Safe food through better labelling; a robust method for the rapid determination of caprine and bovine milk allergens.

Accidental milk cross-contamination is one of the most common causes for costly food recalls. Yet, quantifying trace-levels of allergen is time-consuming and current methods are not adapted for routine analyses making quality control for trace-level allergen content impractical. This perpetuates voluntary "may-contain" statements that are unhelpful for people suffering from food allergies. Here, we developed a rapid LC-MS method enabling milk allergen quantification by comparing all tryptic-peptides of major milk allergens. The bovine-specific αS-2 casein peptide and allergen-epitope NAVPITPTLNR provided excellent performance in sensitivity (LOD 1 mg.kg-1; LOQ 2 mg.kg-1) across various dairy products, good recovery rates in baked croissants (77% with a 10% inter-day RSD) and a linear range of 2-2,000 mg.kg-1. The method can be used for routine determination of trace-contamination with bovine milk allergen and the adulteration of high-value caprine dairy products with lower-value bovine milk products, protecting consumer trust and the growing population suffering from food allergies.

Taking control of microplastics data: A comparison of control and blank data correction methods.

Although significant headway has been achieved regarding method harmonisation for the analysis of microplastics, analysis and interpretation of control data has largely been overlooked. There is currently no consensus on the best method to utilise data generated from controls, and consequently many methods are arbitrarily employed. This study identified 6 commonly implemented strategies: a) No correction; b) Subtraction; c) Mean Subtraction; d) Spectral Similarity; e) Limits of detection/ limits of quantification (LOD/LOQ) or f) Statistical analysis, of which many variations are possible. Here, the 6 core methods and 45 variant methods (n = 51) thereof were used to correct a dummy dataset using control data. Most of the methods tested were too inflexible to account for the inherent variation present in microplastic data. Only 7 of the 51 methods tested (six LOD/LOQ methods and one statistical method) showed promise, removing between 96.3 % and 100 % of the contamination data from the dummy set. The remaining 44 methods resulted in deficient corrections for background contamination due to the heterogeneity of microplastics. These methods should be avoided in the future to avoid skewed results, especially in low abundance samples. Overall, LOD/LOQ methods or statistical analysis comparing means are recommended for future use in microplastic studies.

Rapid Progression of Large B-cell Lymphoma in Behçet's Disease on Immunosuppressive Therapy: A Case Report with Literature Review.

Behçet's disease (BD) is a systemic vasculitis characterized by various symptoms, including orogenital ulcers, uveitis, arthritis, skin lesions, and the involvement of the gastrointestinal tract and central nervous system. BD has been associated with malignancies such as leukemia, myelodysplastic syndrome, lymphoma, multiple myeloma, Hodgkin's disease, and lymphosarcoma. The rarity of association with B-cell lymphoma may also be added to the list, given our findings in this case report. Patients with vasculitides benefit from immunosuppressive therapy that can minimize disease and may prevent disease manifestations and exacerbations. However, there may be an increased risk of cancer development, which calls for consideration while starting and maintaining this population of patients on immunosuppressive therapy.

Demographic Discrepancies of Vitamin D Deficiency in Craniofacial Fracture Patients.

Background: The relationship between craniofacial fracture and vitamin D status has not been studied. Given the important role vitamin D status plays in postfracture prognosis, a deep investigation into this relationship is due. The primary objective of this study was to assess the demographic discrepancies in the vitamin D status of patients with craniofacial fracture. Methods: The Cerner Health Facts database was used to collect data on serum 25-hydroxyvitamin D, demographics, hospital admission and discharge, and fracture type of 76 craniofacial fracture patients with available vitamin D levels from October 2015 until May 2018. Pairwise Spearman Correlation was used for multivariate data analysis. Results: Of the 76 craniofacial fracture patients identified, 55.3% were insufficient in vitamin D and 32.9% were deficient in vitamin D. Vitamin D deficiency and insufficiency were more common in women, African American individuals, and patients over 50 years of age. Conclusions: The investigation revealed a high prevalence of vitamin D deficiency and insufficiency in craniofacial fracture patients. Despite the higher incidence of fractures in men and Caucasian individuals, women and African American individuals with craniofacial fractures had poorer vitamin D status. Clinicians should consider empiric vitamin D supplementation following craniofacial fracture in high-risk groups.

Radiation Therapy for Local Cutaneous Melanoma.

