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Public health inspectors may schedule the frequency of their inspections by using a criterion that reflects the level of risk in a food facility’s food handling practices. Previous research has shown that higher risk facilities have more difficulty adhering to food safety practices, and thus are linked with more restaurant associated foodborne illness outbreaks. Given limits on state spending for public health, this methodology of spending more resources on perceived higher risk establishments makes fiscal sense. Foodservice establishments with a greater potential risk for harm are inspected more often. The next logical point would be to record whether the high-risk foodservice establishment had more opportunities for food safety infractions simply because of a greater total observed and applicable food safety practices. For example, there are significant differences in the number of potential food safety violations for a facility that only serves pre-packaged foods compared to a facility that prepares raw ingredients and cooks meals on site. The objective of the present study was to address gaps in the literature by accounting for variations in health inspections in Arkansas validating whether foodservice establishments labeled as higher risk are more likely to incur food safety violations. Our analysis of Arkansas food service inspection reports showed that high priority facilities had the highest critical and non-critical violation rates, followed by medium and low priority facilities. Average critical violations per inspection were 0.65, 1.01, and 2.07 for low, medium, high priority establishments, respectively. The results in this study show the risk classification scheme used by the Arkansas state health department coincides with health inspection violation rates and total applicable and observed food safety items.

Background Precision oncology relies on molecular diagnostics, and the value-proposition of modern healthcare networks promises a higher standard of care across partner sites. We present the results of a clinical pilot to standardize precision oncology workflows. Methods Workflows are defined as the development, roll-out, and updating of disease-specific molecular order sets. We tracked the timeline, composition, and effort of consensus meetings to define the combination of molecular tests. To assess clinical impact, we examined order set adoption over a two-year period (before and after roll-out) across all gastrointestinal and hepatopancreatobiliary (GI) malignancies, and by provider location within the network. Results Development of 12 disease center-specific order sets took ~9 months, and the average number of tests per indication changed from 2.9 to 2.8 (P = .74). After roll-out, we identified significant increases in requests for GI patients (17%; P < .001), compliance with testing recommendations (9%; P < .001), and the fraction of “abnormal” results (6%; P < .001). Of 1088 GI patients, only 3 received targeted agents based on findings derived from non-recommended orders (1 before and 2 after roll-out); indicating that our practice did not negatively affect patient treatments. Preliminary analysis showed 99% compliance by providers in network sites, confirming the adoption of the order sets across the network. Conclusion Our study details the effort of establishing precision oncology workflows, the adoption pattern, and the absence of harm from the reduction of non-recommended orders. Establishing a modifiable communication tool for molecular testing is an essential component to optimize patient care via precision oncology.

The safety and utility of adeno-associated virus (AAV) to modulate target gene expression has been well demonstrated, and AAV vectors are a leading gene therapy platform. However, manufacturing presents challenges in terms of productivity and scalability as compared to incumbent therapeutic modalities. In particular, a pivot from adherent cell- to suspension culture-based AAV manufacturing processes requires enhanced study of the transfection step. For the method proposed herein, a Response Surface Design of Experiments is suggested to explore the role of five transfection factors-cell density at transfection, DNA concentration, ratio of complexing reagent to DNA, and molar ratios of the transfecting plasmids-influencing viral genome titer and biological potency. Additionally, an AAV categorical factor matrix is presented for developing a workflow to interrogate the impact of AAV permutations for different capsid serotypes, harbored genes of interest, and inverted terminal repeat configurations on transfection process parameters.

