The use of multiple hypothesis-generating methods in an outbreak investigation of Escherichia coli O121 infections associated with wheat flour, Canada 2016-2017.

A Canadian outbreak investigation into a cluster of Escherichia coli O121 was initiated in late 2016. When initial interviews using a closed-ended hypothesis-generating questionnaire did not point to a common source, cases were centrally re-interviewed using an open-ended approach. The open-ended interviews led cases to describe exposures with greater specificity, as well as food preparation activities. Data collected supported hypothesis generation, particularly with respect to flour exposures. In March 2017, an open sample of Brand X flour from a case home, and a closed sample collected at retail of the same brand and production date, tested positive for the outbreak strain of E. coli O121. In total, 76% (16/21) of cases reported that they used or probably used Brand X flour or that it was used or probably was used in the home during their exposure period. Crucial hypothesis-generating techniques used during the course of the investigation included a centralised open-ended interviewing approach and product sampling from case homes. This was the first outbreak investigation in Canada to identify flour as the source of infection.

Salmonella Thompson outbreak associated with consumption of chicken shawarma and the usefulness of genome sequencing in the investigation.

BACKGROUND: A sudden increase in Salmonella Thompson (S. Thompson) cases distributed throughout three border regions in the province of Quebec in November 2016 triggered a provincial investigation to identify a common source of contamination and to put the appropriate control measures into place. OBJECTIVE: To report on the outbreak and to describe the use of genomic sequencing to identify the salmonella serotype responsible. METHODS: A descriptive survey of all reported cases of Salmonella serogroup C1 that had occurred between October 1, 2016 and February 15, 2017 was conducted. A case definition was developed. Pulsed field gel electrophoresis supplemented by analyses of genome sequences using the single nucleotide variant phylogenomics method were used to demarcate and manage the outbreak. RESULTS: Eighteen cases of S. Thompson were identified through whole genome sequencing. The onset dates of symptoms for the 16 cases that presented enteric symptoms were November 21-December 2, 2016. Two cases that presented with atypical symptoms were not reported until February 2017. Among the 18 cases, 16 had eaten or probably eaten chicken shawarma at the same restaurant chain and nine of these cases ate it at the same restaurant. In total, five restaurants from this chain, spread throughout three border regions of Quebec, were identified. CONCLUSION: Outbreaks associated with chicken shawarma have been identified in the past. Efforts must be made to ensure that the owners of this type of restaurant know the contamination risk associated with this type of cooking and take the necessary steps to reduce this risk. The use of the genome sequencing method was very useful in defining the outbreak.

Influence of aerobic exercise training on the neural correlates of motor learning in Parkinson's disease individuals.

BACKGROUND: Aerobic exercise training (AET) has been shown to provide general health benefits, and to improve motor behaviours in particular, in individuals with Parkinson's disease (PD). However, the influence of AET on their motor learning capacities, as well as the change in neural substrates mediating this effect remains to be explored. OBJECTIVE: In the current study, we employed functional Magnetic Resonance Imaging (fMRI) to assess the effect of a 3-month AET program on the neural correlates of implicit motor sequence learning (MSL). METHODS: 20 healthy controls (HC) and 19 early PD individuals participated in a supervised, high-intensity, stationary recumbent bike training program (3 times/week for 12 weeks). Exercise prescription started at 20 min (+ 5 min/week up to 40 min) based on participant's maximal aerobic power. Before and after the AET program, participants' brain was scanned while performing an implicit version of the serial reaction time task. RESULTS: Brain data revealed pre-post MSL-related increases in functional activity in the hippocampus, striatum and cerebellum in PD patients, as well as in the striatum in HC individuals. Importantly, the functional brain changes in PD individuals correlated with changes in aerobic fitness: a positive relationship was found with increased activity in the hippocampus and striatum, while a negative relationship was observed with the cerebellar activity. CONCLUSION: Our results reveal, for the first time, that exercise training produces functional changes in known motor learning related brain structures that are consistent with improved behavioural performance observed in PD patients. As such, AET can be a valuable non-pharmacological intervention to promote, not only physical fitness in early PD, but also better motor learning capacity useful in day-to-day activities through increased plasticity in motor related structures.

