Multimorbidity, consisting of a combination of chronic diseases and geriatric syndromes, predicts the risk of difficulty in discharge home in older patients admitted to acute care hospital.

AIM: To determine whether multimorbidity, consisting of chronic diseases and geriatric syndromes, is associated with home discharge difficulties in older patients. METHODS: A total of 522 older adults (mean age: 85 ± 7 years) who were admitted to an acute care hospital were enrolled. Multimorbidity was assessed by calculating the number of 16 chronic conditions (CCs): 8 chronic diseases (cardiac diseases, diabetes mellitus, chronic kidney disease, respiratory diseases, gastrointestinal diseases, anemia, dementia, and Parkinson disease) and 8 geriatric syndromes (depression, constipation, chronic pain, polypharmacy, dysphagia, underweight, hypoalbuminemia, and functional limitations). The patients were divided into four groups based on the number of CCs. The outcome was difficulty in discharging home (transfer to other facilities or in-hospital death). Multivariate logistic regression analysis was performed to assess independent associations between four CC groups and failure to discharge home after adjusting for age, sex, living alone, and Barthel index and odds ratio (OR) and 95% confidence interval (CI) were calculated. RESULTS: Of the 522 patients, 18.8% were transferred to other facilities or died. The proportion of poor outcome in those with 0-2, 3-4, 5-6, and ≥7 CCs was 4.4%, 14.8%, 25.5%, and 37.5%, respectively. Logistic regression analysis after adjusting for covariates revealed that multimorbidity increased the risk of difficulty in discharging home (OR, 2.9 [95% CI, 1.1-8.0] for 3-4 CCs; OR, 4.9 [95% CI, 1.8-13.5] for 5-6 CCs; OR, 8.7 [95% CI, 3.1-24.6] for ≥7 CCs). CONCLUSION: Multimorbidity, consisting of chronic diseases and geriatric syndromes, predicted difficulty in discharge home in older patients. Geriatr Gerontol Int 2024; 24: 300-305.

Growth of Listeria monocytogenes in Thawed Frozen Foods.

The growth characteristics of Listeria monocytogenes inoculated onto frozen foods (corn, green peas, crabmeat, and shrimp) and thawed by being stored at 4, 8, 12, and 20°C were investigated. The growth parameters, lag-phase duration (LPD) and exponential growth rate (EGR), were determined by using a two-phase linear growth model as a primary model and a square root model for EGR and a quadratic model for LPD as secondary models, based on the growth data. The EGR model predictions were compared with growth rates obtained from the USDA Pathogen Modeling Program, calculated with similar pH, salt percentage, and NaNO2 parameters, at all storage temperatures. The results showed that L. monocytogenes grew well in all food types, with the growth rate increasing with storage temperature. Predicted EGRs for all food types demonstrated the significance of storage temperature and similar growth rates among four food types. The predicted EGRs showed slightly slower rate compared with the values from the U.S. Department of Agriculture Pathogen Modeling Program. LPD could not be accurately predicted, possibly because there were not enough sampling points. These data established by using real food samples demonstrated that L. monocytogenes can initiate growth without a prolonged lag phase even at refrigeration temperature (4°C), and the predictive models derived from this study can be useful for developing proper handling guidelines for thawed frozen foods during production and storage.

Effect of Storage Temperature on the Outgrowth and Toxin Production of Staphylococcus aureus in Freeze-Thawed Precooked Tuna Meat.

The aim of this study was to determine the time for a 3-log CFU/g outgrowth of Staphylococcus aureus and its toxin production in previously frozen precooked tuna meat (albacore [Thunnus alalunga] prepared as loin, chunk, and flake or skipjack [Katsuwonus pelamis] prepared as chunk and flake) held either at 21 or 27°C. A five-strain cocktail of enterotoxin-producing S. aureus was surface inoculated with ∼10(3) CFU/g onto tuna samples. The experimental time-temperature conditions were designed to mimic common industry holding conditions. After a 3-h incubation at 37°C, inoculated samples were individually vacuum sealed and stored at 20°C for 4 weeks. Following frozen storage, samples were thawed to the target temperature (21 or 27°C) and then incubated aerobically. Growth of S. aureus in tuna was then monitored using Baird Parker agar; simultaneously, aerobic plate counts, enterotoxin production, and sensory profile (color and odor) were determined. The results showed that the time for a 3-log CFU/g increase was >20 h at 21°C and 8 to 12 h at 27°C for albacore, with toxin production observed at 14 to 16 h at 21°C and at 8 h at 27°C. A 3-log CFU/g increase for skipjack occurred at 22 to 24 h at 21°C and at 10 to 14 h at 27°C. The toxin production in skipjack started at 20 to 22 h at 21°C and at 8 to 10 h at 27°C. Toxin production was observed before a 3-log increase was achieved in albacore samples at 21°C. Under all conditions, toxins were detected when the cell density of S. aureus was 6 log CFU/g. Overall, significantly faster S. aureus growth was observed in albacore compared with skipjack (P < 0.05), possibly owing to differences in sample composition (e.g., pH and salt content). The data developed from this study can be used by the tuna industry to model the growth and enterotoxin production of S. aureus and to design manufacturing controls that ensure food safety.

