Genetics providers' perspectives on the use of digital tools in clinical practice.

PURPOSE: Digital tools are increasingly incorporated into genetics practice to address challenges with the current model of care. Yet, genetics providers' perspectives on digital tool use are not well characterized. METHODS: Genetics providers across Canada were recruited. Semistructured interviews were conducted to ascertain their perspectives on digital tool use and the clinical practice factors that might inform digital tool integration. A qualitative interpretive description approach was used for analysis. RESULTS: Thirty-three genetics providers across 5 provinces were interviewed. Participants had favorable attitudes toward digital tool use. They were open to using digital tools in the pretest phase of the genetic testing pathway and for some posttest tasks or in a hybrid model of care. Participants expressed that digital tools could enhance efficiency and allow providers to spend more time practicing at the top of scope. Providers also described the need for careful consideration of the potential impact of digitalization on the clinician-patient dynamic, access to and equity of care, and unintended digital burden on providers. CONCLUSION: Genetics providers considered digital tools to represent a viable solution for improving access, efficiency, and quality of care in genetics practice. Successful use of digital tools in practice will require careful consideration of their potential unintended impacts.

Nuclear and cytoplasmic poly(A) binding proteins (PABPs) favor distinct transcripts and isoforms.

The poly(A)-tail appended to the 3'-end of most eukaryotic transcripts plays a key role in their stability, nuclear transport, and translation. These roles are largely mediated by Poly(A) Binding Proteins (PABPs) that coat poly(A)-tails and interact with various proteins involved in the biogenesis and function of RNA. While it is well-established that the nuclear PABP (PABPN) binds newly synthesized poly(A)-tails and is replaced by the cytoplasmic PABP (PABPC) on transcripts exported to the cytoplasm, the distribution of transcripts for different genes or isoforms of the same gene on these PABPs has not been investigated on a genome-wide scale. Here, we analyzed the identity, splicing status, poly(A)-tail size, and translation status of RNAs co-immunoprecipitated with endogenous PABPN or PABPC in human cells. At steady state, many protein-coding and non-coding RNAs exhibit strong bias for association with PABPN or PABPC. While PABPN-enriched transcripts more often were incompletely spliced and harbored longer poly(A)-tails and PABPC-enriched RNAs had longer half-lives and higher translation efficiency, there are curious outliers. Overall, our study reveals the landscape of RNAs bound by PABPN and PABPC, providing new details that support and advance the current understanding of the roles these proteins play in poly(A)-tail synthesis, maintenance, and function.

Finding the sweet spot: a qualitative study exploring patients' acceptability of chatbots in genetic service delivery.

Chatbots, web-based artificial intelligence tools that simulate human conversation, are increasingly in use to support many areas of genomic medicine. However, patient preferences towards using chatbots across the range of clinical settings are unknown. We conducted a qualitative study with individuals who underwent genetic testing for themselves or their child. Participants were asked about their preferences for using a chatbot within the genetic testing journey. Thematic analysis employing interpretive description was used. We interviewed 30 participants (67% female, 50% 50 + years). Participants considered chatbots to be inefficient for very simple tasks (e.g., answering FAQs) or very complex tasks (e.g., explaining results). Chatbots were acceptable for moderately complex tasks where participants perceived a favorable return on their investment of time and energy. In addition to achieving this "sweet spot," participants anticipated that their comfort with chatbots would increase if the chatbot was used as a complement to but not a replacement for usual care. Participants wanted a "safety net" (i.e., access to a clinician) for needs not addressed by the chatbot. This study provides timely insights into patients' comfort with and perceived limitations of chatbots for genomic medicine and can inform their implementation in practice.

A comprehensive genomic reporting structure for communicating all clinically significant primary and secondary findings.

