Higher sustained virological response rates at 12 weeks in HIV-HCV co-infection; a tertiary centre experience.

OBJECTIVES: The advent of direct-acting antivirals (DAAs) has revealed high rates of sustained virological response at 12 weeks (SVR 12) in Hepatitis C (HCV) treatment. Since the introduction of DAAs, in our centre, 42% of patients treated for HCV are HIV co-infected. Our study aimed to identify the SVR 12 rates between this group and HCV mono-infected patients. METHODS: Retrospective data analysis of HCV mono-infection and HIV-HCV co-infection patients between 1st July 2015 and 30th November 2018, who had a SVR at 12 weeks post treatment. Co-infected patients were only referred for HCV treatment if they had well controlled HIV. Patients treated with Pegylated Interferon and Ribavirin were excluded. RESULTS: During this period, 724 patients were treated for HCV and had data on SVR 12. Of those, 303 (41.8%) were co-infected with HIV. The SVR 12 was achieved in 386 (91.6%) of the HIV negative patients and 288 (95%) of the HIV positive patients (χ²= 3.10 p = 0.078). Cirrhotic patients had poorer SVR 12 in both groups (90% in co-infection and 88.4% in HCV mono-infection). CONCLUSIONS: Our results demonstrate a higher SVR 12 in co-infected patients compared to patients with HCV mono-infection. We hypothesise that adherence to HIV treatment could increase compliance and success of HCV treatment.

Uptake of cancer screening services among middle and older ages in Ireland: the role of healthcare eligibility.

OBJECTIVES: The aim of this analysis was to examine the association between public healthcare eligibility combined with private health insurance (PHI) status and the uptake of breast and prostate cancer screening services among middle and older age groups in Ireland. STUDY DESIGN: This is a cross-sectional analysis using The Irish Longitudinal Study on Ageing (TILDA). METHODS: The analysis included 6902 people aged 50 years and older who completed an in-house interview as part of TILDA. The interview collects information on a range of demographic, socio-economic, health and health service usage variables including the uptake of cancer screening services. An eligibility variable was created using information on public healthcare entitlement and PHI status. The association between eligibility and the uptake of two cancer screening services-mammogram and prostate-specific antigen (PSA) test-was examined using weighted multivariate logistic regression analysis. RESULTS: The uptake of a mammogram and PSA testing was significantly higher in those with PHI. This relationship held after controlling for a range of confounders including health and socio-economic status. CONCLUSIONS: More research is required to identify the reasons for the higher uptake of cancer screening services among those with PHI, given that insurance does not confer any advantages in accessing these services. It is possible that the higher uptake is explained by differential access to secondary care services between those with and without PHI. Consideration of the integrated nature of healthcare systems is essential when seeking to maximise the uptake of services (such as cancer screening) that potentially involve multiple parts of the healthcare system.

Effect of ultrasonic treatment during cleaning on the microbiological condition of poultry transport crates.

1. Small sections cut from commercial crates used to transport live poultry to the processing plant were artificially contaminated with effluent taken from a commercial crate-cleaning system. 2. Laboratory trials, involving the immersion of these sections in an ultrasonic water bath (4 kW energy) showed that aerobic plate counts (APC) and counts of Enterobacteriaceae were progressively reduced as the immersion time was increased from 0 to 120 s and the water temperature raised from 35 to 58 degrees C. 3. In subsequent trials at a processing plant, using commercially cleaned crates, there was relatively little effect of ultrasound (or pressure washing) on the biofilm present. However, ultrasonic treatment in combination with an immersion temperature of 60 degrees C reduced counts of Enterobacteriaceae to below the detection limit (log(10) 2.3 cfu) within 1 to 3 min, while APC were reduced by >2 log(10) units after 3 min. 4. It was concluded that ultrasonic treatment has a possible role in the crate-cleaning process, when used in conjunction with higher immersion temperatures. In this way, it could contribute significantly to hygiene control.

Evaluation of the performance of different cleaning treatments in reducing microbial contamination of poultry transport crates.

