Prolonged Disease Course of COVID-19 in a Patient with CTLA-4 Haploinsufficiency.

Patients with primary immunodeficiencies are especially vulnerable to developing severe coronavirus disease 2019 (COVID-19) after infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Cytotoxic T lymphocyte antigen-4 (CTLA-4) is an important regulator of immune responses, and patients who suffer from CTLA4 haploinsufficiency have hyperactivation of effector T cells and infiltration of various organs. Overexpression of CTLA4 has been associated with a more severe disease course in patients with COVID-19, but there have only been a few reports on the disease course of COVID-19 in patients with CTLA4 haploinsufficiency. We report on a 33-year-old female with a history of immune thrombocytopenia, autoimmune haemolytic anaemia, granulomatous-lymphocytic interstitial lung disease, and common variable immunodeficiency who developed COVID-19. She was admitted and discharged from the hospital several times in the months thereafter and remained symptomatic and had a positive SARS-CoV-2 PCR for up to 137 days after the first symptoms. No SARS-CoV-2 antibodies were identified in the patients' serum. The disease was finally controlled after repeated infusions of convalescent plasma and treatment of concurrent bacterial and fungal infections. Genetic analysis revealed a likely pathogenic variant in CTLA4, and CTLA4 expression on regulatory T-cells was low. This case illustrates that patients with primary immunodeficiencies who have a protracted disease course of COVID-19 could benefit from convalescent plasma therapy.

Potential interstitial lung abnormalities on chest X-rays prior to symptoms of idiopathic pulmonary fibrosis.

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) often has significant diagnostic delay. At present it is not well-known what factors associate with time to diagnosis and if this is associated with survival after the diagnosis. There has also been increasing attention for interstitial lung abnormalities on chest CT-scans. In this study we assessed what factors associate with time to diagnosis in patients with IPF, and whether early stages of pulmonary fibrosis can be seen on chest X-rays prior to the start of symptoms. METHODS: In this retrospective study, 409 Dutch patients with IPF were included. Clinical characteristics, including patient demographics, medical history, time of start of symptoms, time of first visit to pulmonologist, and any previous radiographic imaging reports were collected from patient records. RESULTS: In 96 patients (23%) a chest X-ray was available that had been made prior to the start of symptoms (median of 50.5 months (IQR 26.3-83.3 months)), and this showed potential interstitial lung abnormalities in 56 patients (58%). The median time from the start of symptoms to the final diagnosis was 24.0 months (interquartile range 9.0-48.0 months). In a multivariate model that corrected for diffusion capacity of the lung for carbon monoxide, forced vital capacity, sex, and age at diagnosis, time to diagnosis did not associate with survival (hazard ratio 1.051 (95% CI 0.800-1.380; p = 0.72)). CONCLUSIONS: There is a significant diagnostic delay for patients with IPF, but longer time to diagnosis did not associate with survival. Interstitial lung abnormalities were seen in more than half of the patients in whom a chest X-ray had been made prior to the start of symptoms. This illustrates that a computed tomography scan should be strongly considered for analysis of unexplained abnormalities on a chest X-ray. This could facilitate early detection and possibly prevention of disease progression for patients with pulmonary fibrosis.

Aetiology and prognosis of community-acquired pneumonia at the Adult University Teaching Hospital in Zambia.

