A qualitative analysis of interprofessional students' perceptions toward patients with opioid use disorder after a patient panel experience.

Background: Students from health professional schools participated in a half-day interprofessional education workshop centered on substance use disorder training. One component was a patient panel featuring individuals with a history of opioid use disorder who described the impact of addiction on their lives and their road to recovery using varied treatment options. We hypothesized that interacting with individuals with opioid use disorder early in training would elicit more humanistic perspectives and decrease bias and stigma in future health care professionals. Methods: After participating in the panel experience, health professional students (N = 580) from medicine, nursing, pharmacy, physical therapy, and social work were asked to complete short, 5-minute, rapid reflections. Prompts asked students whether the panel changed their perception of individuals with substance use disorder, to reflect on their attitudinal changes or lack thereof, and how working in interprofessional teams could impact the management and treatment of these patients. Conventional content analysis was performed. Results: Eighty-nine percent of students who attended the session completed the rapid reflections (n = 514). Overall, approximately 70% (n = 369) of students indicated that their perceptions of individuals with substance use disorder had changed as a result of the patient panel, with students from pharmacy more likely to indicate a change in attitudes. Themes across all professions included a change toward a more humanistic perspective, value of hearing real patient stories, and learning about treatment and recovery options. Student responses described how interprofessional health care teams can provide more holistic care with a broader range of therapeutic options that may improve long-term outcomes. Conclusions: A patient panel experience is influential on interprofessional students' attitudes toward patients who suffer from opioid use disorder. Students identified an interprofessional approach as being a valuable component of management and treatment of these patients.

Persistent Bacteremia from Pseudomonas aeruginosa with In Vitro Resistance to the Novel Antibiotics Ceftolozane-Tazobactam and Ceftazidime-Avibactam.

Ceftazidime-avibactam and ceftolozane-tazobactam are new antimicrobials with activity against multidrug-resistant Pseudomonas aeruginosa. We present the first case of persistent P. aeruginosa bacteremia with in vitro resistance to these novel antimicrobials. A 68-year-old man with newly diagnosed follicular lymphoma was admitted to the medical intensive care unit for sepsis and right lower extremity cellulitis. The patient was placed empirically on vancomycin and piperacillin-tazobactam. Blood cultures from Day 1 of hospitalization grew P. aeruginosa susceptible to piperacillin-tazobactam and cefepime identified using VITEK 2 (Biomerieux, Lenexa, KS). Repeat blood cultures from Day 5 grew P. aeruginosa resistant to all cephalosporins, as well as to meropenem by Day 10. Susceptibility testing performed by measuring minimum inhibitory concentration by E-test (Biomerieux, Lenexa, KS) revealed that blood cultures from Day 10 were resistant to ceftazidime-avibactam and ceftolozane-tazobactam. The Verigene Blood Culture-Gram-Negative (BC-GN) microarray-based assay (Nanosphere, Inc., Northbrook, IL) was used to investigate underlying resistance mechanism in the P. aeruginosa isolate but CTX-M, KPC, NDM, VIM, IMP, and OXA gene were not detected. This case report highlights the well-documented phenomenon of antimicrobial resistance development in P. aeruginosa even during the course of appropriate antibiotic therapy. In the era of increasing multidrug-resistant organisms, routine susceptibility testing of P. aeruginosa to ceftazidime-avibactam and ceftolozane-tazobactam is warranted. Emerging resistance mechanisms to these novel antibiotics need to be further investigated.

Gender, ethnic, age, and relationship differences in non-traditional college student alcohol consumption: a tri-ethnic study.

Group differences in four aspects of alcohol consumption behaviors were examined in non-traditional college students (N = 1092; 828 women and 264 men) attending a large, non-residential, urban university. Findings demonstrated several differences between traditional and non-traditional students' drinking behaviors. Specifically, non-traditional students are more likely to abstain; Caucasians are more apt to drink in isolation and experience negative social consequences of drinking; Hispanic and African American women control their alcohol consumption better; and African American men are more likely to experience antisocial consequences due to drinking. These findings have implications for education and prevention efforts targeting non-traditional college students.