1. The present systems for cleaning the plastic crates (drawers) used to transport live poultry to the processing plant are known to be inadequate for removing microbial contamination. 2. To investigate possible improvements, a mobile experimental rig was constructed and operated in the lairage of a poultry processing plant. The cleaning rig could simulate the conditions of commercial cleaning systems and utilise freshly emptied crates from the processing plant. 3. The aim of the study was to improve cleaning by enhancing the removal of adherent organic material on the crates and by reducing microbial contamination by at least 4 log(10) units. 4. Trials showed that the most effective treatments against Campylobacter were either (a) the combination of soaking at 55 degrees C, brushing for 90 s, washing for 15 s at 60 degrees C, followed by the application of disinfectant (Virkon S in this study) or (b) the use of ultrasound (4 kW) at 65 degrees C for 3 to 6 min, with or without mechanical brushing of crates. 5. Both of these treatments also achieved a 4 log(10) reduction or more in the counts of Enterobacteriaceae but were less effective in reducing aerobic plate counts. 6. It was noted that there was little correlation between the visual assessment of crate cleanliness and microbiological counts. 7. It was concluded that the demonstrated enhanced cleaning could contribute significantly to overall hygiene control in poultry meat production.

Survey of domestic food handling practices in New Zealand.

The purpose of this survey was to obtain information on the domestic meat and poultry handling practices of New Zealanders in order to support the development of quantitative risk models, as well as providing data to underpin food safety campaigns to consumers. A sample of 1000 New Zealand residents, over 18 years of age, were randomly selected from the electoral roll and asked to participate in a national postal food safety study during 2005. Three hundred and twenty six respondents completed and returned questionnaires containing usable answers, and most of these respondents 'always' prepared the main meal within the household. The majority of meat (84.6%) and poultry (62.9%) purchased by New Zealanders was fresh (rather than frozen), and most consumers (94.4%) claimed that the time taken from food selection to reaching their home was 1 h or less. The majority (approximately 64%) of fresh meat and poultry was frozen in the home and the most favoured method of thawing was at room temperature for up to 12 h. The most common time period for storing cooked or raw meat and poultry in domestic refrigerators was up to 2 days. Most survey respondents preferred their meat and poultry to be cooked either medium or well done. The most popular cooking method for chicken was roasting or baking, while most respondents preferred to pan-fry steak/beef cuts, minced beef or sausages/hamburgers. The potential for undercooking was greatest with pan-fried steak with 19.8% of respondents preferring to consume this meat raw or rare. In answer to questions relating to food handling hygiene practices, 52.2% of respondents selected a hand washing sequence that would help prevent cross contamination. However, it was estimated that 41% and 28% of respondents would use knives and kitchen surfaces respectively in a manner that could allow cross contamination. The data in this survey are self-reported and, particularly for the hygiene questions, respondents may report an answer that they perceive as being correct rather than reflecting their actual behaviour. Nevertheless, the data on food processing, transport, storage and cooking preferences represent useful inputs into the assessment of food safety along the meat and poultry food chains.

Campylobacter spp. contamination of chicken carcasses during processing in relation to flock colonisation.

The presence and numbers of campylobacters on chicken carcasses from 26 slaughter groups, originating from 22 single-house flocks and processed in four UK plants, were studied in relation to the level of flock colonisation determined by examining the caecal contents of at least ten birds per group. The prevalence of campylobacters on carcasses from five campylobacter-negative flocks processed just after other negative flocks was low (8.0 log(10) cfu) than carcasses originating from low prevalence flocks (average of 2.3 log(10) cfu; range: <1.1 to 4.1 log(10) cfu). There was a reduction in the numbers of campylobacters on carcasses between plucking and chilling in eight of ten fully colonised flocks. In another eight flocks, a significant (P<0.001) decrease (0.8 log(10) cfu) in the number of campylobacters on carcasses from just before to after chilling was detected. Campylobacter spp. could be isolated from aerosols, particles and droplets in considerable numbers in the hanging-on, defeathering and evisceration areas but not in the chillers. This was the case even when campylobacters were not isolated from the target flock. Campylobacters on carcasses from two partly colonised flocks were either the same subtype, as determined by speciation, Multi-Locus Sequence Typing (MLST) and flaA Restricted Fragment Length Polymorphism (RFLP) typing, as those in the fully colonised flocks processed previously, although not necessarily the most prevalent ones; or were the same subtypes as those found in the caeca of the flock itself. The prevalences of the different campylobacter subtypes found on carcasses from two fully colonised flocks did not closely reflect those found in the caeca. MLST combined with flaA RFLP provided a good method for ascertaining the relatedness of strains isolated from carcasses and caecal contents. This study showed that carcass contamination is related to the within-flock prevalence of campylobacter colonisation, but that contamination from previously processed flocks was also significant, especially on carcasses from low prevalence flocks. Forced dry air cooling of carcasses reduced contamination levels.

