The utility of cardiac-gated computed tomography in diagnosing a reverse patent ductus arteriosus in a dog with a concurrent intracardiac right-to-left shunt.

A five-month-old male intact Goldendoodle presented for evaluation for peripheral cyanosis following exercise. Transthoracic echocardiography demonstrated severe right ventricular wall thickening and right atrial dilation secondary to pulmonary hypertension. An agitated saline contrast study demonstrated an interatrial right-to-left shunt. Cardiac-gated computed tomography confirmed a reverse patent ductus arteriosus. This case report highlights the utility of cardiac-gated computed tomography in identifying multi-level intra- and extra-cardiac shunts.

700,000 years of tropical Andean glaciation.

Our understanding of the climatic teleconnections that drove ice-age cycles has been limited by a paucity of well-dated tropical records of glaciation that span several glacial-interglacial intervals. Glacial deposits offer discrete snapshots of glacier extent but cannot provide the continuous records required for detailed interhemispheric comparisons. By contrast, lakes located within glaciated catchments can provide continuous archives of upstream glacial activity, but few such records extend beyond the last glacial cycle. Here a piston core from Lake Junín in the uppermost Amazon basin provides the first, to our knowledge, continuous, independently dated archive of tropical glaciation spanning 700,000 years. We find that tropical glaciers tracked changes in global ice volume and followed a clear approximately 100,000-year periodicity. An enhancement in the extent of tropical Andean glaciers relative to global ice volume occurred between 200,000 and 400,000 years ago, during sustained intervals of regionally elevated hydrologic balance that modified the regular approximately 23,000-year pacing of monsoon-driven precipitation. Millennial-scale variations in the extent of tropical Andean glaciers during the last glacial cycle were driven by variations in regional monsoon strength that were linked to temperature perturbations in Greenland ice cores1; these interhemispheric connections may have existed during previous glacial cycles.

A participatory method for prioritizing invasive species: Ranking threats to Minnesota's terrestrial ecosystems.

Terrestrial invasive species threaten the integrity of diverse and highly-valued ecosystems. The Minnesota Invasive Terrestrial Plants and Pests Center (MITPPC) was established by the state of Minnesota to fund research projects aimed at minimizing harms posed by the most threatening terrestrial invasive species to the state's prairies, wetlands, forests, and agriculture. MITPPC used the Analytic Hierarchy Process (AHP) to identify and prioritize diverse invasive species threats. We describe how MITPPC tailored AHP to establish its research priorities and highlight major outcomes and challenges with our approach. We found that subject matter experts considered factors associated with the severity of impact from invasion, rather than the potential for invasion, to be the greatest contributors in identifying the most threatening species. Specifically, out of the 17 total criteria identified by the experts to rank species, negative environmental impact was the most influential threat criterion. Currently, narrowleaf cattail, mountain pine beetle, and the causative agent of Dutch elm disease are top threats to Minnesota terrestrial ecosystems. AHP does not handle data-poor situations well; however, it allows for easy incorporation of new information over time for a species without undoing the original framework. The MITPPC prioritization has encouraged interdisciplinary, cross-project synergy among its research projects. Such outcomes, coupled with the transparent and evidence-based decision structure, strengthen the credibility of MITPPC activities with many stakeholders.

Application of optical technologies in the US poultry slaughter facilities for the detection of poultry carcase condemnation.

1. This article reviews the studies on optical technologies for automated poultry carcase inspection, discusses challenges and potential solutions in their real-time applications in poultry slaughter facilities. 2. Over the past few decades, extensive research has been underway to develop an optical technology-based machine vision system for automated inspection of poultry carcases and viscera. Such an automated technology will not only aid in carcase inspection to maximise food safety, but it will also support the U.S. New Poultry Inspection System's aim to foster innovation in poultry processing as well as increase line speed. 3. Many earlier studies based on visible and near-infrared spectroscopy showed promise, but could not be implemented successfully in an on-line poultry processing plant. Currently, multi- and hyper-spectral imaging-based machine vision systems have shown promising outcomes. 5. The critical hurdles for real-time application of automated imaging technology in poultry carcase inspection include high-speed processing lines, slaughter facilities environment and variation in broiler rearing practices. Therefore, further improvement in imaging and machine vision technologies based on physiochemical properties on poultry carcases, the establishment of more technology friendly inspection station, and an integrated data management for different rearing practices are essential to overcome those hurdles.