Modeling time to inactivation of Listeria monocytogenes in response to high pressure, sodium chloride, and sodium lactate.

A mathematical model was developed to predict time to inactivation (TTI) by high pressure processing of Listeria monocytogenes in a broth system (pH 6.3) as a function of pressure (450 to 700 MPa), inoculum level (2 to 6 log CFU/ml), sodium chloride (1 or 2%), and sodium lactate (0 or 2.5%) from a 4°C initial temperature. Ten L. monocytogenes isolates from various sources, including processed meats, were evaluated for pressure resistance. The five most resistant strains were used as a cocktail to determine TTI and for model validation. Complete inactivation of L. monocytogenes in all treatments was demonstrated with an enrichment method. The TTI increased with increasing inoculum level and decreasing pressure magnitude, from 1.5 min at 700 MPa and 2 log CFU/ml, to 15 min at 450 MPa and 6 log CFU/ml. Neither NaCl nor sodium lactate significantly influenced TTI. The model was validated with ready-to-eat, uncured, Australian retail poultry products, and with product specially made at a U.S. Department of Agriculture, Food Safety and Inspection Service (FSIS)-inspected pilot plant in the United States. Data from the 210 individual product samples used for validation indicate that the model gives "fail-safe" predictions (58% with response as expected, 39% with no survivors where survivors expected, and only 3% with survivors where none were expected). This model can help manufacturers of refrigerated ready-to-eat meats establish effective processing criteria for the use of high pressure processing as a postlethality treatment for L. monocytogenes in accordance with FSIS regulations.

Thermal death time measurement using thin flexible sleeves: a new experimental approach for determining microbial destruction kinetics in fluids of arbitrary viscosity.

The thermal death time kinetics of Salmonella Enteritidis (SE) was measured in buffer, egg yolk, and albumen using thin layer plastic sleeves. The sleeves allowed for the loading and sampling of liquids of high or unusual viscosity, as in the case of yolk and albumen, and accepted relatively large volumes (2 to 3 ml) of fluid. The sleeves maintained the volume of the fluid in a thin layer and could be easily handled for heat exposure. The thin layer maintained one-dimensional heat transfer and minimized temperature gradients, thus preventing parts of the fluid from experiencing different heating rates. A representative strain of SE associated with an egg-based salmonellosis outbreak was used in this study. The D- and z-values of the chosen strain, H7037, were measured in buffer, yolk, and albumen. In buffer, SE had the following mean (±standard deviation) D-values: D(55°C) = 3.51 ± 0.30 min, D(57°C) = 1.75 ± 0.13 min, and D(60°C) = 0.25 ± 0.06 min. In yolk, D(58°C) = 0.90 ± 0.05, D(60°C) = 0.26 ± 0.03, and D(62°C) = 0.20 ± 0.02. In albumen, D(55°C) = 1.26 ± 0.31, D(56°C) = 0.68 ± 0.10, and D(57°C) = 0.44 ± 0.04. The z-values for SE calculated from these D-values were 4.29 ± 0.39°C in buffer, 6.12 ± 0.26°C in yolk, and 4.63 ± 1.14°C in albumen. The sleeves allowed one consistent approach to determining thermal death time kinetics regardless of viscosity.

Development of a high pressure processing inactivation model for hepatitis A virus.