While primary treatment for melanoma consists of surgical resection and chemotherapeutics, radiation can be used as either definitive or adjuvant therapy in certain clinical scenarios. This chapter aims to explore the indications for primary definitive radiotherapy as well as adjuvant treatment following resection. Delivery, dose, fractionation, and toxicity of radiation treatment will be discussed. As our understanding of melanoma tumor biology increases, the role of radiotherapy may expand for more effective treatment of oligometastatic disease.

Pseudohyponatremia Leading to a Fatal Outcome in a Patient With Familial Hypertriglyceridemia.

Serum sodium assay is a commonly performed laboratory test in a clinical setting and the results are taken for granted without being aware of the actual methods involved. In conditions like hyperlipidemia and hyperproteinemia, excessive lipids in serum dilute the water component of the serum. Since sodium is dissolved only in the aqueous phase of serum, the sodium content per unit volume of plasma is reduced. Currently, most of the laboratories use the indirect ion-selective electrode method (ISE), where the plasma sample is diluted before the measurement. Indirect ISE may not give accurate results in conditions with higher serum lipid and protein levels. Overcorrection of the serum sodium levels in pseudohyponatremia may cause serious complications. We report a case of a 26-year-old Asian male with a past medical history of chronic pancreatitis, familial hypertriglyceridemia, and fatty liver who presented to the emergency department with acute pancreatitis. Initially, the patient was found to have hyponatremia and he was started on hypertonic saline for one day. Later the patient's condition deteriorated and then it was determined that serum sodium results were a measurement artifact since the patient had extremely high levels of triglycerides. After realizing that it was a measurement artifact, the saline infusion was stopped and he was started on desmopressin. However, the patient deteriorated neurologically and expired later. As this patient had normal sodium levels, administration of hypertonic saline led to a fatal outcome.

How Much Is Too Much? Exploring Pseudohyperaldosteronism in Glycyrrhizic Acid Toxicity From Chronic Licorice Root Consumption.

Licorice has been around for centuries and has been commercialized in the food, tobacco, and healthcare industry. Historically, its therapeutic benefits have been reaped in countless ways, including as a thirst sensation suppressor in battlefields, flavoring agent in medicinal preparations, antacid for gastric discomfort and peptic ulcers, and even as an estrogenic agent in postmenopausal women. Licorice and its derivatives are recognized safe by the US Food and Drug Administration (FDA). Though FDA recognized the licorice to be a food additive in certain concentrations, it has issued warnings against its use in at-risk group and in larger amount. However, it is a lesser known fact that glycyrrhizic acid, the active component in licorice, can cause a metabolic syndrome presenting as pseudohyperaldosteronism. Chronic consumption leads to the development of hypertension, metabolic alkalosis, and hypokalemia. We present a patient who developed a sinus pause on telemetry and subsequent syncope after presenting for evaluation of hypertension and hypokalemia. The patient had been ingesting a significant quantity of deglycyrrhizinated licorice for many years to alleviate postprandial epigastric pain. Although seemingly benign electrolyte disturbance, it is crucial to recognize that chronic consumption of licorice without strict regulation can lead to supraventricular and ventricular ectopics and tachyarrhythmias with the potential to develop life-threatening arrhythmias including ventricular tachycardia, ventricular fibrillation, and Torsades de Pointes.

Relevance and reliability of evidence for microplastic contamination in seafood: A critical review using Australian consumption patterns as a case study.

Seafood contamination with, and human consumption of, microplastics (MPs) have recently been highlighted as an emerging concern for global food security. While there is evidence that commercial marine species are contaminated with MPs, it is still unknown if seafood can act as a vector for MP transfer to human consumers. Microplastics have been reported in the digestive tract, gills and in select internal organs of marine animals. However, many of these tissues are not typically eaten by human consumers but discarded. In this critical review, we examined the peer-reviewed literature for evidence of MP contamination in seafood, and the potential transfer to human consumers. Based on known seafood consumption patterns in a typical Australian diet, we assessed the relevance and reliability of the current body of literature to examine the prospect and risk of MP transfer. The relevance of data was considered based on the organism studied, origin of the samples, and the tissues analysed, while reliability was assessed based on procedural methodologies used to derive the data. A review of 132 studies found limited evidence of MP contamination in edible tissues from fresh fish or crustaceans. MP presence was confirmed in packaged fish, as well as in fresh and packaged bivalve molluscs. The limited number of studies satisfying the relevance and reliability criteria (n = 24) precluded a quantitative assessment of the potential risk associated with MP transfer. While consumption of packaged fish and bivalve molluscs may result in the consumption of MPs by humans, it is currently unknown whether this presents a health risk.

Long-Term Acute Care Hospitals Extend ICU Capacity for COVID-19 Response and Recovery.