Enhancing both motor and cognitive functioning in Parkinson's disease: Aerobic exercise as a rehabilitative intervention.

BACKGROUND: Aerobic exercise training (AET) has been shown to provide health benefits in individuals with Parkinson's disease (PD). However, it is yet unknown to what extent AET also improves cognitive and procedural learning capacities, which ensure an optimal daily functioning. OBJECTIVE: In the current study, we assessed the effects of a 3-month AET program on executive functions (EF), implicit motor sequence learning (MSL) capacity, as well as on different health-related outcome indicators. METHODS: Twenty healthy controls (HC) and 19 early PD individuals participated in a supervised, high-intensity, stationary recumbent bike-training program (3 times/week for 12 weeks). Exercise prescription started at 20 min (+5 min/week up to 40 min) based on participant's maximal aerobic power. Before and after AET, EF tests assessed participants' inhibition and flexibility functions, whereas implicit MSL capacity was evaluated using a version of the Serial Reaction Time Task. RESULTS: The AET program was effective as indicated by significant improvement in aerobic capacity in all participants. Most importantly, AET improved inhibition but not flexibility, and motor learning skill, in both groups. CONCLUSION: Our results suggest that AET can be a valuable non-pharmacological intervention to promote physical fitness in early PD, but also better cognitive and procedural functioning.

Qualitative representation of trends: an alternative approach to process diagnosis and control.

The potential for qualitative representation of trends in the context of process diagnosis and control is evaluated in this paper. The technique for qualitative description of the data series is relatively new to the field of process monitoring and diagnosis and is based on the cubic spline wavelet decomposition of the data. It is shown that the assessed qualitative description of trends can be coupled easily with existing process knowledge and does not demand the user to understand the underlying technique in detail, in contrast to, for instance, multivariate techniques in Statistical Process Control. The assessed links can be integrated straightforwardly into the framework of supervisory control systems by means of look-up tables, expert systems or case-based reasoning frameworks. This in turn allows the design of a supervisory control system leading to fully automated control actions. The technique is illustrated by an application to a pilot-scale SBR.

Comparison of two wavelet-based tools for data mining of urban water networks time series.

In this paper, two approaches to data mining of time series have been tested and compared. Both methods are based on the wavelet decomposition of data series and allow the localization of important characteristics of a time series in both the time and frequency domain. The first method is a common method based on the analysis of wavelet power spectra. The second approach is new to the applied field of urban water networks and provides a qualitative description of the data series based on the cubic spline wavelet decomposition of the data. It is shown that wavelet power spectra indicate important and basic characteristics of the data but fail to provide detailed information of the underlying phenomena. In contrast, the second method allows the extraction of more and more detailed information that is important in a context of process monitoring and diagnosis.

cAMP protection of pancreatic cancer cells against apoptosis induced by ERK inhibition.

Large increases in cAMP concentration inside the cell are generally growth inhibitory for most cell lines of mesenchymal and epithelial origin. Moreover, recent data suggest a role of cAMP in survival of different cell types. Herein, the ability of forskolin (an adenylyl cyclase activator) and IBMX (3-isobutyl-1-methylxanthine) (a phosphodiesterase inhibitor) to modulate cell cycle progression and survival of human pancreatic cancer cells was evaluated. We showed that forskolin + IBMX inhibited serum-induced ERK activities, Rb hyperphosphorylation, Cdk2 activity, and p27(Kip1) downregulation and caused G1 arrest in MIA PaCa-2 cells. Furthermore, forskolin + IBMX protected pancreatic cells against apoptosis induced by prolonged inhibition of ERK activities by preventing Bcl-X(L) downregulation, activation of caspases 3, 6, 8, and 9, and PARP cleavage and by inducing Bad phosphorylation (ser112). Taken together, our data demonstrate for the first time that cAMP is an inhibitor of cell cycle progression and apoptosis in human pancreatic cancer cells.

