Genomic Diversity, Competition, and Toxin Production by Group I and II Clostridium botulinum Strains Used in Food Challenge Studies.

Botulinum neurotoxins (BoNTs) produced by the bacteria Clostridium botulinum are the causative agent of human and animal botulism, a rare but serious and potentially deadly intoxication. Foodborne botulism is caused by the consumption of foods containing BoNTs, which results from contamination of foods with C. botulinum spores and toxin production by the bacteria during growth within the food. Validation of the safety of food products is essential in preventing foodborne botulism, however, limited guidance and standards exist for the selection of strains used in C. botulinum food challenge studies. Sequencing and genomics studies have revealed that C. botulinum is a large, diverse, and polyphyletic species, with physiologic and growth characteristics studied only in a few representatives. Little is known about potential growth competition or effects on toxin production between C. botulinum strains. In this study, we investigated an applied cocktail of ten C. botulinum strains, seven Group I and three Group II. Whole genome SNP alignments revealed that this strain cocktail encompasses the major clades of the Group I and II C. botulinum species. While growth competition appears to exist between several of the strains, the cocktail as a whole resulted in high levels of BoNT production.

Outcomes of motor vehicle crashes with fracture: a pilot study of early rehabilitation interventions.

AIM: To determine the effects of early rehabilitation interventions on the physical, psychological and vocational outcomes of patients presenting to the Emergency Department with fracture resulting from a motor vehicle crash. METHOD: Prospective non-randomized cohort controlled trial. Seventy-six subjects were enrolled and formed 2 groups. The control group received usual care, and the intervention group received a consultation with a rehabilitation physician and was offered pain management, physiotherapy, psychological treatment and further specialist referrals if indicated. The battery of outcome measures covering pain, psychological assessment, return to work and return to driving was performed at the same time intervals for both cohorts. RESULTS: Significant (p < 0.05) improvement was seen in pain levels at 12 weeks in the intervention group compared to control group. The intervention group showed a significantly better rate of return to normal work compared to the control group. CONCLUSIONS: Early proactive rehabilitation can benefit patients with fractures resulting from motor vehicle crashes. This pilot study suggests the need for further investigation of the recovery from fractures among such patients.

Orthopaedic trauma from road crashes: is enough being done?

A file review of patients presenting to the Emergency Department of St Vincent's Hospital with fractures sustained in a road crash was completed to describe patterns of orthopaedic injury, acute intervention and separation as well as the cost of care for adult road crash victims. One-hundred and eighty-seven patients were included. 65.8% were male; 48.1% were pedestrians. Differing patterns of injury corresponded to the role of the patient in the road crash (eg, pedestrian, driver of vehicle, etc). The mean length of stay was 8.8 days. 35.2% of patients were prescribed a different analgesic at discharge to that which they had received in the previous 24 hours. 35.8% had a documented discussion regarding insurance matters, usually with a social worker. 11.9% were discharged to inpatient rehabilitation. 56.2% had orthopaedic follow-up arranged at discharge, while 4.8% were discharged to an outpatient rehabilitation clinic. The mean overall cost was $13 336, with patients aged over 65 costing the most. The quality of acute care for fractures sustained in road crashes could be improved with evidence-based analgesia management, increased screening for psychiatric sequelae, enhanced assistance with insurance matters and vocational issues, and closer follow-up. Further research into the impact of these factors on long-term recovery is warranted.