectively. However, it was noted that the addition of riboflavin and rose bengal in the absence of 405-nm light treatment produced some inactivation. Average untreated log reductions for riboflavin and rose bengal were -0·13 and -0·66 respectively. Also, 60-30-s 405-nm light pulses with 2-min ambient cooling periods without the dry ice nitrogen cooling system did not inactivate TV, suggesting that oxygen limitation by the nitrogen CO2 mixture was not the cause of limited inactivation. CONCLUSIONS: Overall results indicate that 405-nm light has some potential to inactivate viruses if singlet oxygen enhancers are present. SIGNIFICANCE AND IMPACT OF THE STUDY: The potential of visible monochromatic violet/blue light (405 nm) as a nonthermal intervention for viruses on foods, such as berries that are prone to norovirus contamination, had not been previously evaluated. Use of food-grade singlet oxygen enhancer compounds in combination with visible spectra light may offer a means to inactivate foodborne viruses.

Clinical judgement and the emotions.

The basic emotions are more important in decision making than we think. So we need to be aware of them and look not just for rationality in our clinical judgements but rational judgements that 'feel' right.

Clinical and radiographic outcomes of the mobility total ankle arthroplasty system: early results from a prospective multicenter study.

BACKGROUND: The Mobility Total Ankle System is a third-generation design consisting of a 3-component, cementless, unconstrained, mobile-bearing prosthesis. This study reports the early results of a prospective multicenter study of the Mobility prosthesis. METHODS: Eighty-eight Mobility total ankle arthroplasties (TAAs) were implanted in 85 patients. The most common underlying diagnosis was posttraumatic arthritis (53%). Ankles were classified according to the Canadian Orthopedic Foot and Ankle Society (COFAS) end-stage ankle arthritis classification system. Coronal plane deformity was quantified preoperatively. Patients were reviewed at regular intervals postoperatively, with clinical and radiographic assessment. The mean follow-up time was 40 months (range, 30-60 months). RESULTS: Type 1 ankle arthritis was demonstrated in 44 ankles (50%). No patient had preoperative coronal plane angulation greater than 20 degrees. In 32 ankles (36%) the preoperative coronal alignment was neutral, and in 34 ankles (39%) the deformity was less than 10 degrees. The mean American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score improved from 38.2 (range, 12-59) preoperatively to 74.8 (range, 46-100) postoperatively. Bone-implant interface abnormalities were identified in 33 ankles with a retained prostheses (43%). Thirty (91%) of these involved zones around the tibial plate. In total, 8 TAAs required revision, 6 for aseptic loosening, 1 for talar migration, and 1 for deep infection. There was 1 conversion to arthrodesis for component malpositioning and 1 transtibial amputation for chronic regional pain syndrome. Six patients were being investigated for ongoing pain. The cumulative survival was 89.6% (95% confidence interval, 80.8-94.8) at 3 years and 88.4% (95% confidence interval, 79.3-93.9) at 4 years. CONCLUSION: Early results of the Mobility TAA for independent researchers do not match those reported by other surgeons. Good pain relief and improved function were achieved postoperatively in 72 ankles (82%). High rates of bone-implant interface abnormalities around the tibial plate are concerning but require longer follow-up to determine their clinical significance.

SU(3) spin-orbit coupling in systems of ultracold atoms.

Motivated by the recent experimental success in realizing synthetic spin-orbit coupling in ultracold atomic systems, we consider N-component atoms coupled to a non-Abelian SU(N) gauge field. More specifically, we focus on the case, referred to here as "SU(3) spin-orbit-coupling," where the internal states of three-component atoms are coupled to their momenta via a matrix structure that involves the Gell-Mann matrices (in contrast to the Pauli matrices in conventional SU(2) spin-orbit-coupled systems). It is shown that the SU(3) spin-orbit-coupling gives rise to qualitatively different phenomena and in particular we find that even a homogeneous SU(3) field on a simple square lattice enables a topologically nontrivial state to exist, while such SU(2) systems always have trivial topology. In deriving this result, we first establish an equivalence between the Hofstadter model with a 1/N Abelian flux per plaquette and a homogeneous SU(N) non-Abelian model. The former is known to have a topological spectrum for N>2, which is thus inherited by the latter. It is explicitly verified by an exact calculation for N=3, where we develop and use a new algebraic method to calculate topological indices in the SU(3) case. Finally, we consider a strip geometry and establish the existence of three gapless edge states-the hallmark feature of such an SU(3) topological insulator.

Education debate: clinical diagnostic reasoning.