Genomic sequencing (GS) can reveal secondary findings (SFs), findings unrelated to the reason for testing, that can be overwhelming to both patients and providers. An effective approach for communicating all clinically significant primary and secondary GS results is needed to effectively manage this large volume of results. The aim of this study was to develop a comprehensive approach to communicate all clinically significant primary and SF results. A genomic test report with accompanying patient and provider letters were developed in three phases: review of current clinical reporting practices, consulting with genetic and non-genetics experts, and iterative refinement through circulation to key stakeholders. The genomic test report and consultation letters present a myriad of clinically relevant GS results in distinct, tabulated sections, including primary (cancer) and secondary findings, with in-depth details of each finding generated from exome sequencing. They provide detailed variant and disease information, personal and familial risk assessments, clinical management details, and additional resources to help support providers and patients with implementing healthcare recommendations related to their GS results. The report and consultation letters represent a comprehensive approach to communicate all clinically significant SFs to patients and providers, facilitating clinical management of GS results.

"Doctors shouldn't have to cheat the system": Clinicians' real-world experiences of the utility of genomic sequencing.

PURPOSE: Emerging genetic tests such as genomic sequencing (GS) can generate a broad range of benefits, but funding criteria only prioritize diagnosis and clinical management. There is limited evidence on all types of benefits obtained from GS in practice. We aimed to explore real-world experiences of Canadian clinicians across specialties on the full range of benefits obtained from the results from GS. METHODS: We conducted a qualitative study using semistructured interviews with Canadian clinicians. Transcripts were thematically analyzed using constant comparison. RESULTS: In total, 25 clinicians participated, including 12 geneticists, 7 genetic counselors, 4 oncologists, 1 neurologist, and 1 family physician. Although diagnoses and management were the most valued benefits of GS, clinicians also prioritized nontraditional utility, such as access to community supports. However, clinicians felt "restricted" by funding bodies, which only approved funding when GS would inform diagnoses and management. Consequently, clinicians sought ways to "cheat the system" to access GS (eg, research testing) but acknowledged workarounds were burdensome, drove inequity, and undermined patient care. CONCLUSION: Current governance structures undervalue real-world benefits of GS leading clinicians to adopt workarounds, which jeopardize patient care. These results support calls for the expansion of the definition of clinical utility and research to quantify the additional benefits.

Shiga Toxin-Producing Escherichia coli in the Long-Term Survival Phase Exhibit Higher Chlorine Tolerance and Less Sublethal Injury Following Chlorine Treatment of Romaine Lettuce.

The extent of chlorine inactivation and sublethal injury of stationary-phase (STAT) and long-term survival-phase (LTS) cells of Shiga toxin-producing Escherichia coli (STEC) in vitro and in a lettuce postharvest wash model was investigated. Four STEC strains were cultured in tryptic soy broth supplemented with 0.6% (w/v) yeast extract (TSBYE; 35°C) for 24 h and 21 d to obtain STAT and LTS cells, respectively. Minimum bactericidal concentration (MBC) and dose-response assays were performed to determine chlorine's antibacterial efficacy against STAT and LTS cells. Chlorine solutions (pH 6.5) and romaine lettuce were each inoculated with STAT and LTS cells to obtain initial populations of ∼7.8 log colony-forming units (CFU)/mL. Survivors in chlorine solutions were determined after 30 s. Inoculated lettuce samples were held at 22°C ± 1°C for 2 h or 20 h and then exposed to chlorine (10-40 ppm) for 60 s. Survivors were enumerated on nonselective and selective agar media following incubation (35°C, 48 h). The MBC for STAT and LTS cells was 0.04 and 0.08 ppm, respectively. Following exposure (30 s) to chlorine at 2.5, 5.0, and 10 ppm, STAT cells were reduced to <1.0 log CFU/mL, whereas LTS survivors were at 5.10 (2.5 ppm), 3.71 (5.0 ppm), and 2.55 (10 ppm) log CFU/mL. At 20 and 40 ppm chlorine, greater log CFU reductions of STAT cells (1.64 and 1.85) were observed compared with LTS cells (0.94 and 0.83) after 2 h of cell contact with lettuce (p < 0.05), but not after 20 h. Sublethal injury in STEC after chlorine (40 ppm) treatment was lower in LTS compared with STAT survivors (p < 0.05). Compared with STAT cells, LTS cells of STEC seem to have higher chlorine tolerance as planktonic cells and as attached cells depending on cell contact time on lettuce. In addition, a higher percentage of LTS cells, compared with STAT cells, survive in a noninjured state after chlorine (40 ppm) treatment of lettuce.

