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Within the European activities for the 'Monitoring and Collection of Information on Zoonoses', annually EFSA publishes a European report, including information related to the prevalence of Campylobacter spp. in Germany. Spatial epidemiology becomes here a fundamental tool for the generation of these reports, including the representation of prevalence as an essential element. Until now, choropleth maps are the default visualization technique applied in epidemiological monitoring and surveillance reports made by EFSA and German authorities. However, due to its limitations, it seems to be reasonable to explore alternative chart type. Four maps including choropleth, cartogram, graduated symbols and dot-density maps were created to visualize real-world sample data on the prevalence of Campylobacter spp. in raw chicken meat samples in Germany in 2011. In addition, adjacent and coincident maps were created to visualize also the associated uncertainty. As an outcome, we found that there is not a single data visualization technique that encompasses all the necessary features to visualize prevalence data alone or prevalence data together with their associated uncertainty. All the visualization techniques contemplated in this study demonstrated to have both advantages and disadvantages. To determine which visualization technique should be used for future reports, we recommend to create a dialogue between end-users and epidemiologists on the basis of sample data and charts. The final decision should also consider the knowledge and experience of end-users as well as the specific objective to be achieved with the charts. [ABSTRACT FROM AUTHOR]

Abstract Background Hepatitis E virus (HEV) is a pathogen of emerging concern in industrialized countries. The consumption of wild boar meat has been identified as one risk factor for autochthonous HEV infections. Only limited information is available about thermal stability of HEV, mainly due to the lack of rapid and efficient cell culture systems for measurement of HEV infectivity. Methods A molecular biological method was implemented in order to distinguish disassembled from intact viral particles using RNase treatment followed by quantitative real-time RT-PCR. The method was applied to a wild boar liver suspension containing HEV genotype 3. Results Time-course analyses indicated that the decline of protected RNA could be described by a biphasic model with an initial decrease followed by a stationary phase. The stationary phase was reached after 1 hour at 4°C, 3 days at 22°C and 7 days at 37°C with log reductions of 0.34, 0.45 and 1.24, respectively. Protected RNA was detectable until the end of the experiments at day 50 or 70. Heat exposure for 1 minute resulted in a log reduction of 0.48 at 70°C and increased with higher temperatures to 3.67 at 95°C. Although HEV infectivity titration by inoculation of the liver suspension onto three cell lines did not succeed, the results of the RNase-based method are in accordance with published cell culture-based data. Conclusions Measurement of intact viral particles using the RNase-based method may provide data on the stability of RNA viruses when cell culture-based infectivity titrations are not efficient or not available. The method enables processing of large sample numbers and may be suitable to estimate stability of HEV in different types of food.

Abstract Background Although antimicrobial resistance and persistence of resistant bacteria in humans and animals are major health concerns worldwide, the impact of antimicrobial resistance on bacterial intestinal colonization in healthy domestic animals has only been rarely studied. We carried out a retrospective analysis of the antimicrobial susceptibility status and the presence of resistance genes in intestinal commensal E. coli clones from clinically healthy pigs from one production unit with particular focus on effects of pheno- and/or genotypic resistance on different nominal and numerical intestinal colonization parameters. In addition, we compared the occurrence of antimicrobial resistance phenotypes and genotypes with the occurrence of virulence associated genes typical for extraintestinal pathogenic E. coli. Results In general, up to 72.1% of all E. coli clones were resistant to ampicillin, chloramphenicol, kanamycin, streptomycin, sulfamethoxazole or tetracycline with a variety of different resistance genes involved. There was no significant correlation between one of the nominal or numerical colonization parameters and the absence or presence of antimicrobial resistance properties or resistance genes. However, there were several statistically significant associations between the occurrence of single resistance genes and single virulence associated genes. Conclusion The demonstrated resistance to the tested antibiotics might not play a dominant role for an intestinal colonization success in pigs in the absence of antimicrobial drugs, or cross-selection of other colonization factors e.g. virulence associated genes might compensate "the cost of antibiotic resistance". Nevertheless, resistant strains are not outcompeted by susceptible bacteria in the porcine intestine. Trial Registration The study was approved by the local animal welfare committee of the "Landesamt für Arbeitsschutz, Gesundheitsschutz und technische Sicherheit" Berlin, Germany (No. G0037/02).

To facilitate cross-sector integration of surveillance data it is necessary to improve and harmonize the meta-information provided in surveillance data reports. Cross-sector integration of surveillance results in sector-specific reports is frequently difficult as reports with a focus on a single sector often lack aspects of the relevant meta-information necessary to clarify the surveillance context. Such reporting deficiencies reduce the value of surveillance reports to the One Health community. The One Health Consensus Report Annotation Checklist (OH-CRAC), described in this paper along with potential application scenarios, was developed to improve the current practice of annotating data presented in surveillance data reports. It aims to provide guidance to researchers and reporting officers on what meta-information should be collected and provided to improve the completeness and transparency of surveillance data reports. The OH-CRAC can be adopted by all One Health-related sectors and due to its cross-sector design, it supports the mutual mapping of surveillance meta-information from sector-specific surveillance reports on federal, national and international levels. To facilitate the checklist completion, OH-CRAC is also available as an online resource that allows the collection of surveillance meta-information in an easy and user-friendly manner. Completed OH-CRAC checklists can be attached as annexes to the corresponding surveillance data reports or even to individual data files regardless of the data source. In this way, reports and data become better interpretable, usable and comparable to information from other sectors, improving their value for all surveillance actors and providing a better foundation for advice to risk managers., (© 2022 The Authors. Zoonoses and Public Health published by Wiley-VCH GmbH.)