ObjectiveHighlighting diagnostic and treatment challenges of Faciobrachial Dystonic Seizures (FBDS) associated with LGI1-antibody limbic encephalitis (LE)BackgroundAnti-LGI1 LE presents with FDBS as its hallmark: brief, recurrent, contractions of facial and upper limb muscles. Patients have associated cognitive decline and psychiatric disturbance. Temporal lobe involvement is often found on MRI.Design/MethodsNA.ResultsThis 85-year-old female presented with a 2-week history of involuntary “twitching” in the face and arms.Family reported that she hadalsobeen uncharacteristically quiet.Neurological exam and a CT headwere normal.rEEG showed no epileptiform activity.One monthafter onset, episodes became longer and more frequent.Observation during outpatient evaluation led to consideration ofFDBS based on semiology. MRI revealedT2/flairhyperintensity in medial temporal lobes consistent with LE.InpatientcEEG was obtained: 26 episodes were marked, with no ictal EEGcorrelate seen.IVIG and methylprednisolone were started.InitialCSF studies were unremarkable andencephalitis/meningitis panelwas negative. Autoimmuneand paraneoplastic encephalopathy panel later revealed LGI-1antibodiesin the CSF. Chest and abdominopelvic CT were unrevealing of underlying malignancy. Whilereceiving methylprednisolone and IVIG, she developed impaired orientation, hallucinations, and agitation. A 5-day course was completed but with worsening mentation and limited improvement in FBDS.Thus,a decision was made to initiate PLEX (now 1.5 months fromsymptomonset). FBDS episodes resolved withPLEX and mentation improved, butshe development bleeding and retroperitoneal hematoma requiring transfusion, delaying completion of PLEX. Her course was further complicated by a UTI and delirium. PLEX was restarted afteroneweek andhermental status improved, reportedly 80% back to baseline after five sessions.ConclusionsThe main diagnostic challenge for LE is recognizing its unique hallmark, FBDS, often associated with insidious decline in cognition. FDBS may have no ictal correlate on EEG. Early diagnosis and management prevents long term disability - mainly cognitive. LE is commonly treated with immunotherapy, corticosteroids and PLEX. Monitoring response is challenging as patients are commonly older with multiple comorbidities: steroid-induced psychosis and delirium may complicate evaluation and treatment side effects limit options.

The safety and utility of adeno-associated virus (AAV) to modulate target gene expression has been well demonstrated, and AAV vectors are a leading gene therapy platform. However, manufacturing presents challenges in terms of productivity and scalability as compared to incumbent therapeutic modalities. In particular, a pivot from adherent cell- to suspension culture-based AAV manufacturing processes requires enhanced study of the transfection step. For the method proposed herein, a Response Surface Design of Experiments is suggested to explore the role of five transfection factors-cell density at transfection, DNA concentration, ratio of complexing reagent to DNA, and molar ratios of the transfecting plasmids-influencing viral genome titer and biological potency. Additionally, an AAV categorical factor matrix is presented for developing a workflow to interrogate the impact of AAV permutations for different capsid serotypes, harbored genes of interest, and inverted terminal repeat configurations on transfection process parameters.

Recent models have conceptualized food safety climate as a subcomponent of food safety culture that consists of the shared values and perceptions of employees. The present study sought to understand how food safety climate indicators including commitment, role overload, and contingent rewards affect handwashing frequency of restaurant food handlers (n = 124). Managerial commitment was the only variable significantly correlated with handwashing frequency r(120) = .313, p

Fresh and fresh-cut produce are associated with a significant proportion of foodborne disease outbreaks, driving the need for proper food handling that mitigates the risk of pathogen spread in foodservice environments. The objective of this study was to investigate cross-contamination patterns resulting from preparing these foods. For the first part of the study, forty-five participants simulated preparing fresh and fresh-cut produce in a mock deli kitchen in three scenarios. Produce or participant hands were coated with an innocuous fluorescent compound (Glo Germ™), then, following the simulations, high touch areas were swabbed to quantify cross-contamination. For scenarios 1–3, the cutting board, leafy greens, and participant gloves had the highest log10 percent of fluorescent compound (1.81, 1.31, 1.48, respectively). These results reinforce the need to properly sanitize kitchen equipment and to properly wash hands to reduce the likelihood of spreading harmful microorganisms. For the second part of the study, microbial experiments were conducted in a BSL-2 laboratory with two scenarios to determine how and to what extent Listeria monocytogenes, E.coli O157:H7, and Salmonella spp. spread from handling dip inoculated fresh and fresh-cut produce. Findings showed the propensity for pathogen harborage in utensils and wash water in scenario one. E.coli O157:H7 counts increased 33% from the inoculated lettuce sample to a second sample soaked in the same ice bath. By identifying and quantifying cross-contamination outcomes from food preparation, researchers can design task-specific educational materials that improve work flows which may reduce the risk of foodborne disease outbreaks.

Proper handwashing is a simple, cost effective means for reducing the risk of foodborne disease transmission. Low compliance rates are often observed among food handlers, and a wide range of interventions have attempted to increase compliance, often with little success. Promoting lasting behavior change is difficult, and theoretical models like the Intervention Ladder developed by the Nuffield Council on Bioethics function as useful paradigms to help guide and promote behavior change. While the Intervention Ladder was developed to address issues like infectious disease, obesity, and drug use, it is applicable to the food industry with regards to promoting food safety practices like handwashing. The aim of this review is to expand on the Intervention Ladder and describe its application in the food industry. We believe the Intervention Ladder can serve as a model to benefit food industry stakeholders through providing strategies to promote handwashing compliance. We have modified the original model to include various levels of employee freedom that might impact which strategy is most appropriate depending on the circumstances. Limitations for each strategy are also considered, and directions for future research are included to help guide and expand the knowledge base of food safety behavior change strategies.

