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The U.S. Food and Drug Administration (FDA) conducted a sampling assignment in 2014 to ascertain the prevalence of Cronobacter spp. and Salmonella in the processing environment of facilities manufacturing milk powder. Cronobacter was detected in the environment of 38 (69%) of 55 facilities. The average prevalence of Cronobacter in 5,671 subsamples (i.e., swabs and sponges from different facility locations) was 4.4%. In the 38 facilities where Cronobacter was detected, the average prevalence of positive environmental subsamples was 6.25%. In 20 facilities where zone information of the sampling location was complete, Cronobacter was most frequently detected in zone 4, followed by zone 3, then zone 2, with zone 1 yielding the lowest percentage of positive samples. The prevalence of Cronobacter across the zones was statistically different (P < 0.05). There was no significant association between product type (i.e., lactose, whey products, buttermilk powder, and nonfat dried milk) and prevalence of Cronobacter in the facility. Salmonella was detected in the environment of three (5.5%) of the 55 facilities; all three facilities produced dried whey product. The overall prevalence of Salmonella in 5,714 subsamples was 0.16%. In facilities in which Salmonella was detected, the average prevalence was 2.5%. Salmonella was most frequently detected in zone 4, followed by zone 3. Salmonella was not detected in zone 1 or zone 2. The disparity between Salmonella and Cronobacter prevalence indicates that additional measures may be required to reduce or eliminate Cronobacter from the processing environment.

Validity and Reproducibility of Measurement of Islet Autoreactivity by T-Cell Assays in Subjects With Early Type 1 Diabetes Kevan C. Herold 1 , Barbara Brooks-Worrell 2 , Jerry Palmer 3 , H. Michael Dosch 4 , Mark Peakman 5 , Peter Gottlieb 6 , Helena Reijonen 7 , Sefina Arif 5 , Lisa M. Spain 8 , Clinton Thompson 1 , John M. Lachin 1 and the Type 1 Diabetes TrialNet Research Group * 1 Yale University, New Haven, Connecticut; 2 University of Washington, Seattle, Washington; 3 University of Toronto, Toronto, Canada; 4 Department of Immunobiology and the National Institute for Health Research Biomedical Research Centre at Guy's and St. Thomas' National Health Service Foundation Trust and Kings College, London, U.K.; 5 University of Colorado, Boulder, Colorado; 6 Benaroya Research Institute, Seattle, Washington; 7 National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland; 8 The George Washington University Biostatistics Center, Rockville, Maryland. Corresponding author: Kevan C. Herold, kevan.herold{at}yale.edu . Abstract OBJECTIVE Type 1 diabetes results from an immunemediated destruction of β-cells, likely to be mediated by T lymphocytes, but the sensitivity, specificity, and other measures of validity of existing assays for islet autoreactive T-cells are not well established. Such assays are vital for monitoring responses to interventions that may modulate disease progression. RESEARCH DESIGN AND METHODS We studied the ability of cellular assays to discriminate responses in patients with type 1 diabetes and normal control subjects in a randomized blinded study in the U.S. and U.K. We evaluated the reproducibility of these measurements overall and to individual analytes from repeat collections. RESULTS Responses in the cellular immunoblot, U.K.-ELISPOT, and T-cell proliferation assays could differentiate patients from control subjects with odds ratios of 21.7, 3.44, and 3.36, respectively, with sensitivity and specificity as high as 74 and 88%. The class II tetramer and U.S. ELISPOT assays performed less well. Despite the significant association of the responses with type 1 diabetes, the reproducibility of the measured responses, both overall and individual analytes, was relatively low. Positive samples from normal control subjects (i.e., false positives) were generally isolated to single assays. CONCLUSIONS The cellular immunoblot, U.K.-ELISPOT, and T-cell proliferation assays can distinguish responses from patients with type 1 diabetes and healthy control subjects. The limited reproducibility of the measurements overall and of responses to individual analytes may reflect the difficulty in detection of low frequency of antigen-specific T-cells or variability in their appearance in peripheral blood. Footnotes *A complete list of co-investigators can be found in an online appendix available at http://diabetes.diabetesjournals.org/cgi/content/full/db09-0249/DC1 . The TrialNet Study Group is presented at www.diabetestrialnet.org . Clinical trial reg. no. NCT 00212329, clinicaltrials.gov . The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. Received February 19, 2009. Accepted July 16, 2009. © 2009 American Diabetes Association

