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In 2006, a multistate Escherichia coli O157:H7 outbreak linked to spinach grown in California's Central Coast region caused public concerns, catalyzing far-reaching reforms in vegetable production. Industry and government pressured growers to adopt costly new measures to improve food safety, many of which targeted wildlife as a disease vector. In response, many growers fenced fields, lined field edges with wildlife traps and poison, and removed remaining adjacent habitat. Although the efficacy of these and other practices for mitigating pathogen risk have not been thoroughly evaluated, their widespread adoption has substantial consequences for rural livelihoods, biodiversity, and ecological processes. Today, as federal regulators are poised to set mandatory standards for on-farm food safety throughout the United States, major gaps persist in understanding the relationships between farming systems and food safety. Addressing food-safety knowledge gaps and developing effective farming practices are crucial for co-managing agriculture for food production, conservation, and human health.

Objective: To compare fetal microchimerism (FMc) in pregnancies with uncomplicated vaginal delivery (VD) versus caesarean delivery (CD).Design: Prospective cohort study.Setting: University of Washington and Fred Hutchinson Cancer Research Center, USA.Population: Women delivering singleton pregnancies without pertinent antenatal complications with uncomplicated deliveries (n = 36).Methods: We collected maternal predelivery, postdelivery and umbilical cord blood for each mother-baby pair. Following maternal and fetal genotyping, FMc was measured with quantitative polymerase chain reaction assays targeting fetus-specific polymorphisms. Quantification of FMc is expressed as genome equivalents (gEq) of fetal DNA/100 000 total gEq tested. FMc detection was evaluated by logistic regression while controlling for total number of cell equivalents tested and clinically relevant covariates. FMc concentrations were compared using negative binomial regression while controlling for the same covariates and predelivery FMc positivity.Main Outcome Measure: Detection and concentration of FMc by mode of delivery.Results: Twenty-four mother-baby pairs had a VD and 12 had a CD. Postdelivery FMc detection was higher following CD than after VD (58.3% versus 16.7%, P = 0.02). After controlling for covariates, the likelihood of postdelivery FMc detection was almost nine-fold higher after CD than VD (odds ratio 8.8, 95% CI 1.6-47.6; P = 0.01). With respect to postdelivery FMc concentration, the detection rate ratio for CD versus VD in the adjusted negative binomial regression model was 14.7 (95% CI 3.2-66.8; P = 0.001).Conclusion: Postdelivery peripheral FMc detection and concentration are significantly higher after CD than after VD. As FMc is associated with long-term maternal health, our findings suggest that the mode of delivery may impact this risk.Tweetable Abstract: Greater fetal microchimerism found in maternal blood following caesarean delivery compared with vaginal delivery. [ABSTRACT FROM AUTHOR]

Background: Fetal cells (microchimerism) are acquired by women during pregnancy. Fetal microchimerism persists decades later and includes cells with pluripotent capacity. Persistent microchimerism has the capacity for both beneficial and detrimental maternal health consequences. Both miscarriage and termination of pregnancy can result in fetal microchimerism. We sought to determine whether cellular fetal microchimerism is acquired during management of pregnancy loss and further explored factors that could influence fetal cell transfer, including viability of fetal tissue, surgical versus medical management and gestational age.Methods: Pregnant women (n= 150 samples from 75 women) with singleton pregnancies undergoing a TOP (n= 63) or treatment for embryonic or fetal demise (miscarriage, n= 12) were enrolled. Mononuclear cells were isolated from blood samples drawn before, and 30 min after, treatment. Fetal cellular microchimerism concentrations were determined using quantitative PCR for a Y chromosome-specific sequence, expressed as genome equivalents of fetal DNA per 100 000 maternal cell equivalents (gEq/10(5)). Detection rate ratios were determined according to clinical characteristics.Results: Cellular fetal microchimerism was found more often in post- compared with pretreatment samples, 24 versus 5% (P= 0.004) and at higher concentrations, 0-36 versus 0-0.7 gEq/10(5) (P< 0.001). Likelihood of microchimerism was higher in surgical than medical management, detection rate ratio 24.7 (P= 0.02). The detection rate ratio for TOP versus miscarriage was 16.7 for known male fetuses (P= 0.02). Microchimerism did not vary with gestational age.Conclusions: Significant fetal cell transfer occurs during miscarriage and TOP. Exploratory analyses support relationships between obstetric clinical factors and acquisition of fetal cellular microchimerism; however, our limited sample size precludes definitive analysis of these relationships, and confirmation is needed. In addition, the long-term persistence and potential consequences of fetal microchimerism on maternal health merit further investigation. [ABSTRACT FROM AUTHOR]

