Moderating Effects of Individual Traits on the Association Between Nature and Patient Wait Experiences.

OBJECTIVES: We empirically investigated to what extent plants in the emergency department (ED) waiting areas influence patient wait experiences (i.e., anxiety, perceived service quality, and perception of wait time) depending on individual differences in cognitive thinking styles and one's bonds with the natural world. BACKGROUND: Positive effects of nature on patient experiences in healthcare environments are well established by empirical research findings. However, evidence is scarce on the impact of nature on patient wait experiences and the roles of patient traits often related to their backgrounds. METHODS: A within-subjects study was conducted (N = 116) with two virtually built ED waiting rooms: with versus without indoor and outdoor plants. RESULTS: Findings confirmed that plants lower anxiety and improve perceptions of service quality and wait time. Cognitive thinking style significantly moderated how plants affected patient wait experiences. Although participants with higher connectedness to nature showed more positive responses to the nature condition, connectedness to nature did not significantly affect the association between nature and wait experiences. CONCLUSIONS: This study contributes to the existing body of knowledge on nature's effects in healthcare environments by examining the roles of individual differences in patients' and visitors' cognitive styles and connectedness to nature. Results highlighted the impact of these differences in patient experiences for effective implications of nature in waiting areas of healthcare facilities.

An Investigation of the Effect of Virtual Reality on Alleviating Anxiety in Patients With Breast Cancer Undergoing Radiation Therapy: A Randomized Controlled Trial.

PURPOSE: The aim of this study was to evaluate the anxiety-reducing effects of virtual reality (VR) on patients with breast cancer undergoing adjuvant radiation therapy (RT). METHODS AND MATERIALS: This randomized controlled trial was conducted among patients with breast cancer receiving RT at a single institution. Of 196 enrolled and randomized patients, 97 were assigned to a VR explanation group (intervention) and 99 were assigned to the standard-of-care group (control). Anxiety levels were measured using the Amsterdam Preoperative Anxiety and Information Scale (APAIS) as the primary endpoint and the State-Trait Anxiety Inventory (STAI) and Linear Analogue Scale Assessment (LASA) as secondary endpoints. Knowledge of the RT procedure, patient satisfaction, and time spent for counseling were also assessed. RESULTS: Intervention significantly reduced patient anxiety immediately, not only on the primary endpoint, APAIS, but also on the STAI and LASA anxiety scales. Specifically, in the intervention group, there were immediate reductions of 26.0%, 16.1%, and 55.8% for APAIS, STAI, and LASA, respectively, whereas in the control group, the respective reductions were 8.1%, 8.5%, and 13.7%. Among the 3 anxiety scales, long-term anxiety reduction was observed only when anxiety was measured by LASA. Subgroup analyses showed that the effect on anxiety did not differ based on the physician, baseline anxiety level, use of hormone therapy, or health literacy. The intervention also significantly improved knowledge of the RT procedure (81.9/100 vs 76.8/100; P = .006) and patient satisfaction with the explanation manner (6.56 vs 5.72; P < .001) compared with the control group. CONCLUSIONS: Immersive VR applied to the current procedure reduces anxiety during RT planning for patients with breast cancer. Further research is necessary to investigate the long-term effects of VR on anxiety.

Assessing Spatial User Experience for Design Guidelines: A Comparative Study of Outpatient Waiting Rooms With Conventional Versus Modern Features.

OBJECTIVES: Identify waiting room design features that are most appreciated by outpatients and their companions in conventional and modern waiting rooms. Evaluate if end users evaluate the environment differently from experts and in what aspects. Provide evidence-based design guidelines that orient designers and healthcare managers. BACKGROUND: Built environments are relevant in patients' evaluation of overall healthcare service. For outpatients, waiting frequently consumes the largest amount of time; thus, waiting room interior design has great potential to enhance their experience. METHODS: This study compares perceptions of two types of waiting rooms-conventional and modern-based on the spatial user experience (SUE) model. In the first stage of the study, we compared user evaluations of conventional waiting rooms (n = 137) and modern waiting rooms (n = 426) with respect to the eight SUE model dimensions using multigroup structural equation modeling. In the second stage, an expert ergonomist and two professional interior designers assessed both types of waiting rooms. RESULTS: Results showed that modern waiting rooms were perceived to be significantly better in all SUE dimensions. We also found experts' evaluations were overall consistent with users' perceptions. Discrepancies were only found in temperature perception, signage evaluation, and spatial appreciation. CONCLUSIONS: Participants valued modern style waiting room features such as good quality signage, use of armchairs and sofas, a controlled environment, and decoration. We suggest involving end users in the design process to respond to their needs and promote a positive experience. Finally, we provide easy-to-adopt design guidelines to improve patients' waiting room experience.