The COVID-19 pandemic has presented novel challenges for the entire health-care continuum, requiring transformative changes to hospital and post-acute care, including clinical, administrative, and physical modifications to current standards of operations. Innovative use and adaptation of long-term acute care hospitals (LTACHs) can safely and effectively care for patients during the ongoing COVID-19 pandemic. A framework for the rapid changes, including increasing collaboration with external health-care organizations, creating new methods for enhanced communication, and modifying processes focused on patient safety and clinical outcomes, is described for a network of 94 LTACHs. When managed and modified correctly, LTACHs can play a vital role in managing the national health-care pandemic crisis.

Fake news and fake research: Why meta-research matters more than ever.

Research is in a crisis of credibility, and this is to the peril of all paediatricians. Billions of dollars are being wasted each year because research is not planned, badly conducted or poorly reported, and this is on a background of rapidly reducing research budgets. How can paediatricians, families and patients make informed treatment choices if the evidence base is absent or not trustworthy? This article discusses why meta-research now matters more than ever, how it can help solve this crisis of credibility and how this should lead to more efficient and effective clinical care. The field of meta-research or research-on-research is the ultimate big picture approach to identifying and solving issues of bias, error, misconduct and waste in research. Meta-researchers value authenticity over aesthetics and quality over quantity. The utility of meta-research does not rely on accusations or critical assessments of individual research, but through highlighting where and how the scientific method and research standards across all fields can be improved. Meta-researchers study, analyse and critique the research pathway, focusing on elements such as methods (how to conduct), evaluation (how to test), reporting (how to communicate), reproducibility (how to verify) and incentives (how to reward). In the current climate it is now more critical than ever that we make use of meta-research and prioritise high-quality high-impact research, ultimately leading to improved patient outcomes.

An Atypical Presentation of Fulminant Myocarditis Secondary to COVID-19 Infection.

The potential etiologies of fulminant myocarditis include autoimmune diseases, infections, drug hypersensitivity, and drug/toxin reactions. We present an atypical case of fulminant myocarditis in a patient with a history of diabetic ketoacidosis with recent novel coronavirus (COVID-19) infection, who presented with acute upper gastrointestinal bleeding. The patient improved with a three-day course of methylprednisolone 1 gram daily.

Screening Testing for SARS-CoV-2 upon Admission to Rehabilitation Hospitals in a High COVID-19 Prevalence Community.

BACKGROUND: While planning for the care of coronavirus disease 2019 (COVID-19) patients during the pandemic crisis has dominated the focus of leaders of inpatient rehabilitation facilities (IRFs), patients with injuries/illnesses unrelated to COVID-19 continue to need inpatient rehabilitation admission. To maintain a safe environment for all patients and staff, we established an admission screening plan of testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to determine the presence of asymptomatic patients who were infected with the virus upon admission. OBJECTIVE: To determine the prevalence of patients who test positive for SARS-CoV-2 but were presumed to be COVID-19 negative at the time of admission to IRF in New Jersey. DESIGN: Retrospective analysis of SARS-CoV-2 testing results. SETTING: Four freestanding IRFs in New Jersey operated as one system. PATIENTS: All (N = 103) patients sequentially admitted from 4 to 27 April 2020 with no symptoms or evidence of COVID-19 disease at the time of transfer from the acute hospital. INTERVENTIONS: Specimens were collected for SARS-CoV-2 analysis at the time of admission to the IRF and patients were monitored for subsequent symptom development over the next 14 days. MAIN OUTCOME MEASURES: Results of SARS-CoV-2 testing upon admission and evidence of development of clinical signs or symptoms of COVID-19. RESULTS: Seven asymptomatic persons (6.8% of admissions) without clinical signs/symptoms of COVID-19 tested positive on admission. Of these, five developed symptoms of COVID-19, with a mean onset of 3.2 (range of 2-5) days. Five additional patients became symptomatic and tested positive within the next 3 to 10 days (mean of 5.2 days). Overall, 11.6% of admissions (12/103) had a positive test within 14 days of admission. CONCLUSIONS: Admission testing to postacute centers for SARS-CoV-2 can help identify presymptomatic or asymptomatic individuals, especially in areas where COVID-19 is prevalent. Negative results, however, do not preclude COVID-19 and should not be used as the sole basis for patient management decisions.

Potential Beneficial Effects of Dietary Protein Supplementation and Exercise on Functional Capacity in a Pilot Study of Individuals with Heart Failure with Preserved Ejection Fraction.