Are consumers of modern fertility treatments satisfied?

OBJECTIVE: To determine the extent of patients satisfaction with fertility treatments, its antecedents, and its correlates. DESIGN: This is a two-wave correlational panel study in which consumer satisfaction was assessed 6 and 12 months after admission to the clinic. PATIENTS: The sample consisted of 385 couples who consulted the fertility clinic of a large metropolitan hospital. MEASURES: After their admission, patients completed scales measuring psychosocial disturbances. These variables were reassessed 6 and 12 months later along with a consumer satisfaction questionnaire. RESULTS: Patients were generally satisfied with modern fertility treatments. Approximately 10% of the sample expressed dissatisfaction with received services. Analyses revealed that consumer satisfaction was significantly related to poor psychosocial functioning at intake and after 6 months. CONCLUSIONS: Our results suggest that consumers of fertility treatments are generally satisfied with the quality and quantity of service they received at the clinic. The more patients exhibited personal, marital, and social symptoms of distress when they were admitted to the clinic, the more they were likely to be later dissatisfied with fertility treatments.

Impact of a second insemination on the results of an in vitro fertilization-embryo transfer (IVF-ET) program.

In an attempt to increase the fertilization and pregnancy rates in our program, a second insemination was carried out when the first insemination yielded fewer than two fertilized oocytes. One hundred eighty consecutive patients were studied retrospectively and thirty-four required second insemination, 35% of them by donor semen. Fifty-five and nine-tenths percent of the patients had at least one fertilized oocyte for embryo transfer, but only 21.9% of the oocytes exposed to a second insemination were fertilized. No pregnancy resulted from the transfer of oocytes fertilized by the second insemination. There were no significant correlations between the success of fertilization after a second insemination and the number of oocytes retrieved, the protocol for the induction of superovulation, or the age of the female patient. Considering that the first insemination was done at a variable time after oocyte retrieval to allow oocyte maturation, we expected all oocytes to be mature at the time of first insemination and we considered the possibility of delayed fertilization as negligible since second insemination was done at least 24-30 hr after oocyte retrieval. Even though a second insemination provides further hope for the patient, by yielding additional fertilized oocytes for embryo transfer, its main value is that it may provide additional information about male fertility.

Psychosocial distress and infertility: men and women respond differently.

The purpose of this study was to evaluate gender differences in psychosocial responses of 449 consecutive first-admission couples in a fertility clinic. Consistent with previous research, infertile women showed higher distress than their partners on a global measure of psychiatric symptoms and subscales of anxiety, depression, hostility, and cognitive disturbances, as well as on measures of stress and self-esteem. When compared with same-sexed population norms on the measure of psychiatric symptoms, both male and female infertile patients were significantly more distressed than average. No evidence was found for unusually high levels of marital or sexual distress at intake. Implications of results for clinical management are explored.

[The psychosocial profile of couples consulting a fertility clinic]. / Le profil psychosocial de couples consultant à une clinique de fertilité.

The objective of this study is to draw the psychosocial profile of couples who consult fertility clinics. More specifically, it consists of a) comparing the psychosocial status of subjects who seek fertility consultation with that of normal subjects or individuals at grips with psychological problems; b) determining whether there are profile differences between men and women who seek fertility consultation; and c) assessing whether it is possible to predict the nature of the psychosocial profile of the subjects from various sociodemographic and medical characteristics. The sampling includes 30 couples who are consulting a specialist in a fertility clinic belonging to a Montréal-area hospital. Analysis of results shows that the psychosocial profile of subjects consulting a fertility clinic is midway between that or normal subjects and that of individuals suffering of psychological problems. The psychological status of men and women consulting a fertility clinic is different according to three variables: depression, self-esteem and stress. Finally, multiple regression analysis has allowed the author to identify several medical characteristics linked to the extent of the psychosocial difficulties experienced by the infertile subjects.