Whilst it is clear that experienced clinicians adopt a rational approach of diagnosis, the logic of their clinical reasoning has been difficult to define. I outline here an approach based on the four categories of a complete diagnosis: Anatomical diagnosis (system involved); Pathological diagnosis (nature of the condition); Physiological diagnosis (functional consequences) and Aetiological diagnosis (background cause). Each phrase of the history and examination data is assigned to one or other of these categories as the case unfolds, with interpretations and interactions allowing sub-conclusions that gradually build to a final clinical diagnosis overall. The system has the advantage of facilitating a diagnosis individualized to the patient, rather than to some previously learned diagnostic 'checklist'. As such, it should provide an advance over current problem-based approaches to clinical diagnosis.

Autopsy artifact created by the Revivant AutoPulse resuscitation device.

In certain cases, the evaluation and correct identification of resuscitative artifacts is critical to the correct diagnosis and determination of the cause and manner of death. Resuscitative artifacts can resemble homicidal or accidental injury and thus possibly be misinterpreted. Occasionally, new technologies and/or medical procedures will create original and/or distinctive artifacts. In 2003, the San Francisco Fire Department emergency personnel began field-testing the Revivant AutoPulse, an automated chest compression device. This device is currently being used in two other counties in the San Francisco Bay Area as well as regions of Florida, Virginia, and Ohio. We present three cases of resuscitative artifact that could be potentially confused with homicidal or accidental injury. These cases illustrate resuscitative artifacts, specifically lateral chest and horizontally oriented upper abdomen cutaneous abrasions created by this automated chest compression device.

Criteria for the interpretation of cocaine levels in human biological samples and their relation to the cause of death.

The determination that cocaine is directly responsible for the immediate cause of death should be considered only when there is a reasonably complete understanding of the circumstances or facts surrounding the death. Another, more obvious and immediate cause of death must be absent, or, at least cocaine must be shown to be a significant contributing factor in the chain of medical findings that lead directly to the immediate cause of death. Not all death investigation requires the sequential steps described in this paper, but these steps must be considered early on in the investigation whenever there is scene, investigational, medical or a historical basis to believe that cocaine is directly related to the cause of death. A relatively high profile death when cocaine is known to be involved, or a death involving unusual behavior on the part of the deceased with police involvement are examples where these considerations may well apply. Information needs to be obtained as soon as possible to have the highest chance of successfully documenting the toxicologic basis for the diagnosis. These facts would include, but would not necessarily be limited to, a scene investigation (whenever possible), a careful review of the investigative reports from all involved agencies, the initial core temperature of the body as well as that of the environment at the time of the collapse or death, the past medical history of the individual, and the results of a complete forensic autopsy and toxicologic studies. Knowledge of and an understanding of the current relevant forensic literature on this subject should be available to the reviewer prior to any interpretation of the significance of cocaine upon a specific death.

National Association of Medical Examiners position paper on the certification of cocaine-related deaths.

The National Association of Medical Examiners Committee on Cocaine-related Deaths recommends that the following guidelines be applied in the process of documenting, interpreting, and certifying potential cocaine-related fatalities. The committee cautions that the investigation of any drug-related death requires a complete investigation of the circumstances of death, the death scene, and past medical history. It is also necessary to have the results of the forensic toxicological analysis and those of a complete forensic autopsy examination prior to formulating an opinion as to the cause and manner of death. Cocaine should be considered the underlying cause of the death when 1 or more of the following is true: (1). the circumstances surrounding the death can be associated with an acute cocaine exposure and there are no supervening causes of death; (2). the immediate cause of death is directly due to a readily identifiable mechanism or disease such as a gunshot wound or a stroke, yet the acute use of cocaine was the direct underlying cause of the trauma or the disease process; and (3). chronic cocaine use leads to a disease that results in an ultimately fatal pathologic process leading to organ injury and death. The committee further cautions that reported drug levels may not directly relate to the toxic or lethal effects of the drug upon the patient. These guidelines are intended for use by practicing medical examiners and physicians who certify drug deaths, as well as providing education tools for students.

Multiple thoracic vertebral compression fractures caused by non-accidental injury: case report with radiological-pathological correlation.

We report a 21-month-old boy with multiple contiguous thoracic vertebral compression fractures involving eight vertebral bodies, attributable to non-accidental injury. No subluxation was associated, however, there was extensive injury to the upper cervical and lower lumbar regions of the spinal cord. Anterosuperior beaking, thought to represent a previous injury, was evident in a mid-lumbar vertebra. Clinical examination revealed bilateral retinal hemorrhages and retinoschisis. Death occurred as a result of severe brain edema with bilateral subdural and subarachnoid hemorrhages. Radiological-pathological correlation is presented.