BACKGROUND: Community-acquired pneumonia (CAP) is a frequent cause of death worldwide, and in sub-Saharan Africa particularly. Human immunodeficiency virus infection (HIV) and tuberculosis (TB) influence pathogen distribution in patients with CAP. Previous studies in sub-Saharan Africa have shown different frequencies of respiratory pathogens and antibiotic susceptibility compared to studies outside Africa. This study aimed to investigate the aetiology, presentation, and treatment outcomes of community-acquired pneumonia in adults at the University Teaching Hospital in Lusaka, Zambia. MATERIALS AND METHODS: Three-hundred-and-twenty-seven patients were enrolled at the University Teaching Hospital in Lusaka between March 2018 and December 2018. Clinical characteristics and laboratory data were collected. Sputum samples were tested by microscopy, other TB diagnostics, and bacterial cultures. RESULTS: The commonest presenting complaint was cough (96%), followed by chest pain (60.6%), fever (59.3%), and breathlessness (58.4%). The most common finding on auscultation of the lungs was chest crackles (51.7%). Seventy percent of the study participants had complaints lasting at least a week before enrolment. The prevalence of HIV was 71%. Sputum samples were tested for 286 patients. The diagnostic yield was 59%. The most common isolate was Mycobacterium tuberculosis (20%), followed by Candida species (18%), Klebsiella pneumoniae (12%), and Pseudomonas aeruginosa (7%). Streptococcus pneumoniae was isolated in only four patients. There were no statistically significant differences between the rates of specific pathogens identified in HIV-infected patients compared with the HIV-uninfected. Thirty-day mortality was 30%. Patients with TB had higher 30-day mortality than patients without TB (p = 0.047). CONCLUSION: Mycobacterium tuberculosis was the most common cause of CAP isolated in adults at the University Teaching Hospital in Lusaka, Zambia. Gram-negative organisms were frequently isolated. A high mortality rate was observed, as 30% of the followed-up study population had died after 30 days.

Serologic response to a third dose of an mRNA-based SARS-CoV-2 vaccine in lung transplant recipients.

Lung transplant recipients have an increased risk for severe coronavirus disease 2019 (COVID-19) due to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A third dose of a SARS-CoV-2 vaccine has been recommended for all solid organ transplant recipients, but data from lung transplant recipients specifically are scarce. In this study, the serologic response to a third dose of an mRNA-based SARS-CoV-2 vaccine was measured in 78 lung transplant recipients. Sixty-two percent (n = 48) had a serological response to vaccination, which was significantly higher than after the second vaccine dose (27 patients (35%); p = 0.0013). A positive serologic response was associated with having had COVID-19 (p = 0.01), and higher serum IgG level and complement mannose binding lectin pathway activity prior to vaccination (p = 0.04 and p = 0.03, respectively). Serologic response was not associated with the dose of mycophenolate mofetil or prednisone or other immune status parameters. Eleven patients (14%) developed COVID-19 after the second or third vaccine dose, but this did not associate with serologic response after the second vaccine dose (9% in patients who developed COVID-19 versus 39% in patients who did not develop COVID-19 (p = 0.09)), or with serologic response above cut-off values associated with clinical protection in previous studies. In conclusion, the response to mRNA-based SARS-CoV-2 vaccines in lung transplant recipients improves significantly after a third vaccine dose. Factors associated with a positive serologic response are having had COVID-19 prior to vaccination, and serum IgG and complement mannose binding lectin pathway activity prior to vaccination. Serologic response did not associate with clinical protection against COVID-19 in this study.

Humoral Immune Status in Relation to Outcomes in Patients with Idiopathic Pulmonary Fibrosis.

PURPOSE: Idiopathic pulmonary fibrosis (IPF) is a severe fibrotic lung disease, in which inflammation is thought to only play a secondary role. Several factors associated with acute exacerbations of IPF (AE-IPF) have been identified, including infections. This study investigated whether humoral immunodeficiency or increased inflammatory markers at diagnosis were associated with AE-IPF and survival. METHODS: Four-hundred-and-nine patients diagnosed with IPF between 2011 and 2017 were retrospectively included. Immune status investigations at diagnosis included measurement of serum immunoglobulins (available in 38%), leukocyte and lymphocyte subsets in blood and bronchoalveolar lavage (BAL) fluid (available in 58%), as well as response to pneumococcal vaccination (available in 64%). RESULTS: Serum immunoglobulins or IgG subclass levels were below the lower limit of normal in 6%. The response to pneumococcal vaccination was severely impaired in 1%. Thirteen percent of patients developed an AE-IPF (4.7% per year). AE-IPF were associated with elevated lymphocytes in BAL fluid at diagnosis (p = 0.03). Higher serum IgA and IgG at diagnosis were associated with worse survival (p = 0.01; and p = 0.04), as were an increased BAL lymphocyte percentage (p = 0.005), and higher blood leukocytes and neutrophils (p = 0.01; and p = 0.0005). In a multivariate model, only BAL lymphocyte count retained statistical significance (p = 0.007). CONCLUSION: The prevalence of humoral immunodeficiencies was low in patients with IPF and not associated with AE-IPF or survival. Elevated lymphocytes in BAL were associated with the development of AE-IPF and worse survival. Higher serum immunoglobulins and immune cells in blood were also associated with worse survival. The local immune response in the lungs may be a target for future therapies.