Anxiety disorders comorbidity in pediatric bipolar disorder: a meta-analysis and meta-regression study.

OBJECTIVE: Anxiety disorders (AD) are known for its comorbidity and negative impact on the course of adult bipolar disorder (BD). However, there is limited research on AD comorbidity in pediatric BD (PBD). Here, we aimed to conduct a meta-analysis and meta-regression study about the comorbidity and covariates of AD and PBD. METHOD: We systematically searched relevant articles published until May 2019, as defined in PRISMA guidelines. Variables for associated features and prevalence of AD were extracted. RESULTS: Thirty-seven articles represented data for the analysis. Lifetime any AD comorbidity was 44.7%; panic disorder (PD) was 12.7%; generalized anxiety disorder (GAD) was 27.4%; social phobia was 20.1%; separation anxiety disorder (SAD) was 26.1%; and obsessive-compulsive disorder (OCD) was 16.7%. Childhood-onset studies reported higher GAD and SAD comorbidity, while adolescent-onset studies reported higher PD, OCD, and social phobia. Age of onset, gender, comorbidity of ADHD, substance use, oppositional defiant disorder and conduct disorder affected each anxiety disorders' comorbidity with PBD differently. CONCLUSION: Anxiety disorders are highly comorbid with PBD. Early-onset PBD increases the risk of AD. Biopsychosocial aspects of this comorbidity and its course needs to be evaluated further.

Efficacy of neutralizing buffered peptone water for recovery of Salmonella, Campylobacter, and Enterobacteriaceae from broiler carcasses at various points along a commercial immersion chilling process with peroxyacetic acid.

In 2016, USDA-Food Safety and Inspection Service began using a neutralizing buffered peptone water (nBPW) to rinse broiler carcasses for Salmonella and Campylobacter performance standard testing. The nBPW contains standard buffered peptone water (BPW) with compounds to neutralize residual antimicrobials that may be transferred from the carcass to the sample rinsate. However, a direct comparison of nBPW and BPW on carcasses commercially treated with antimicrobials has not been conducted. On 3 replicate days in a commercial broiler processing plant, an immersion chilling biomap using whole carcass rinse samples taken prior to any chilling treatment (30), after pre-chill treatment (30), after primary chill (30), after secondary chill (30), after post-chill treatment (50), and after post-chill treatment without the pre-chill treatment (49) were tested. Carcasses were rinsed with either BPW (without neutralizer) or nBPW. Rinsates were sampled for Salmonella and Campylobacter prevalence and both Enterobacteriaceae (EB) prevalence and counts. No significant differences were observed between sampling sites or rinse media for Salmonella due to an overall low prevalence (4 positive/219 samples). Campylobacter prevalence significantly decreased from prior to chilling (93%) to after all chilling steps (47%) as anticipated (P < 0.0001); however, overall significantly fewer Campylobacter positive carcasses were detected when nBPW was used (55%) in comparison to BPW (70%, P = 0.0258). Both EB prevalence and counts significantly decreased (both P < 0.0001) from prior to chilling (100%, 2.35 log10 CFU/mL) through after all chilling steps (52%, 0.47 log10 CFU/mL). The use of nBPW versus BPW did not impact EB prevalence; however, samples rinsed with nBPW had significantly higher overall counts (1.26 vs. 1.00 log10 CFU/mL, P = 0.0134). The results from this study indicate that the use of a PAA pre-chill treatment did not significantly impact bacteria recovery following all chilling steps. The use of nBPW was effective in neutralizing residual PAA in carcass rinsates when sampling for EB counts; however, nBPW may lessen the ability to detect Campylobacter in these same samples.