A novel method for assessing the role of air in the microbiological contamination of poultry carcasses.

This paper describes a novel method of measuring the contamination of raw foods with airborne bacteria during primary processing. To demonstrate the approach, this study aimed to quantify the role of airborne bacteria in the contamination of broiler chicken carcasses undergoing processing in an evisceration room. Settle plates and broiler carcasses were exposed to the evisceration room air or to ultra-clean air provided by a high efficiency particulate air (HEPA) unit located within the room. The use of ultra-clean air reduced the total aerobic counts on horizontal settle plates by 68-fold, and on vertical settle plates by 14-fold. The use of ultra-clean air had no significant effect on the total aerobic counts on carcasses as measured by sponging (3.5 log(10) CFU cm(-2)) or skin excision (4.0 log(10) CFU cm(-2)). The novel approach was able to show that the carcasses entering the room were so heavily contaminated that the airborne bacteria in the evisceration room contributed less than 1% of the total numbers of bacteria on the carcasses.

Campylobacter in chicken livers and their destruction by pan frying.

AIM: To enumerate Campylobacter spp. on the external surface and internal portions of chicken livers, and to assess the cooking required to inactivate naturally present cells. METHODS AND RESULTS: Of 30 livers tested all yielded Campylobacter spp. on their surfaces and 90% were found to contain the organism in internal tissue. Four (13%) livers contained >10(4) MPN campylobacters, and an additional seven (23%) contained >10(3) MPN campylobacters per liver. The internal temperature of pan-fried livers under the conditions used reached a maximum of 70-80 degrees C, and maintaining this temperature for 2-3 min was necessary to inactivate naturally occurring Campylobacter spp. All isolates identified were either C. jejuni or C. coli. CONCLUSIONS: Chicken livers represent a potential source of human campylobacteriosis as they contained >10(4) MPN per liver in 13% of the samples tested. Pan-frying can produce an acceptable product that is safe to eat. SIGNIFICANCE AND IMPACT OF THIS STUDY: The data provided can be used in exposure assessments of Campylobacter in poultry products in terms of both quantitative data and assessing pan-frying and its ability to destroy campylobacters.

Sources of Campylobacter spp. colonizing housed broiler flocks during rearing.

The study aimed to identify sources of campylobacter in 10 housed broiler flocks from three United Kingdom poultry companies. Samples from (i) the breeder flocks, which supplied the broilers, (ii) cleaned and disinfected houses prior to chick placement, (iii) the chickens, and (iv) the environments inside and outside the broiler houses during rearing were examined. Samples were collected at frequent intervals and examined for Campylobacter spp. Characterization of the isolates using multilocus sequence typing (MLST), serotyping, phage typing, and flaA restriction fragment length polymorphism typing was performed. Seven flocks became colonized during the growing period. Campylobacter spp. were detected in the environment surrounding the broiler house, prior to as well as during flock colonization, for six of these flocks. On two occasions, isolates detected in a puddle just prior to the birds being placed were indistinguishable from those colonizing the birds. Once flocks were colonized, indistinguishable strains of campylobacter were found in the feed and water and in the air of the broiler house. Campylobacter spp. were also detected in the air up to 30 m downstream of the broiler house, which raises the issue of the role of airborne transmission in the spread of campylobacter. At any time during rearing, broiler flocks were colonized by only one or two types determined by MLST but these changed, with some strains superseding others. In conclusion, the study provided strong evidence for the environment as a source of campylobacters colonizing housed broiler flocks. It also demonstrated colonization by successive campylobacter types determined by MLST during the life of a flock.

Growth of enterotoxigenic Staphylococcus aureus in povi masima, a traditional Pacific island food.