Pneumococcal vaccination in lung transplant patients.

Introduction: This review analyzes the efficacy of pneumococcal vaccinations in lung transplant patients before and after transplantation.Areas covered: This review addresses the risk for respiratory infections, in particular pneumococcal infections, in lung transplantation patients in the context of immunodeficiency and immunosuppressive medication. Vaccination is recommended to counteract the increased risk of pneumococcal infection, and the relevant guidelines are discussed in this review. The design of specific vaccination schedules is required because of the impaired antibody response in specific patient categories.Expert opinion: Lung transplantation candidates should be vaccinated with pneumococcal vaccines prior to transplantation. Currently, the 23-valent pneumococcal polysaccharide vaccine offers the broadest coverage, but the antibody response should be monitored. New generation pneumococcal conjugate vaccines with equally broad serotype coverage could be used in the future. During the post-transplantation period, the immune status of the patients should be monitored regularly, and vaccination should be repeated when indicated.

Thoracic proportions in children without scoliosis.

PURPOSE: Scoliosis is a condition of abnormal growth resulting in 3D deformity of both the spine and thoracic cage. The aim of this study is to use chest radiographs of healthy children to define normal thoracic proportions so as to provide a useful normal reference range against which children with spinal deformity can be compared. METHODS: Three independent reviewers assessed posteroanterior and lateral chest radiographs of 184 normal children aged between two and 15 years. Duplicate assessments were undertaken by all three raters on 36 of these radiographs. We measured the T1 to T12 length, sternal length, chest depth at T6, chest width at T3, chest width at T6 and maximum chest width. Ratios of thoracic dimensions were calculated to define the normal proportions of the thorax. Inter- and intra-rater variance was estimated for all dimensions and dimension ratios. RESULTS: The intra-rater and inter-rater reliability was excellent with intra-class-correlation coefficients values > 80% and both intra- and inter-rater coefficients of variance < 9% for all parameters. All measured dimensions of the thorax and spine progressed linearly with respect to age. The mean proportions of T1 to 12 length of the sternal length, chest depth at T6, chest width at T3, chest width at T6 and maximum chest width were 0.5, 0.4, 0.7, 0.9 and 1.0, respectively. CONCLUSION: It is possible to accurately and reproducibly measure the dimensions of the thoracic cage and spine on plain film radiology. The ratios of T1 to T12 length with respect to sternal length, chest depth at T6, chest width at T3, chest width at T6 and maximum chest remain constant with increasing age. Thoracic dimensions in children progress linearly with increasing age. LEVEL OF EVIDENCE: V.

SEIS: Insight's Seismic Experiment for Internal Structure of Mars.

By the end of 2018, 42 years after the landing of the two Viking seismometers on Mars, InSight will deploy onto Mars' surface the SEIS (Seismic Experiment for Internal Structure) instrument; a six-axes seismometer equipped with both a long-period three-axes Very Broad Band (VBB) instrument and a three-axes short-period (SP) instrument. These six sensors will cover a broad range of the seismic bandwidth, from 0.01 Hz to 50 Hz, with possible extension to longer periods. Data will be transmitted in the form of three continuous VBB components at 2 sample per second (sps), an estimation of the short period energy content from the SP at 1 sps and a continuous compound VBB/SP vertical axis at 10 sps. The continuous streams will be augmented by requested event data with sample rates from 20 to 100 sps. SEIS will improve upon the existing resolution of Viking's Mars seismic monitoring by a factor of ∼ 2500 at 1 Hz and ∼ 200 000 at 0.1 Hz. An additional major improvement is that, contrary to Viking, the seismometers will be deployed via a robotic arm directly onto Mars' surface and will be protected against temperature and wind by highly efficient thermal and wind shielding. Based on existing knowledge of Mars, it is reasonable to infer a moment magnitude detection threshold of M w ∼ 3 at 40 ∘ epicentral distance and a potential to detect several tens of quakes and about five impacts per year. In this paper, we first describe the science goals of the experiment and the rationale used to define its requirements. We then provide a detailed description of the hardware, from the sensors to the deployment system and associated performance, including transfer functions of the seismic sensors and temperature sensors. We conclude by describing the experiment ground segment, including data processing services, outreach and education networks and provide a description of the format to be used for future data distribution. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11214-018-0574-6) contains supplementary material, which is available to authorized users.