Protein synthesis and acrosome reaction-inducing activity of human cumulus cells.

The acrosome reaction of human spermatozoa is a prerequisite to fertilization. It has been hypothesized that secretions of cumulus cells could be involved in the induction of this sperm reaction. A source of variation in the in-vitro fertilization of human oocytes could be the maturational differences in the cumulus cells which affect the acrosome reaction. In order to investigate this possibility, we have studied the capability of secretions obtained from cumulus cells of different maturational stages to induce the acrosome reaction. Capacitated spermatozoa were exposed to the culture medium containing cumulus cell secretions and their acrosomal status was evaluated using the triple stain technique. The maturational status of the cumulus or fertilization of the enclosed oocyte did not influence the percentage of acrosome-reacted live spermatozoa. In order to further document these observations, cumulus cells were submitted to [35S]methionine incorporation and total and secreted proteins were analysed by SDS-PAGE electrophoresis. Neither quantitative nor qualitative changes were detected in the electrophoretic patterns of the proteins obtained from cumulus cells of different maturational status. Thus, variation of the acrosome reaction-inducing activity of cumulus cells does not appear to be involved in the variable fertilization of oocytes obtained from follicles of differing maturity.

Qualitative changes in protein synthesis associated with polyspermic fertilization of human eggs.

To investigate the early molecular events in human oocytes that are triggered by fertilization, the authors examined the pattern of polypeptides synthesized by unfertilized and dispermic embryos obtained through an in vitro fertilization and embryo transfer (IVF-ET) program. Compared with unfertilized oocytes of the same postovulatory age, the de novo protein synthesis in tripronuclear dispermic zygotes (21 hours postinsemination) was characterized by the appearance of three novel protein bands with molecular weights of 41.2, 35.3, and 26.0 kD. Concomitant with these changes, these zygotes showed the disappearance of bands at 54.0, 36.5, and 28.0 kD, along with the decreased synthesis of a protein band at 42.5 kD. Although 24% of the aged unfertilized oocytes exhibited bands corresponding to 41.2 and 35.3 kD, the 26.0 kD protein is restricted to the tripronuclear embryos. The significance of these results is discussed in relation to the use of polyspermic human oocytes as a model for the study of the early molecular events triggered by fertilization.

Profile of women who request reversal of tubal sterilization: comparison with a randomly selected control group.

The characteristics of 96 women who requested reversal of tubal ligation at two fertility clinics in Montreal were compared with those of 403 randomly selected sterilized women in Quebec. The two groups were found to have a similar socioeconomic profile. In only two respects were the groups significantly different: the women who requested reversal generally had been sterilized at an earlier age and had more complex marital histories.

Bromocriptine mesylate for prevention of postpartum lactation.

The efficacy and safety of bromocriptine mesylate in preventing postpartum breast engorgement and milk secretion were evaluated in 420 normal puerperal women. The usual dose was 2.5 mg twice a day for 14 days. Complete inhibition of the target symptoms was obtained in 97% (409 of 420) of the women after 5 days of therapy. Of 370 women who completed 14 days of therapy, 73.5% (272) were completely symptom free, and the remainder showed only grade I or grade II breast engorgement and secretion. Side effects, primarily nausea, vomiting, and dizziness, were experienced by 3% of the women, and 7% reported rebound engorgement and secretion. It was concluded that bromocriptine is safe and efficacious for the stated indication. Moreover, bromocriptine's apparent lack of thromboembolic complications and low incidence of rebound effects suggest possible advantages over other pharmacologic preparations, ie, estrogen-containing drugs, currently used to prevent postpartum lactation.