AIM: The delivery of patient-centered care is basic to a large midwestern healthcare institution's mission and highly valued by the department of nursing. Even so, nurses on one medical unit questioned whether caring behaviors were devalued in a technology-oriented environment of providing care. The nursing leadership on the unit responded to the inquiry by conducting a research study. This study explored the state of patient-centered nursing care on a medical unit as perceived by the nursing staff and patients, using Watson's Theory of Human Caring as a framework. SUBJECTS AND METHODS: The study utilized surveys for both nursing staff (n = 31) and patients (n = 62), and included a focus group of nursing staff (n = 8) to explore ideas for innovation. RESULTS AND CONCLUSIONS: Both nurses and patients perceived a high level of caring on the unit. The overall theme from the focus group was that 'caring begets caring,' with 2 subthemes: 'relationships of care' and 'the context of caring.' Caring for each other was identified as essential to keep staff energized and able to work lovingly with patients. Nursing leadership brought the research findings to all staff on the unit for discussion and implementation of structural support for the unit culture of caring. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the safety and efficacy of allogeneic hematopoietic cell transplantation (HCT) after myeloablative conditioning in patients with severe systemic sclerosis (SSc). METHODS: Eligibility criteria for the study included SSc patients with features indicative of a poor prognosis. The myeloablative conditioning regimen included busulfan, cyclophosphamide, and antithymocyte globulin. Prophylaxis for graft-versus-host disease (GVHD) consisted of cyclosporine and methotrexate. Bone marrow was transplanted from HLA-identical siblings. RESULTS: Two patients with diffuse cutaneous SSc and lung involvement who were refractory to conventional immunosuppressive treatment were enrolled in the study. In patient 1, there were no complications related to the conditioning regimen, and GVHD did not develop after transplantation. At 5 years after HCT, there was nearly complete resolution of the scleroderma and marked improvement in physical functioning. Internal organ function improved (lung) or remained stable. On examination of serial skin biopsy samples, there was resolution of the dermal fibrosis. Patient 2 experienced skin toxicity from the conditioning regimen and hypertensive crisis that was likely related to high-dose corticosteroids given for treatment of GVHD. Although this patient experienced an improvement in scleroderma and overall functioning, a fatal opportunistic infection developed 17 months after HCT. CONCLUSION: Allogeneic HCT may result in sustained remission of SSc. GVHD and opportunistic infections are the major risks associated with allogeneic HCT for SSc, as for allogeneic HCT in general. [ABSTRACT FROM AUTHOR]

Medical implants are sometimes colonized by biofilm-forming bacteria, which are very difficult to treat effectively. The combination of gentamicin and ultrasonic exposure for 24 hours was previously shown to reduce the viability of Escherichia coli biofilms in vivo. This article shows that such treatment for 48 hours reduced viable E coli bacteria to nearly undetectable levels. However, when Pseudomonas aeruginosa biofilms were implanted and treated for 24 and 48 hours, no significant ultrasonic-enhanced reduction of viable bacteria was observed. The difference in response of these 2 organisms is attributed to greater impermeability and stability of the outer membrane of P aeruginosa. [ABSTRACT FROM AUTHOR]

The preceptors and leadership team on a busy acute care general medical unit collaborated on a temporary plan to provide clinical support for 38 nurses who had been hired during the year. A pilot role was created and designated 'unit coach.' Each coach questioned and prompted reflective practice in building confidence and critical thinking. [ABSTRACT FROM AUTHOR]