Plasmapheresis for Management of Antiphospholipid Syndrome in the Neurosurgical Patient.

BACKGROUND AND IMPORTANCE: Antiphospholipid syndrome (APS) is an autoimmune disorder associated with a hypercoagulable state and increased risk of intraoperative and postoperative thrombosis. Few neurosurgical studies have examined the management of these patients, though the standard of care in most other disciplines involves the use of anticoagulation therapy. However, this is associated with risks such as hemorrhage, thrombosis due to warfarin withdrawal, and is not compatible with operative intervention. CLINICAL PRESENTATION: We report the cases of 2 antiphospholipid positive patients who were on anticoagulant therapy and underwent surgical bypasses and received perioperative management with plasmapheresis. The first was a 44-yr-old woman who presented with worsening vision, recurring headaches, and a known left internal carotid artery aneurysm that was unsuccessfully treated twice via extracranial to intracranial (ECIC) bypass at another institution. Preoperative tests at our institution revealed elevated beta 2 glycoprotein 1 IgA autoantibodies. The second case was a 24-yr-old woman with previously diagnosed APS, who presented for surgical evaluation of moyamoya disease after sustaining recurrent left hemispheric strokes. Both cases were managed with perioperative plasmapheresis to avoid the need for anticoagulation during the perioperative period, and both underwent successful ECIC bypass procedures without perioperative ischemic or hemorrhagic complications. CONCLUSION: Management of neurosurgical patients with APS can be a precarious proposition. We describe the successful use of plasmapheresis and antiplatelet therapy to better manage patients undergoing neurosurgical procedures, specifically ECIC bypass, and feel this approach can be considered in future cases.

Extended Experience with High Submuscular Placement of Urological Prosthetic Balloons and Reservoirs: Refined Technique for Optimal Outcomes.

INTRODUCTION: Since 2012, we have routinely placed urological prosthetic balloons and reservoirs in a high submuscular location between the transversalis fascia and rectus abdominis muscle during inflatable penile prosthesis and artificial urinary sphincter surgery. We review our experience of more than 600 high submuscular cases, describe refinements in our technique through time and compare outcomes to prior consecutive space of Retzius prosthetic cases. METHODS: We retrospectively reviewed patients who underwent inflatable penile prosthesis and/or artificial urinary sphincter placement between January 2009 and April 2016. Complications and need for surgical revision were recorded and compared between the 2 placement locations. RESULTS: During the study period 872 prosthetic cases were performed, including 619 high submuscular cases from 2012 to 2016 (inflatable penile prosthesis in 344, artificial urinary sphincter in 275). Of 399 first-time high submuscular implants 54 (14%) required revision, of which 8 (2%) were attributable to the urological balloon or reservoir due to "pain/bother" (4) or herniation (4). Of the 161 space of Retzius urological balloons and reservoirs placed from 2009 to 2011 a similar rate of herniation (3 cases, 1.9%) was noted, although higher rates of deep pelvic complications (3, 1.9%) were noted compared to high submuscular cases (2, 0.5%; p=0.14). Since implementing our refined high submuscular technique, no deep pelvic complications have occurred. CONCLUSIONS: Experience with high submuscular placement of urological balloons and reservoirs confirms that it is safe and well tolerated. With refinements in technique the complication rates are similar in frequency to those with space of Retzius but appear to be minor in nature with negligible risk of visceral or vascular injury.

Effect of Using 2mm Voxels on Observer Performance for PET Lesion Detection.