Three-dimensional printing of metals for biomedical applications.

Three-dimensional (3D) printing technology has received great attention in the past decades in both academia and industry because of its advantages such as customized fabrication, low manufacturing cost, unprecedented capability for complex geometry, and short fabrication period. 3D printing of metals with controllable structures represents a state-of-the-art technology that enables the development of metallic implants for biomedical applications. This review discusses currently existing 3D printing techniques and their applications in developing metallic medical implants and devices. Perspective about the current challenges and future directions for development of this technology is also presented.

Transbronchial biopsy in the management of pulmonary complications of hematopoietic stem cell transplantation.

The utility of transbronchial biopsy in the management of pulmonary complications following hematopoietic stem cell transplantation (HSCT) has shown variable results. Herein, we examine the largest case series of patients undergoing transbronchial biopsy following HSCT. We performed a retrospective analysis of 130 transbronchial biopsy cases performed in patients with pulmonary complications post HSCT. Logistic regression models were applied to examine diagnostic yield, odds of therapy change and complications. The most common histologic finding on transbronchial biopsy was a nonspecific interstitial pneumonitis (n=24 cases, 18%). Pathogens identified by transbronchial biopsy were rare, occurring in <5% of cases. A positive transbronchial biopsy significantly increased the odds of a subsequent change in corticosteroid therapy (odds ratio (OR)=3.12; 95% confidence interval (CI) 1.18-8.23; P=0.02) but was not associated with a change in antibiotic therapy (OR=1.01; 95% CI 0.40-2.54; P=0.98) or changes in overall therapy (OR=1.92; 95% CI 0.79-4.70; P=0.15). Patients who underwent a transbronchial biopsy had increased odds of complications related to the bronchoscopy (OR=3.33, 95% CI 1.63-6.79; P=0.001). In conclusion, transbronchial biopsy may contribute to the diagnostic management of noninfectious lung injury post HSCT, whereas its utility in the management of infectious pulmonary complications of HSCT remains low.

Pyrolysis of wastewater biosolids significantly reduces estrogenicity.

Most wastewater treatment processes are not specifically designed to remove micropollutants. Many micropollutants are hydrophobic so they remain in the biosolids and are discharged to the environment through land-application of biosolids. Micropollutants encompass a broad range of organic chemicals, including estrogenic compounds (natural and synthetic) that reside in the environment, a.k.a. environmental estrogens. Public concern over land application of biosolids stemming from the occurrence of micropollutants hampers the value of biosolids which are important to wastewater treatment plants as a valuable by-product. This research evaluated pyrolysis, the partial decomposition of organic material in an oxygen-deprived system under high temperatures, as a biosolids treatment process that could remove estrogenic compounds from solids while producing a less hormonally active biochar for soil amendment. The estrogenicity, measured in estradiol equivalents (EEQ) by the yeast estrogen screen (YES) assay, of pyrolyzed biosolids was compared to primary and anaerobically digested biosolids. The estrogenic responses from primary solids and anaerobically digested solids were not statistically significantly different, but pyrolysis of anaerobically digested solids resulted in a significant reduction in EEQ; increasing pyrolysis temperature from 100°C to 500°C increased the removal of EEQ with greater than 95% removal occurring at or above 400°C. This research demonstrates that biosolids treatment with pyrolysis would substantially decrease (removal>95%) the estrogens associated with this biosolids product. Thus, pyrolysis of biosolids can be used to produce a valuable soil amendment product, biochar, that minimizes discharge of estrogens to the environment.

TINF2 Gene Mutation in a Patient with Pulmonary Fibrosis.