Affective experience in a virtual crowd regulates perceived travel time.

Time sometimes feels like it is flying by or slowing down. Previous research indicates objective number of items, subjective affect, and heart rate all can influence the experience of time. While these factors are usually tested in isolation with simple stimuli in the laboratory, here we examined them together in the ecological context of a virtual subway ride. We hypothesized that subjective affective experience associated with objective crowding lengthens subjective trip duration. Participants (N = 41) experienced short (1-2 min) immersive virtual reality subway trips with different levels of public crowding. Consistent with the immersive nature of decreased interpersonal virtual space, increased crowding decreased pleasantness and increased the unpleasantness of a trip. Virtual crowding also lengthened perceived trip duration. The presence of one additional person per square meter of the train significantly increased perceived travel time by an average of 1.8 s. Degree of pleasant relative to unpleasant affect mediated why crowded trips felt longer. Independently of crowding and affect, heart rate changes were related to experienced trip time. These results demonstrate socioemotional regulation of the experience of time and that effects of social crowding on perception and affect can be reliably created during a solitary virtual experience. This study demonstrates a novel use of Virtual Reality technology for testing psychological theories in ecologically valid and highly controlled settings. Supplementary Information: The online version contains supplementary material available at 10.1007/s10055-022-00713-8.

Ultra-Stable and Highly Efficient White Light Emitting Diodes through CsPbBr3 Perovskite Nanocrystals-Silica Composite Phosphor Functionalized with Surface Phenyl Molecules.

Poor stability of CsPbBr3 perovskite nanocrystals (NCs) to moisture/heat/light has significantly limited their application as a green phosphor, despite their outstanding luminescent properties. Here, a remarkably stable CsPbBr3 NCs-silica composite phosphor functionalized with surface phenyl molecules (CsPbBr3 -SiO2 Ph ) is synthesized by controlling low-temperature hydrolysis and condensation reaction of perhydropolysilazane in the presence of CsPbBr3 NCs followed by phenyl-functionalization. Through the process, CsPbBr3 NCs are confined in a compact silica matrix, which is impermeable to H2 O. The synthesis strategy is extended to a classical red quantum dot, CdZnSeS@ZnS NCs, to fabricate a white light emitting diode (WLED) consisting of CsPbBr3 -SiO2 Ph and CdZnSeS@ZnS-SiO2 Ph phosphor and silicone resin packaged on a commercial blue InGaN chip with luminous efficacy (LE) of 9.36 lm W-1 . The WLED undergoes enhancements in both green and red photoluminescence over time to achieve a highly efficient performance of 38.80 lm W-1 . More importantly, the WLED exhibits unprecedented operational stability of LE/LE0  = 94% after 101 h-operation at 20 mA (2.56 V). The ultra-high operational stability and efficient performance are mainly attributed to thermal curing and aging through which grain growth occurs as well as deactivation of defect states by permeated atmospheric O2 .

Passivation and Interlayer Effect of Zr(i-PrO)4 on Green CuGaS2/ZnS/Zr(i-PrO)4@Al2O3 and Red CuInS2/ZnS/Zr(i-PrO)4@Al2O3 QD Hybrid Powders.