Positron emission tomography (PET) images are typically reconstructed with an in-plane pixel size of approximately 4mm for cancer imaging. The objective of this work was to evaluate the effect of using smaller pixels on general oncologic lesion-detection. A series of observer studies was performed using experimental phantom data from the Utah PET Lesion Detection Database, which modeled whole-body FDG PET cancer imaging of a 92kg patient. The data comprised 24 scans over 4 days on a Biograph mCT time-of-flight (TOF) PET/CT scanner, with up to 23 lesions (diam. 6-16mm) distributed throughout the phantom each day. Images were reconstructed with 2.036mm and 4.073mm pixels using ordered-subsets expectation-maximization (OSEM) both with and without point spread function (PSF) modeling and TOF. Detection performance was assessed using the channelized non-prewhitened numerical observer with localization receiver operating characteristic (LROC) analysis. Tumor localization performance and the area under the LROC curve were then analyzed as functions of the pixel size. In all cases, the images with ~2mm pixels provided higher detection performance than those with ~4mm pixels. The degree of improvement from the smaller pixels was larger than that offered by PSF modeling for these data, and provided roughly half the benefit of using TOF. Key results were confirmed by two human observers, who read subsets of the test data. This study suggests that a significant improvement in tumor detection performance for PET can be attained by using smaller voxel sizes than commonly used at many centers. The primary drawback is a 4-fold increase in reconstruction time and data storage requirements.

Application of separable parameter space techniques to multi-tracer PET compartment modeling.

Multi-tracer positron emission tomography (PET) can image two or more tracers in a single scan, characterizing multiple aspects of biological functions to provide new insights into many diseases. The technique uses dynamic imaging, resulting in time-activity curves that contain contributions from each tracer present. The process of separating and recovering separate images and/or imaging measures for each tracer requires the application of kinetic constraints, which are most commonly applied by fitting parallel compartment models for all tracers. Such multi-tracer compartment modeling presents challenging nonlinear fits in multiple dimensions. This work extends separable parameter space kinetic modeling techniques, previously developed for fitting single-tracer compartment models, to fitting multi-tracer compartment models. The multi-tracer compartment model solution equations were reformulated to maximally separate the linear and nonlinear aspects of the fitting problem, and separable least-squares techniques were applied to effectively reduce the dimensionality of the nonlinear fit. The benefits of the approach are then explored through a number of illustrative examples, including characterization of separable parameter space multi-tracer objective functions and demonstration of exhaustive search fits which guarantee the true global minimum to within arbitrary search precision. Iterative gradient-descent algorithms using Levenberg-Marquardt were also tested, demonstrating improved fitting speed and robustness as compared to corresponding fits using conventional model formulations. The proposed technique overcomes many of the challenges in fitting simultaneous multi-tracer PET compartment models.

HER2 expression in oesophageal carcinoma and Barrett's oesophagus associated adenocarcinoma: An Australian study.

BACKGROUND: Several studies have evaluated the prognostic value of HER2 in oesophageal cancer, but the prognostic influence of HER2 overexpression in oesophageal cancer remains uncertain. The aim of this study was to assess the incidence of HER2 positivity and relationship with clinicopathological features in patients with oesophageal cancer. DESIGN: The study cohort consisted of 269 patients diagnosed with oesophageal carcinoma in a single institution. HER2 expression was analysed by immunohistochemistry (IHC) and silver in situ hybridization (SISH) in 152 archival oesophageal cancer specimens. Survival analysis was assessed using Hazard models. RESULTS: HER2 expression was IHC3+ in 14 (9.2%), IHC2+ in 14 (9.2%), IHC1+ in 57 (37.5%), and IHC0 in 67 (44.1%) cases. SISH results confirmed that 15 specimens (9.9%) were HER2 gene amplified. Among 27 squamous cell carcinomas (SCCs) only 3.7% were HER2 positive whereas 11.2% of 125 adenocarcinomas were HER2 positive. The HER2 positive tumours were more likely to occur in men (OR: 5.00, 95% CI: 1.69-14.29), smokers (OR: 10.00, 95% CI: 4.17-25) and in patients with Barrett's oesophagus (OR: 8.33, 95% CI: 3.71-20.00). There was no significant difference in survival between the (HER2 +ve, 14.3 months vs HER2 -ve, 24.6 months, p = 0.42) CONCLUSION: A HER2 prevalence rate of 9.9% was found among patients with oesophageal cancer and no correlation with survival was detected overall.

Age-Related Emergency Department Reliance in Patients with Sickle Cell Disease.