Vascular modulation through exercise improves chemotherapy efficacy in Ewing sarcoma.

Recent studies in mouse models of cancer have shown that exercise improves tumor vascular function, thereby improving chemotherapy delivery and efficacy. However, the mechanisms underlying this improvement remain unclear and the effect of exercise on Ewing sarcoma (ES), a pediatric bone and soft tissue cancer, is unknown. The effect of exercise on tumor vascular hyperpermeability, which inversely correlates with drug delivery to the tumor, has also not been evaluated. We hypothesized that exercise improves chemotherapy efficacy by enhancing its delivery through improving tumor vascular permeability. We treated ES-bearing mice with doxorubicin with or without moderate treadmill exercise. Exercise did not significantly alter ES tumor vessel morphology. However, compared to control mice, tumors of exercised mice had significantly reduced hyperpermeability, significantly decreased hypoxia, and higher doxorubicin penetration. Compared to doxorubicin alone, doxorubicin plus exercise inhibited tumor growth more efficiently. We evaluated endothelial cell sphingosine-1-phosphate receptors 1 and 2 (S1PR1 and S1PR2) as potential mediators of the improved vascular permeability and increased function afforded by exercise. Relative to tumors from control mice, vessels in tumors from exercised mice had increased S1PR1 and decreased S1PR2 expression. Our results support a model in which exercise remodels ES vasculature to reduce vessel hyperpermeability, potentially via modulation of S1PR1 and S1PR2, thereby improving doxorubicin delivery and inhibiting tumor growth more than doxorubicin alone does. Our data suggest moderate aerobic exercise should be tested in clinical trials as a potentially useful adjuvant to standard chemotherapy for patients with ES.

Survival of Escherichia coli O157:H7 after application of lactic acid bacteria.

BACKGROUND: Establishing novel preharvest intervention strategies for leafy green growers is of critical need with the rise in foodborne outbreaks associated with these products. Recent studies have shown that lactic acid bacteria (LAB) are able to reduce the presence of Escherichia coli O157:H7 in various food matrices. Electrostatic application of organic acids has been shown to be effective as a postharvest safety intervention to reduce E.coli O157:H7 on leafy greens. The effect of LAB electrostatically applied and sprinkler irrigated once over a 4 week growth cycle was evaluated against E. coli O157:H7 on spinach. RESULTS: The results indicated that E. coli O157:H7 when applied once during the 4 week growth cycle will survive in the soil and spinach leaves at harvest. LAB applied electrostatically and by sprinkler irrigation water on the soil and/or leaf surface within the first 4 weeks of the growing cycle resulted in a significant reduction (almost a 3 log10 reduction) of E. coli O157:H7 both on the leaf and in the soil at harvest, regardless of the application time (P < 0.01). CONCLUSION: LAB surface treatments have the potential to improve the safety of leafy green plants as a preharvest food safety intervention when combined with good agricultural practices. © 2018 Society of Chemical Industry.

Aerobic Exercise During Early Murine Doxorubicin Exposure Mitigates Cardiac Toxicity.