Background    Persistent gastrointestinal (GI) symptoms after travel abroad may be common. It remains unclear how often subjects who developed new GI symptoms while abroad have persistent symptoms on return. The objective of this retrospective study was to evaluate the prevalence of persistent GI symptoms in a healthy cohort of travelers. Methods    One hundred and eight consecutive patients, mostly returned missionaries, attending the University of Utah International Travel Clinic for any reason (but mostly GI symptoms) had data recorded about their bowel habits before, during, and after travel abroad. All subjects had standard hematological, biochemical, and microbiological tests to exclude known causes of their symptoms. Endoscopic procedures were performed when considered necessary by the treating physician. Diarrhea, constipation, irritable bowel syndrome (IBS), bloating, and dyspepsia were defined according to the Rome II Criteria. Results    Eighty three (82% men and 18% women, median age 21 years) completed the survey with 68 subjects completing the questionnaire about bowel habits before and during travel. Among the respondents, 55 (82.1%) did not have any symptoms before travel. During travel, 41 (63%) developed new onset diarrhea; 6 (9%) developed constipation; 16 (24%) IBS, 29 (45%) bloating; and 11 (16%) dyspepsia. Of those who developed symptoms during travel, 27 (68%) had persistent diarrhea, 3 (50%) had persistent constipation, 10 (63%) had persistent IBS, 12 (43%) had persistent bloating and 8 (73%) had persistent dyspepsia. The presence of bowel symptoms during and after travel was not associated with age, gender, travel destination, or duration of travel. Conclusions: This study suggests that new onset of diarrhea, IBS, constipation, and dyspepsia are common among subjects traveling abroad. Gastrointestinal symptoms that develop during travel abroad usually persist on return.

* BACKGROUND AND OBJECTIVE: To measure endothelial cell loss and predictability of lamellar thickness after preparing donor tissue for deep keratoplasty with an artificial anterior chamber and microkeratome.* MATERIALS AND METHODS: A microkeratome set at a depth of 350 µm and a diameter of 9 mm was used to obtain ten lamellar lenticules from corneoscleral rims mounted in an artificial chamber. A punch trephine then was used to cut the donor tissue 7 mm in diameter. Specular microscopy was performed to evaluate endothelial cell density before the procedure, after cutting with the microkeratome, and after trephination. Pachymetry was performed to determine the predictability of lenticule thickness, before the procedure and after microkeratome incision.* RESULTS: Mean post-microkeratome endothelial cell loss was 79 ± 88 cells/mmp 2 and post-punch trephination was 85 ± 94 cells/mmp 2. This represented a mean percentage loss of 3.2% and 3.5% for the respective steps of this procedure. Nine of the ten lenticules were cut within ± 75 µm of the intended 350-µm thickness.* CONCLUSIONS: Preparing donor lenticules for deep lamellar endothelial keratoplasty with a microkeratome with artificial chamber system caused a relatively small loss of endothelial cells (6.7% of the total) and a reproducible thickness. This may have advantages over manual preparation techniques.[Ophthalmic Surg Lasers Imaging 2005;36:381-385.]

[...]it was clear and beautiful and our peace was disturbed only occasionally by the tat-tat-tat of nearby automatic weapons. Six fighter planes plus a few tanks and several hundred soldiers had overthrown the government of Afghanistan. A house full of Peace Corps Volunteers was flattened by a bomb, but nobody was seriously injured; a German friend had a rocket rip through a wall in his house, barely miss him, and exit another wall without exploding; an Afghan friend was hit in his arm by a bullet. The new communist rulers stupidly changed the colors of the flag from Islamic green to communist red. [...]their clumsy efforts to effect revolutionary change in the conservative and traditional society incited a full-scale rebellion.

An obituary for Judy Wilkerson, who died on Jun 10, 2005, is presented. During her fifteen years of service at the Robert M. Bird Health Sciences Library, University of Oklahoma, she directed serial services, was responsible for developing electronic resources, and headed interlibrary loan services. One of the crowning moments in her career was an internship at the National Cancer Institute in 1985.

