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As existing technologies are refined and novel microbial inactivation technologies are developed, there is a growing need for a metric that can be used to judge equivalent levels of hazard control stringency to ensure food safety of commercially sterile foods. A food safety objective (FSO) is an output-oriented metric that designates the maximum level of a hazard (e.g., the pathogenic microorganism or toxin) tolerated in a food at the end of the food supply chain at the moment of consumption without specifying by which measures the hazard level is controlled. Using a risk-based approach, when the total outcome of controlling initial levels (Ho), reducing levels (ΣR), and preventing an increase in levels (ΣI) is less than or equal to the target FSO, the product is considered safe. A cross-disciplinary international consortium of specialists from industry, academia, and government was organized with the objective of developing a document to illustrate the FSO approach for controlling Clostridium botulinum toxin in commercially sterile foods. This article outlines the general principles of an FSO risk management framework for controlling C. botulinum growth and toxin production in commercially sterile foods. Topics include historical approaches to establishing commercial sterility; a perspective on the establishment of an appropriate target FSO; a discussion of control of initial levels, reduction of levels, and prevention of an increase in levels of the hazard; and deterministic and stochastic examples that illustrate the impact that various control measure combinations have on the safety of well-established commercially sterile products and the ways in which variability all levels of control can heavily influence estimates in the FSO risk management framework. This risk-based framework should encourage development of innovative technologies that result in microbial safety levels equivalent to those achieved with traditional processing methods. [ABSTRACT FROM AUTHOR]

During June 2003, a period of mid level discharge (17,400 m-3 s-1), a parcel of water in the lower Mississippi River was sampled every 2 h during its 4-d transit from river km 362 near Eaton Rouge to km 0 at Head of Passes, Louisiana, United States. Properties measured at the surface during each of the 48 stations were temperature, salinity, dissolved organic carbon (DOC), total dissolved nitrogen, dissolved macronutrients (NO3 + NO2, PO4, Si(OH)4), chlorophyll a (chl a; three size fractions: < 5 µm, 5-20 µm, and > 20 µm), pigment composition by HPLC, total suspended matter (TSM), particulate organic carbon (POC), and particulate nitrogen (PN). Air-water CO2 flux was calculated from surface water dissolved inorganic carbon and pH. During the 4 d transit, large particles appeared to be settling out of the surface water. Concentrations of chl a containing particles > 20 µm declined 37%, TSM declined 43%, POC declined 42% and PN declined 57%. Concentrations of the smaller chl a containing particles did not change suggesting only large particulate materials were settling. There was no measurable loss of dissolved NO3, PO4, or Si(OH)4, consistent with the observation that chl a did not increase during the 4-d transit. DOC declined slightly (3%). These data indicate there was little autotrophic or heterotrophic activity in the lower Mississippi River at this time, but the system was slightly net heterotrophic. [ABSTRACT FROM AUTHOR]

Background: Technological advances in the distribution of information have opened new avenues for patient care. Few trials, however, have used telemedicine to improve blood pressure in patients with essential hypertension.Objective: To determine the efficacy of a telecommunication service in reducing blood pressure.Design: Randomized, controlled trial.Setting: University-affiliated primary care outpatient clinics.Patients: 121 adults with essential hypertension who were under evaluation for a change in antihypertensive therapy.Intervention: A home service consisting of automatic transmission of blood pressure data over telephone lines, computerized conversion of the information into report forms, and weekly electronic transmission of the report forms to physicians and patients.Measurements: 24-hour ambulatory blood pressure monitoring at baseline and exit. The primary end point was change in mean arterial pressure from baseline to exit.Results: Mean arterial pressure decreased by 2.8 mm Hg in patients receiving the home service and increased by 1.3 mm Hg in patients receiving usual care (P = 0.013 for the difference). Mean diastolic blood pressure decreased by 2.0 mm Hg for home service but increased by 2.1 mm Hg for usual care (P = 0.012 for the difference). Mean systolic blood pressure decreased by 4.9 mm Hg for home service and 0.1 mm Hg for patients receiving usual care (P = 0.047 for the difference). Among African-American patients, mean arterial pressure decreased by 9.6 mm Hg in those receiving home service and increased by 5.25 mm Hg in those receiving usual care (P = 0.047). Part of the decrease in blood pressure for home service was due to more frequent changes in the type or dose of antihypertensive medications.Conclusion: This telecommunication service was efficacious in reducing the mean arterial pressure of patients with established essential hypertension. [ABSTRACT FROM AUTHOR]

This study investigated alcohol consumption during pregnancy and its relationships with socio-economic, psychological and behavioral factors in 1463 women. Information about alcohol consumption in the preceding 7 days was obtained by structured interview at booking, 28 and 36 weeks gestation. The prevalence of current drinking was about 50% at each interview. Combining the three interviews, the cumulative prevalence of drinking was 71%. Six per cent reported drinking 100 G/wk or more at at least one interview, a level of consumption which has been reported to be associated with adverse fetal outcome. Higher proportions of drinkers titan non-drinkers were married, better educated, of higher social class and financial status. These factors were also associated with higher levels of consumption amongst those who drank. There was little evidence of an association between drinking and psychiatric state. Smoking was not associated with drinking stares but was strongly related to the amount drunk by drinkers. Cluster analysis of heavier drinkers indicated the presence of a small sub-group of socially disadvantaged women. These findings carry implications for both prevention and perinatal epidemiology. [ABSTRACT FROM AUTHOR]

Sixty-seven patients with keratoconus were classified according to atopic status. Keratoconus patients with and without atopy did not differ significantly with regard to sex, age of onset, or rate of keratoplasty, but patients with very high IgE levels were more prone to graft rejection. Atopy was less common in patients with unilateral keratoconus, and keratoconus occurred more frequently on the side of the dominant hand. There was a significantly lower frequency of HLA B7 in the keratoconus group than in the controls. No abnormalities of essential fatty acid metabolism were found in keratoconus patients with or without atopy. There was no social class bias in the group. The study included a brother and sister with keratoconus and atopy, and a non-atopic patient whose identical twin did not have keratoconus. [ABSTRACT FROM PUBLISHER]