Broadband emissive I-III-VI quantum dots (QDs) are synthesized as efficient and stable I-III-VI QDs to be used as eco-friendly luminescent materials in various applications. Here, we introduce the additional passivation of zirconium isopropoxide (Zr(i-PrO)4) to improve the optical properties and environmental stability of green-emitting CuGaS2/ZnS (G-CGS/ZnS) and red-emitting CuInS2/ZnS (R-CIS/ZnS) QDs. The photoluminescence quantum yield (PLQY) of both resultant Zr(i-PrO)4-coated G-CGS/ZnS and R-CIS/ZnS QDs reaches similar values of ~ 95%. In addition, the photostability and thermal-stability of G-CGS/ZnS/Zr(i-PrO)4 and R-CIS/ZnS/Zr(i-PrO)4 QDs are improved by reducing the ligand loss via encapsulation of the ligand-coated QD surface with Zr(i-PrO)4. It is also proved that the Zr(i-PrO)4-passivated interlayer mitigates the further degradation of I-III-V QDs from ligand loss even under harsh conditions during additional hydrolysis reaction of aluminum tri-sec-butoxide (Al(sec-BuO)3), forming easy-to-handle G-CGS/ZnS and R-CIS/ZnS QD-embedded Al2O3 powders. Therefore, the introduction of a Zr(i-PrO)4 complex layer potentially provides a strong interlayer to mitigate degradation of I-III-VI QD-embedded Al2O3 hybrid powders as well as passivation layer for protecting I-III-VI QD.

Assessing the Visualization-Based Decision Support System for Environmental Impact Assessments.

Even though environmental impact assessments (EIAs) have been an important tool for environmental decision-making, most EIAs are published as a mix of text and tabular data that is not easily accessible to or understandable for the public. In this paper, we present a decision support system (DSS) that supports the decision-making of stakeholders in the EIA stage. The system was designed to improve the public's understanding of stakeholders before and after a construction project by providing visualization of key environmental elements. We recruited 107 participants to test the usability of the system and examined the impacts of individual differences between the participants on their perceptions of the system, including their environmental expertise and computer self-efficacy. The results showed that the proposed system had high usability, especially for users with high computational efficacy and environment expertise. The system could thus help to improve the communication between the public and experts during public hearings and enhance the environmental literacy of the public.

Subcutaneously Injectable Hyaluronic Acid Hydrogel for Sustained Release of Donepezil with Reduced Initial Burst Release: Effect of Hybridization of Microstructured Lipid Carriers and Albumin.

The daily oral administration of acetylcholinesterase (AChE) inhibitors for Alzheimer's disease features low patient compliance and can lead to low efficacy or high toxicity owing to irregular intake. Herein, we developed a subcutaneously injectable hyaluronic acid hydrogel (MLC/HSA hydrogel) hybridized with microstructured lipid carriers (MLCs) and human serum albumin (HSA) for the sustained release of donepezil (DNP) with reduced initial burst release. The lipid carrier was designed to have a microsized mean diameter (32.6 ± 12.8 µm) to be well-localized in the hydrogel. The hybridization of MLCs and HSA enhanced the structural integrity of the HA hydrogel, as demonstrated by the measurements of storage modulus (G'), loss modulus (G″), and viscosity. In the pharmacokinetic study, subcutaneous administration of MLC/HSA hydrogel in rats prolonged the release of DNP for up to seven days and reduced the initial plasma concentration, where the Cmax value was 0.3-fold lower than that of the control hydrogel without a significant change in the AUClast value. Histological analyses of the hydrogels supported their biocompatibility for subcutaneous injection. These results suggest that a new hybrid MLC/HSA hydrogel could be promising as a subcutaneously injectable controlled drug delivery system for the treatment of Alzheimer's disease.

Development and Validation of Liquid Chromatography-Tandem Mass Spectrometry Method for Pharmacokinetic Evaluation of 7ß-(3-Ethyl-cis-crotonoyloxy)-1α-(2-methylbutyryloxy)-3,14-dehydro-Z-notonipetranon in Rats.

Recently, potent neuroprotective and anti-diabetic effects of 7ß-(3-Ethyl-cis-crotonoyloxy)-1α-(2-methylbutyryloxy)-3,14-dehydro-Z-notonipetranone (ECN), a sesquiterpenoid isolated from Tussilago farfara Linnaeus, have been elucidated. To facilitate further pre-clinical evaluation in rats, an analytical method for the determination of ECN in rat plasma was developed and optimized by using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Plasma samples were pretreated by the protein precipitation method with an acetonitrile solution of losartan (LST) as the internal standard. Chromatographic separation was performed using a an Octadecyl-silica (ODS) column (2.6 µm, 100 x 4.6 mm) in the isocratic mode. The mobile phase, comprising 10 mM ammonium formate in water pH 5.75) and acetonitrile (11:89, v/v), was eluted at a flow rate of 0.4 mL/min. Mass spectrometric detection was performed in the multiple reaction monitoring mode with positive electrospray ionization, and the mass transitions of ECN and LST were m/z 431.3 to 97.3 and m/z 423.1 to 207.2, respectively. The calibration curves of spiked plasma samples were linear in the 10.0-10,000 ng/mL range (r2 > 0.996). The lower limit of quantification (LLOQ) was determined as 10.0 ng/mL. Validation was conducted in the LLOQ, and three quality control (QC) sample levels (10.0, 25.0, 3750, and 7500 ng/mL) were studied. Among them, the relative standard deviation for the within- and between-run precisions was under 9.90%, and the relative error of the accuracies was within the -8.13% to 0.42% range. The validated method was successfully employed to investigate the pharmacokinetic properties of ECN in rats, which revealed the linear pharmacokinetic behavior of ECN for the first time.