Pulmonary fibrosis is a frequent manifestation of telomere syndromes. Telomere gene mutations are found in up to 25% and 3% of patients with familial disease and sporadic disease, respectively. The telomere gene TINF2 encodes an eponymous protein that is part of the shelterin complex, a complex involved in telomere protection and maintenance. A TINF2 gene mutation was recently reported in a family with pulmonary fibrosis. We identified a heterozygous Ser245Tyr mutation in the TINF2 gene of previously healthy female patient that presented with progressive cough due to pulmonary fibrosis as well as panhypogammaglobulinemia at age 52. Retrospective multidisciplinary evaluation classified her as a case of possible idiopathic pulmonary fibrosis. Telomere length-measurement indicated normal telomere length in the peripheral blood compartment. This is the first report of a TINF2 mutation in a patient with sporadic pulmonary fibrosis, which represents another association between TINF2 mutations and this disease. Furthermore, this case underlines the importance of telomere dysfunction and not telomere length alone in telomere syndromes and draws attention to hypogammaglobulinemia as a manifestation of telomere syndromes.

Early versus delayed umbilical cord clamping in infants with congenital heart disease: a pilot, randomized, controlled trial.

OBJECTIVE: Delayed umbilical cord clamping (DCC) at birth may provide a better neonatal health status than early umbilical cord clamping (ECC). However, the safety and feasibility of DCC in infants with congenital heart disease (CHD) have not been tested. This was a pilot, randomized, controlled trial to establish the safety and feasibility of DCC in neonates with CHD. STUDY DESIGN: Pregnant women admitted >37 weeks gestational age with prenatal diagnosis of critical CHD were enrolled and randomized to ECC or DCC. For ECC, the umbilical cord was clamped <10 s after birth; for DCC, the cord was clamped ~120 s after delivery. RESULTS: Thirty infants were randomized at birth. No differences between the DCC and ECC groups were observed in gestational age at birth or time of surgery. No differences were observed across all safety measures, although a trend for higher peak serum bilirubin levels (9.2±2.2 vs 7.3±3.2 mg dl(-1), P=0.08) in the DCC group than in the ECC group was noted. Although similar at later time points, hematocrits were higher in the DCC than in the ECC infants during the first 72 h of life. The proportion of infants not receiving blood transfusions throughout hospitalization was higher in the DCC than in the ECC infants (43 vs 7%, log-rank test P=0.02). CONCLUSION: DCC in infants with critical CHD appears both safe and feasible, with fewer infants exposed to red blood cell transfusions than with ECC. A more comprehensive appraisal of this practice is warranted.

Design of Cherenkov bars for the optical part of the time-of-flight detector in Geant4.

We present the results of studies devoted to the development and optimization of the optical part of a high precision time-of-flight (TOF) detector for the Large Hadron Collider (LHC). This work was motivated by a proposal to use such a detector in conjunction with a silicon detector to tag and measure protons from interactions of the type p + p → p + X + p, where the two outgoing protons are scattered in the very forward directions. The fast timing detector uses fused silica (quartz) bars that emit Cherenkov radiation as a relativistic particle passes through and the emitted Cherenkov photons are detected by, for instance, a micro-channel plate multi-anode Photomultiplier Tube (MCP-PMT). Several possible designs are implemented in Geant4 and studied for timing optimization as a function of the arrival time, and the number of Cherenkov photons reaching the photo-sensor.

Response to pneumococcal vaccination in mannose-binding lectin-deficient adults with recurrent respiratory tract infections.

Mannose-binding lectin (MBL)-deficiency is associated with an increased susceptibility to pneumococcal infections and other forms of disease. Pneumococcal vaccination is recommended in MBL-deficient patients with recurrent respiratory tract infections (RRTI). The response to pneumococcal vaccination in MBL-deficient individuals has not yet been studied in detail. An impaired response to pneumococcal polysaccharides in MBL-deficient patients might explain the association between MBL deficiency and pneumococcal infections. This study investigates the antibody response to pneumococcal vaccination in MBL-deficient adult patients with RRTI. Furthermore, we investigated whether there was a difference in clinical presentation between MBL-deficient and -sufficient patients with RRTI. Eighteen MBL-deficient and 63 MBL-sufficient adult patients with RRTI were all vaccinated with the 23-valent pneumococcal polysaccharide vaccine and antibodies to 14 pneumococcal serotypes were measured on a Luminex platform. There were no differences observed in the response to pneumococcal vaccination between MBL-sufficient and -deficient patients. Forty-three MBL-sufficient patients could be classified as responders to pneumococcal vaccination and 20 as low responders, compared to 15 responders and three low responders in the MBL-deficient patients. We found no clear difference in clinical, radiological, lung function and medication parameters between MBL-sufficient and -deficient patients. In conclusion, our study suggests that MBL-deficient adults with RRTI have a response to a pneumococcal capsular polysaccharide vaccine comparable with MBL-sufficient patients. Moreover, we did not find a clear clinical role of MBL deficiency in adults with RRTI. As MBL deficiency is associated with an increased susceptibility to pneumococcal infections, pneumococcal vaccination might be protective in MBL-deficient patients with RRTI.