Cells traffic in both directions between the fetus and the mother during pregnancy. Recent studies indicate that a low level of fetal cells commonly persists in the maternal circulation for years after pregnancy completion. The harboring of DNA or cells from another individual at low levels is called microchimerism. Chronic graft-vs-host disease is a condition of human chimerism that shares similarities to some autoimmune diseases and for which the specific HLA genes of donor and host are known to be of central importance. Considered together with the female predilection to autoimmunity, these observations led to the hypothesis that microchimerism and HLA genes of host and non-host cells are involved in autoimmune disease. The hypothesis also extends to men and females who have not been pregnant because there are other sources of microchimerism. Maternal cells are now know to persist in her progeny and microchimerism can also derive from a twin or from a blood transfusion. Studies of systemic sclerosis, primary biliary cirrhosis, Sjögrens syndrome, polymorpyhic eruption of pregnancy, myositis and thyroid disease have both lent support and raised doubts about the role of microchimerism in autoimmune disease. [ABSTRACT FROM AUTHOR]

Ob/gyns have long known that women are disproportionately affected by many autoimmune diseases. Now, new findings about the cellular and molecular activities of the immune system are beginning to explain the causes of these conditions. The next goal: immunologically based treatments. [ABSTRACT FROM AUTHOR]

The article presents information on fetal cellular microchimerism in miscarriage and pregnancy termination. During pregnancy, fetal cells transfer to the mother and can persist long-term as microchimerism. During pregnancy loss, acquisition of microchimerism may also happen. The magnitude of fetal cell transfer during pregnancy loss was examined.

Objective: To conduct a replication study to investigate whether the -945 CTGF genetic variant is associated with systemic sclerosis (SSc) susceptibility or specific SSc phenotype.Methods: The study population comprised 1180 patients with SSc and 1784 healthy controls from seven independent case-control sets of European ancestry (Spanish, French, Dutch, German, British, Swedish and North American). The -945 CTGF genetic variant was genotyped using a Taqman 5' allelic discrimination assay.Results: An independent association study showed in all the case-control cohorts no association of the CTGF -945 polymorphism with SSc susceptibility. These findings were confirmed by a meta-analysis giving a pooled OR = 1.12 (95% CI 0.99 to 1.25), p = 0.06. Investigation of the possible contribution of the -945 CTGF genetic variant to SSc phenotype showed that stratification according to SSc subtypes (limited or diffuse), selective autoantibodies (anti-topoisomerase I or anticentromere) or pulmonary involvement reached no statistically significant skewing.Conclusion: The results do not confirm previous findings and suggest that the CTGF -945 promoter polymorphism does not play a major role in SSc susceptibility or clinical phenotype. [ABSTRACT FROM AUTHOR]

Objectives: Some patients with rheumatoid arthritis (RA) lack RA-associated human leukocyte antigen (HLA) alleles. Prior studies investigated non-inherited maternal HLA alleles (NIMA) in RA risk with conflicting results.Methods: We examined NIMA in a large cohort of families from the North American Rheumatoid Arthritis Consortium (NARAC).Results: Among 620 patients with 1 or both parents having a HLA genotype, patients with RA informative for analysis included 176 without HLA-DRB1*04 and 86 without the HLA shared epitope (SE). The frequency of NIMA encoding HLA-DR4 or the SE was compared to the non-inherited paternal allele (NIPA). DR4-encoding NIMA vs NIPA revealed no significant difference (27% vs 20%). However, parity is known to modulate RA risk and analyses stratified by sex and age of onset showed significant variation among women. Interestingly, among women with onset <45 years DR4-encoding NIMA was increased compared to NIPA; among women > or =45 years at onset the reverse was observed (31% vs 16% compared to 10% vs 60%, p = 0.008). DR4 encoding NIMA vs NIPA did not differ in men. The SE did not differ in men or women.Conclusions: Risk of RA was associated with HLA-DR4 encoding NIMA in younger-onset women but not in older-onset women or men. These observations could help explain conflicting prior results of NIMA in RA. [ABSTRACT FROM AUTHOR]