Demographic, pathologic, and toxicological profiles of 127 decedents testing positive for ephedrine alkaloids.

The relative toxicity of ephedra-containing dietary supplements is disputed. In order to ascertain the magnitude of the problem, we reviewed all autopsies in our Medical Examiner's jurisdiction, from 1994 to 2001, where ephedrine or any its isomers (E+) were detected. Toxicology testing results were tabulated and anatomic findings in E+ cases were compared to those in a control group of drug-free trauma victims. Of 127 E+ cases identified, 33 were due to trauma. Decedents were mostly male (80.3%) and mostly Caucasian (59%). Blood ephedrine concentrations were <0.49 mg/l in 50% of the cases, range 0.07-11.73 mg/l in trauma victims, and 0.02-12.35 mg/l in non-trauma cases. Norephedrine (NE) was present in the blood of 22.8% (mean of 1.81 mg/l, S.D.=3.14 mg/l) and in the urine of 36.2% (mean of 15.6 mg/l, S.D.=21.50mg/l). Pseudoephedrine (PE) was present in the blood of 6.3% (8/127). More than 88% (113/127) of the decedents also tested positive for other drugs, the most common being cocaine (or its metabolites) and morphine. The most frequent pathologic diagnoses were hepatic steatosis (27/127) and nephrosclerosis (22/127). Left ventricular hypertrophy was common, and coronary artery disease (CAD) detected in nearly one third of the cases. The most common findings in E+ deaths are those generally associated with chronic stimulant abuse, and abuse of other drugs was common in those with CAD. There were no cases of heat stroke or rhabdomyolysis. In most cases, norephedrine was not detected, suggesting it plays no role in ephedrine toxicity.

Takes your breath away--the immunology of allergic alveolitis.

Extrinsic allergic alveolitis (synonym: hypersensitivity pneumonitis) is caused by inhaling antigenic aerosols which induce hypersensitivity responses in susceptible individuals. It is an interstitial inflammatory disease affecting the distal, gas-exchanging parts of the lung, in contrast to allergic asthma where the inflammation is more proximal, affecting the conducting airways. The aims of this review are to describe current concepts of the immunology of this model of lung inflammation, to describe some of the constitutional and environmental characteristics which affect disease susceptibility and development, and to describe topics for prospective study.

Effect of irradiation temperature on inactivation of Escherichia coli O157:H7 and Staphylococcus aureus.

The resistance of Escherichia coli O157:H7 and Staphylococcus aureus in ground beef to gamma radiation was significantly (P < 0.05) higher at subfreezing temperatures than above freezing. Ground beef was inoculated (ca. 2 x 10(8) CFU/g) with five isolates of either E. coli O157:H7 or S. aureus and subdivided into 25-g samples, vacuum packaged in barrier pouches, and tempered to 20, 12, 4, 0, -4, -12, -20, -30, -40, or -76 degrees C before gamma irradiation. The studies were repeated twice. The D10-values for both of these pathogens increased significantly at subfreezing temperatures, reaching maxima at approximately -20 degrees C. The D10-values for E. coli O157:H7 at 4 and -20 degrees C were 0.39 +/- 0.04 and 0.98 +/- 0.23 kGy, respectively. The D10-values for S. aureus at 0 and -20 degrees C were 0.51 degrees 0.02 and 0.88 +/- 0.05 kGy, respectively.

Inhibition of cancer cell growth by ruthenium(II) arene complexes.

Inhibition of the growth of the human ovarian cancer cell line A2780 by organometallic ruthenium(II) complexes of the type [(eta(6)-arene)Ru(X)(Y)(Z)], where arene is benzene or substituted benzene, X, Y, and Z are halide, acetonitrile, or isonicotinamide, or X,Y is ethylenediamine (en) or N-ethylethylenediamine, has been investigated. The X-ray crystal structures of the complexes [(eta(6)-p-cymene)Ru(en)Cl]PF(6) (5), [(eta(6)-p-cymene)RuCl(2)(isonicotinamide)] (7), and [(eta(6)-biphenyl)Ru(en)Cl]PF(6) (9) are reported. They have "piano stool" geometries with eta(6) coordination of the arene ligand. Complexes with X,Y as a chelated en ligand and Z as a monofunctional leaving group had the highest activity. Complexes 5, 6 (the iodo analogue of 5), 9, and 10 (ethylethylenediamine analogue of 9) were as active as carboplatin. Hydrolysis of the reactive Ru-Cl bond in complex 5 was detected by HPLC but was suppressed by the addition of chloride ions. Complex 5 binds strongly and selectively to G bases on DNA oligonucleotides to form monofunctional adducts. No inhibition of topoisomerase I or II by complexes 5, 6, or 9 was detected. These chelated Ru(II) arene complexes have potential as novel metal-based anticancer agents with a mechanism of action different from that of the Ru(III) complex currently on clinical trial.