Enhanced Efficacy of Immunization with a Foot-and-Mouth Disease Multi-Epitope Subunit Vaccine Using Mannan-Decorated Inulin Microparticles.

BACKGROUND: Despite the many advantages of recombinant subunit vaccines, they have critical weaknesses that include a low efficacy for promoting cellular and humoral immune responses against antigens because of their poor immunogenicity, and a rapidly cleared properties as a result of proteolytic enzymes in the body. To circumvent these problems, we developed mannan-decorated inulin acetate microparticles (M-IA MPs) that functioned as carriers and adjuvants for immunization with the recombinant foot-and-mouth disease multi-epitope subunit vaccine (M5BT). METHODS: The M5BT-loaded M-IA MPs were obtained by a double-emulsion solvent-evaporation method. Their properties including morphology, size and release ability were determined by field emission scanning electron microscope, dynamic light-scattering spectrophotometer and spectrophotometer. To assess the immunization efficacy of the MPs, mice were immunized with MPs and their sera were analyzed by ELISA. RESULTS: The M-IA MPs obtained by a double-emulsion solvent-evaporation method were spherical and approximately 2-3 µm, and M5BT was encapsulated in the M-IA MPs. The M5BT-loaded M-IA MPs showed higher antigen-specific IgG, IgG1, IgG2a and anti-FMDV antibodies than the M5BT-loaded IA MPs and the Freund's adjuvant as a control. CONCLUSION: The M-IA MPs showed a powerful and multifunctional polymeric system that combined two toll-like receptor agonists compared to the conventional adjuvant.

[Influence of Partnerships with Nurses and Social Support on Readiness for Discharge among Mothers of Premature Infants]. / 미숙아 어머니의 간호사와의 파트너십, ì‚¬íšŒì  지지가 퇴원준비도에 미치는 영향.

PURPOSE: The purpose of this study was to investigate partnerships with nurses, social support and readiness for discharge among mothers of premature infants in the neonatal intensive care unit (NICU) and to examine the factors associated with readiness for discharge. METHODS: A survey was conducted among 85 mothers of premature infants hospitalized in a NICU in Seoul, Korea. The collected data were analyzed with descriptive statistics, the t-test, one-way analysis of variance, Pearson' correlation coefficients, and multiple linear regression using SPSS version 25.0. RESULTS: The results of the regression analysis showed that partnerships with nurses (ß=.32, p=.011) and parenting experience (ß=.32, p=.001) were significantly associated with readiness for discharge. CONCLUSION: To improve the readiness for discharge among mothers of premature infants, developing strategies to strengthen their partnership with nurses and to provide family-centered care will be needed.

Oral Immunization of FMDV Vaccine Using pH-Sensitive and Mucoadhesive Thiolated Cellulose Acetate Phthalate Microparticles.

Several barriers such as gastric pH, enzymatic degradation and rapid transit should be overcome to orally deliver antigens for taking up by epithelial microfold cells in Peyer's patches of small intestine. To solve the above mentioned problems, we designed pH-sensitive and mucoadhesive polymeric microparticles (MPs) prepared by double emulsion technique using cellulose acetate phthalate (CAP) to enhance immune response of foot-and-mouth disease (FMD) virus (FMDV) subunit vaccine. Thiolation of CAP improved mucoadhesive property of CAP to prolong the MPs transit time through the gastrointestinal tract. Thiolated CAP (T-CAP) also slowed down antigen release in acidic pH of stomach but released more antigens in neutral pH of small intestine due to the pH-sensitivity of the T-CAP. Oral immunization of a chimerical multi-epitope recombinant protein as the FMD subunit vaccine via T-CAP MPs effectively delivered the vaccine to Peyer's patches eliciting mucosal IgA response. It will make a step forward into a promising oral subunit vaccine development in livestock industry.

