Bacterial Foodborne Disease: Medical Costs and Productivity Losses

Microbial pathogens in food cause an estimated 6.5-33 million cases of human illness and up to 9,000 deaths in the United States each year. Over 40 different foodborne microbial pathogens, including fungi, viruses, parasites, and bacteria, are believed to cause human illnesses. For six bacterial pathogens, the costs of human illness are estimated to be $9.3-$12.9 billion annually. Of these costs, $2.9-$6.7 billion are attributed to foodborne bacteria. These estimates were developed to provide analytical support for USDA's Hazard Analysis and Critical Control Point (HACCP) systems rule for meat and poultry. (Note that the parasite Toxoplasma gondii is not included in this report.) To estimate medical costs and productivity losses, ERS uses four severity categories for acute illnesses: those who did not visit a physician, visited a physician, were hospitalized, or died prematurely. The lifetime consequences of chronic disease are included in the cost estimates for E. coli O157:H7 and fetal listeriosis.cost-of-illness, foodborne pathogens, lost productivity, medical costs, Food Consumption/Nutrition/Food Safety, Health Economics and Policy,

Field efficacy of hermetic and other maize grain storage options under smallholder farmer management

Household grain storage continues to be of paramount importance in improving food security in sub-Saharan Africa (SSA) where maize postharvest losses of 10-20 % are reported. On-farm trials to compare alternative solutions for reducing household maize storage losses were conducted in the 2014/15 and 2015/16 storage seasons in two contrasting agro-ecological zones in Hwedza district of Zimbabwe. A wide range of treatments including a commercial synthetic pesticide (Shumba super dust®1), unregistered but commonly used botanical pesticides (Aloe ash, Colophospermum mopane leaves, Eleusine coracana (rapoko) chaff, and Ocimum gratissimum), hermetic storage facilities (metal silos, GrainPro Super Grain Bags (SGB) IVR™, Purdue Improved Crop Storage (PICS) bags), and storage bags with pesticide incorporated into their fabric (ZeroFly® bags), were evaluated. The results demonstrated the superiority of hermetic storage facilities (PICS bags, SGBs, and metal silos) in suppressing insect pest build up, insect grain damage and weight loss in stored maize grain. A newly introduced synthetic pesticide on the Zimbabwean market, Actellic gold dust®, was also evaluated in the 2015/16 season and was found to be highly effective. The following grain storage technologies; hermetic metal silos, SGB bags, PICS bags, and Actellic gold dust® pesticide are therefore recommended for smallholder farmer use to reduce stored grain losses due to insect pests

Learning for Sustainability:young people and practitioner perspectives

This report is based on research conducted by a team at the University of Dundee into the understanding and implementation of Learning for Sustainability amongst young people aged 14+ in school and community learning and development settings and the practitioners responsible for their education

Unbiased Gene Expression Analysis Implicates the huntingtin Polyglutamine Tract in Extra-mitochondrial Energy Metabolism

The Huntington's disease (HD) CAG repeat, encoding a polymorphic glutamine tract in huntingtin, is inversely correlated with cellular energy level, with alleles over ∼37 repeats leading to the loss of striatal neurons. This early HD neuronal specificity can be modeled by respiratory chain inhibitor 3-nitropropionic acid (3-NP) and, like 3-NP, mutant huntingtin has been proposed to directly influence the mitochondrion, via interaction or decreased PGC-1α expression. We have tested this hypothesis by comparing the gene expression changes due to mutant huntingtin accurately expressed in STHdhQ111/Q111 cells with the changes produced by 3-NP treatment of wild-type striatal cells. In general, the HD mutation did not mimic 3-NP, although both produced a state of energy collapse that was mildly alleviated by the PGC-1α-coregulated nuclear respiratory factor 1 (Nrf-1). Moreover, unlike 3-NP, the HD CAG repeat did not significantly alter mitochondrial pathways in STHdhQ111/Q111 cells, despite decreased Ppargc1a expression. Instead, the HD mutation enriched for processes linked to huntingtin normal function and Nf-κB signaling. Thus, rather than a direct impact on the mitochondrion, the polyglutamine tract may modulate some aspect of huntingtin's activity in extra-mitochondrial energy metabolism. Elucidation of this HD CAG-dependent pathway would spur efforts to achieve energy-based therapeutics in HD