Parsonage-Turner syndrome (PTS) is a clinical syndrome characterized by rapid onset of upper extremity pain typically followed by varying degrees of weakness and atrophy. In this case, we discuss a 54-year-old female who developed severe right upper extremity pain soon after receiving a shingles vaccine, which was then followed by weakness and atrophy. Thorough medical workup was unrevealing, as it was too early to see electromyography (EMG) changes. Nine months later she presented to the hospital again with a similar presentation of the contralateral upper extremity. EMG findings at that time were supportive of a PTS diagnosis. This report discusses the clinical variability, etiology, and treatment of PTS, as well as some diagnostic complexities and how they were overcome to diagnose this patient.

Food safety training does not always result in behavior change, perhaps because of flaws inherent in traditional training designs. New technologies such as augmented reality headsets or head-mounted action cameras could transform the way food safety training is conducted in the food industry. Training conducted with wearable technology presents visual content in the first-person or actor's perspective, as opposed to the traditional third-person or observer perspective. This visual hands-on first-person perspective may provide an effective way of conveying information and encouraging behavior execution because it uses the mirror neuron system. There is little published literature about the impact of perspective on food safety training outcomes, such as motivation. The present study included a repeated-measures design to determine how first- and third-person camera angles affected hand washing training reactions among 108 currently employed restaurant food handlers. Participants were assessed on their posttraining compliance intentions, compliance self-efficacy, perceived utility of the training, overall satisfaction with the training, and video perspective preference. A significant proportion of food handlers (64%) preferred the first-person video perspective ( z = 5.00, P < 0.001), and a significant correlation was found between compliance intentions and compliance self-efficacy ( r(108) = 0.361, P < 0.001) for the first-person video. No significant differences in video preference were found for demographic variables, including age (χ2 (2, n = 104) = 1.69, P = 0.430), which suggests that the first-person training format appeals to a diverse workforce. These findings support the application of wearable technology to enhance hand washing training outcomes across a wide range of demographic groups. This research lays the framework for future studies to assess the impact of instructional design on compliance concerning hand washing and other food handling behaviors.

All traditional surveillance techniques for Aedes aegypti have been developed for the cosmopolitan domestic subspecies Ae. aegypti aegypti, and not the sylvatic subspecies, Ae. aegypti formosus. The predominant form in Western Kenya is Ae. aegypti formosus that is rarely associated with human habitations but is linked to transmission of sylvatic dengue virus strains. We compared five surveillance methods for their effectiveness in sampling Ae. aegypti formosus with the goal of determining a sustainable surveillance strategy in Kenya. The methods included larval and pupal surveys, oviposition trapping, BG-Sentinel trapping, resting boxes, and backpack aspirations. Larval and pupal surveys collected the highest number of Ae. aegypti formosus (51.3%), followed by oviposition traps (45.7%), BG-Sentinel traps (3.0%), and zero collected with either backpack aspiration or resting box collections. No Ae. aegypti formosus larvae or pupae were found indoors. The results indicate that oviposition traps and outdoor larval and pupal surveys were better surveillance methods for Ae. aegypti formosus in Western Kenya.

Co-packaging high-density optical engines with high-speed electronic switch chips can cut interconnect power consumption in half. Our novel, de-matable, low-profile connector helps by coupling transceivers waveguides to single-mode fiber arrays.

This study assessed hospitality students’ perceptions of a video game to determine likelihood of acceptance as one of three components of a habit-focused intervention to promote handwashing practices. The game was designed to be played while simultaneously washing hands and involved pressing a foot pedal that caused a character to jump over pipes to progress through a level. Students were shown a video of the game components and how to play it then given a survey based on a variant of the Technology Acceptance Model. Based on a 7-point Likert scale from “1 = Strongly disagree” to “7 = Strongly agree”, mean values for preference, perceived ease of use, perceived enjoyment, and perceived usefulness were, respectively, 4.73 ± 1.55, 5.26 ± 1.31, 4.98 ± 1.33, and 4.64 ±1.56. Students ( n = 100) expressed a slightly positive response towards video game use as evident by the survey results; one third of respondents had an average preference of “Agree” or higher for using the video game in foodservice. This study suggests the video game in its current state may have limited effectiveness in promoting handwashing practices. Future work should involve improving the game mechanics or implementing alternative reward mechanisms for promoting handwashing habits in foodservice.

