Cleaning frequency and the microbial load in ice-cream

This study investigates the efficacy of a 62 h cleaning frequency in the manufacturing of ice-cream. Various product and product contact surfaces were sampled progressively throughout the time period between cleaning cycles, and analyzed for microbial growth. The coliform and standard plate counts (SPC) of these samples did not vary significantly over time after 0, 24, 48, or 62 h from Cleaning in Place (CiP). Data for product contact surfaces were significant for the SPC representing sample locations. Some of the variables in cleaning practices had significant influence on microbial loads. An increase in the number of flavors manufactured caused a decrease in SPC within the 24 h interval, but by the 48 h interval the SPC increased. More washouts within the first 24 h interval were favorable, as indicated by decreased SPC. The more frequently the liquefier was sanitized within the 62 h interval, the lower the SPC. This study indicates that food safety was not compromised and safety practices were effectively implemented throughout the process.     

Increasing the success of physician order entry through human factors engineering

Even though the success of a physician order entry (POE) system depends on meeting physicians' needs, no studies of POE systems report using standard, formal methods for assessing physician needs and how to design the best technology to meet those needs. To increase the chance of a successful POE implementation, the article proposes that techniques from the field of human factors engineering (HFE) be used to enhance the interaction between technology and the physicians.     

Fungal flora in groundwater-derived public drinking water

In order to assess the dissemination of hygienically relevant fungi via the public drinking water distribution system, a 12-month survey was performed on groundwater-derived drinking water from 29 water supplies in North Rhine-Westphalia, Germany. Frequencies of contaminated water samples, and the prevalent species and patterns of occurrence in raw water, waterworks, the network and house installations were studied on the basis of 2657 water samples. Results were obtained by long-term incubation of 1 ml aliquots of water samples on agar-based culture media, following bacteriological procedures documented in the German drinking water regulations (Anon, 1990). No correlation with standard hygiene indicators, such as E. coli or other coliform bacteria was observed. Common opportunistic and allergenic Aspergillus species were encountered only rarely. The fungal flora was dominated by a limited number of species of Acremonium, Exophiala, Penicillium and particularly Phialophora; some of them occurred throughout the entire drinking water system and are thought to constitute a resident fungal flora. Phialophora sp. nov., to be described as a new species elsewhere, was ubiquitous; it was found in 26.6% of the samples positive for fungi (7.5% of 2657). Fungal diversity in the network itself was significantly lower than in raw water and house installations, indicating that not all fungi gaining access to the system are capable of surviving for longer periods. For species such as Verticillium lecanii, found exclusively after the introduction of newly buried pipes and remaining localized at those sites, introduction via arthropod vectors is likely. The resident species of Phialophora, Exophiala and Acremonium are particularly significant as they are shown to be disseminated efficiently by public drinking water.     

Insulin aspart: a review of its use in the management of type 1 and 2 diabetes mellitus

Insulin aspart, a rapid-acting human insulin analogue, provides more rapid absorption than regular human insulin after subcutaneous administration. In most randomised, nonblind clinical trials in patients with type 1 diabetes mellitus, insulin aspart administered immediately before meals resulted in significantly lower mean glycosylated haemoglobin A(1c ) (HbA(1c)) levels than regular human insulin (usually administered 30 minutes before a meal). Insulin aspart also significantly improved postprandial glycaemic control compared with regular human insulin. The efficacy of insulin aspart was similar to that of insulin lispro when administered to patients with type 1 diabetes mellitus via continuous subcutaneous infusion in a randomised, nonblind trial. Preliminary data from randomised, nonblind trials suggest insulin aspart had a trend towards lower HbA(1c) levels compared with regular human insulin in patients with type 2 diabetes mellitus. Biphasic insulin aspart [30% soluble (rapid-acting) and 70% protamine-bound insulin aspart (BIAsp30)] generally provided significantly better postprandial glucose control than a similar mixture of biphasic regular human insulin (BHI30) in a randomised, nonblind trial in patients with type 1 or 2 diabetes mellitus. However, the long-term efficacy of BIAsp30 was similar to that of BHI30 after 2 years in a randomised, nonblind trial in patients with type 2 diabetes mellitus. Patients with type 1 or 2 diabetes mellitus reported greater treatment satisfaction with insulin aspart or BIAsp30 than with regular human insulin or BHI30. The overall incidence of hypoglycaemia with insulin aspart was lower than, or similar to, that of regular human insulin. Moreover, insulin aspart tended to be associated with a lower occurrence of nocturnal hypoglycaemia and severe hypoglycaemic events than regular human insulin. CONCLUSION: The standard preparation of insulin aspart has the potential to better mimic the physiological response to meals than regular human insulin. Insulin aspart when combined with a suitable basal insulin improved overall glycaemic control and led to a similar or lower number of hypoglycaemic episodes compared with a similar regular human insulin regimen. Insulin aspart was generally as effective and well tolerated as insulin lispro when administered by continuous subcutaneous infusion in a single comparative trial. The efficacy of biphasic insulin aspart has been documented in a small number of trials. Both insulin aspart and biphasic insulin aspart provide for flexible and convenient administration. Insulin aspart is now well established as an effective and convenient means of providing glycaemic control which offers clinical and practical advantages over regular human insulin.     