The purpose of this research was to investigate and elucidate the relationship between medication adherence and optimism-pessimism in a population of people living with HIV/AIDS. The first aim was to assess the association between optimism-pessimism and two different measures of medication adherence via two different multivariable models. The first measure of adherence was a self-report measure of the frequency with which a person missed their medications for various reasons where a higher score denoted less adherence to their current medication regimen. A robust Poisson regression model was used as the primary mechanism to analyze this measure of adherence. The second measure of adherence was an ordinal-scaled question that inquired about level of confidence to take medication as prescribed by a health care provider. An ordered logit regression (proportional odds regression) was used to analyze this measure of adherence. In both analyses, the quantification of optimism-pessimism on medication adherence began with unadjusted univariate models then progressed to fully-adjusted multivariable models. The second aim was to determine whether the hypothesized association between optimism-pessimism and medication adherence followed from the expression of optimism-pessimism as a single, bipolar metric or as two distinct, unipolar metrics. Both expressions of optimism-pessimism—the single continuum measure and the disaggregated unidimensional measures, respectively—were included in the multivariable models proposed in the first aim. The data used in this project came from a randomized controlled trial conducted between December 2005 and January 2007 by the International Nursing Network for HIV/AIDS Research. The findings from this research indicated that optimism (both dispositional and disaggregated) was positively associated with medication adherence in unadjusted and partially adjusted models but not when depression, quality of life, and self-efficacy were adjusted for. An exploratory analysis that led to the stratification of the sample by the median age, 44, returned a positive association between optimism and medication adherence across all models among subjects <44 years of age. A similar pattern was observed for the association between optimism and confidence to take medications as directed. The analysis of optimism-pessimism as a single continuum or as two independent constructs suggested that optimism and pessimism are not opposite ends of the same continuum but represent two unipolar dimensions. Medication adherence is central to benefits realized at both the individual- and population-levels and these findings help to elucidate the relationship between adequate adherence and a not-yet-fully-understood psychological factor, optimism-pessimism.

The tight-binding model that has been used for many years in condensed matter physics, due to its analytic and numerical tractability, has recently been used to describe light propagating through an array of evanescently coupled waveguides. This dissertation presents analytic and numerical simulation results of light propagating in a waveguide array. The first result presented is that photonic transport can be achieved in an array where the propagation constant is linearly increasing across the array. For an input at the center waveguide, the breathing modes of the system are observed, while for a phase displaced, asymmetric input, phase-controlled photonic transport is predicted. For an array with a waveguide-dependent, parity-symmetric coupling constant, the wave packet dynamics are predicted to be tunable. In addition to modifying the propagation constant, the coupling between waveguides can also be modified, and the quantum correlations are sensitive to the form of the tunneling function. In addition to modifying the waveguide array parameters in a structured manner, they can be randomized as to mimic the insertion of impurities during the fabrication process. When the refractive indices are randomized and real, the amount of light that localizes to the initial waveguide is found to be dependent on the initial waveguide when the waveguide coupling is non-uniform. In addition, when the variance of the refractive indices is small, light localizes in the initial waveguide as well as the parity-symmetric waveguide. In addition to real valued disorder, complex valued disorder can be introduced into the array through the imaginary component of the refractive index. It is shown that the two-particle correlation function is qualitatively similar to the case when the waveguide coupling is real and random, as both cases preserve the symmetry of the eigenvalues. Lastly, different input fields have been used to investigate the quantum statistical aspects of Anderson localization. It is found that the fluctuations in the output intensity are enhanced and the entropy of the system is reduced when disorder is present in the waveguides.

Engagement with care for those living with HIV is aimed at establishing a strong relationship between patients and their health care provider and is often associated with greater adherence to therapy and treatment (Flickinger, Saha, Moore, and Beach, 2013). Substance use behaviors are linked with lower rates of engagement with care and medication adherence (Horvath, Carrico, Simoni, Boyer, Amico, and Petroli, 2013). This study is a secondary data analysis using a cross-sectional design from a larger randomized controlled trial (n=775) that investigated the efficacy of a self-care symptom management manual for participants living with HIV. Participants were recruited from countries of Africa and the US. This study provides evidence that substance use is linked with lower self-reported engagement with care and adherence to therapy. Data on substance use and engagement are presented. Clinical implications of the study address the importance of utilizing health care system and policy factors to improve engagement with care.