Strategies for Gait Retraining in a Collegiate Runner with Transfemoral Amputation: A Case Report

# Background More than fifty percent of people with limb amputations participate in sports or physical activity following amputation. Athletes with limb amputations may face additional challenges including phantom limb pain (PLP), psychological barriers, prosthetic complications, and gait abnormalities. Prevalence of PLP in the general amputee population is estimated to be as high as 85%. Despite the high prevalence of PLP, there is little research regarding the use of gait training as a treatment for PLP among both the general amputee population and athletes. # Case Description A 20-year old female collegiate track and field athlete presented with phantom knee pain brought on with running. The athlete demonstrated deficits in core and hip strength as well as decreased single leg stability bilaterally. Running gait analysis revealed circumduction with the prosthesis for limb advancement and increased vaulting with push off on the sound (uninvolved) limb. Gait retraining strategies were implemented to address video analysis findings and create a more efficient running gait and address phantom limb pain symptoms. # Outcomes Rehabilitation and gait retraining strategies were effective in improving several clinical and functional outcomes in this case. Significant improvements were noted in PLP, running gait mechanics, and the patient’s psychological and functional status as measured with a standardized outcome tool, the Patient-Reported Outcomes Measurement Information System^®^ (PROMIS^®^). # Discussion Running gait training following amputation could be a crucial component of rehabilitation for athletes in an attempt to lessen pain while running, especially in those experiencing phantom limb pain (PLP). Utilization of a multidisciplinary team in the gait retraining process is recommended. There is a need for further research to determine the effects of running gait retraining for management of PLP in athletes with amputation. # Level of Evidence

Adjunctive antimicrobial photodynamic therapy for treating periodontal and peri‐implant diseases