AIMS: To obtain preliminary data on the microbiology and hurdles to pathogen growth in the traditional Pacific Island food, povi masima, which is essentially beef brisket cured in brine. METHODS AND RESULTS: Six containers of povi masima were prepared and two were inoculated with five enterotoxigenic strains of Staphyloccocus aureus. The povi masima were divided into two lots each containing two uninoculated control and an inoculated container. Lot 1 was incubated at room temperature (20 degrees C) and lot 2 under refrigeration (4-5 degrees C) for up to 98 days. During storage, samples were removed and tested for aerobic plate count, coagulase-producing Staphylococci, Clostridium perfringens, staphylococcal enterotoxin and various chemical parameters of the food. Coagulase-producing Staphylococci and aerobic plate counts grew to high levels in both the inoculated and uninoculated lots stored at room temperature, but enterotoxin was only detected at one time point in these lots and this may represent a false positive result. The concentration of NaCl in the meat increased with time as concentrations equilibrated, and nitrite was rapidly lost in those lots stored at room temperature. Storage at 4-5 degrees C prevented proliferation of coagulase-producing Staphylococci. CONCLUSIONS: For safe curing and storage, this food should be kept under refrigeration as this prevented growth of staphylococci. Optimum storage would also be achieved with improved attempts to ensure equal distribution of NaCl prior to storage. SIGNIFICANCE AND IMPACT OF THE STUDY: Under conditions traditionally used to cure and store this food, enterotoxigenic staphylococci can grow to numbers where toxigenesis might occur, especially during the early stages of curing where the salt has not diffused from the brine into the meat.

Occupational exposure of poultry stockmen in current barn systems for egg production in the United Kingdom.

1. The occupational exposure to inhalable dust and ammonia of 12 stockmen working in barn systems conforming to the UK Royal Society for the Prevention of Cruelty to Animals (RSPCA) Freedom Foods requirements was measured and compared with established limits for occupational exposure. The influence of the type of task upon the daily exposure was assessed and comparisons of daily exposure were made with that of battery cage system stockmen. 2. The mean inhalable dust exposures experienced by poultry stockmen working in barn systems was 10.8 mg/m3 (9.5 mg/m3, time-weighted average), for a complete working day. This was greater (P < 0.01) than the mean dust exposure measured in current cage systems of 4.8 mg/m3 (4.4 mg/m3, time-weighted average). The individual values of dust exposure for 4 of the 12 barn stockmen exceeded the occupational exposure standard (OES) of 10.0 mg/m3 for inhalable dust, whereas that of all of the individual cage stockmen taking part in this study did not. 3. The mean ammonia exposure experienced by poultry stockmen working in barn systems was 14 ppm (11 ppm, time-weighted average), for a complete working day. This also was greater (P < 0.01) than the mean ammonia exposure measured in current cage systems of 8 ppm (7 ppm, time-weighted average). None of the individual values of ammonia exposures for both barn and cage system stockmen taking part in this study exceeded the OESs of 25 ppm, although the short-term limit of 35 ppm for 15 min was exceeded on a number of occasions. 4. Current methods for assessing the combined effects of dust and ammonia indicated that 8 of the 12 barn stockmen were at risk compared with 1 of the 8 cage system stockmen. 5. The average dust burden in daily common tasks such as maintenance and collecting floor eggs ranged from 5 to 15 mg/m3, while intermittent common tasks such as nest box checks and litter spreading ranged from 13 to 35 mg/m3. Tasks that had the highest exposure values included sweeping and partition removal, ranging from 63.3 to 70.7 mg/m3. 6. Designs of the typical barn systems investigated offer little scope for reducing airborne dust for common daily tasks. Personal respiratory protection while carrying out tasks that result in high dust concentrations in barns is advisable.

Assessment and development of procedures and apparatus to reduce contamination of lamb carcasses during pelt removal in low-throughput abattoirs.