Background: Although interprofessional collaboration (IPC) has been discussed for over 40 years, in nursing education as well as the majority of health professionals, education continues to primarily take place in silos with curricula that is discipline specific. Educators need to implement models of education that are linked to collaborative practice and team-based care., Objectives: To introduce the principles from the Core Competencies for Interprofessional Collaborative Practice, the American Association of Colleges of Nursing Essentials of Doctoral Education for Advanced Nursing Practice and the National Organization of Nurse Practitioners Faculties Nurse Practitioner Core Competencies into the coursework. To demonstrate an application process for incorporating collaboration in their future nurse practitioner roles., Method: Students in the Doctor of Nursing Practice mental health nurse practitioner program participated in a set of assignments to develop essential knowledge and skills for integration of IPC into practice. A pretest-posttest design was used to evaluate student attitudes towards IPC following immersion in IPC subject matter and experiential learning with other healthcare providers working together to coordinate patient care., Results: There were significant findings for six of the 18 survey questions. This project can serve as an example for successful implementation of IPE in the nursing curricula., (© Copyright 2022 Springer Publishing Company, LLC.)

Processing of meat is one possible approach to control meat-borne parasites. Processing methods such as freezing, cooking and irradiation are recommended for the control of Trichinella in pork, horse or game meat if specific technical conditions are fulfilled. Curing is a widely used preservation process influencing product characteristics such as shelf life, food safety, and taste. As curing methods are characterized by high parameter variability and predictions about inactivation of parasitic stages in raw meat products are difficult, curing and smoking are not recommended for Trichinella control. The objective of this study was to investigate the survival of T. spiralis in cured raw sausages taking into account water activity (a w -value), pH value, temperature, and time. For this purpose, four different types of sausage (Knackwurst, vacuum packed Knackwurst, short ripened salami, long ripened salami) were produced using T. spiralis infested batter. After production, the sausages were stored at product specific conditions for up to 35 days. During storage, pH value and a w -value of the sausages were monitored over time. Further, sausages of each type were digested using the magnetic stirrer method and the viability of the isolated larvae was assessed using a previously published larval motility test as a proxy for viability and infectivity of Trichinella larvae. In this context, we also introduce a three-level rated infectivity score (RIS) with a clear categorization scheme allowing the assessment of the infectivity of larvae. Based on the RIS, larvae isolated from the salamis were regarded as potentially infective until day 2 (short ripened salami) or day 3 (long ripened salami) post ripening, whereas in Knackwurst, potentially infective larvae were still found by day 8 post ripening. In contrast potentially infective larvae were detected in vacuum-packed Knackwurst until day 24 post ripening. Finally, using the RIS approach, data from previously published studies were collected and subjected to a correlation analysis to identify matrix factors linked to short Trichinella inactivation times., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Collaboration across sectors, disciplines and countries is a key concept to achieve the overarching One Health (OH) objective for better human, animal and environmental health. Differences in terminology and interpretation of terms are still a significant hurdle for cross-sectoral information exchange and collaboration within the area of OH including One Health Surveillance (OHS). The development of the here described glossary is a collaborative effort of three projects funded within the One Health European Joint Programme (OHEJP). We describe the infrastructure of the OHEJP Glossary, as well as the methodology to create such a cross-sectoral web resource in a collaborative manner. The new OHEJP Glossary allows OH actors to identify terms with different or shared interpretation across sectors. Being aware of such differences in terminology will help overcome communication hurdles in the future and consequently support collaboration and a more inclusive development of OHS. The OHEJP Glossary was implemented as a web-based, user-friendly and searchable infrastructure that complies with the Findable, Accessible, Interoperable, Reusable (FAIR) data principles. Maintenance, enrichment and quality control of the OHEJP Glossary is supported through a flexible and updatable curation infrastructure. This increases the uptake potential and exploitation of the OHEJP Glossary by other OH initiatives or tools and services., Competing Interests: None., (© 2021 The Authors.)

Cross-sector communication, collaboration and knowledge exchange are still significant challenges for practical adoption of the One Health paradigm. To address these needs the "One Health Surveillance Codex" (OHS Codex) was established to provide a framework for the One Health community to continuously share practical solutions (e.g. tools, technical resources, guidance documents and experiences) applicable for national and international stakeholders from different One Health Surveillance sectors. Currently, the OHS Codex provides a number of resources that support the adoption of the OH paradigm in areas linked to the harmonization and interpretation of surveillance data. The OHS Codex framework comprises four high-level "action" principles, which respectively support collaboration, knowledge exchange, data interoperability, and dissemination. These principles match well with priority areas identified in the "Tripartite Guide to Addressing Zoonotic Diseases in Countries" published by WHO, FAO and OIE. Within each of the four principles, the OHS Codex provides a collection of useful resources as well as pointers to success stories for the application of these resources. As the OHS Codex is designed as an open community framework, it will continuously evolve and adapt to the needs of the OH community in the future., Competing Interests: None., (© 2021 The Authors.)