High pressure processing (HPP) inactivation data were obtained for hepatitis A virus (HAV) suspended in buffered growth medium containing salt at either 15 or 30 g/liter. Pressures between 300 and 500 MPa were applied for treatment times of 60 to 600 s. In medium containing 15 g/liter salt, the HAV titer was reduced by approximately 1 and 2 log 50% tissue culture infectious dose units (TCID50) per ml after 600 s of treatment with 300 and 400 MPa, respectively. Under the same treatment conditions but in medium containing 30 g/liter salt, HAV was reduced by <0.50 log TCID50/ml. HAV was inactivated by >3 log TCID50/ml after treatment with 500 MPa for 300 and 360 s in medium containing 15 and 30 g/liter salt, respectively. Weibull and log-linear models were fitted to inactivation data. Individual Weibull curves generally provided a good fit at each pressure and salinity, but the curve shapes were qualitatively inconsistent between treatments, making interpolation between pressures difficult and unreliable. High variability was observed in the inactivation data, but the log-linear model described the entire data set and interpolated between specific treatment conditions. Therefore, this model was evaluated by using high pressure to treat HAV artificially inoculated into Pacific oyster (Crassostrea gigas) homogenate adjusted to 15 or 30 g/liter salinity. The log-linear model generally provided fail-safe predictions at pressures > or = 375 MPa and may aid shellfish processors wishing to incorporate HPP into an oyster processing regime. Additional inactivation data with greater reproducibility should be collected to enable expansion of the model and to increase the accuracy of its predictions.

Gender differences in the mediated relationship between alcohol use and academic motivation among late adolescents.

This study utilized structural equation modeling to examine the relationship between alcohol use and academic motivation controlling for potentially mediating variables of deviant behavior, depressive cognitions, family communication, and peer relations. The study also examined the manner in which these relationships were moderated by gender. Results indicated that alcohol use was directly related to deviance for both males and females, but was not associated with depressive cognitions for either males or females. Deviant behavior was directly associated with depressive cognitions for both males and females, but this effect was significantly stronger for females. Deviance was significantly, inversely related to family communication among males, but not females. Depressive cognitions were significantly, inversely related to family communication for both males and females. Family communication and peer relations were directly related to academic motivation for both males and females, and the relationship between family communication and academic motivation was also mediated through peer relations. The necessity of providing information that focuses on minimizing involvement in deviant behaviors for females and the differential importance of family and peer relations is discussed.

Inactivation of foodborne viruses of significance by high pressure and other processes.

The overall safety of a food product is an important component in the mix of considerations for processing, distribution, and sale. With constant commercial demand for superior food products to sustain consumer interest, nonthermal processing technologies have drawn considerable attention for their ability to assist development of new products with improved quality attributes for the marketplace. This review focuses primarily on the nonthermal processing technology high-pressure processing (HPP) and examines current status of its use in the control and elimination of pathogenic human viruses in food products. There is particular emphasis on noroviruses and hepatitis A virus with regard to the consumption of raw oysters, because noroviruses and hepatitis A virus are the two predominant types of viruses that cause foodborne illness. Also, application of HPP to whole-shell oysters carries multiple benefits that increase the popularity of HPP usage for these foods. Viruses have demonstrated a wide range of sensitivities in response to high hydrostatic pressure. Viral inactivation by pressure has not always been predictable based on nomenclature and morphology of the virus. Studies have been complicated in part from the inherent difficulties of working with human infectious viruses. Consequently, continued study of viral inactivation by HPP is warranted.

Enteric-coated pancreatic enzyme with bicarbonate is equal to standard enteric-coated enzyme in treating malabsorption in cystic fibrosis.

OBJECTIVES: To compare the efficacy of an enteric-coated buffered pancreatic enzyme (EC buffered PE) containing 1.5 mEq of bicarbonate per capsule with a conventional enteric-coated enzyme (EC-PE) capsule in cystic fibrosis patients with signs or symptoms of moderate to severe malabsorption. METHODS: In a double-blind crossover study, subjects were randomly assigned to two consecutive, 2-week phases using an EC buffered PE product and conventional EC-PE product. Seventy-two hour stool collections from each phase were analyzed for energy, fat, and nitrogen content and expressed as percent of estimated intake. RESULTS: Twenty-one patients with cystic fibrosis and pancreatic insufficiency (14 female, mean age 20.6 +/- 11.5 years, range 8.8-41.9) completed the study. There was no significant difference in percent malabsorption of energy (19.4% vs. 19.0%), fat (20.7% vs. 20.2%), or nitrogen (10.4% vs. 10.7%) between the EC buffered PE product and the conventional EC-PE product. However, patients taking the EC buffered PE product received less enzyme based on actual enzyme activity measured in vitro (3,468 +/- 1,434 U lipase/g fat vs. 3,978 +/- 1,474 U lipase/g fat, P < 0.02). CONCLUSIONS: In the doses used, nutrient absorption of patients taking EC buffered PE preparation offers no advantage over a conventional EC-PE preparation.