Background Fluoroquinolones (FQs) are used commonly for patients with community acquired bacterial pneumonia (CABP). A recent FDA Drug Safety Communication strengthened labeling regarding tendinopathy/tendon rupture for FQs. The data prompting this change lacked a comparator group of patients using other antibiotics, like ceftriaxone/azithromycin (CTX-AZ) for similar indications. The objectives of this study were to compare the incidence of adverse tendon events (TE) between FQ and CTX-AZ among patients with CABP and determine if FQ treatment is independently associated with TE. Methods A retrospective cohort study was performed among patients in the Upstate New York Veterans’ Healthcare Administration. Inclusion criteria: (1) age ≥ 18 years, (2) diagnosis of CABP (ICD9 code with manual confirmation) from January 2014 to December 2015, (3) receipt of IV/oral FQ or CTX-AZ ≥ 1 day, and (4) treatment initiated as inpatient. Data were collected from pt’s medical records. Occurrence of TE was defined using a natural word search algorithm of patients’ clinical progress notes within 90 days of starting FQ or CTX-AZ therapy. Search terms were: tendinopathy, tendon pain, tendon rupture, tendinitis, and Achilles heel pain/tear/torn/rupture. Classification and regression tree (CART) was used to identify breakpoints in continuous variables associated with TE. Results There were 379 FQ and 274 CTX-AZ recipients. Mean ± standard deviation (SD) ages for FQ and CTX-AZ recipients were, 73.0 ± 12.7 vs. 72.8 ± 12.7 years, respectively. Mean (SD) APACHE-II was significantly higher for FQ than CTX-AZ recipients, 10.2 ± 5.1 vs. 8.5 ± 3.6, respectively (P < 0.001). Residence in the intensive care unit at start of therapy did not differ (FQ: 11.6% vs. CTX-AZ: 10.2%, P = 0.58). The incidence of TE did not differ between groups (FQ: 9/379 [2.4%] vs. CTX-AZ: 4/274 [1.5%], P = 0.57). In multivariate analyses (figure), treatment was not independently associated with TE (aOR: 1.78, 95% confidence interval: 0.51–6.21, P = 0.37) after adjustment for treatment duration, APACHE-II, age ≥52 years and BMI ≥27.5. Conclusion Incidence of TE did not significantly differ between FQ and CTX-AZ recipients. After adjustment, FQ treatment was not independently associated with an increased risk of TE. Disclosures T. P. Lodise, paratek: Consultant and Scientific Advisor, Consulting fee.

Introduction: In 2012, the Veterans Affairs (VA) Pharmacy Benefits Management Services created recommendations for antipsychotic selection in schizophrenia and schizoaffective disorders. The recommendations stated that patients must fail two first line agents (haloperidol, loxapine, quetiapine, risperidone or perphenazine) and clozapine (if appropriate) before being allowed to trial second line agents olanzapine, ziprasidone or aripiprazole. The aim of this project was to determine the amount of cost savings that could have been provided had the above recommendations been implemented last year. Use of second generation antipsychotics has been associated with weight gain, diabetes, and worsening lipid profiles. The American Diabetes Association (ADA) has created guidelines regarding cardiometabolic monitoring of second generation antipsychotic agents. A secondary aim of this project was to determine the rate of provider adherence to the ADA recommendations. Methods: A retrospective chart review was performed for patients >18 years of age who were initiated on aripiprazole, ziprasidone, or olanzapine for all indications between July 1, 2011 and July 1, 2012. The costs of the mean doses of these agents were compared to an equivalent mean dose of the first line agent risperidone (4mg) using VA drug acquisition costs. Cardiometabolic monitoring data were collected to include weight, blood pressure, fasting glucose and fasting lipid profiles at baseline and at 12 weeks. Results: Of the 542 patients started on second line agents, only 68 met criteria for their use. A potential cost savings of over $850,000 may have been realized had these criteria been enacted within the one year time period studied. None of the 542 patients had both baseline and follow-up values for weight, blood pressure, fasting glucose and fasting lipid profiles. While roughly 60% of patients had blood pressure and weight values at baseline and 27% had glucose and cholesterol values, less than 14% received follow-up testing with approximately 2% receiving neither baseline nor follow-up testing. Discussion: Significant cost savings can be realized via the use of selection criteria without sacrificing efficacy as most studies do not demonstrate the superiority of one agent and the rates of adverse events between first and second generation agents are more similar than previously thought. This study also highlighted the lack of adequate cardiometabolic monitoring which could lead to cardiovascular disease.