In the last decades, mathematical models and model-based simulations became important elements not only in the area of risk assessment concerning microbiological and chemical hazards but also in modelling biological phenomena in general. Unfortunately, many of the developed models are published in non-standardized ways, which hinders efficient exchange, re-use and continuous improvement of models within the risk assessment domain. The establishment of guidelines for model annotation is an important pre-condition to overcome these obstacles. Additionally, implementation of annotation guidelines can improve transparency, quality control and even aid the clarification of intellectual property rights. Here, we address the question of "What is the minimum set of metadata that should be provided for a model in the risk assessment domain?". The proposed guideline focuses on food safety risk assessment models and is called "Minimum Information Required to Annotate food safety Risk Assessment Models (MIRARAM)". MIRARAM supports the model creator during the model documentation step and could also be used as a checklist by scientific journal editors or database curators. Software developers could take up MIRARAM and develop easy-to-use software tools or new features in existing programs that can help model creators to provide proposed model annotations in harmonized file formats. Based on experiences from similar guidelines in related scientific disciplines (like systems biology), it is expected that MIRARAM could contribute to the promotion of application and re-use of models as well as to implementing more standardized quality control in the food safety modelling domain., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Processing of meat is one possible approach to control meat-borne parasites. Processing methods such as freezing, cooking and irradiation are recommended for the control of Trichinella in pork, horse or game meat if specific technical conditions are fulfilled. Curing is a widely used preservation process influencing product characteristics such as shelf life, food safety, and taste. As curing methods are characterized by high parameter variability and predictions about inactivation of parasitic stages in raw meat products are difficult, curing and smoking are not recommended for Trichinella control. The objective of this study was to investigate the survival of T. spiralis in cured raw sausages taking into account water activity (a w -value), pH value, temperature, and time. For this purpose, four different types of sausage (Knackwurst, vacuum packed Knackwurst, short ripened salami, long ripened salami) were produced using T. spiralis infested batter. After production, the sausages were stored at product specific conditions for up to 35 days. During storage, pH value and a w -value of the sausages were monitored over time. Further, sausages of each type were digested using the magnetic stirrer method and the viability of the isolated larvae was assessed using a previously published larval motility test as a proxy for viability and infectivity of Trichinella larvae. In this context, we also introduce a three-level rated infectivity score (RIS) with a clear categorization scheme allowing the assessment of the infectivity of larvae. Based on the RIS, larvae isolated from the salamis were regarded as potentially infective until day 2 (short ripened salami) or day 3 (long ripened salami) post ripening, whereas in Knackwurst, potentially infective larvae were still found by day 8 post ripening. In contrast potentially infective larvae were detected in vacuum-packed Knackwurst until day 24 post ripening. Finally, using the RIS approach, data from previously published studies were collected and subjected to a correlation analysis to identify matrix factors linked to short Trichinella inactivation times., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Health care provider communication proficiency is critical in the initiation and revisitation of these discussions throughout the trajectory of chronic illness. The delivery of palliative care (PC) throughout the continuum of illness has traditionally been underutilized. Nurses have the ability to significantly improve PC utilization through the use of advance care planning strategies to confidently initiate conversations with patients and families at multiple points throughout the continuum of illness. Nurses are uniquely positioned to contribute to the improvement of care provided to terminally and chronically ill patients because of the relationship developed and the knowledge of patient-specific disease progression that unfolds during the time spent with patients. In this study, nurses improved communication efficacy by learning to utilize advance care planning-specific interview strategies inclusive of scripting and cued language when initiating PC conversations. The preintervention/postintervention confidence levels of nurses in initiating early PC conversations significantly increased to improve the delivery of PC to patients.

Abstract: In contrast to Bacillus cereus, the role of Bacillus thuringiensis in foodborne illness has been controversially discussed. As B. thuringiensis-based biopesticides containing a mixture of crystal toxins and viable spores are widely used, a current European Food Safety Authority opinion underlines the need for additional data to enable risk assessment. However, it is currently poorly understood if B. thuringiensis is able to multiply in food, which is crucial to sound risk assessment. Therefore, the aim of this study was to investigate growth of selected B. thuringiensis strains from food and insecticides in a ratatouille food model. To this end, the growth parameters of three B. thuringiensis strains were determined: insecticide strain ABTS-351 (CH_119, B. thuringiensis serovar kurstaki), insecticide strain ABTS-1857 (CH_121, B. thuringiensis serovar aizawai), and CH_48 (wild-type B. thuringiensis isolated from rosemary), producing extremely high levels of enterotoxins. After an initial drop in colony counts, we observed a statistically significant growth for the tested B. thuringiensis strains between 6 and 24 h at 22, 30, and 37°C, conditions mimicking prolonged holding times. We were also able to show that the enterotoxin overproducer CH_48 can grow up to 108 CFU/g in the ratatouille matrix within 24 h at 37°C. The two midlevel enterotoxin formers ABTS-351 (CH_119) and ABTS-1857 (CH_121) isolated from biopesticides exhibited growth between 6 and 24 h, with one of the strains growing to 107 CFU/g. To our knowledge, this is the first study providing evidence of B. thuringiensis growth in a food model with intact competitive flora. Our findings suggest strain-specific variation and stress the complexity of assessing the risk related to B. thuringiensis in food, indicating that some strains can represent a risk to consumer health when vegetable-based foods are stored under conditions of prolonged temperature abuse., (Copyright ©, International Association for Food Protection.)