Toward validation of process criteria for high-pressure processing of orange juice with predictive models.

Mathematical models were developed to predict time to inactivation (TTI) by high-pressure processing of Salmonella in Australian Valencia orange juice (pH 4.3) and navel orange juice (pH 3.7) as a function of pressure magnitude (300 to 600 MPa) and inoculum level (3 to 7 log CFU/ml). For each model, the TTI was found to increase with increasing inoculum level and decrease with increasing pressure magnitude. The U.S. Food and Drug Administration Juice Hazard Analysis and Critical Control Point Regulation requires fruit juice processors to include control measures that produce a 5-log reduction of the pertinent microorganism of public health significance in the juice. To achieve a 5-log reduction of Salmonella in navel orange juice at 20 degrees C, the models predicted hold times of 198, 19, and 5 s at 300, 450, and 600 MPa, respectively. In Valencia orange juice at 20 degrees C, a 5-log reduction of Salmonella was achieved in 369, 25, and 5 s at 300, 450, and 600 MPa, respectively. At pressures below 400 MPa, Salmonella was more sensitive to pressure in the more acidic conditions of the navel orange juice and TTIs were shorter. At higher pressures, little difference in the predicted TTI was observed. Refrigerated storage (4 degrees C) of inoculated navel orange juice treated at selected pressure/time/inoculum combinations showed that under conditions in which viable Salmonella was recovered immediately after high-pressure processing, pressure-treated Salmonella was susceptible to the acidic environment of orange juice or to chill storage temperature. These TTI models can assist fruit juice processors in selecting processing criteria to achieve an appropriate performance criterion with regard to the reduction of Salmonella in orange juice, while allowing for processing flexibility and optimization of high-pressure juice processing.

Effect of prior growth temperature, type of enrichment medium, and temperature and time of storage on recovery of Listeria monocytogenes following high pressure processing of milk.

A five-isolate cocktail of Listeria monocytogenes (10(3) cfu/ml in skim or whole raw milk) was subjected to 450 MPa for 900 s or 600 MPa for 90 s. The effects of prior growth temperature, type of milk (skim vs. whole), type of recovery-enrichment media (optimized Penn State University [oPSU] broth, Listeria Enrichment Broth [LEB], Buffered LEB [BLEB], Modified BLEB [MBLEB], and milk), storage temperature and storage time on the recovery of L. monocytogenes were examined. Optimized PSU broth significantly increased the recovery of L. monocytogenes following high pressure processing (HPP), and was 63 times more likely to recover L. monocytogenes following HPP, compared to LEB, BLEB and MBLEB broths (p<0.05; Odds Ratio=63.09, C.I. 23.70-167.96). There was a significant main effect for prior growth temperature (p<0.05). However, this relationship could not be interpreted given the significant interaction effects between temperature and both pressure and milk type. HPP-injured L. monocytogenes could be recovered using both LEB and oPSU broths after storage of milk at 4, 15 and 30 degrees C, with recovery being maximal after 24 to 72 h of storage; however, recovery yield dropped to 0% after prolonged storage of milk at 4 and 30 degrees C. In contrast, storage of milk at 15 degrees C yielded the most rapid rate of recovery and the highest recovery yield (100%), which remained high throughout the 14 days of storage at 15 degrees C. The above factors need to be taken into consideration when designing challenge studies to insure complete inactivation of L. monocytogenes and possibly other foodborne pathogens during high pressure processing of foods.

Predicting patterns of adolescent alcohol use: a longitudinal study.