A novel nonpeptidic caspase-3/7 inhibitor, (S)-(+)-5-[1-(2-methoxymethylpyrrolidinyl)sulfonyl]isatin reduces myocardial ischemic injury

A continuing challenge for studies in the neurobiology of drug abuse is to identify and characterize long-lived neuroadaptations that can trigger craving and relapse. We previously reported that rats that had actively self-administered methamphetamine for 5 weeks and were then withdrawn from methamphetamine for 24 h showed marked decreases in somatodendritic dopamine D(2) autoreceptor levels in the ventral tegmental area and median and dorsal part of the substantia nigra zona compacta with a corresponding down-regulation of dopamine D(1) receptors in the shell of the nucleus accumbens. The purpose of the present study was to determine whether neuroadaptive changes in dopamine receptors or transporters in the brains of rats withdrawn for 24 h from chronic methamphetamine self-administration are persistent changes that can be demonstrated long after withdrawal. A "yoked" procedure was used in which rats were tested simultaneously in groups of three, with only one rat actively self-administering methamphetamine while the other two received yoked injections of either methamphetamine or saline. In vitro quantitative autoradiography was used to determine densities of dopamine uptake sites and dopamine D(1) and D(2) receptors in different brain regions following 7- and 30-day periods of withdrawal from chronic methamphetamine self-administration. No changes in dopamine transporter and dopamine receptor numbers were detected in any brain region examined in rats self-administering methamphetamine compared with littermates receiving yoked infusions of either methamphetamine or saline. Thus, neuroadaptive changes in densities of dopamine receptors or transporters in certain brain areas may contribute to the reinforcing effects of methamphetamine during the acquisition and maintenance phases of self-administration, but do not appear to contribute to the long-lasting neuroadaptive effects of chronic methamphetamine self-administration, which may trigger craving and relapse.     

Defining hormesis: comments on Calabrese and Baldwin (2002)

The definition of hormesis should not include non-scientific judgments as to beneficial or harmful effects. Evaluating the significance of hormesis is a separate issue that ultimately requires risk:risk comparisons, particularly since the evolutionary basis for hormesis appears to be Lamarkian rather than Darwinian. It is arguable whether 'hormesis' is the correct umbrella term for all low-dose exposure responses, in particular those at higher organization levels than single species, or whether it includes arousal responses.     

Management of croup

Croup, or laryngotracheobronchitis, is a common childhood illness most often caused by viral infections. It is usually a benign, self-limiting disease, but can result in life-threatening upper airway obstruction. Until recently, it was not uncommon for children with severe croup to be admitted to intensive care for intubation. Management used to be limited to supportive measures, including mist therapy. The use of corticosteroids in patients with croup was controversial for many years but has, in the last decade, transformed the management of this disorder. Although corticosteroids do not alter the history of the viral infection, an adequate dose of oral or parenteral dexamethasone or nebulized budesonide has been shown to have a beneficial effect on the symptoms of croup.     

A memory clinic at a geriatric hospital: a report on 577 patients assessed with the CAMDEX over 9 years

OBJECTIVE: To report 9 years' experience of an Australian memory clinic using the -Cambridge Mental Disorders in the Elderly Examination (CAMDEX) assessment schedule, summarizing patient demographics, diagnoses at presentation and the utility of four instruments used in distinguishing patients with and without dementia. METHODS: All patients seen at the clinic between December 1989 and September 1998 were assessed using the CAMDEX. Diagnoses were determined according to criteria of the International Classification of Diseases, tenth edition (ICD-10). RESULTS: The mean age of 577 patients seen was 72.9 years and 60.8% were female. Over 40% fulfilled ICD-10 diagnostic criteria for dementia in Alzheimer's disease. A further 24% had another dementing illness. Only 28 patients were "normal". There was no significant difference in the ability of the 107-item Cambridge cognitive examination, the 30-item mini-mental state examination, the 10-item abbreviated mental test score and the 26-item informant questionnaire on cognitive decline in the elderly to differentiate dementia patients from those who were normal or had functional psychiatric disorders. The four cognitive screening tools had high correlations with one another (r = - 0.57 to 0.93). CONCLUSION: Patient demographics and diagnoses were similar to those found in other clinics. Most people who attended the memory clinic had significant cognitive or psychiatric disorders.