The US homeless population is predisposed to serious complications of influenza with increased likelihood of hospitalization and death. This quality improvement project sought to increase influenza vaccination in the homeless population of a rural area in the Midwest and improve provider knowledge of risks and preventive care responsibilities.

The food supply chain has been recognised by the EU as a critical infrastructure, and its complexity is the main cause of vulnerability. Depending on the food matrix, natural and/or deliberate contamination, food-borne diseases or even food fraud incidents may occur worldwide. Consequently, robust predictive models and/or software tools are needed to support decision-making and mitigating risks in an efficient and timely manner. In this frame, the fellow participated in data collection and analysis tasks, so as to provide additional predictive models. The working programme, covered a wide range of aspects related to risk assessment including identification of emerging risks (quantitative), microbiological risk assessment, authenticity assessment, spatio-temporal epidemiological modelling and database formation for hosting predictive microbial models. The training and close integration, in the open-source, in-house (German Federal Institute for Risk Assessment (BfR)) developed software tools under the framework of FoodRisk-Labs (https://foodrisklabs.bfr.bund.de.) for data analysis, predictive microbiology, quantitative microbiological risk assessment and automatic data retrieval purposes allowed for the independent use. Moreover, the fellow actively contributed to the update of the upcoming Yersinia enterocolitica risk assessment, and also in authenticity assessment of edible oils. Over the course of the year, the fellow was closely involved in international and national research projects with experts in the above-mentioned disciplines. Lastly, he consolidated his acquired knowledge by presenting his scientific work to conferences, and BfR-internal meetings., (© 2019 European Food Safety Authority. EFSA Journal published by John Wiley and Sons Ltd on behalf of European Food Safety Authority.)

The Spatiotemporal Epidemiologic Modeler (STEM) is an open source software project supported by the Eclipse Foundation and used by a global community of researchers and public health officials working to track and, when possible, control outbreaks of infectious disease in human and animal populations. STEM is not a model or a tool designed for a specific disease; it is a flexible, modular framework supporting exchange and integration of community models, reusable plug-in components, and denominator data, available to researchers worldwide at www.eclipse.org/stem. A review of multiple projects illustrates its capabilities. STEM has been used to study variations in transmission of seasonal influenza in Israel by strains; evaluate social distancing measures taken to curb the H1N1 epidemic in Mexico City; study measles outbreaks in part of London and inform local policy on immunization; and gain insights into H7N9 avian influenza transmission in China. A multistrain dengue fever model explored the roles of the mosquito vector, cross-strain immunity, and antibody response in the frequency of dengue outbreaks. STEM has also been used to study the impact of variations in climate on malaria incidence. During the Ebola epidemic, a weekly conference call supported the global modeling community; subsequent work modeled the impact of behavioral change and tested disease reintroduction via animal reservoirs. Work in Germany tracked salmonella in pork from farm to fork; and a recent doctoral dissertation used the air travel feature to compare the potential threats posed by weaponizing infectious diseases. Current projects include work in Great Britain to evaluate control strategies for parasitic disease in sheep, and in Germany and Hungary, to validate the model and inform policy decisions for African swine fever. STEM Version 4.0.0, released in early 2019, includes tools used in these projects and updates technical aspects of the framework to ease its use and re-use.

The currently applied approaches, procedures and tools used for the identification of emerging risks vary greatly among Member States of the EU. EFSA established a structured approach for emerging risk identification that mainly consists of systematically searching, collecting, collating and analysing information and data. In addition, EFSA concluded that new methodologies and tools are needed to facilitate efficient and transparent sharing of data, knowledge and methods in the field of emerging risk identification between Member States. As the result of an open call issued by EFSA, the 'Determination and metrics of emerging risks' (DEMETER) project was established in spring 2017 to support current and future procedures for identification of emerging risks. As the Bundesinstitut für Risikobewertung (BfR) hosting site is involved in the DEMETER project, as well as in several other software development activities in the area of quantitative microbiological risk assessment, the fellow had the opportunity to play an active role in the project work and development of the running DEMETER project. The training and close integration in the project team enabled the fellow to make significant contributions, e.g. with the creation of new open source data processing workflows and by contributing to the Emerging Risk Knowledge Exchange Platform (ERKEP) Framework Concept Note. Besides DEMETER, the fellow participated in other activities of the Unit for Food Technologies, Supply Chains and Food Defence, including testing and applying several BfR open source software tools which had been developed in previous projects and that are used in microbiological risk assessment (e.g. Predictive Microbial Modelling Lab (PMM-Lab)) or as automatic data retrieval systems (e.g. SiLeBAT NewsRadar) - see https://foodrisklabs.bfr.bund.de., (© 2018 European Food Safety Authority. EFSA Journal published by John Wiley and Sons Ltd on behalf of European Food Safety Authority.)

Noting the small number of studies on the influence of an entire curriculum on graduate nursing students' cultural competence, the researchers examined the effect of a curricular intervention using a pretest-posttest design. The study, conducted from 2012 to 2014, focused solely on the Doctor of Nursing Practice program at a midwestern university. Results from a pre- and postintervention faculty curriculum survey indicated that the percentage of courses including a cultural competence objective increased from 65 percent to 81 percent. Results from the pre- and postintervention administration of the Transcultural Self-Efficacy Tool showed a statistically significant improvement in students' overall score and three subscale scores.