BACKGROUND: Emergency Department Reliance (EDR: total emergency department [ED] visits/total ambulatory [outpatient + ED] visits) differentiates acute episodic ED users from those who may not have adequate access to outpatient care. OBJECTIVE: This study's aim was to investigate age-related patterns of EDR and associated health-care costs in pediatric patients with sickle cell disease (SCD) and those transitioning from pediatric to adult care. METHODS: State Medicaid data were used for this study. Patients with two or more SCD diagnoses and one or more blood transfusion were included. Quarterly rates of ED visits, EDR, SCD complications associated with ED visits, and ED visits resulting in hospitalization were evaluated. Risk factors associated with high EDR and the association between high EDR and health-care costs were explored through regression analyses. RESULTS: A total of 3208 patients were included. The most common SCD complications associated with ED visits were pain, infection, and pneumonia. Beginning at the age of 15 years, EDR rose from 0.17 to 0.29 visits per quarter at age 22 years, and remained high throughout adulthood. Regression analyses indicated that patients were most likely to have high EDR during the post-transition period and when experiencing an SCD complication. Patients with high EDR incurred statistically significantly higher inpatient and ED costs, resulting in significantly higher total health-care costs. CONCLUSIONS: Compared to children, patients transitioning to adulthood relied more on the ED for their care. In addition, patients with high EDR incurred more days in the hospital and significantly higher health-care costs, highlighting the need to improve transition-related support, including better access to primary care and increased engagement with patients with SCD.

Effects of fluconazole treatment of mice infected with fluconazole-susceptible and -resistant Candida tropicalis on fungal cell surface hydrophobicity, adhesion and biofilm formation.

BACKGROUND: The incidence of Candida tropicalis less susceptible to fluconazole (FLC) has been reported in many parts of the world. OBJECTIVES: The aim of this study was to examine the changes of putative virulence attributes of Candida tropicalis accompanying the development of resistance to FLC in vitro and in vivo. MATERIALS AND METHODS: A FLC-resistant strain (FLC-R) was obtained after sequential exposure of a clinical isolate FLC-sensitive (FLC-S) to increasing concentrations of the antifungal. The course of infection by both strains was analyzed in BALB/c mice. Analyses of gene expression were performed by real-time polymerase chain reaction PCR. The cell surface hydrophobicity, adhesion and biofilm formation were also determined. RESULTS: Development of resistance to FLC could be observed after 15 days of subculture in azole-containing medium. Overexpression of MDR1 and ERG11 genes were observed in FLC-R, and this strain exhibited enhanced virulence in mice, as assessed by the mortality rate. All mice challenged with the FLC-R died and FLC-treatment caused earlier death in mice infected with this strain. All animals challenged with FLC-S survived the experiment, regardless of FLC-treatment. Overall, FLC-R derivatives strains were significantly more hydrophobic than FLC-S strains and showed greater adherence and higher capacity to form biofilm on polystyrene surface. CONCLUSIONS: The expression of virulence factors was higher in FLC-R-C. tropicalis and it was enhanced after FLC-exposure. These data alert us to the importance of identifying microorganisms that show resistance to the antifungals to establish an appropriate management of candidiasis therapy.

c-Myc and Her2 cooperate to drive a stem-like phenotype with poor prognosis in breast cancer.

The HER2 (ERBB2) and MYC genes are commonly amplified in breast cancer, yet little is known about their molecular and clinical interaction. Using a novel chimeric mammary transgenic approach and in vitro models, we demonstrate markedly increased self-renewal and tumour-propagating capability of cells transformed with Her2 and c-Myc. Coexpression of both oncoproteins in cultured cells led to the activation of a c-Myc transcriptional signature and acquisition of a self-renewing phenotype independent of an epithelial-mesenchymal transition programme or regulation of conventional cancer stem cell markers. Instead, Her2 and c-Myc cooperated to induce the expression of lipoprotein lipase, which was required for proliferation and self-renewal in vitro. HER2 and MYC were frequently coamplified in breast cancer, associated with aggressive clinical behaviour and poor outcome. Lastly, we show that in HER2(+) breast cancer patients receiving adjuvant chemotherapy (but not targeted anti-Her2 therapy), MYC amplification is associated with a poor outcome. These findings demonstrate the importance of molecular and cellular context in oncogenic transformation and acquisition of a malignant stem-like phenotype and have diagnostic and therapeutic consequences for the clinical management of HER2(+) breast cancer.

