Tools to support the self assessment of the performance of Food Safety Management Systems

Changes in food supply chains, health and demographic situations, lifestyle and social situations, environmental conditions, and increased legislative requirements have led to significant efforts in the development of quality and safety management systems in agribusiness and food industry worldwide (Ropkins and Beck, 2000; Efstratiadis, Karirti, and Arvanitoyannis, 2000; Jacxsens, et al, 2009a, Luning and Marcelis, 2009a). Nowadays, companies have implemented various quality assurance (QA) guidelines and standards, such as GMP and HACCP guidelines (like General Principles of food hygiene (Codex Alimentarius 2003), GFSI guidance document (GFSI (2007), and quality assurance standards (like ISO 9001:2008 (2008), ISO22000:2005 (2005), BRC (2008), and IFS (2007) into their company own food safety management system. The performance of such systems in practice is, however, still variable. Moreover, the continuous pressure on food safety management system (FSMS) performance and the dynamic environment wherein the systems operate (such as emerging pathogens, changing consumer demands, developments in preservation techniques) require that they can be systematically analysed to determine opportunities for improvement (Wallace, et al, 2005; Manning et al, 2006; Van der Spiegel et al, 2006; Cornier et al, 2007; Luning et al, 2009a). Within the European project entitled ‘PathogenCombat- EU FOOD-CT-2005-007081’ various tools have been developed to support food companies and establishments in systematically analysing and judging their food safety management system and its microbiological performance as basis for strategic choices on interventions to improve the FSMS performance. This chapter describes briefly principles of the major tools that have been developed and some others, which are still under still under construction

Cerebral Infarcts and Vasculopathy in Tanzanian Children With Sickle Cell Anemia

BACKGROUND: Cerebral infarcts and vasculopathy in neurologically asymptomatic children with sickle cell anemia (SCA) have received little attention in African settings. This study aimed to establish the prevalence of silent cerebral infarcts (SCI) and vasculopathy and determine associations with exposure to chronic hemolysis, anemia, and hypoxia. METHODS: We prospectively studied 224 children with SCA with transcranial Doppler (TCD), and magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA). Regressions were undertaken with contemporaneous hemoglobin, reticulocyte count, mean prior hemoglobin, oxygen content, reticulocyte count, and indirect bilirubin. RESULTS: Prevalence of SCI was 27% (61 of 224); cerebral blood flow velocity was abnormal (>200 cm/s) in three and conditional (>170<200 cm/s) in one. Vasculopathy grades 2 (stenosis) and 3 (occlusion) occurred in 16 (7%) and two (1%), respectively; none had grade 4 (moyamoya). SCI was associated with vasculopathy on MRA (odds ratio 2.68; 95% confidence intervals [95% CI] 1.32 to 5.46; P = 0.007) and mean prior indirect bilirubin (odds ratio 1.02, 95% CI 1.00 to 1.03, P = 0.024; n = 83) but not age, sex, non-normal TCD, or contemporaneous hemoglobin. Vasculopathy was associated with mean prior values for hemoglobin (odds ratio 0.33, 95% CI 0.16 to 0.69, P = 0.003; n = 87), oxygen content (odds ratio 0.43, 95% CI 0.25 to 0.74, P = 0.003), reticulocytes (odds ratio 1.20, 95% CI 1.01-1.42, P = 0.041; n = 77), and indirect bilirubin (odds ratio 1.02, 95% CI 1.01 to 1.04, P = 0.009). CONCLUSIONS: SCI and vasculopathy on MRA are common in neurologically asymptomatic children with SCA living in Africa, even when TCD is normal. Children with vasculopathy on MRA are at increased risk of SCI. Longitudinal exposure to anemia, hypoxia, and hemolysis appear to be risk factors for vasculopathy