Does iodine gas released from seaweed contribute to dietary iodine intake?

Thyroid hormone levels sufficient for brain development and normal metabolism require a minimal supply of iodine, mainly dietary. Living near the sea may confer advantages for iodine intake. Iodine (I(2)) gas released from seaweeds may, through respiration, supply a significant fraction of daily iodine requirements. Gaseous iodine released over seaweed beds was measured by a new gas chromatography-mass spectrometry (GC-MS)-based method and iodine intake assessed by measuring urinary iodine (UI) excretion. Urine samples were obtained from female schoolchildren living in coastal seaweed rich and low seaweed abundance and inland areas of Ireland. Median I(2) ranged 154-905 pg/L (daytime downwind), with higher values (~1,287 pg/L) on still nights, 1,145-3,132 pg/L (over seaweed). A rough estimate of daily gaseous iodine intake in coastal areas, based upon an arbitrary respiration of 10,000L, ranged from 1 to 20 µg/day. Despite this relatively low potential I(2) intake, UI in populations living near a seaweed hotspot were much higher than in lower abundance seaweed coastal or inland areas (158, 71 and 58 µg/L, respectively). Higher values >150 µg/L were observed in 45.6% of (seaweed rich), 3.6% (lower seaweed), 2.3% (inland)) supporting the hypothesis that iodine intake in coastal regions may be dependent on seaweed abundance rather than proximity to the sea. The findings do not exclude the possibility of a significant role for iodine inhalation in influencing iodine status. Despite lacking iodized salt, coastal communities in seaweed-rich areas can maintain an adequate iodine supply. This observation brings new meaning to the expression "Sea air is good for you!"

National Beef Quality Audit-2005: survey of targeted cattle and carcass characteristics related to quality, quantity, and value of fed steers and heifers.

The National Beef Quality Audit-2005 assessed the current status of quality and consistency of US fed steers and heifers. Hide colors or breed type were black (56.3%), red (18.6%), Holstein (7.9%), gray (6.0%), yellow (4.9%), brown (3.0%), white (2.3%), and brindle (1.0%). Identification method and frequency were lot visual tags (63.2%), individual visual tags (38.7%), metal-clip tags (11.8%), electronic tags (3.5%), bar-coded tags (0.3%), by other means (2.5%), and without identification (9.7%). Brand frequencies were no (61.3%), 1 (35.1%), and 2 or more (3.6%), and brands were located on the butt (26.5%), side (7.4%), and shoulder (1.2%). There were 22.3% of cattle without horns, and the majority of those with horns (52.2%) were between 2.54 and 12.7 cm in length. Percentages of animals with mud or manure on specific body locations were none (25.8%), legs (61.4%), belly (55.9%), side (22.6%), and top-line (10.0%). Permanent incisor number and occurrence were zero (82.2%), 1 (5.2%), 2 (9.9%), 3 (0.4%), 4 (1.2%), 5 (0.1%), 6 (0.3%), 7 (0.0%), and 8 (0.7%). Most carcasses (64.8%) were not bruised, 25.8% had one bruise, and 9.4% had multiple bruises. Bruise location and incidence were round (10.6%), loin (32.6%), rib (19.5%), chuck (27.0%), and brisket, flank, and plate (10.3%). Condemnation item and incidence were liver (24.7%), lungs (11.5%), tripe (11.6%), heads (6.0%), tongues (9.7%), and carcasses (0.0%). Carcass evaluation revealed these traits and frequencies: steer (63.7%), heifer (36.2%), bullock (0.05%), and cow (0.04%) sex classes; dark-cutters (1.9%); A (97.1%), B (1.7%), and C or older (1.2%) overall maturities; and native (90.9%), dairy-type (8.3%), and Bos indicus (0.8%) estimated breed types. Mean USDA yield grade (YG) traits were USDA YG (2.9), HCW (359.9 kg), adjusted fat thickness (1.3 cm), LM area (86.4 cm(2)), and KPH (2.3%). The USDA YG were YG 1 (16.5%), YG 2 (36.3%), YG 3 (33.1%), YG 4 (11.8%), and YG 5 (2.3%). Mean USDA quality grade traits were USDA quality grade (Select(90)), marbling score (Small(32)), overall maturity (A(64)), lean maturity (A(57)), and skeletal maturity (A(68)). Marbling score distribution was Slightly Abundant or greater (2.7%), Moderate (4.3%), Modest (14.4%), Small (34.5%), Slight (41.2%), and Traces or less (2.9%). This information helps the beef industry measure progress and provides a benchmark for future educational and research activities.