Exertional sickling: questions and controversy.

Sickle cell trait (SCT) occurs in about 8% of African-Americans and is often described to be of little clinical consequence. Over time, a number of risks have emerged, and among these are rare but catastrophic episodes of sudden death in athletes and other individuals associated with physical activities which is often described as exercise collapse associated with sickle trait (ECAST). Despite an epidemiologic link between SCT and sudden death as well as numerous case reports in both medical literature and lay press, no clear understanding of the key pathophysiologic events has been identified. Strategies for identification of individuals at risk and prevention of ECAST have been both elusive and controversial. Stakeholders have advocated for different approaches to this issue particularly with regard to screening for hemoglobin S. Furthermore, the recommendations and guidelines that are in place for the early recognition of ECAST and the prevention and treatment of the illness are not well defined and remain fragmented. Among the cases identified, those in collegiate football players in the United States are often highlighted. This manuscript examines these case studies and the current recommendations to identify areas of consensus and controversy regarding recommendations for prevention, recognition and treatment of ECAST.

Effect of varying number of OSEM subsets on PET lesion detectability.

UNLABELLED: Iterative reconstruction has become the standard for routine clinical PET imaging. However, iterative reconstruction is computationally expensive, especially for time-of-flight (TOF) data. Block-iterative algorithms such as ordered-subsets expectation maximization (OSEM) are commonly used to accelerate the reconstruction. There is a tradeoff between the number of subsets and reconstructed image quality. The objective of this work was to evaluate the effect of varying the number of OSEM subsets on lesion detection for general oncologic PET imaging. METHODS: Experimental phantom data were taken from the Utah PET Lesion Detection Database, modeling whole-body oncologic (18)F-FDG PET imaging of a 92-kg patient. The experiment consisted of 24 scans over 4 d on a TOF PET/CT scanner, with up to 23 lesions (diameter, 6-16 mm) distributed throughout the thorax, abdomen, and pelvis. Images were reconstructed with maximum-likelihood expectation maximization (MLEM) and with OSEM using 2-84 subsets. The reconstructions were repeated both with and without TOF. Localization receiver-operating-characteristic (LROC) analysis was applied using the channelized nonprewhitened observer. The observer was first used to optimize the number of iterations and smoothing filter for each case that maximized lesion-detection performance for these data; this was done to ensure that fair comparisons were made with each test case operating near its optimal performance. The probability of correct localization and the area under the LROC curve were then analyzed as functions of the number of subsets to characterize the effect of OSEM on lesion-detection performance. RESULTS: Compared with the baseline MLEM algorithm, lesion-detection performance with OSEM declined as the number of subsets increased. The decline was moderate out to about 12-14 subsets and then became progressively steeper as the number of subsets increased. Comparing TOF with non-TOF results, the magnitude of the performance drop was larger for TOF reconstructions. CONCLUSION: PET lesion-detection performance is degraded when OSEM is used with a large number of subsets. This loss of image quality can be controlled using a moderate number of subsets (e.g., 12-14 or fewer), retaining a large degree of acceleration while maintaining high image quality. The use of more aggressive subsetting can result in image quality degradations that offset the benefits of using TOF or longer scan times.

Successful orthotopic liver transplantation in an adult patient with sickle cell disease and review of the literature.

Sickle cell disease can lead to hepatic complications ranging from acute hepatic crises to chronic liver disease including intrahepatic cholestasis, and iron overload. Although uncommon, intrahepatic cholestasis may be severe and medical treatment of this complication is often ineffective. We report a case of a 37 year-old male patient with sickle cell anemia, who developed liver failure and underwent successful orthotopic liver transplantation. Both pre and post-operatively, he was maintained on red cell transfusions. He remains stable with improved liver function 42 months post transplant. The role for orthotopic liver transplantation is not well defined in patients with sickle cell disease, and the experience remains limited. Although considerable challenges of post-transplant graft complications remain, orthotopic liver transplantation should be considered as a treatment option for sickle cell disease patients with end-stage liver disease who have progressed despite conventional medical therapy. An extended period of red cell transfusion support may lessen the post-operative complications.