Background: Doctor of Nursing Practice (DNP) programs have experienced rapid growth across the United States. With the expansion of electronic health records, DNP students are expected to acquire the knowledge and skills needed to manage data and apply informatics concepts. However, little information exists to help faculty evaluate student competency in these areas., Method: This retrospective analysis evaluated the competencies of a convenience sample of DNP students enrolled in an online informatics course. Two areas were assessed in this study: acquisition of informatics skills, and analysis or application of informatics concepts., Results: Regarding informatics skills, postbaccalaureate students performed better than post-master's students. In analysis and application of informatics concepts, post-master's students performed better than postbaccalaureate students., Conclusion: Different educational strategies may need to be created to meet the varying needs of postbaccalaureate and post-master's students in DNP programs. [J Nurs Educ. 2017;56(6):364-367.]., (Copyright 2017, SLACK Incorporated.)

Unlabelled: Hepatitis E virus (HEV) is an increasingly recognized zoonotic pathogen. Transmission is suspected to occur from infected pigs or wild boars to humans through direct contact, environmental pathways, or contaminated food. However, the physical and chemical stability of HEV is largely unknown, because suitable cell culture methods for infectivity measurement are missing. Here, we developed a titration method using infection of the cell line A549/D3 with HEV genotype 3 strain 47832c and subsequent counting of focus-forming units by immunofluorescence, which allowed HEV infectivity measurements within a 4-log-dilution range. Long-term storage of HEV in cell culture medium at different temperatures indicated a phase of rapid virus inactivation, followed by a slower progression of virus inactivation. Infective HEV was detected up to 21 days at 37°C, up to 28 days at room temperature, and until the end of the experiment (56 days) with a 2.7-log decrease of infectious virus at 4°C. Heat treatment for 1 min resulted in moderate decreases of infectivity up to 60°C, 2- to 3.5-log decreases between 65°C and 75°C, and no remaining virus was detected at temperatures of ≥80°C. Heating for 70°C resulted in a 3.6-log decrease after 1.5 min and the absence of detectable virus (>3.9-log decrease) after 2 min. The data were used to calculate predictive heat inactivation models for HEV. The results may help estimate HEV stability in the environment or food. The established method may be used to study other aspects of HEV stability in the future., Importance: In this study, a cell culture method was developed which allows the measurement of hepatitis E virus (HEV) infectivity. Using this system, the stability of HEV at different time-temperature combinations was assessed, and a predictive model was established. The obtained data may help estimate HEV stability in the environment or food, thus enabling an assessment of the relative risks of HEV infection through distinct routes and by distinct types of food in the future., (Copyright © 2016, American Society for Microbiology. All Rights Reserved.)

FoodChain-Lab is modular open-source software for trace-back and trace-forward analysis in food-borne disease outbreak investigations. Development of FoodChain-Lab has been driven by a need for appropriate software in several food-related outbreaks in Germany since 2011. The software allows integrated data management, data linkage, enrichment and visualization as well as interactive supply chain analyses. Identification of possible outbreak sources or vehicles is facilitated by calculation of tracing scores for food-handling stations (companies or persons) and food products under investigation. The software also supports consideration of station-specific cross-contamination, analysis of geographical relationships, and topological clustering of the tracing network structure. FoodChain-Lab has been applied successfully in previous outbreak investigations, for example during the 2011 EHEC outbreak and the 2013/14 European hepatitis A outbreak. The software is most useful in complex, multi-area outbreak investigations where epidemiological evidence may be insufficient to discriminate between multiple implicated food products. The automated analysis and visualization components would be of greater value if trading information on food ingredients and compound products was more easily available.

Aims: The aim of this study was to assess the impact of screening and teaching interventions for sleep-wake disturbances in parents of childhood patients with epilepsy., Methods: This was a prospective, descriptive study using convenience sampling. After informed consent was obtained from eligible parents who agreed to participate, study questionnaires were administered. All parents were provided with an individualized teaching intervention. Study tools were readministered 8-12 weeks later to evaluate if the individualized teaching intervention altered or improved sleep-wake disturbances., Results: The t value for the paired t test of the Epworth Sleepiness Scale prescore and postscore was 0.000 with a two-tailed probability value of 1.000, and the t value for the paired t test of the Pittsburgh Sleep Quality Index prescore and postscore was 0.713 with a two-tailed probability value of .492, indicating no significant difference between pre and post Epworth Sleepiness Scale or Pittsburgh Sleep Quality Index scores., Conclusions: A sleep hygiene teaching intervention for parents of children with epilepsy was not effective in this setting of an inner-city epilepsy monitoring unit in changing postintervention scores on measures of both nighttime sleep quality and daytime sleepiness. These results must be interpreted with caution secondary to the small number included in the initial phase of this study. A larger number of participants will be needed to verify these findings. If the results remain consistent with a larger number, studies evaluating variables of cause may be helpful to determine more effective interventions.