We report the cardioprotective effects of moderate aerobic exercise from parallel pediatric murine models of doxorubicin (Doxo) exposure in non-tumor-bearing immune competent (NTB-IC) mice and tumor-bearing nude mice (TB-NM). In both models, animals at 4 weeks of age underwent Doxo treatment with or without 2 weeks of simultaneous exercise. In sedentary NTB-IC or TB-NM mice, Doxo treatment resulted in a statistically significant decrease in ejection fraction and fractional shortening compared with control animals. Interestingly, moderate aerobic exercise during Doxo treatment significantly mitigated decreases in ejection fraction and fractional shortening. In contrast, these protective effects of exercise were not observed when exercise was started after completion of Doxo treatments. Moreover, in the TB-NM model, Doxo caused a decrease in heart mass: tibia length and in body weight that was prevented by exercise, whereas NTB-IC mice exhibited no change in these measurements. Doxo delivery to the hearts of TB-NM was decreased by consistent moderate aerobic exercise before Doxo injection. These findings demonstrate the important but subtle differences in cardiotoxicity observed in different mouse models. Collectively, these results also strongly suggest that aerobic exercise during early-life Doxo exposure mitigates cardiotoxicity, possibly through altered delivery of Doxo to myocardial tissue.

Long-Term Survival Phase Cells of Salmonella Typhimurium ATCC 14028 Have Significantly Greater Resistance to Ultraviolet Radiation in 0.85% Saline and Apple Juice.

Nonendospore-forming pathogenic bacteria in the long-term survival (LTS) phase can remain viable for months or years and may show reduced susceptibility to various antimicrobial interventions. In the present study, we investigated the response of LTS phase Salmonella enterica serovar Typhimurium (ATCC 14028) to ultraviolet (UV) radiation in 0.85% (w/v) saline and apple juice and the extent of sublethal injury in LTS phase survivors. The LTS-phase Salmonella Typhimurium cells were cultured at 35°C for 14 days in tryptic soy broth with 0.6% (w/v) yeast extract (TSBYE). Exponential- and stationary-phase cells, cultured in TSBYE (35°C) for 2.5 and 18 h, respectively, served as control samples. Cells (107 CFU [colony-forming unit]/mL) from each physiological state were exposed to UV light in saline (80 µW/cm2) and apple juice (1500 µW/cm2). The Salmonella Typhimurium survivors were plated for enumeration on either tryptic soy agar with 0.6% yeast extract or xylose-lysine-tergitol 4 (XLT4) agar and colonies counted after incubation (35°C, 24 h). Of all the growth phases tested, LTS phase cells were consistently impacted the least by UV treatment (p < 0.05). In saline, D-values of exponential, stationary, and LTS Salmonella Typhimurium were 0.35, 0.38, and 0.49 min, respectively. D-values in apple juice at pH 3.63 and pH 5.65 were 2.52, 3.19, and 3.57 min and 3.24, 3.50, and 4.18 min, respectively. UV radiation (80 µW/cm2) of Salmonella Typhimurium in saline for 2.5 min reduced the number of exponential- and stationary-phase cells by ∼7.19 and 6.30 log10 CFU/mL, respectively. In contrast, LTS cells were only reduced by 5.08 log10 CFU/mL. Among the three physiological states, LTS phase cells had the least sublethal injury in the surviving population (p < 0.05). These results indicate that the LTS state cross-protects Salmonella Typhimurium against UV radiation and should be considered in determination of the UV radiation D-value for this pathogen.

Antimicrobial Efficacy of Cinnamaldehyde Against Escherichia coli O157:H7 and Salmonella enterica in Carrot Juice and Mixed Berry Juice Held at 4°C and 12°C.

