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Clinical simulations are gaining more attention in the field of maternal-child health and allow nursing programs and service organizations to assess competency of students and staff in key patient safety situations. Nursing and midwifery programs, orientations, and yearly reaccreditation modules commonly include simulation on postpartum hemorrhage, placenta abruption, shoulder distocia, and other high-risk, low-incidence emergency events. This article describes the use of simulations by educators and managers as teaching or professional development strategies.

Food allergies affect an estimated 10 to 12 million people in the United States. Some of these individuals can develop life-threatening allergic reactions when exposed to allergenic proteins. At present, the only successful method to manage food allergies is to avoid foods containing allergens. Consumers with food allergies rely on food labels to disclose the presence of allergenic ingredients. However, undeclared allergens can be inadvertently introduced into a food via cross-contact during manufacturing. Although allergen removal through cleaning of shared equipment or processing lines has been identified as one of the critical points for effective allergen control, there is little published information on the effectiveness of cleaning procedures for removing allergenic materials from processing equipment. There also is no consensus on how to validate or verify the efficacy of cleaning procedures. The objectives of this review were (i) to study the incidence and cause of allergen cross-contact, (ii) to assess the science upon which the cleaning of food contact surfaces is based, (iii) to identify best practices for cleaning allergenic foods from food contact surfaces in wet and dry manufacturing environments, and (iv) to present best practices for validating and verifying the efficacy of allergen cleaning protocols.

Chemical sanitizers are commonly used to inactivate Listeria monocytogenes and other Listeria species that persist in food-processing environments after cleaning. In this study, Listeria innocua cultures were exposed to acid, heat, cold, and starvation stress and then assessed for sensitivity to the quaternary ammonium compound cetrimide. Unstressed and stressed cultures were exposed to cetrimide for 3 min, neutralized, and plated on tryptic soy agar with yeast extract to determine the percentage of survivors. Relative to controls, L. innocua exposed to acid and starvation conditions was less sensitive to cetrimide, whereas heat and cold stress increased cetrimide sensitivity (P < 0.05). The diminished sensitivity of acid- and starvation-stressed L. innocua to cetrimide suggests that these stressors might increase the persistence of this organism within food-manufacturing facilities. In contrast, enhanced L. innocua sensitivity to cetrimide following heat and cold stress suggests that these interventions might increase sanitation efficacy.

In animals and human beings exposed to arsine gas (AsH3) a severe and fulminant lysis of erythrocytes occurs. Little is known about the effects of subchronic exposure on the hematopoietic system or about the mechanism of hemolysis produced by arsine gas. To examine these, we exposed male and female mice to 0.000, 0.025, 0.500 and 2.500 ppm arsine gas for 6 h a day, 5 days a week during a 90-day period. After 5, 15, and 90 days of exposure, blood was collected and routine hematologic profiles were performed to document the effects of arsine gas on peripheral blood. A moderate hemolytic anemia, indicated by decreases in erythrocyte counts, hematocrits, hemoglobin concentrations and increases in mean corpuscular hemoglobins and mean corpuscular hemoglobin concentrations, was seen in blood samples collected after 5 days of exposure. In blood collected after 15 and 90 days of exposure, the anemia was less severe but a greater increase in mean corpuscular volumes and absolute reticulocyte counts revealed an active regenerative response. Higher concentrations of methemoglobin in animals in the 2.500 ppm exposure group (measured after 90 days of exposure) indicated that the rate of oxidation of heme (ferrous to ferric) increased due to exposure to arsine gas. Additionally, the presence of Heinz bodies in blood smears stained with brilliant cresyl blue and decreases in reduced glutathione concentrations in red blood cells exposed to arsine gas in vitro provide evidence that the mechanism of hemolysis involves depletion of intracellular reduced glutathione resulting in an oxidation of sulfhydryl groups in hemoglobin and possibly red cell membranes.

The effect of dietary vomitoxin on the serum IgA and IgG responses to two model intestinal antigens, casein and cholera toxin (CT), were assessed in 4 experimental groups: (1) mice fed casein-based diet, (2) mice fed casein-based diet containing 25 ppm vomitoxin, (3) mice fed casein-based diet and immunized with CT, and (4) mice fed casein-based diet containing 25 ppm vomitoxin and immunized with CT. Unimmunized and CT-immunized mice that were fed vomitoxin exhibited increased levels of total serum IgA relative to matched control animals fed the standard diet. Relative concentrations of casein-specific IgA were greater in both unimmunized mice and CT-immunized mice fed standard diet with vomitoxin than in matched controls fed standard diet only. CT-specific serum IgA in CT-immunized mice was not affected by vomitoxin feeding, but relative levels of CT-specific IgA were higher in unimmunized mice fed vomitoxin than in unimmunized mice fed standard diet. Both casein- and CT-specific serum IgG were depressed in mice fed vomitoxin. Significant differences in total, casein-specific and CT-specific IgA within the intestinal contents were not observed between CT-immunized mice fed vomitoxin and those fed the control diet. The results suggest that vomitoxin altered regulation of the normal immunoglobulin response to intestinal antigens and that this was manifested in the systemic compartment.

Exposure of rabbits for 12 weeks to 300 ppm carbon disulfide (CS2) for 6 h/day, 5 days/week, or to 25 mg/day of thiourea or 2% cholesterol in the diet, or to any combination thereof caused a significant reduction in the concentration of serum thyroxine (T4). The reduction of the concentration of serum T4 in rabbits by the treatments was completely offset by the inclusion of 0.1 mg/day of sodium levothyroxine in the diet. Ingestion of feed containing 2% cholesterol significantly increased the degree of atherosclerosis present in the aortic arch and significantly increased the oil red O positive lipid present in the heart and the aorta, with the aortic arch being the most severely affected. The response of the aorta and the heart to the 2% cholesterol diet was not significantly modified by concurrent exposure to CS2 by inhalation or by treatment with thiourea, a metabolite of CS2. We found no evidence that the development of cardiovascular lesions induced by a 2% cholesterol diet in rabbits was mediated by a mechanism involving a component of hypothyroidism.

The results of a variety of in vivo and in vitro experiments suggested that the kidneys were the primary route of elimination of morpholine in the rabbit. Morpholine was not bound to serum proteins and was excreted 90% unchanged. The concentration of [14C]morpholine in the renal cortex was 6.6 times the concentration in the blood, and in the renal medulla was 15.3 times the concentration in the blood 30 min after the intravenous injection of single boluses of labelled compound. The chemical appeared to be distributed mainly to the extracellular space, and its rate of elimination was enhanced by acidification of the urine.