Approximately half of heart failure patients in the US have heart failure with preserved ejection fraction (HFpEF). HFpEF impairs physical performance and thus reduces quality of life. Increasing dietary protein intake can increase lean body mass and physical performance in healthy elderly individuals, but the effect of a high-quality protein supplement, with or without a structured exercise program, has not been investigated in HFpEF patients. Twenty-three obese elderly HFpEF patients with grade 1 or 2 diastolic dysfunction were randomized into three groups: control, protein supplementation alone, and protein plus exercise. Protein supplementation involved providing sufficient whey protein so that total intake was 1.2 g protein/kg/day. The exercise intervention was 2 days of hydrotherapy and 1 day of gym sessions per week under supervision of a fitness expert. Physical parameters and functional tests were performed at baseline and at 12 weeks. Protein supplementation alone failed to improve physical performance. However, when combined with light exercise, there was significant improvement in some (6-minute walk, 10 m walking speed, quadriceps strength), but not all, physical function measurements. The results of this pilot study suggest that further exploration of potential interactive effects between protein supplementation and light exercise in individuals with HFpEF is warranted.

An immersive orientation programme to improve medical student integration and well-being.

BACKGROUND: Multiple common challenges exist for medical students transitioning to regional clinical placements, including a relative paucity of well-being skills required for the promotion of work-life integration. Beginning Education at Central Coast Hospitals (BEACCHES) is an immersive orientation programme aimed at negotiating this transition and promoting student well-being through improved social connectedness. The programme was evaluated with the objectives of understanding the most highly valued and effective components. METHOD: BEACCHES is offered to medical students commencing regional clinical placement at the Central Coast Medical School, Australia. The programme emphasises teamwork and self care, and promotes multidirectional interaction among peers, staff and the local community. A specific well-being forum is an essential component of the programme. An evaluation of the inaugural programme was performed using semi-structured surveys with a mixed-method analysis of quantitative data (pre- and post-programme knowledge and confidence scores) and qualitative data (emergent themes). RESULTS: Knowledge acquisition significantly improved across all domains. Importantly, this included items that could positively impact on well-being, including: knowledge of psychological first aid (p = 0.01), student support services (p < 0.01), connectedness with fellow students and staff (p < 0.01), and self-management of health and workload (p = 0.01). Qualitative analysis also revealed substantial support for the importance of interaction with peers and staff outside of the formal education setting. According to the Australian Medical Association, medical schools' responsibilities include incorporating curricula designed to improve stress management CONCLUSION: Our survey results indicated that BEACCHES has the potential to foster student well-being through targeted orientation and engagement to enhance connectedness. We highlight the value of embedding an interactive experiential programme for students beginning a new regional clinical placement.

The student experience of clinical supervision across health disciplines - Perspectives and remedies to enhance clinical placement.

Effective clinical practice supervision for health students is essential prior to commencing their respective professions. Students require adequate preparation before their clinical practice event with an experienced clinical supervisor able to impart professional 'know how' and skills to students. The purpose of this study was to describe final year health students' perspectives and experiences of clinical supervision, and to develop an interprofessional model of clinical supervision. Focus groups and semi-structured interviews were conducted with undergraduate health students across a range of disciplines. Some students provided email comments. Qualitative data was analysed thematically using NVivo (V11). Six key themes and their various sub-themes (refer Table 1) were identified: (1) undergraduate learning valued by the CP provider; (2) effective connections (communications) between student, CS, CP provider and university; (3) undergraduate student learning not being valued; (4) ineffective connections; (5) mitigating factors for students; and (6) the impact of increasing student numbers. Undergraduate health student clinical placement requires careful educational preparation, structuring and adequate support for both the student undergoing the practice event and for the clinical supervisor stewarding the undergraduate health professional. A prospective plan to ensure an excellent experience is required (Fig. 1).

Turning microplastics into nanoplastics through digestive fragmentation by Antarctic krill.

Microplastics (plastics <5 mm diameter) are at the forefront of current environmental pollution research, however, little is known about the degradation of microplastics through ingestion. Here, by exposing Antarctic krill (Euphausia superba) to microplastics under acute static renewal conditions, we present evidence of physical size alteration of microplastics ingested by a planktonic crustacean. Ingested microplastics (31.5 µm) are fragmented into pieces less than 1 µm in diameter. Previous feeding studies have shown spherical microplastics either; pass unaffected through an organism and are excreted, or are sufficiently small for translocation to occur. We identify a new pathway; microplastics are fragmented into sizes small enough to cross physical barriers, or are egested as a mixture of triturated particles. These findings suggest that current laboratory-based feeding studies may be oversimplifying interactions between zooplankton and microplastics but also introduces a new role of Antarctic krill, and potentially other species, in the biogeochemical cycling and fate of plastic.