The effectiveness of cinnamaldehyde for inactivating Salmonella enterica and Escherichia coli O157:H7 in carrot juice (CRJ) and mixed berry juice (MBJ) was investigated. Brain heart infusion broth (BHI), CRJ, and MBJ, with concentrations of added cinnamaldehyde ranging from 0.15 to 1.5 µL/mL, 0.25 to 2.0 µL/mL, and 0.25 to 1.5 µL/mL, respectively, were each inoculated with a 5-strain mixture of Salmonella enterica or Escherichia coli O157:H7 to give an initial viable count of 5.07 log10 colony-forming units/mL. Inoculated BHI or juices without cinnamaldehyde served as controls. Growth of the pathogens in BHI (35°C) was monitored by taking absorbance readings (optical density [OD] 600 nm) for 24 h. The inoculated juices were held at 4°C or 12°C for 24 h, and numbers of viable pathogens were determined at 0, 2, 4, 8, and 24 h by plating samples on selective agar followed by incubation (35°C) and counting bacterial colonies at 48 h. The minimum inhibitory concentration of cinnamaldehyde for both pathogens in BHI was 0.25 µL/mL. The pathogens were more sensitive to cinnamaldehyde in MBJ compared with CRJ, irrespective of storage temperature (p < 0.05). At 4°C, cinnamaldehyde (1.5 µL/mL) completely inactivated S. enterica and E. coli in MBJ (negative by enrichment) within 2 h and 8 h, respectively; whereas both pathogens were detected in CRJ (4°C; with 2.0 µL/mL cinnamaldehyde) at 8 and 24 h. At 12°C, S. enterica and E. coli were undetected in MBJ (1.5 µL/mL cinnamaldehyde) within 2 and 4 h, respectively; however, in CRJ (12°C; 2.0 µL/mL cinnamaldehyde), complete inactivation of S. enterica and E. coli occurred within 4 and 24 h, respectively. Cinnamaldehyde is an effective antimicrobial from natural sources that can be used for inactivating bacterial pathogens in fruit and vegetable juices to enhance microbial safety of these nutritious food products.

Survival of Escherichia coli on strawberries grown under greenhouse conditions.

Strawberries are soft fruit that are not recommended to have a post-harvest wash due to quality concerns. Escherichia coli O157:H7 has been linked to outbreaks with strawberries but little is known about the survival of E. coli during the growth cycle of strawberries. The survival of E. coli on strawberry plants during growing under greenhouses conditions was evaluated. Soil, leaves, and strawberries (if present) were artificially contaminated with an E. coli surrogate either at the time of planting, first runner removal (4 wk), second runner removal (8 wk), or one week prior to harvest. At harvest E. coli was recovered from the leaves, soil, and strawberries regardless of the contamination time. Time of contamination influenced (P < 0.05) numbers of viable E. coli on the plant. The highest survival of E. coli (P < 0.0001) was detected in soil that was contaminated at planting (4.27 log10 CFU g soil(-1)), whereas, the survival of E. coli was maximal at later contamination times (8 wk and 1 wk prior to harvest) for the leaves (4.40 and 4.68 log10 CFU g leaves(-1)) and strawberries (3.37 and 3.53 log10 CFU strawberry(-1)). Cross contamination from leaves to fruit was observed during this study, with the presence of E. coli on strawberries which had not been present at the time of contamination. These results indicate that good agricultural best practices to avoid contamination are necessary to minimize the risk of contamination of these popular fruit with enteric pathogens. Practices should include soil testing prior to harvest and avoiding contamination of the leaves.

Radiation resistance and injury in starved Escherichia coli O157:H7 treated with electron-beam irradiation in 0.85% saline and in apple juice.