Systemic administration of RANKL overcomes the bottleneck of oral vaccine delivery through microfold cells in ileum.

A successful delivery of antigen through oral route requires to overcome several barriers, such as enzymatic barrier of gastrointestinal tract and epithelial barrier that constitutes of microfold cells (M cells) for antigen uptake. Although each barrier represents a critical step in determining the final efficiency of antigen delivery, the transcytosis of antigen by M cells in the follicle-associated epithelium (FAE) to Peyer's patches appears to be a major bottleneck. Considering the systemic administration of receptor activator of nuclear factor (NF)-ĸB ligand (RANKL) induces differentiation of receptor activator of nuclear factor (NF)-ĸB (RANK)-expressing enterocytes into M cells, here, we illustrated a promising approach of antigen delivery using full length transmembrane RANKL (mRANKL). The results showed that the intraperitoneal injection of mRANKL increased the population of dendritic cells and macrophages in mesenteric lymph nodes and spleen. Subsequently, systemic administration of mRANKL resulted in significantly higher number of functional GP2(+) M cells leading higher transcytosis of fluorescent beads through them. To corroborate the effect of mRANKL in antigen delivery through M cells, we orally delivered microparticulate antigen to mice treated with mRANKL. Oral immunization induced strong protective IgA and systemic IgG antibody responses against orally delivered antigen in mRANKL-treated mice. The higher antibody responses are attributed to the higher transcytosis of antigens through M cells. Ultimately, the higher memory B cells and effector memory CD4 T cells after oral immunization in RANKL-treated mice confirmed potency of RANKL-mediated antigen delivery. To the best of our knowledge, this is the first study to demonstrate significant induction of mucosal and humoral immune responses to M cell targeted oral vaccines after the systemic administration of RANKL.

A Korean multicenter study of prenatal risk factors for overt diabetes during the postpartum period after gestational diabetes mellitus.

OBJECTIVE: To identify prenatal risk factors for postpartum diabetes among pregnant women with gestational diabetes mellitus (GDM). METHODS: In a retrospective study, baseline characteristics and data from a postpartum 75-g glucose tolerance test (GTT) were reviewed for patients with GDM who had delivered in four Korean tertiary institutions from 2006 to 2012. Clinical characteristics were compared between women with and those without postpartum diabetes. Cutoffs to predict postpartum diabetes and diagnostic values were calculated from receiver operating characteristic (ROC) curves. RESULTS: Of 1637 patients with GDM, 498 (30.4%) underwent a postpartum 75-g GTT. Postpartum diabetes was diagnosed in 40 (8.0%) patients and impaired glucose intolerance in 157 (31.5%). Women with postpartum diabetes had higher glycated hemoglobin (HbA1c) levels at GDM diagnosis (P=0.008) and higher 100-g GTT values (P<0.05 for all). In ROC curve analysis, optimal cutoffs for predicting postpartum diabetes were 0.058 for HbA1c level and 5.3 mmol/L (fasting), 10.9 mmol/L (1h), 10.2 mmol/L (2h), and 8.6 mmol/L (3h) for 100-g GTT. The highest sensitivity was observed for 3-h 100-g GTT (76.9%) and the highest positive predictive value was for HbA1c at diagnosis (15.2%). CONCLUSION: HbA1c level at GDM diagnosis and 100-g GTT values could be used to identify patients at high risk of postpartum diabetes who should undergo postpartum screening.

A combined ultrasound and clinical scoring model for the prediction of peripartum complications in pregnancies complicated by placenta previa.