OBJECTIVE: Because most studies of adolescent alcohol use have focused primarily on the frequency and quantity of consumption, we know little about how adolescent drinking patterns change during the high school years. The purpose of this article is to provide such data, as well as to identify some of the individual, family, social life and community predictors of changes in drinking patterns over time. METHOD: A sample of 1,253 students in grades 9 through 12 (57% female) in a large metropolitan school district participated. Three ethnicities were represented: African American, European American and Mexican American. Students completed questionnaires every 6 months for a 2-year period (n = 743 at Time 4). RESULTS: Cluster analyses of the drinking variables yielded one problem-drinking group (heavy, multiple-context drinking), two high-risk groups (i.e., date and outdoor drinking) and three normative groups (light, family/parent, moderate/ party drinking). The most predictable patterns of longitudinal changes in adolescent drinking were consistent with the following progression (or the reverse): abstainer --> normative drinker --> high-risk drinker --> problem drinker. Paternal attitudes toward adolescent drinking and peer involvement in antisocial behavior predicted movement into normative drinking; social activity with peers predicted movement into high-risk drinking; and emotional distress predicted the transition into problem drinking. CONCLUSIONS: These findings are consistent with the multistage social learning model, demonstrating that the predictors of adolescent alcohol use vary across different levels of adolescent alcohol involvement.

Changes in response to insulin and the effects of varying glucose tolerance on whole-body protein metabolism in patients with cystic fibrosis.

BACKGROUND: Diabetes mellitus has been reported to increase whole-body protein breakdown and thus loss of lean body mass. Cystic fibrosis-related diabetes (CFRD) is associated with undernutrition and increased mortality. OBJECTIVE: We hypothesized that CFRD is associated with increased whole-body protein breakdown, which results in negative protein balance, and that correction of the glucose intolerance with insulin therapy would normalize whole-body protein metabolism. DESIGN: Rates of whole-body protein turnover and protein balance were measured in 28 adults with cystic fibrosis (17 M, 11 F). Subjects were assessed with a modified oral-glucose-tolerance test and categorized as having normal glucose tolerance, impaired glucose tolerance, or CFRD with and without fasting hyperglycemia; then they were compared with previously diagnosed CFRD adults already receiving insulin therapy. Indexes of protein turnover were calculated from [15N]glycine and 15N in urinary urea. RESULTS: Analysis of variance for the 28 subjects showed that whole-body protein breakdown was highest (P<0.05) in patients with CFRD. Whole-body protein synthesis was not significantly affected by impaired glucose tolerance. Significant (P<0.05) improvement in net protein synthesis occurred in the CFRD group 3 mo after insulin therapy was administered. Follow-up studies of 3 subjects with CFRD showed significant improvement in net protein synthesis after insulin therapy. Monitoring of the protein homeostasis of the impaired glucose tolerance group gave clues to the progression of their metabolic homeostasis. CONCLUSION: CFRD has an adverse effect on protein homeostasis by increasing net protein synthesis.

Effects of high-pressure processing on the safety, quality, and shelf life of ready-to-eat meats.

Ready-to-eat (RTE) meats (low-fat pastrami, Strassburg beef, export sausage, and Cajun beef) were pressure treated at 600 MPa, 20 degrees C, for 180 s to evaluate the feasibility of using high-pressure processing (HPP) for the safe shelf-life extension of these products. After processing, samples were stored at 4 degrees C for 98 days during which time microbiological enumeration and enrichments were performed. Additionally, sensory analyses were undertaken to determine consumer acceptability and purchase intent over the duration of storage. Counts of aerobic and anaerobic mesophiles, lactic acid bacteria, Listeria spp., staphylococci, Brochothrix thermosphacta, coliforms, and yeasts and molds revealed that there were undetectable or low levels for all types of microorganisms throughout storage. Comparison of consumer hedonic ratings for unprocessed and processed meats revealed no difference in consumer acceptability, and no deterioration in the sensory quality was evident for any of the products tested during the study. Additionally, inoculated pack studies were conducted to determine if HPP could be used as a postlethality treatment to reduce or eliminate Listeria monocytogenes and thus assess the potential use of HPP in a hazard analysis critical control point plan for production of RTE meats. Inoculated samples (initial level of 10(4) CFU/g) were pressure treated (600 MPa, 20 degrees C, for 180 s) and stored at 4 degrees C, and survival of L. monocytogenes was monitored for 91 days. L. monocytogenes was not detected by plating methods until day 91, but selective enrichments showed sporadic recovery in three of the four products examined. The results show that HPP at 600 MPa, 20 degrees C, for 180 s can extend the refrigerated shelf life of RTE meats and reduce L. monocytogenes numbers by more than 4 log CFU/g in inoculated product.