This study evaluated the influence of starvation on the radiation resistance and injury in Escherichia coli O157:H7, following electron beam irradiation in 0.85% (wt/vol) saline and in apple juice. Washed exponential-phase cells of E. coli O157:H7 that were grown in tryptic soy broth (TSB) at 35°C were starved in 0.85% saline (25°C) for 10 days. Exponential- or stationary-phase cells grown in TSB (35°C) served as controls. Samples of 0.85% saline or pasteurized apple juice, inoculated with control cells or cells starved for 8 days, were exposed to electron beam irradiation at doses ranging from 0.0 (control) to 0.70 kGy. The E. coli survivors were enumerated by plating diluted samples on tryptic soy agar or on Sorbitol McConkey agar and counting bacterial colonies after incubation (35°C) for 24 h. Starved cells consistently exhibited higher irradiation D-values than controls (p<0.05). The D-values for control and starved E. coli O157:H7 in 0.85% saline were 0.11 and 0.26 kGy, respectively; D-values in apple juice were 0.16, 0.19, and 0.33 kGy for exponential, stationary, and starved cells, respectively. Irradiation (0.70 kGy) of E. coli O157:H7 in apple juice reduced numbers of exponential- and stationary-phase cells by ∼4.32 and 3.74 logs, respectively, whereas starved cells were reduced by only 2.20 logs. Exponential-phase cells exhibited the lowest resistance to irradiation, and sublethal injury in survivors of this group was higher than that of stationary-phase or starved cells irradiated at 0.50 or 0.70 kGy (p<0.05). The results of this study indicate that starvation-induced stress cross-protects E. coli O157:H7 from ionizing radiation and should be considered an important factor when determining irradiation D-values for this pathogen.

Comparing the effectiveness of delivery style in produce safety training for growers.

The Produce Safety Alliance grower training has been offered since 2016. Prior to the pandemic, the course was offered exclusively in-person. During the pandemic, trainers were allowed to offer the course remotely. The effectiveness of in-person and remote delivery options was compared utilizing four methods: course evaluations completed at the training; a pre- and post-training knowledge assessment; a 1-year follow-up survey; and focus groups with course trainers. All methods, except the focus groups, were used as evaluation tools starting before and continuing during the pandemic. On the course evaluations, remote delivery and in-person participants rated their satisfaction with the training and their confidence in their ability to make changes at the same high rate. The knowledge assessment found remote delivery participants scored higher on the posttest than in-person participants when controlling for pretest score (p < 0.001); the effect size was between low and medium (ηp 2 = 0.025). On the follow-up survey, remote delivery participants reported making changes to food safety practices or infrastructure at a higher rate than in-person participants (68% vs. 53%, respectively, Χ2 (1, N = 700) = 6.372, p = 0.012, Cramer's V = 0.012 (very low)). There were demographic differences in educational level, job description, and number of years farming between the two populations. The focus group revealed advantages and disadvantages of both delivery methods, including internet availability, engagement activity, and course logistics and planning. Because no practical differences in outcome were measured between delivery methods and each had unique strengths, researchers recommend that educators should utilize both methods in the future. PRACTICAL APPLICATION: 1. When deciding between offering in-person or synchronous virtual training, trainers can feel confident that both delivery methods result in positive experiences from participants, learning, and behavior change. 2. PSA trainers may choose to offer the training remotely to increase accessibility for people who live in areas where there may not be enough growers to warrant holding an in-person training nearby, but should also consider that reliable high-speed internet access may not be available to all. 3. Remote delivery trainings can be smoother by hosting remote delivery participants at local extension or other partner offices where high-speed internet is available.

Beef Handling Practices Among Consumers in the U.S. Virgin Islands.

U.S. Virgin Islands (USVI) imports more than 95% of its food. Transportation limitations throughout the territory's supply chain can make temperature control of protein foods challenging for consumers. This study aimed to characterize the beef handling practices used by consumers in USVI to determine any educational needs. Printed and online surveys (n = 620 total) were disseminated in USVI through extension agents and local media sources. Three hundred and thirty-four consumers completed a 30-question food handling questionnaire on consumption patterns and food handling from purchasing to their kitchen. Frequencies and Pearson chi-square tests of independence were performed. Beef ranked second among the different meat types consumed, 92% of consumers bought beef from grocery stores, and 55% removed beef from shelves immediately after entering the store. When shopping, 59.1% of respondents always checked the use-by/freeze-by dates of beef, 46.3% always separated beef from other foods, but only 27.5% always used insulated bags. Eighty-three percent of consumers returned home within 1 h of shopping, 92% took less than 30 min to store groceries in either a freezer or refrigerator (98%) and during power outages, 45.1% maintained cold temperatures of beef. Seventy-two percent of consumers washed their hands for more than 10 s, but 33% of those from households with a vulnerable person did not use soap to wash their hands and dried them with reusable towels. When cooking, 44.6% of consumers thawed beef within the temperature danger zone, 80.1% did not check the temperature of beef for doneness, and 34 respondents cooked hamburgers below 160°F. Future consumer food safety education initiatives in the USVI should address hand hygiene among food preparers in homes with vulnerable persons, temperature control practices by promoting the use of insulated bags, safe meat thawing techniques, and the use of thermometers during cooking.