In case of contamination in the food chain, fast action is required in order to reduce the numbers of affected people. In such situations, being able to predict the fate of agents in foods would help risk assessors and decision makers in assessing the potential effects of a specific contamination event and thus enable them to deduce the appropriate mitigation measures. One efficient strategy supporting this is using model based simulations. However, application in crisis situations requires ready-to-use and easy-to-adapt models to be available from the so-called food safety knowledge bases. Here, we illustrate this concept and its benefits by applying the modular open source software tools PMM-Lab and FoodProcess-Lab. As a fictitious sample scenario, an intentional ricin contamination at a beef salami production facility was modelled. Predictive models describing the inactivation of ricin were reviewed, relevant models were implemented with PMM-Lab, and simulations on residual toxin amounts in the final product were performed with FoodProcess-Lab. Due to the generic and modular modelling concept implemented in these tools, they can be applied to simulate virtually any food safety contamination scenario. Apart from the application in crisis situations, the food safety knowledge base concept will also be useful in food quality and safety investigations.

Mathematical models on properties and behavior of harmful organisms in the food chain are an increas- ingly relevant approach of the agriculture and food industry. As a consequence, there are many efforts to develop biological models in science, economics and risk assessment nowadays. However, there is a lack of international harmonized standards on model annotation and model formats, which would be neces- sary to set up efficient tools supporting broad model application and information exchange. There are some established standards in the field of systems biology, but there is currently no corresponding provi- sion in the area of plant protection. This work therefore aimed at the development of an annotation scheme using domain-specific metadata. The proposed scheme has been validated in a prototype implementation of a web-database model repository. This prototypic community resource currently contains models on aflatoxin secreting fungal Aspergillus flavus in maize, as these models have a high relevance to food safety and economic impact. Specifically, models describing biological processes of the fungus (growth, Aflatoxin secreting), as well as dose-response- and carry over models were included. Furthermore, phenological models for maize were integrated as well. The developed annotation scheme is based on the well-established data exchange format SBML, which is broadly applied in the field of systems biology. The identified example models were annotated according to the developed scheme and entered into a Web-table (Google Sheets), which was transferred to a web based demonstrator available at https://sites.google.com/site/test782726372685/. By implementation of a software demonstrator it became clear that the proposed annotation scheme can be applied to models on plant pathogens and that broad adoption within the domain could promote communication and application of mathematical models.

Foodborne disease outbreaks of recent years demonstrate that due to increasingly interconnected supply chains these type of crisis situations have the potential to affect thousands of people, leading to significant healthcare costs, loss of revenue for food companies, and--in the worst cases--death. When a disease outbreak is detected, identifying the contaminated food quickly is vital to minimize suffering and limit economic losses. Here we present a likelihood-based approach that has the potential to accelerate the time needed to identify possibly contaminated food products, which is based on exploitation of food products sales data and the distribution of foodborne illness case reports. Using a real world food sales data set and artificially generated outbreak scenarios, we show that this method performs very well for contamination scenarios originating from a single "guilty" food product. As it is neither always possible nor necessary to identify the single offending product, the method has been extended such that it can be used as a binary classifier. With this extension it is possible to generate a set of potentially "guilty" products that contains the real outbreak source with very high accuracy. Furthermore we explore the patterns of food distributions that lead to "hard-to-identify" foods, the possibility of identifying these food groups a priori, and the extent to which the likelihood-based method can be used to quantify uncertainty. We find that high spatial correlation of sales data between products may be a useful indicator for "hard-to-identify" products.

Since the 2001 anthrax attack in the United States, awareness of threats originating from bioterrorism has grown. This led internationally to increased research efforts to improve knowledge of and approaches to protecting human and animal populations against the threat from such attacks. A collaborative effort in this context is the extension of the open-source Spatiotemporal Epidemiological Modeler (STEM) simulation and modeling software for agro- or bioterrorist crisis scenarios. STEM, originally designed to enable community-driven public health disease models and simulations, was extended with new features that enable integration of proprietary data as well as visualization of agent spread along supply and production chains. STEM now provides a fully developed open-source software infrastructure supporting critical modeling tasks such as ad hoc model generation, parameter estimation, simulation of scenario evolution, estimation of effects of mitigation or management measures, and documentation. This open-source software resource can be used free of charge. Additionally, STEM provides critical features like built-in worldwide data on administrative boundaries, transportation networks, or environmental conditions (eg, rainfall, temperature, elevation, vegetation). Users can easily combine their own confidential data with built-in public data to create customized models of desired resolution. STEM also supports collaborative and joint efforts in crisis situations by extended import and export functionalities. In this article we demonstrate specifically those new software features implemented to accomplish STEM application in agro- or bioterrorist crisis scenarios.

Various systems for prioritizing biological agents with respect to their applicability as biological weapons are available, ranging from qualitative to (semi)quantitative approaches. This research aimed at generating a generic risk ranking system applicable to human and animal pathogenic agents based on scientific information. Criteria were evaluated and clustered to create a criteria list. Considering availability of data, a number of 28 criteria separated by content were identified that can be classified in 11 thematic areas or categories. Relevant categories contributing to probability were historical aspects, accessibility, production efforts, and possible paths for dispersion. Categories associated with impact are dealing with containment measures, availability of diagnostics, preventive and treatment measures in human and animal populations, impact on society, human and veterinary public health, and economic and ecological consequences. To allow data-based scoring, each criterion was described by at least 1 measure that allows the assignment of values. These values constitute quantities, ranges, or facts that are as explicit and precise as possible. The consideration of minimum and maximum values that can occur due to natural variations and that are often described in the literature led to the development of minimum and maximum criteria and consequently category scores. Missing or incomplete data, and uncertainty resulting therefrom, were integrated into the scheme via a cautious (but not overcautious) approach. The visualization technique that was used allows the description and illustration of uncertainty on the level of probability and impact. The developed risk ranking system was evaluated by assessing the risk originating from the bioterrorism threat of the animal pathogen bluetongue virus, the human pathogen Enterohemorrhagic Escherichia coli O157:H7, the zoonotic Bacillus anthracis, and Botulinum neurotoxin.