Managing the risk of staphylococcal food poisoning from cream-filled baked goods to meet a food safety objective.

The International Commission on Microbiological Specifications for Foods (ICMSF) has recently proposed a scheme for the management of microbial hazards for foods that involves the concept of food safety objectives (FSOs). FSOs are intended to specify the maximum levels of hazardous agents required to meet a given public health goal. This scheme offers flexibility for the food industry in terms of allowing the use of alternative but equivalent means for achieving a given FSO. This paper illustrates the application of the ICMSF model via the analysis of the microbiological hazard of Staphylococcus aureus in cream-filled baked goods. Cream-filled baked goods have a notorious history as vehicles for foodborne illness, particularly staphylococcal food poisoning. Although the numbers of cases reported in the United States and Europe have declined in recent years, staphylococcal food poisoning may be much more common than is recognized, particularly in other countries. The ICMSF principles for setting FSOs and the use of performance criteria, process criteria, and validation in relation to hazard analysis critical control point and good hygiene practice plans for managing S. aureus in cream-filled baked goods are described.

High-dose myeloablative therapy and autologous peripheral blood progenitor cell transplantation for elderly patients (greater than 65 years of age) with relapsed large cell lymphoma.

Eleven elderly patients (older than 65 years) with relapsed large cell lymphoma were treated with high-dose myeloablative therapy and autologous peripheral blood progenitor cell support (ABMT). All 11 patients were in sensitive relapse at the time of ABMT. Treatment-related mortality was 9%. Median CD34 cell collection was 4.8 x 10(6) cells/kg. Median time to hematologic recovery was 11 days for granulocytes (range, 9 to 16 days) and 18 days for platelets (range, 14 to 42 days). Nine of 11 patients (81%) achieved a complete response following ABMT. Median time to treatment failure was 17 months. The 4-year disease-free and overall survival is projected to be 44%. When compared with a cohort of patients under age 65 years with sensitive relapsed large cell lymphoma treated with ABMT during the same time interval, disease-free and overall survival are comparable. ABMT is feasible, tolerable, and effective in elderly patients with relapsed large cell lymphoma with disease-free survival rates comparable to younger patients.

Staphylococcus aureus growth boundaries: moving towards mechanistic predictive models based on solute-specific effects.

The formulation of shelf-stable intermediate-moisture products is a critical food safety issue. Therefore, knowing the precise boundary for the growth-no-growth interface of Staphylococcus aureus is necessary for food safety risk assessment. This study was designed to examine the effects of various humectants and to produce growth boundary models as tools for risk assessment. The molecular mobility and the effects of various physical properties of humectants, such as their glass transition temperatures, their membrane permeability, and their ionic and nonionic properties, on S. aureus growth were investigated. The effects of relative humidity (RH; 84 to 95%, adjusted by sucrose plus fructose, glycerol, or NaCl), initial pH (4.5 to 7.0, adjusted by HCl), and potassium sorbate concentration (0 or 1,000 ppm) on the growth of S. aureus were determined. Growth was monitored by turbidity over a 24-week period. Toxin production was determined by enterotoxin assay. The 1,792 data points generated were analyzed by LIFEREG procedures (SAS Institute, Inc., Cary, N.C.), which showed that all parameters studied significantly affected the growth responses of S. aureus. Differences were observed in the growth-no-growth boundary when different humectants were used to achieve the desired RH values in both the absence and the presence of potassium sorbate. Sucrose plus fructose was most inhibitory at neutral pH values, while NaCl was most inhibitory at low pH values. The addition of potassium sorbate greatly increased the no-growth regions, particularly when pH was <6.0. Published kinetic growth and survival models were compared with boundary models developed in this work. The effects of solutes and differences in modeling approaches are discussed.