Development of a Dry Inoculation Method for Thermal Challenge Studies in Low-Moisture Foods by Using Talc as a Carrier for Salmonella and a Surrogate (Enterococcus faecium).

The objective of this study was to obtain dry inocula of Salmonella Tennessee and Enterococcus faecium, a surrogate for thermal inactivation of Salmonella in low-moisture foods, and to compare their thermal resistance and stability over time in terms of survival. Two methods of cell growth were compared: cells harvested from a lawn on tryptic soy agar (TSA-cells) and from tryptic soy broth (TSB-cells). Concentrated cultures of each organism were inoculated onto talc powder, incubated at 35 °C for 24 h, and dried for additional 24 h at room temperature (23 ± 2 °C) to achieve a final water activity of ≤ 0.55 before sieving. Cell reductions of Salmonella and E. faecium during the drying process were between 0.14 and 0.96 log CFU/g, depending on growth method used. There was no difference between microbial counts at days 1 and 30. Heat resistance of the dry inoculum on talc inoculated into a model peanut paste (50 % fat and 0.6 water activity) was determined after 1 and 30 days of preparation, using thermal death time tests conducted at 85 °C. For Salmonella, there was no significant difference between the thermal resistance (D(85 °C)) for the TSB-cells and TSA-cells (e.g. day 1 cells D(85 °C) = 1.05 and 1.07 min, respectively), and there was no significant difference in D(85 °C) between dry inocula on talc used either 1 or 30 days after preparation (P > 0.05). However, the use the dry inocula of E. faecium yielded different results: the TSB-grown cells had a significantly (P < 0.05) greater heat resistance than TSA-grown cells (e.g. D(85 °C) for TSB-cells = 3.42 min versus 2.60 min for TSA-cells). E. faecium had significantly (P < 0.05) greater heat resistance than Salmonella Tennessee regardless what cell type was used for dry inoculum preparation; therefore, it proved to be a conservative but appropriate surrogate for thermal inactivation of Salmonella in low-moisture food matrices under the tested conditions.

Clinical characteristics and outcomes of Möbius syndrome in a children's hospital.

BACKGROUND: Möbius syndrome is a congenital disorder with facial and abducens palsy. Although a few case series studies have examined comorbid conditions in Möbius syndrome, follow-up and outcome data are sparse. OBJECTIVES: To examine the clinical characteristics and outcomes of Möbius syndrome. METHODS: Clinical data were reviewed for 10 patients. Neonatal history, neurological examination, comorbid anomalies, medical home care, outcomes, and neuroimaging were summarized. RESULTS: The patients' mean age was 7.3 ± 6.2 years. On neurological examination, absent blink reflex, jaw ankylosis, absent gag reflex, and tongue atrophy were frequently observed. Poland anomaly and clubfoot were present in three and six patients, respectively. Specific therapies required for patients included medical home care (six patients), suction apparatus (six), tube feeding (five), gastrostomy (two), tracheostomy (three), oxygen therapy (three), and home ventilator (two). Punctate calcification in the brainstem was observed in four patients. Pontine and medulla hypoplasia were detected on the basis of anteroposterior diameter in four and seven patients, respectively. Two patients had congenital hydrocephalus with aqueductal stenosis. Global developmental delay occurred in five patients. Three patients died. CONCLUSION: The rate of both the use of home medical devices and death was high in our patients. Möbius syndrome is extremely diverse, not only in clinical manifestation, but also outcome. Early multidisciplinary intervention is important to ensure an optimal outcome. Aqueductal stenosis is an occasional comorbid anomaly resulting from midbrain abnormality.