A Review of Regulatory Standards and Advances in Essential Oils as Antimicrobials in Foods.

As essential oils (EOs) possess GRAS status, there is a strong interest in their application to food preservation. Trends in the food industry suggest consumers are drawn to environmentally friendly alternatives and less synthetic chemical preservatives. Although the use of EOs has increased over the years, adverse effects have limited their use. This review aims to address the regulatory standards for EO usage in food, techniques for delivery of EOs, essential oils commonly used to control pathogens and molds, and advances with new active compounds that overcome sensory effects for meat products, fresh fruits and vegetables, fruit and vegetable juices, seafood, dairy products, and other products. This review will show adverse sensory effects can be overcome in various products by the use of edible coatings containing encapsulated EOs to facilitate the controlled release of EOs. Depending on the method of cooking, the food product has been shown to mask flavors associated with EOs. In addition, using active packaging materials can decrease the diffusion rate of the EOs, thus controlling undesirable flavor characteristics while still preserving or prolonging the shelf life of food. The use of encapsulation in packaging film can control the release of volatile or active ingredients. Further, use of EOs in the vapor phase allows for contact indirectly, and use of nanoemulsion, coating, and film wrap allows for the controlled release of the EOs. Research has also shown that combining EOs can prevent adverse sensory effects. Essential oils continue to serve as a very beneficial way of controlling undesirable microorganisms in food systems.

Cultivating Food Safety Together: Insights About the Future of Produce Safety in the U.S. Controlled Environment Agriculture Sector.

Controlled environment agriculture (CEA) is a rapidly growing sector that presents unique challenges and opportunities in ensuring food safety. This manuscript highlights critical gaps and needs to promote food safety in CEA systems as identified by stakeholders (n=47) at the Strategizing to Advance Future Extension andResearch (S.A.F.E.R.) CEA conference held in April 2023 at The Ohio State University's Ohio CEA Research Center. Feedback collected at the conference was analyzed using an emergent thematic analysis approach to determine key areas of focus. Research-based guidance is specific to the type of commodity, production system type, and size. Themes include the need for improved supply chain control, cleaning, and sanitization practices, pathogen preventive controls and mitigation methods and training and education. Discussions surrounding supply chain control underscored the significance of the need for approaches to mitigate foodborne pathogen contamination. Effective cleaning and sanitization practices are vital to maintaining a safe production environment, with considerations such as establishing standard operating procedures, accounting for hygienic equipment design, and managing the microbial communities within the system. Data analysis further highlights the need for risk assessments, validated pathogen detection methods, and evidence-based guidance in microbial reduction. In addition, training and education were identified as crucial in promoting a culture of food safety within CEA. The development of partnerships between industry, regulatory, and research institutions are needed to advance data-driven guidance and practices across the diverse range of CEA operations and deemed essential for addressing challenges and advancing food safety practices in CEA. Considering these factors, the CEA industry can enhance food safety practices, foster consumer trust, and support its long-term sustainability.

Impact of nitrite-embedded packaging film on quality and sensory attributes of alternatively-cured and nitrite-free bologna.

