Analysis of microbial diversity on deli slicers using polymerase chain reaction and denaturing gradient gel electrophoresis technologies.

Cross-contamination of pathogenic and spoilage bacteria from food-contact surfaces to food products is a serious public health issue. Bacteria may survive and attach to food-contact surfaces by residual food components and/or background bacteria which may subsequently transfer to other food products. Deli slicers, generally used for slicing ready-to-eat products, can serve as potential sources for considerable bacterial transfer. The objective of this study was to assess the extent and distribution of microbial diversity of deli slicers by identification of pathogenic and background bacteria. Slicer-swab samples were collected from restaurants in Arkansas and Texas in the United States. Ten surface areas for each slicer were swabbed using sterile sponges. Denaturing gradient gel electrophoresis (DGGE) was applied to investigate the fingerprint of samples, and each band was further identified by sequence analysis. Pseudomonads were identified as the dominant bacteria followed by Enterobacteriaceae family, and lactic acid bacteria such as Lactococcus lactis and Streptococcus thermophilus were also found. Bacterial distribution was similar for all surface areas, while the blade guard exhibited the greatest diversity. This study provides a profile of the microbial ecology of slicers using DGGE to develop more specific sanitation practices and to reduce cross-contamination during slicing.

Role delineation study of pediatric nurse practitioners: a national study of practice responsibilities and trends in role functions.

INTRODUCTION: This study explored the current practice responsibilities of pediatric nurse practitioners (PNPs) from a national perspective Educational preparation, geographic region of practice, years of employment as a PNP, type of employment setting, and full-time versus part-time employment were examined. METHOD: From a randomly selected sample (N = 997), a total of 387 respondents returned their questionnaire, resulting in 325 usable questionnaires. RESULTS: Years of experience as a PNP, setting of employment, geographic region, prescriptive authority, and subspecialty practice were significantly related to various health supervision and illness-focused activities performed by PNPs, as well as level of management responsibility. Anticipatory guidance supervision continues to be an integral part of the PNP role. PNPs report that they assume major responsibility for the health assessment and management of children with common pediatric illnesses as well as chronic illnesses and conditions. DISCUSSION: The ability to prescribe prescription medications produced the greatest overall effect on PNP role activities and level of management responsibility. Years of experience exerted an interesting effect on role functions related to the overall health supervision and illness-focused activities in which PNPs engaged. Implications for the educational preparation of PNPs, the updating of national certification examinations, and planning for adequate numbers in the workforce to replace the cohort of retiring PNPs in the next 20 years are discussed.

Analysis of the analgesic efficacy and cost-effective use of long-acting local anesthetics in outpatient third molar surgery.

Bupivacaine hydrochloride, an amide-type of long-acting local anesthetic was compared with lidocaine hydrochloride to determine its analgesic efficacy and its cost-effective use in an oral and maxillofacial surgery private practice. The results show that 0.5% bupivacaine hydrochloride provides greater analgesia than 2% lidocaine, with an insignificant cost increase to the operating surgeon.

Malignant peripheral nerve sheath tumors (malignant schwannomas) in children.

We studied the clinical and pathologic features of 78 malignant peripheral nerve sheath tumors in children less than or equal to 15 years of age. There were 42 boys and 36 girls, with a median age of 10 years. The majority of the tumors (42, or 54%) were central or axial in location; the rest were peripheral. Sixteen patients (21%) had a history of von Recklinghausen's disease. Fourteen (18%) had a malignant peripheral nerve sheath tumor arising in a nerve trunk or a neurofibroma and were unassociated with von Recklinghausen's disease. Patients typically presented with a painful mass of variable duration. Tumors ranged from 2 to 33 cm (median, 7.5 cm) and demonstrated a wide histologic spectrum that included spindled, epithelioid, and primitive neuroepithelial-like cells as well as heterologous elements (11). Immunohistochemical staining revealed S-100 protein in 28 of 50 cases (56%) as well as vimentin (13 of 21 cases, or 62%), Leu 7 (22 of 49 cases, or 45%), actin (eight of 20 cases, or 40%), and keratin (seven of 27 cases, or 26%). Survival status was known for 57 patients (73%). Kaplan-Meier estimates revealed a median survival of 45 months. Half of the patients had local recurrences at 12 months, and half had metastases at 24 months, most commonly to lungs, followed by lymph nodes, liver, bone, soft tissue, and brain. Age greater than or equal to 7 years, male sex, presence of von Recklinghausen's disease, central location, larger tumor size, and tumors with greater than or equal to 25% necrosis were found to be potentially significant adverse prognostic indicators by univariate analysis. Multivariate analysis revealed that larger tumor size, age greater than or equal to 7 years, tumor necrosis greater than or equal to 25%, and von Recklinghausen's disease to be independent adverse prognostic factors.

Intra-arterial reserpine for Raynaud's syndrome. Systemic reactions without therapeutic benefit.

Twenty-four patients classified as having Raynaud's disease or Raynaud's phenomenon were given bilateral brachial artery injections of reserpine or saline in a double-blind fashion. In the six weeks following injection, there was no indication that reserpine produced clinical improvement or changed vasomotor reactivity in the treated patients. However, intra-arterial reserpine did produce systemic cardiovascular effects lasting up to six weeks. It is concluded that intra-arterial reserpine as used in this study is an ineffective treatment for Raynaud's disease or Raynaud's phenomenon and may have significant adverse effects.

Comparison of four provocative tests for the diagnosis of gastrinoma.

In an attempt to determine the best provocative test for the diagnosis of gastrinoma, ten normal subjects, 13 patients with known gastrinoma, and one patient with presumed gastrinoma were administered four regimens: (1) rapid calcium infusion (2 mg Ca++/kg/min), (2) secretin (2 clinical units (CU)/kg/bolus), (3) long calcium infusion (12 mg Ca++/kg/3 h) and (4) a combination test consisting of a rapid calcium infusion followed immediately by secretin. Blood was drawn for serum gastrin levels before and following infusion of the test agents. The administration of rapid calcium followed by secretin provoked the greatest increases in serum gastrin above basal levels in both normals (29%) and patients (362%). Peak gastrin levels in patients were similar following the long calcium infusion (341%) but were less following the rapid calcium infusion alone (124%) and secretin alone (207%). There were no false-positive or false-negative tests with the calcium plus secretin when the criterion for diagnosis was either a 50% increase or a 200 pg/ml increase above the basal gastrin level. The distinct advantages (short test period, low patient morbidity, and relatively great potency) of the calcium plus secretin test make it an attractive alternative to other previously described provocative tests for the diagnosis of gastrinoma.