Two series of experiments were carried out to investigate methods of reducing contamination of lamb carcasses in low-throughput abattoirs, where cradle dressing is normally employed. In the first series, cradle design and pelt removal procedure were investigated, and a method was developed for assessing gross visible contamination. Significant improvements in microbiological and gross visible contamination (P < 0.01) were achieved by procedural changes only; modifications to the cradle design had no effect. In the second series of experiments, two improved methods of pelt removal and the effect of hand washing prior to carcass contact during the pelt removal procedure were investigated. The improved methods comprised a Frame system, in which the pelt was removed in a manner similar to that in a high-throughput inverted line, and a Hybrid system, in which the pelt was removed from the forequarters on a conventional cradle before the carcass was suspended in an "inverted" vertical position for removal of the pelt from the abdomen and hindquarters. The results of microbiological and gross visible contamination from these methods, with and without hand washing, were compared with the conventional Cradle method of pelt removal. Both the Hybrid and Frame systems had significantly less microbiological and gross visible contamination (P < 0.01). However, hand washing had no significant effect on the level of carcass contamination for all three methods of pelt removal. Greatest reductions in microbiological and gross visible contamination were achieved using techniques that minimized hand contact with the carcass during pelt removal by adoption of inverted dressing procedures. Equipment redesign did not reduce carcass contamination.

Diversity of gene expression in adenocarcinoma of the lung.

The global gene expression profiles for 67 human lung tumors representing 56 patients were examined by using 24,000-element cDNA microarrays. Subdivision of the tumors based on gene expression patterns faithfully recapitulated morphological classification of the tumors into squamous, large cell, small cell, and adenocarcinoma. The gene expression patterns made possible the subclassification of adenocarcinoma into subgroups that correlated with the degree of tumor differentiation as well as patient survival. Gene expression analysis thus promises to extend and refine standard pathologic analysis.

Preliminary microbiological investigation of the preparation of two traditional Maori foods (Kina and Tiroi).

AIMS: Little information exists regarding the microbiology of two traditional Maori food preparation processes which may involve fermentations. Preliminary microbiological and chemical analyses were carried out on these two foods in order to identify the fermentations involved (if any). METHODS AND RESULTS: Testing was carried out on freshly-prepared foods and on those that had been processed and stored. Kina (sea urchins, Evechinus chloroticus) are harvested and then stored either under fresh water or buried underground. The most frequently-occurring process appeared to be an alkaline fermentation. Large numbers of Clostridium perfringens were detected in one set of samples prepared outside of the traditional season, but this was the only pathogen detected. In Kina stored in buried plastic bottles during the traditionally-accepted time of the year, bacterial numbers decreased. Tiroi is prepared from mussels and Puha (sow thistle, Sonchos asper) that have been cooked to some degree, combined and stored. Of three methods used to prepare and store Tiroi, the results for one indicated the possible involvement of a lactic acid fermentation, but the other two methods were effectively only cooking and bottling processes. CONCLUSIONS: In the case of Kina, the use of an alkaline fermentation to prepare a seafood for consumption is unusual. One method of Tiroi production is a lactic acid fermentation. SIGNIFICANCE AND IMPACT OF THE STUDY: If these foods are produced as described and are not either eaten immediately or cooked before consumption, then growth, and intoxication by, Clostridium botulinum might occur.

Traditional Maori food preparation methods and food safety.

Descriptions were obtained from Maori elders knowledgeable in traditional methods for the processing of Tiroi (mussels and Puha), Kina (sea urchins), Kanga Kopiro (fermented maize) and Titi (muttonbird). Information for a number of variations of each method was transformed into process flow charts, and these charts were analysed using a HACCP-based approach. Two of the processes (Kanga Kopiro and Titi) were found to be likely to produce safe foods as Kanga Kopiro undergoes an acid fermentation and Titi preparation involves significant cooking steps. However, the information regarding Tiroi and Kina processing did not supply the necessary data to identify definitely whether fermentations were involved, and if they were, what kind they may be. New Zealand has only experienced one outbreak of botulism, and this was associated with the consumption of Tiroi. It is, therefore, desirable to identify the processes occurring in these foods where the nature of these processes is not understood in order to facilitate their safe future production.

Improved outcome of preterm infants when delivered in tertiary care centers.