Estimated compliance for removal of specified risk materials from 18 U.S. beef packing plants.

The removal of 18,345 specified risk materials was observed during audits of 18 U.S. beef processing facilities that, in total, account for over 90% of total U.S. beef slaughtered. Audited plants varied in capacity (280 to 6,000 head per day) and processed both "fed (young cattle)" and "nonfed (mature cows/bulls)" cattle. When all observations for removal of specified risk materials were combined from plants and adjusted for type of cattle processed, overall compliance with specified risk material removal regulations was 98.08%. A 100% compliance rate for removal of brains and distal ileums was recorded based on a total of 600 observations for removal of brains and a total of 2,400 observations for removal of distal ileums. Observations for removal of dorsal root ganglia were collected from 16 of the 18 plants, and overall compliance for dorsal root ganglia removal was 99.6% (4,783 of 4,800). Fifteen of the 16 plants were 100% compliant. For tonsils, data from 18 plants were collected, and tonsils were correctly removed from 92.8% (4,777 of 5,145) of tongues and heads. Data for spinal cord removal were collected from 18 plants, and the spinal cord was removed completely in line with U.S. Department of Agriculture-Food Safety and Inspection Service regulations for 99.43% of the observations. Based on the results of this study, packing plants have demonstrated that they are complying with regulations for removal of specified risk materials from beef meat products intended for human consumption greater than 98% of the time. To continue to assure food safety and consumer confidence, continued vigilance and provision of training programs for plant workers are essential.

[The beginning psychiatric training syndrome in the year 2007. Myth or reality?]. / Het 'beginning psychiatric training syndrome' anno 2007. Mythe of realiteit?

The beginning psychiatric training syndrome is a controversial, but imaginative nosological concept. This short paper provides a concise overview of the relevant literature on beginning psychiatric training syndrome, and presents the results of a pilot study regarding health problems among 35 residents in the Netherlands. On the basis of the two analyses, it is concluded that, as a rule, health problems among this group of doctors tend not to evolve into states of psychopathology in the restricted sense. Nonetheless, it is advisable to monitor such health problems with a view to their prevention.

[Who are the 'no-shows' and why don't they turn up?]. / Wie zijn de no-shows en waarom blijven zij weg?

BACKGROUND: No-show is a problem in mental health care. AIM: To obtain insight into the characteristics of patients who fail to appear at their intake appointments, to find out their reasons for not turning up, and thereby, if possible, to identify aspects of the intake procedures that may require adaptation. METHOD: In a prospective study based on 333 patients, we compared the characteristics of patients who failed to show up for the intake procedure with those of patients who did show up. Via a telephone interview we asked the 'no-shows' why they had not come. RESULTS: The number of 'no-shows' was lower than expected and we found only two very small differences: patients with a non-western background were less likely to turn up, as were patients whose appointments were later in the day, mainly around lunchtime. Via the telephone interview we found that most of the 'no-shows' still had felt unwell and blamed themselves for not turning up. They still wanted to be given professional help. CONCLUSION: No-show at intake appears to be less of a problem than expected. It seems a good idea to approach patients after they have missed appointments, because 'no-shows' still have serious symptoms and are still eager to receive professional help. It will probably be worthwhile conducting a similar investigation among 'no-shows' once they have begun to receive treatment.