High-performance liquid chromatographic technique for the simultaneous determination of lactone and hydroxy acid forms of camptothecin and SN-38 in tissue culture media and cancer cells.

Analysis of camptothecins in biologic media is hampered by chemical hydrolysis of the parent lactone (form I) to an inactive hydroxy acid (form II). A solid-phase extraction (SPE) method utilizing C2-bonded silica particles (100 mg, 1 ml) is presented for simultaneous determination of forms I and II of camptothecin (CPT) and SN-38 (active metabolite of clinically used CPT-11) in culture media and cell lysates. A new HPLC separation is described that efficiently resolves all four compounds employing gradient elution with 10 mM ammonium acetate, increasing methanol (20-80% over 15 min), and a 15-cm by 3-mm Symmetry Shield (RP8) column. Components were detected by fluorescence at an excitation wavelength of 380 nm and emission wavelength of 423 nm. Lactones were shown to be unstable at alkaline pH and hydroxy acids unstable at alkaline pH while the following conditions preserved the chemical equilibrium in specimens: samples kept on ice, final pH of eluates 7.4, autosampler temperature 4 degrees C, and analysis cycle <4 h. Quantitative recovery of lactones was achieved from RPMI culture medium over a wide concentration range (93.5-111.6% for 1-400 ng/ml) although greater variability was noted with the hydroxy acids (59.6-110.3%, 1-400 ng/ml). Limit of quantitation (precision and accuracy <20%) was 0.2 ng/ml for CPT lactone, 0.5 ng/ml for SN-38 lactone, and 2 ng/ml for the two hydroxy acids. The method was applied to quantitate the accumulation of SN-38 and CPT (form I and II) in HT29 and HCT116 human colon cancer cells.

Thought Field Therapy clinical applications: utilization in an HMO in behavioral medicine and behavioral health services.

Thought Field Therapy (TFT) is a self-administered treatment developed by psychologist Roger Callahan. TFT uses energy meridian treatment points and bilateral optical-cortical stimulation while focusing on the targeted symptoms or problem being addressed. The clinical applications of TFT summarized included anxiety, adjustment disorder with anxiety and depression, anxiety due to medical condition, anger, acute stress, bereavement, chronic pain, cravings, depression, fatigue, nausea, neurodermatitis, obsessive traits, panic disorder without agoraphobia, parent-child stress, phobia, posttraumatic stress disorder, relationship stress, trichotillomania, tremor, and work stress. This uncontrolled study reports on changes in self-reported Subjective Units of Distress (SUD; Wolpe, 1969) in 1,594 applications of TFT, treating 714 patients. Paired t-tests of pre- and posttreatment SUD were statistically significant in 31 categories reviewed. These within-session decreases of SUD are preliminary data that call for controlled studies to examine validity, reliability, and maintenance of effects over time. Illustrative case and heart rate variability data are presented.

Irradiation inactivation of four Salmonella serotypes in orange juices with various turbiditiest.

Reconstituted orange juice inoculated with Salmonella Anatum, Salmonella Infantis, Salmonella Newport, or Salmonella Stanley was treated with gamma radiation at 2 degrees C. To determine the relationship between juice antioxidant power and Dgamma (dose required to achieve 90% mortality), juice solids were removed prior to inoculation by centrifugation and/or filtration to create juice preparations of varying turbidity. In unadulterated orange juice, Salmonella Anatum (Dgamma = 0.71 kGy) was significantly more resistant than the other species tested. Salmonella Newport (Dgamma = 0.48 kGy) and Salmonella Infantis (Dgamma = 0.35 kGy) were significantly different, while Salmonella Stanley (Dgamma = 0.38 kGy) was intermediate between the two. Neither the resistance of each isolate nor the pattern of relative resistance among isolates was altered in reduced turbidity juice preparations. Although total antioxidant power was associated with the level of juice solids resuspended in phosphate buffer, antioxidant power was not significantly associated with turbidity in the juice preparations or with Dgamma of any species. The variable resistance to irradiation of the Salmonella isolates suggests this as a more significant factor than turbidity or antioxidant power in designing antimicrobial juice irradiation protocols.