Age-related treatment patterns in sickle cell disease patients and the associated sickle cell complications and healthcare costs.

BACKGROUND: This study explored the blood transfusion patterns, SCD complications, utilization of iron chelation therapies (ICT), healthcare resource use, and costs in pediatric, transitioning (18 years old) and adult patients with SCD. PROCEDURE: Data from Florida (1998-2009), New Jersey (1996-2009), Missouri (1997-2010), Kansas (2001-2009), and Iowa (1998-2010) state Medicaid were used. Patients with ≥2 SCD diagnoses and ≥1 transfusion event were included. Rates of transfusion events, SCD complications, and proportion of eligible patients receiving ICT were calculated. ICT eligibility was defined as receiving ≥10 transfusions over lifetime. SCD complications included pain, pulmonary event, infection event, renal, cardiovascular, stroke, leg ulcers, and avascular necrosis. Regressions were used to assess risk factors for transfusion and identify the main drivers of costs. RESULTS: The sample included 3,208 patients. The transfusion rate increased from 1-year-old to a peak at 16 years old, then dropped until age 26 and remained stable thereafter. In contrast the frequency of diagnoses for SCD complications increased markedly after age 16. Post-transition patients (≥18 years old) were significantly associated with fewer transfusions (odds ratio: 0.80, P = 0.002). Among eligible patients for ICT, there was no statistically significant difference in total cost between the ICT and no ICT groups (adjusted cost difference, $136, P = 0.114). CONCLUSIONS: Patients transitioning to adult care received less transfusions and hydroxyurea, less ICT when eligible for chelation therapy, had higher healthcare costs and suffered from more frequent SCD related complications than pediatric patients. These findings highlight the changes in treatment patterns corresponding to transition to adult care.

Effect of liquid smoke as an ingredient in frankfurters on Listeria monocytogenes and quality attributes.

Market trends indicate an increased interest in natural antimicrobials to augment safety of ready-to-eat meat and poultry products against Listeria monocytogenes. Liquid smoke, an all-natural condensate of smoke components, applied as a postprocess treatment on product surface has the potential to exhibit antilisterial properties. Studies on its antimicrobial efficacy and quality attributes as an ingredient are not sufficient. A study was designed to validate the antimicrobial effect of liquid smoke as an ingredient against L. monocytogenes and its effect on the shelf life and quality of frankfurters. Chicken/pork frankfurters were incorporated with 0, 2.5, 5, and 10% liquid smoke (Zesti Smoke, Kerry Ingredients and Flavors, TN). Cooked casing-stripped frankfurters (4 per package) were placed in vacuum-pack bags, spray inoculated with either high (8 log(10) cfu/ mL) or low (4 log(10) cfu/ mL) levels of L. monocytogenes serotype 4b, vacuum packaged, and stored at 4°C for up to 12 wk. Samples were taken every week for 12 wk to estimate growth of L. monocytogenes and spoilage microflora (aerobic plate counts, yeast and molds, lactic acid bacteria, and total coliforms) and properties of sensory scores and texture profile analysis. The experiment was conducted as 3 separate trials and data was analyzed to find significant differences at P < 0.05. Formulation of frankfurters with smoke extract at 2.5, 5, and 10% reduced (P < 0.05) populations of L. monocytogenes as compared with the controls throughout the storage period irrespective of the inoculation levels. Furthermore, incorporation of smoke extract did not affect (P > 0.05) the texture, juiciness, flavor, and overall scores as well as hardness and chewiness of the frankfurters. Zesti Smoke can be effectively incorporated as an all-natural antimicrobial in the manufacture of frankfurters without negatively affecting quality attributes.