Survival of Salmonella Tennessee, Salmonella Typhimurium DT104, and Enterococcus faecium in peanut paste formulations at two different levels of water activity and fat.

Long-term survival of heat-stressed Salmonella Tennessee, Salmonella Typhimurium DT104, and Enterococcus faecium was evaluated in four model peanut paste formulations with a combination of two water activity (aw) levels (0.3 and 0.6) and two fat levels (47 and 56%) over 12 months at 20 ± 1°C. Prior to storage, the inoculated peanut paste formulations were heat treated at 75°C for up to 50 min to obtain an approximately 1.0-log reduction of each organism. The cell population of each organism in each formulation was monitored with tryptic soy agar plate counts, immediately after heat treatment, at 2 weeks for the first month, and then monthly for up to 1 year. The log reductions (log CFU per gram) following 12 months of storage were between 1.3 and 2.4 for Salmonella Tennessee, 1.8 and 2.8 for Salmonella Typhimurium, and 1.1 and 2.1 for E. faecium in four types of model peanut paste formulations. Enhanced survivability was observed in pastes with lower aw for all organisms, compared with those with higher aw (P < 0.05). In contrast, the effect of fat level (47 and 56%) on survival of all organisms was not statistically significant (P > 0.05). Whereas survivability of Salmonella Tennessee and Typhimurium DT104 did not differ significantly (P > 0.05), E. faecium demonstrated higher survivability than Salmonella (P < 0.05). Salmonella survived in the model peanut pastes well over 12 months, which is longer than the expected shelf life for peanut butter products. The information from this study can be used to design safer food processing and food safety plans for peanut butter processing.

Heat resistance of histamine-producing bacteria in irradiated tuna loins.

Consumption of foods high in biogenic amines leads to an illness known as histamine, or scombrotoxin, poisoning. The illness is commonly associated with consumption of fish with high levels of histamine ( $ 500 ppm). The objective of this study was to determine and compare the heat resistance of five histamine-producing bacteria in irradiated albacore tuna loins. Heat-resistance parameters (D- and z-values) were determined for Morganella morganii, Raoultella planticola, Hafnia alvei, and Enterobacter aerogenes. D- or z-values were not determined for Photobacterium damselae, which was the most heat-sensitive organism in this study. P. damselae declined > 5.9 log CFU/g after a heat treatment of 50°C for 10 min, 54°C for 3 min, and 56°C for 0.5 min. M. morganii was the most heat-resistant histamine-producing bacteria in albacore tuna loins, followed by E. aerogenes, H. alvei, and R. planticola. M. morganii and E. aerogenes had the highest D(50°C), 49.7 ± 17.57 and 51.8 ± 17.38 min, respectively. In addition, M. morganii had the highest D-values for all other temperatures (54, 56, and 58°C) tested. D- and zvalues were also determined for M. morganii in skipjack tuna. While no significant (P > 0.05) difference was observed between D(54°C) and D(56°C) of M. morganii in either albacore or skipjack tuna, the D(58°C) (0.4 ± 0.17 min) was significantly lower (P < 0.05) in skipjack than in albacore (0.9 ± 0.24 min). The z-values for all organisms tested were in the range of 3.2 to 3.8°C. This study suggests that heat treatment designed to control M. morganii in tuna loins is sufficient for controlling histamine-producing bacteria in canned-tuna processing environments.

Inactivation of Shiga toxin-producing Escherichia coli in single-strength lemon and lime juices containing preservatives.

The objective of this study was to determine the inactivation of non-O157 Shiga toxin-producing Escherichia coli (STEC) serotypes in comparison with O157 STEC in commercially produced, shelf-stable lemon and lime juices. The present validation tests confirmed that storage of the juices containing preservatives at room temperatures (22°C) for 3 days (72 h) ensures a >6-log reduction of O26, O45, O103, O111, O121, O145, and O157 STEC. These results demonstrate that non-O157 STEC had survival abilities comparable to those of E. coli O157:H7 strains in acidic food products such as lemon and lime juices (pH 2.5 ± 0.1); therefore, the storage conditions deemed to inactivate E. coli O157:H7 similarly inactivate the non-O157 serotypes.