OBJECTIVES: To generate a combined ultrasound and clinical model predictive for peripartum complications in pregnancies complicated by placenta previa. STUDY DESIGN: This study included 110 singleton pregnant women with placenta previa delivered by cesarean section (CS) from July 2011 to November 2013. We prospectively collected ultrasound and clinical data before CS and observed the occurrence of blood transfusion, uterine artery embolization and cesarean hysterectomy. We formulated a scoring model including type of previa (0: partials, 2: totalis), lacunae (0: none, 1: 1-3, 2: 4-6, 3: whole), uteroplacental hypervascularity (0: normal, 1: moderate, 2: severe), multiparity (0: no, 1: yes), history of CS (0: none, 1: once, 2: ≥ twice) and history of placenta previa (0: no, 1: yes) to predict the risk of peripartum complications. RESULTS: In our study population, the risk of perioperative transfusion, uterine artery embolization, and cesarean hysterectomy were 26.4, 1.8 and 6.4%, respectively. The type of previa, lacunae, uteroplacental hypervascularity, parity, history of CS, and history of placenta previa were associated with complications in univariable analysis. However, no factor was independently predictive for any complication in exact logistic regression analysis. Using the scoring model, we found that total score significantly correlated with perioperative transfusion, cesarean hysterectomy and composite complication (p<0.0001, Cochrane Armitage test). Notably, all patients with total score ≥7 needed cesarean hysterectomy. When total score was ≥6, three fourths of patients needed blood transfusion. CONCLUSIONS: This combined scoring model may provide useful information for prediction of peripartum complications in women with placenta previa.

Development of enrichment semi-nested PCR for Clostridium botulinum types A, B, E, and F and its application to Korean environmental samples.

An enrichment semi-nested PCR procedure was developed for detection of Clostridium botulinum types A, B, E, and F. It was applied to sediment samples to examine the prevalence of C. botulinum in the Korean environment. The first pair of primers for the semi-nested PCR was designed using a region shared by the types A, B, E, and F neurotoxin gene sequences, and the second round employed four nested primers complementary to the BoNT/A, /B, /E, and /F encoding genes for simultaneous detection of the four serotypes. Positive results were obtained from the PCR analysis of five of 44 sediments (11%) collected from Yeong-am Lake in Korea; all were identified as deriving from type B neurotoxin (bontb) genes. Two of the C. botulinum type B organisms were isolated, and their bontb genes sequenced. The deduced amino acid sequences of BoNT/B showed 99.5 and 99.8% identity with the amino acid sequence of accession no. AB084152. Our data suggest that semi-nested PCR is a useful tool for detecting C. botulinum in sediments, and renders it practicable to conduct environmental surveys.

Determination of neurotoxin gene expression in Clostridium botulinum type A by quantitative RT-PCR.

Real time reverse transcription (RT)-PCR was used to quantify the expression of the botulinum neurotoxin type A (BoNT/A) gene (cntA) by normalization with the expression of 16S rRNA. The method were confirmed by monitoring the mRNA levels of cntA during growth in five type A strains. In all but one of the strains the expression of cntA mRNA was maximal in the late exponential phase, and approximately 35-fold greater than in the early exponential phase. The concentration of the extracellular BoNT/A complex detected by ELISA was highest in stationary phase. Sodium nitrite and sorbic acid completely inhibited growth at 20 ppm and 4 mg ml-1, respectively. CntA expression became lower in proportion to the concentration of sorbic acid, and this reduction was confirmed by mouse bioassay. Our results show that real time RT-PCR can be used to quantify levels of C. botulinum type A neurotoxin transcripts and to assess the effects of food additives on botulinal risk.

Application of real-time PCR for quantitative detection of Clostridium botulinum type A toxin gene in food.

The TaqMan real-time PCR method for the quantitative detection of C. botulinum type A was developed based on sequence-specific hybridization probes. The validity of this assay was verified by using 10 genera of 20 strains, including reference strains of C. botulinum types A, B, C, D, E and F. The detection limit of this assay was evaluated on C. botulinum type A, using a 10-fold dilution series of DNA and spores . The DNA and spores were detected up to level of 0.1 ng/ml and 10(2)spores/ml, respectively. Spore spiked food sample preparation prior to the real-time PCR was performed by two methods, heat treatment and GuSCN. The detection limits after heat treatment showed 10(2) spores/ml for spiked sausage slurry, and 10(3) spores/ml for spiked canned corn slurry, while detection limits after GuSCN precipitation showed 10(2) spores/ml in both sausage and canned corn. Therefore the real-time PCR assay after GuSCN precipitation is useful for the quantification of C. botulinum type A because it showed identical CT values in both pure spore solutions and food slurries. We suggest that quantitative analysis of C. botulinum type A by TaqMan real-time PCR can be a rapid and accurate assessment method for botulinal risk in food samples.