The objectives were to determine the effects of post-thermal processing nitrite-embedded film (NEF) packaging on the quality attributes of alternatively-cured (nitrite from celery juice powder (AC)) and nitrite-free bologna. Attributes evaluated included lipid oxidation, instrumental color, pigment concentration, and sensory properties such as cured meat flavor, aroma, and color. Three bologna formulations, each packaged with two packaging films were produced. A conventionally-cured control formulation (with nitrite from sodium nitrite; CON), a nitrite-free formulation (UCC), and an alternatively cured formulation (nitrite from cultured celery juice powder; AC) were packaged in conventional (CF) or nitrite-embedded (NEF) film. Instrumental a* values (measured during both light and dark storage at intervals of 7 or 14 days over 126 days of storage) and cured pigment concentration (measured at 14-day intervals over 84 days of storage) were significantly greater (P < 0.05) for the UCC-NEF treatment compared to its conventional film counterpart, UCC-CF. No significant differences (P > 0.05) for lipid oxidation (TBARS values) were observed with NEF. Trained sensory panelists, who evaluated samples at 14-day intervals over 70 days of storage, found significantly greater (P < 0.05) cured aroma, cured flavor, pink color and less off-flavor for uncured bologna packaged in NEF compared to conventional film. For the uncured bologna formulation, NEF packaging provided cured meat attributes comparable to the control formulation that included nitrite. This is the first time that cured aroma and flavor have been observed when nitrite from packaging film is added to a cooked meat product under anaerobic conditions.

Totally Excited about Moving Mobility and Exercise (TEAM Me): A Successful Multidisciplinary Exercise Quality Improvement Initiative for Pediatric and Young Adult Oncology and Stem Cell Transplant Inpatients.

BACKGROUND: Pediatric, adolescent and young adult (PAYA) patients are less active than their healthy counterparts, particularly during inpatient stays. METHODS: We conducted a quality improvement initiative to increase activity levels in patients admitted to our pediatric oncology and cellular therapy unit using a Plan-Do-Study-Act (PDSA) model. An interdisciplinary team was assembled to develop an incentive-based inpatient exercise and activity program titled Totally Excited About Moving Mobility and Exercise (TEAM Me). As part of the program, patients were encouraged by their care team to remain active during their inpatient stay. As an additional incentive, patients earned stickers to display on TEAM Me door boards along with tickets that could be exchanged for prizes. Activity was assessed by documentation of physical therapy participation, tests of physical function, and surveys of staff perceptions of patient activity levels, motivations, and barriers. RESULTS: Compared to baseline, patient refusals to participate in physical therapy decreased significantly (24% vs. 2%) (p < 0.02), and staff perceptions of patient motivation to stay active increased from 40% to 70% in the post implementation period. There were no changes in physical function tests. CONCLUSIONS: An incentive-based exercise program for young oncology inpatients greatly improved patient activity levels, participation in physical therapy and influenced professional caregivers' beliefs.

Escherichia coli Survival on Strawberries and Unpacked Romaine Lettuce Washed Using Contaminated Water.

A number of foodborne outbreaks have occurred in the past decade, with higher incidences associated with romaine lettuce and strawberries. Contaminated agricultural water has been reported as the source of microbial contamination in most of these outbreaks. Maintaining the adequate and sanitary quality (0 E. coli/100 mL) of agricultural water can be challenging during post-harvest operations such as washing. The study focused on the attachment of generic E. coli (Rifampicin resistant) onto romaine lettuce and strawberries, mimicking the produce wash step. The produce was washed with contaminated water, air-dried, and stored in display units for 7 days. The produce was sampled randomly each day and analyzed for the surviving E. coli count. The results indicated that E. coli can survive in both lettuce and strawberries over extended periods. A survival population of 2.3 log CFU/cm2 (day 8) was observed on lettuce with an initial population of 2.8 log CFU/cm2 (day 0). On strawberries, the population reduced from 3.0 (day 0) to 1.7 log CFU/cm2 (day 7), with an initial E. coli concentration of approx. 6 log CFU/mL in the wash water. Strawberry leaves had a higher attachment of E. coli than the fruit (p < 0.05). In conclusion, romaine lettuce and strawberries washed with contaminated water can cause an outbreak affecting consumers and public health.