Although Enterococcus faecium is used as a probiotic feed supplement in animal production, feeding of the bacterium to piglets resulted in a more severe infection with Salmonella Typhimurium DT104 during a challenge experiment. To enlighten the mode of action by which E. faecium affected the piglets' health, we investigated the influence of the probiotic bacterium on the development of intestinal and circulating immune cells during a challenge experiment with S. Typhimurium DT104. To minimise varying impacts of the maternal immunity on the course of infection, only piglets were implemented that descended from Salmonella-free sows. In addition, the potency of purified blood and intraepithelial immune cells to control the growth of Salmonella was tested in vitro. In animals treated with E. faecium, a reduction of intraepithelial CD8alphabeta T cells, reduced circulating CD8alphabeta T cells and a less efficient control of intracellular Salmonella growth, mediated by peripheral blood mononuclear cells, were observed.

Background: Hepatitis E virus (HEV) is a pathogen of emerging concern in industrialized countries. The consumption of wild boar meat has been identified as one risk factor for autochthonous HEV infections. Only limited information is available about thermal stability of HEV, mainly due to the lack of rapid and efficient cell culture systems for measurement of HEV infectivity., Methods: A molecular biological method was implemented in order to distinguish disassembled from intact viral particles using RNase treatment followed by quantitative real-time RT-PCR. The method was applied to a wild boar liver suspension containing HEV genotype 3., Results: Time-course analyses indicated that the decline of protected RNA could be described by a biphasic model with an initial decrease followed by a stationary phase. The stationary phase was reached after 1 hour at 4°C, 3 days at 22°C and 7 days at 37°C with log reductions of 0.34, 0.45 and 1.24, respectively. Protected RNA was detectable until the end of the experiments at day 50 or 70. Heat exposure for 1 minute resulted in a log reduction of 0.48 at 70°C and increased with higher temperatures to 3.67 at 95°C. Although HEV infectivity titration by inoculation of the liver suspension onto three cell lines did not succeed, the results of the RNase-based method are in accordance with published cell culture-based data., Conclusions: Measurement of intact viral particles using the RNase-based method may provide data on the stability of RNA viruses when cell culture-based infectivity titrations are not efficient or not available. The method enables processing of large sample numbers and may be suitable to estimate stability of HEV in different types of food.

Knowledge of the number of organisms in a food product at the time of consumption is crucial to assess the risk from a deliberate contamination of food samples with Brucella. To date, very little data on the survival times of Brucella in different food matrices is available. This study was conducted to assess the survival times of Brucella spp. in water, milk and yogurt. These food products were inoculated with bacteria, serial dilutions of the food samples plated and the number of surviving bacteria counted. Under normal storage conditions Brucella survived in UHT milk for 87 days, for 60 days in water and less than a week in yogurt. Also, when milk was inoculated with low bacterial numbers, Brucella multiplied by five log units within three weeks. Further we could not confirm that a high fat content in food has a protective effect on Brucella survival. Brucella survived in 3.5% and 10.0% fat yogurt for four and two days, respectively. These results show that appropriate methods for the rapid detection of this pathogen from food matrices are required., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Salmonella infection might affect other intestinal Enterobacteriaceae populations and possible correlations between single Enterobacteriaceae populations would help to predict subclinical Salmonella infections in pigs. In one experimental setup, weaned piglets (n=40) were infected with Salmonella and sacrificed at 3h, 24h, 72 h or 28 days post-infection (p.i.). Dilutions of intestinal contents and mucosal tissues were plated on agar plates for determinations of Enterobacteriaceae. In another experimental setup, weaned piglets (n=12) were infected with Salmonella and probed over a period of 28 days p.i., and dilutions of rectal contents were also tested for Enterobacteriaceae populations. The occurrence of single Enterobacteriaceae populations was correlated with the occurrence of other tested Enterobacteriaceae populations as well as with clinical parameters of the piglets. Salmonella (infection strain), Escherichia coli (hemolytic and non-hemolytic) and another six non-E. coli/non-Salmonella Enterobacteriaceae (NENSE) genera with eight species were identified. In general, the absolute numbers of E. coli, Salmonella and NENSE populations decreased with increasing age of the animals. In the jejunum, the numbers of NENSE, E. coli and Salmonella were all highly positively correlated with each other. The occurrence of hemolytic E. coli had no obvious effects on the occurrence of other Enterobacteriaceae. Furthermore, only few associations of Enterobacteriaceae populations with clinical parameters were observed. In conclusion, we did not observe evidences for either a competition between or benefits for specific Enterobacteriaceae populations during Salmonella infection indicating that changes in the composition of the intestinal Enterobacteriaceae microflora are not useful indicators of subclinical Salmonella infections., (Copyright 2009 Elsevier B.V. All rights reserved.)