Uptake and Depuration Kinetics Influence Microplastic Bioaccumulation and Toxicity in Antarctic Krill ( Euphausia superba).

The discarding of plastic products has led to the ubiquitous occurrence of microplastic particles in the marine environment. The uptake and depuration kinetics of ingested microplastics for many marine species still remain unknown despite its importance for understanding bioaccumulation potential to higher trophic level consumers. In this study, Antarctic krill ( Euphausia superba) were exposed to polyethylene microplastics to quantify acute toxicity and ingestion kinetics, providing insight into the bioaccumulation potential of microplastics at the first-order consumer level. In the 10 day acute toxicity assay, no mortality or dose-dependent weight loss occurred in exposed krill, at any of the exposure concentrations (0, 10, 20, 40, or 80% plastic diet). Krill exposed to a 20% plastic diet for 24 h displayed fast uptake (22 ng mg-1 h-1) and depuration (0.22 h-1) rates, but plastic uptake did not reach steady state. Efficient elimination also resulted in no bioaccumulation over an extended 25 day assay, with most individuals completely eliminating their microplastic burden in less than 5 days post exposure. Our results support recent findings of limited acute toxicity of ingested microplastics at this trophic level, and suggest sublethal chronic end points should be the focus of further ecotoxicological investigation.

Signals from the south; humpback whales carry messages of Antarctic sea-ice ecosystem variability.

Southern hemisphere humpback whales (Megaptera novaeangliae) rely on summer prey abundance of Antarctic krill (Euphausia superba) to fuel one of the longest-known mammalian migrations on the planet. It is hypothesized that this species, already adapted to endure metabolic extremes, will be one of the first Antarctic consumers to show measurable physiological change in response to fluctuating prey availability in a changing climate; and as such, a powerful sentinel candidate for the Antarctic sea-ice ecosystem. Here, we targeted the sentinel parameters of humpback whale adiposity and diet, using novel, as well as established, chemical and biochemical markers, and assembled a time trend spanning 8 years. We show the synchronous, inter-annual oscillation of two measures of humpback whale adiposity with Southern Ocean environmental variables and climate indices. Furthermore, bulk stable isotope signatures provide clear indication of dietary compensation strategies, or a lower trophic level isotopic change, following years indicated as leaner years for the whales. The observed synchronicity of humpback whale adiposity and dietary markers, with climate patterns in the Southern Ocean, lends strength to the role of humpback whales as powerful Antarctic sea-ice ecosystem sentinels. The work carries significant potential to reform current ecosystem surveillance in the Antarctic region.

Feasibility of Conducting a 6-month long Home-based Exercise Program with Protein Supplementation in Elderly Community-dwelling Individuals with Heart Failure.

OBJECTIVE: Cardiac cachexia is a condition associated with heart failure, particularly in the elderly, and is characterized by loss of muscle mass with or without the loss of fat mass. Approximately 15% of elderly heart failure patients will eventually develop cardiac cachexia; such a diagnosis is closely associated with high morbidity and increased mortality. While the mechanism(s) involved in the progression of cardiac cachexia is incompletely established, certain factors appear to be contributory. Dietary deficiencies, impaired bowel perfusion, and metabolic dysfunction all contribute to reduced muscle mass, increased muscle wasting, increased protein degradation, and reduced protein synthesis. Thus slowing or preventing the progression of cardiac cachexia relies heavily on dietary and exercise-based interventions in addition to standard heart failure treatments and medications. METHODS: The aim of the present study was to test the feasibility of an at-home exercise and nutrition intervention program in a population of elderly with heart failure, in an effort to determine whether dietary protein supplementation and increased physical activity may slow the progression, or prevent the onset, of cardiac cachexia. Frail elderly patients over the age of 55 with symptoms of heart failure from UAMS were enrolled in one of two groups, intervention or control. To assess the effect of protein supplementation and exercise on the development of cardiac cachexia, data on various measures of muscle quality, cardiovascular health, mental status, and quality of life were collected and analyzed from the two groups at the beginning and end of the study period. RESULTS: More than 50% of those who were initially enrolled actually completed the 6-month study. While both groups showed some improvement in their study measures, the protein and exercise group showed a greater tendency to improve than the control group by the end of the six months. CONCLUSION: These findings suggest that with a larger cohort, this intervention may show significant positive effects for elderly patients who are at risk of developing cardiac cachexia.