OBJECTIVE: Previous studies that compared outcomes of infants born outside tertiary care centers (outborn) with those born in tertiary care centers (inborn) did not account for admission illness severity and perinatal risks. The objective of this study was to examine whether outborn status is associated with higher mortality and morbidity, after adjustment for perinatal risks and admission illness severity (using the Score for Neonatal Acute Physiology, Version II [SNAP-II]) among preterm infants who were admitted to Neonatal Intensive Care Units (NICUs). METHODS: Logistic regression analysis was used to compare the risk-adjusted outcomes of 3769 singleton infants born at or before 32 weeks' gestation, who were admitted to 17 Canadian NICUs during 1996-1997. RESULTS: Outborn and inborn infants had significantly different gestational ages, perinatal risk factors (maternal hypertension, prenatal care, antenatal corticosteroid therapy, 5-minute Apgar score, delivery type, small for gestational age) and admission SNAP-II. Outborn infants were at higher risk of death (adjusted odds ratio [OR] 1.7, 95% confidence interval [CI] 1.2, 2.5), grade III or IV intraventricular hemorrhage (adjusted OR 2.2, 95% CI 1.5, 3.2), patent ductus arteriosus (adjusted OR 1.6, 95% CI 1.2, 2.1), respiratory distress syndrome (adjusted OR 4.8, 95% CI 3.6, 6.3), and nosocomial infection (adjusted OR 2.5, 95% CI 1.9, 3.3), even after adjusting for perinatal risks and admission illness severity. CONCLUSIONS: Outborn infants were less mature and more ill than inborn infants at NICU admission. However, even after adjustment for perinatal risks and admission illness severity, inborn infants had better outcomes than outborn infants. Our results support in-utero transfer of high-risk pregnancies to a tertiary level facility.

Transport risk index of physiologic stability: a practical system for assessing infant transport care.

OBJECTIVES: To develop and validate a practical, physiology-based system for assessment of infant transport care. STUDY DESIGN: Transport teams prospectively collected data, before and after transport, from 1723 infants at 8 neonatal intensive care units (NICUs) from 1996 to 1997. We used logistic regression to derive a prediction model for mortality within 7 days of NICU admission and develop the Transport Risk Index of Physiologic Stability (TRIPS). We validated TRIPS for prediction of 7-day mortality, total NICU mortality (until discharge), and severe (> or =grade 3) intraventricular hemorrhage. RESULTS: TRIPS comprises 4 empirically weighted items (temperature, blood pressure, respiratory status, and response to noxious stimuli). TRIPS discriminated 7-day NICU mortality and total NICU mortality from survival with receiver operating characteristic areas of 0.83 and 0.76, respectively. There was good calibration across the full range of TRIPS scores and gestational age groups. Increase and decrease in TRIPS scores after transport were associated with increased and decreased mortality, respectively. The receiver operating characteristic area for TRIPS prediction of severe intraventricular hemorrhage was 0.74. Addition of TRIPS improved performance of prediction models in which gestational age and baseline population risk variables were used. CONCLUSIONS: TRIPS is validated for infant transport assessment.

Enumeration of Campylobacter in New Zealand recreational and drinking waters.

AIMS: To use a published polymerase chain reaction (PCR) method for the detection and identification of thermotolerant Campylobacter species (Camp. jejuni, Camp. coli and Camp. lari) in tandem with a Most Probable Number (MPN) technique to enumerate these species in water samples. METHODS AND RESULTS: An initial study of 42 river water samples compared the use of conventional culture and PCR methods for the detection of Campylobacter in MPN enrichment tubes. It was found that all samples positive by culture were also positive by PCR. Thirty-seven percent more MPN tubes were positive by PCR compared with culture. The MPN/PCR technique was subsequently applied to 96 additional samples collected from rivers, drinking, roof and shallow ground water. Campylobacter was especially prevalent in river water (60% positive) and shallow ground water (75% positive) samples. Drinking water (29.2% positive) and roof water (37.5% positive) also contained Campylobacter, but the numbers detected were very low (maximum 0.3 and 0.56 MPN 100 ml-1, respectively). CONCLUSION: River waters contained Campylobacter at higher levels than any other water type and in a high percentage of the samples. Although Campylobacter was present in treated drinking water, the levels detected were low. SIGNIFICANCE AND IMPACT OF THE STUDY: These results suggest that water may act as a significant transmission route for human campylobacteriosis.