Our understanding of the composition of Escherichia coli populations in wild boars is very limited. In order to obtain insight into the E. coli microflora of wild boars, we studied E. coli isolates from the jejunums, ileums, and colons of 21 wild boars hunted in five geographic locations in Germany. Ten isolates per section were subjected to clonal determination using pulsed-field gel electrophoresis. One representative isolate per clone was further investigated for virulence traits, phylogenetic affiliation, and antimicrobial susceptibility. Macrorestriction analysis of 620 isolates revealed a range of clone diversity among the sections and animals, with up to 9 and 16 different clones per section and animal, respectively. Most of the clones for a given animal were shared between two adjacent intestinal sections. The overall highest clonal diversity was observed within the colon. While the astA gene was present in a large number of clones, other virulence genes and hemolytic ability were detected only sporadically. Clones of all four ECOR groups dominated the intestinal sections. Phylogenetic analysis and the occurrence of virulence genes correlated with the isolation frequencies for clones. All E. coli clones from wild boars were susceptible to all antimicrobial agents tested. In conclusion, though several parameters (including an animal-specific and highly diverse E. coli clone composition, the simultaneous occurrence of single clones in two adjacent intestinal sections of a given animal, and a higher E. coli diversity in the large intestine than in the small intestine) of E. coli populations of wild boars were similar to those of previously described E. coli populations of conventionally reared domestic pigs, our data also indicate possible differences, as seen for the E. coli diversity in the large intestine, the occurrence of certain virulence genes and phylogenetic groups, and antimicrobial susceptibilities.

Changing immune parameters during pregnancy have previously been reported in humans and cattle, and have been suggested to contribute to increased susceptibility to infections. However, data regarding immune parameters during pregnancy in sows are rare. In this study, we investigated the peripartal immune status of sows using phenotypical (FACS analysis) as well as functional (proliferation assays, cytokine analysis) parameters of peripheral blood mononuclear cells (PBMCs) in pregnant sows. In previous studies, we reported a modulation of the immune system after feed supplementation of the probiotic Bacillus cereus var. toyoi in piglets [Schierack, P., Wieler, L.H., Taras, D., Herwig, V., Tachu, B., Hlinak, A., Schmidt, M.F., Scharek, L., 2007. Bacillus cereus var. toyoi enhanced systemic immune response in piglets. Vet. Immunol. Immunopathol. 118, 1-11]. Here, we extended these previous studies to include investigations of possible probiotic effects on the peripartal immune status of sows and their reproductivity. We show that immune parameters of sows change during pregnancy, the proliferative response of PBMCs to several bacterial antigens in control animals decreased from days 90 to 30 ante partum. Relative numbers (%) of CD3+CD8+, CD4+, cytotoxic T, CD14+ and CD21+ cells were reduced compared to non-pregnant sows. In contrast, the proliferative response of PBMCs of probiotic-treated sows increased during pregnancy. Bacterial antigens primarily stimulated the proliferation of naïve CD21+ cells and the relative CD21+ cell numbers were elevated in the probiotic group in the absence of effects on other immune cell populations. The clinical and microbial status of both control and probiotic sows was similar, excluding pre-existing health problems or infections as responsible for the immunological changes, and feed supplementation also had no significant effects on reproductivity. The results suggest that the probiotic B. cereus var. toyoi can alter the proliferative response of lymphocytes and affects the immune cell population ratios of pregnant sows. How and to what extent this may affect health and reproductivity should be the focus of further studies.

To study the interactions between a probiotic bacterium and the host's immune system, we undertook a feeding trial with Enterococcus faecium SF68 (NCIMB 10415). Starting at an age of 1 day, piglets received a daily oral dose of the probiotic bacteria. Immune cells were isolated from the blood and the distal continuous Peyer's patch (PP) of the piglets. While the percentage of B cells in the distal continuous PP was not influenced by the probiotic treatment, an elevated expression of CD1 on Peyer's patch B cells was observed after probiotic treatment. Furthermore, the fraction of CD4-CD8+ cells was decreased in this organ. In blood lymphocyte fractions of the probiotic-treated piglets, the proportion of CD16-positive cells was also diminished, whereas the portion of γδ T cells and CD4-positive T cells increased. The data indicate that early administration of the probiotic Enterococcus faecium can modulate the composition of blood lymphocyte populations in piglets.

Upon studying the transmission of Escherichia coli from a sow to five of her piglets, we observed domination of the coliform flora in piglets by a single E. coli clone, especially after weaning. This haemolytic cloneH1 did not harbour any virulence determinants typical for intestinal pathogenic E. coli isolates from swine but had a virulence gene profile very similar to extraintestinal E. coli (ExPEC), including genes coding for P fimbriae and several iron acquisition systems, besides having an affiliation to the phylogenetic B2 group. Overall, we show that the presence of higher numbers of ExPEC-typical virulence-associated genes (VAGs) in clones correlate with their successful colonization ability in piglets. We conclude that VAGs typical for ExPEC also support intestinal colonization in healthy pigs. Faeces of healthy domestic pigs can harbour high numbers of ExPEC-similar E. coli and are suggested to be a potential risk for the transmission of such bacteria to other hosts.