BackgroundPeriodontitis and peri‐implant diseases are chronic inflammatory conditions occurring in the mouth. Left untreated, periodontitis progressively destroys the tooth‐supporting apparatus. Peri‐implant diseases occur in tissues around dental implants and are characterised by inflammation in the peri‐implant mucosa and subsequent progressive loss of supporting bone.Treatment aims to clean the pockets around teeth or dental implants and prevent damage to surrounding soft tissue and bone, including improvement of oral hygiene, risk factor control (e.g. encouraging cessation of smoking) and surgical interventions. The key aspect of standard non‐surgical treatment is the removal of the subgingival biofilm using subgingival instrumentation (SI) (also called scaling and root planing). Antimicrobial photodynamic therapy (aPDT) can be used an adjunctive treatment to SI. It uses light energy to kill micro‐organisms that have been treated with a light‐absorbing photosensitising agent immediately prior to aPDT.ObjectivesTo assess the effects of SI with adjunctive aPDT versus SI alone or with placebo aPDT for periodontitis and peri‐implant diseases in adults.Search methodsWe searched the Cochrane Oral Health Trials Register, CENTRAL, MEDLINE, Embase, two other databases and two trials registers up to 14 February 2024.Selection criteriaWe included randomised controlled trials (RCTs) (both parallel‐group and split‐mouth design) in participants with a clinical diagnosis of periodontitis, peri‐implantitis or peri‐implant disease. We compared the adjunctive use of antimicrobial photodynamic therapy (aPDT), in which aPDT was given after subgingival or submucosal instrumentation (SI), versus SI alone or a combination of SI and a placebo aPDT given during the active or supportive phase of therapy.Data collection and analysisWe used standard Cochrane methodological procedures, and we used GRADE to assess the certainty of the evidence. We prioritised six outcomes and the measure of change from baseline to six months after treatment: probing pocket depth (PPD), bleeding on probing (BOP), clinical attachment level (CAL), gingival recession (REC), pocket closure and adverse effects related to aPDT. We were also interested in change in bone level (for participants with peri‐implantitis), and participant satisfaction and quality of life.Main resultsWe included 50 RCTs with 1407 participants. Most studies used a split‐mouth study design; only 18 studies used a parallel‐group design. Studies were small, ranging from 10 participants to 88. Adjunctive aPDT was given in a single session in 39 studies, in multiple sessions (between two and four sessions) in 11 studies, and one study included both single and multiple sessions. SI was given using hand or power‐driven instrumentation (or both), and was carried out prior to adjunctive aPDT. Five studies used placebo aPDT in the control group and we combined these in meta‐analyses with studies in which SI alone was used.All studies included high or unclear risks of bias, such as selection bias or performance bias of personnel (when SI was carried out by an operator aware of group allocation). We downgraded the certainty of all the evidence owing to these risks of bias, as well as for unexplained statistical inconsistency in the pooled effect estimates or for imprecision when evidence was derived from very few participants and confidence intervals (CI) indicated possible benefit to both intervention and control groups.Adjunctive aPDT versus SI alone during active treatment of periodontitis (44 studies)We are very uncertain whether adjunctive aPDT during active treatment of periodontitis leads to improvement in any clinical outcomes at six months when compared to SI alone: PPD (mean difference (MD) 0.52 mm, 95% CI 0.31 to 0.74; 15 studies, 452 participants), BOP (MD 5.72%, 95% CI 1.62 to 9.81; 5 studies, 171 studies), CAL (MD 0.44 mm, 95% CI 0.24 to 0.64; 13 studies, 414 participants) and REC (MD 0.00, 95% CI ‐0.16 to 0.16; 4 studies, 95 participants); very low‐certainty evidence. Any apparent differences between adjunctive aPDT and SI alone were not judged to be clinically important. Twenty‐four studies (639 participants) observed no adverse effects related to aPDT (moderate‐certainty evidence). No studies reported pocket closure at six months, participant satisfaction or quality of life.Adjunctive aPDT versus SI alone during supportive treatment of periodontitis (six studies)We were very uncertain whether adjunctive aPDT during active treatment of periodontitis leads to improvement in any clinical outcomes at six months when compared to SI alone: PPD (MD ‐0.04 mm, 95% CI ‐0.19 to 0.10; 3 studies, 125 participants), BOP (MD 4.98%, 95% CI ‐2.51 to 12.46; 3 studies, 127 participants), CAL (MD 0.07 mm, 95% CI ‐0.26 to 0.40; 2 studies, 85 participants) and REC (MD ‐0.20 mm, 95% CI ‐0.48 to 0.08; 1 study, 24 participants); very low‐certainty evidence. These findings were all imprecise and included no clinically important benefits for aPDT. Three studies (134 participants) reported adverse effects: a single participant developed an abscess, though it is not evident whether this was related to aPDT, and two studies observed no adverse effects related to aPDT (moderate‐certainty evidence). No studies reported pocket closure at six months, participant satisfaction or quality of life.Authors' conclusionsBecause the certainty of the evidence is very low, we cannot be sure if adjunctive aPDT leads to improved clinical outcomes during the active or supportive treatment of periodontitis; moreover, results suggest that any improvements may be too small to be clinically important. The certainty of this evidence can only be increased by the inclusion of large, well‐conducted RCTs that are appropriately analysed to account for change in outcome over time or within‐participant split‐mouth study designs (or both). We found no studies including people with peri‐implantitis, and only one study including people with peri‐implant mucositis, but this very small study reported no data at six months, warranting more evidence for adjunctive aPDT in this population group

Predicting Prostephanus truncatus (Horn) (Coleoptera: Bostrichidae) populations and associated grain damage in smallholder farmers’ maize stores: a machine learning approach

Prostephanus truncatus is a notorious pest of stored-maize grain and its spread throughout sub-Saharan Africa has led to increased levels of grain storage losses. The current study developed models to predict the level of P. truncatus infestation and associated damage of maize grain in smallholder farmer stores. Data were gathered from grain storage trials conducted in Hwedza and Mbire districts of Zimbabwe and collated with weather data for each of the sites. Insect counts of P. truncatus and other common stored grain insect pests had a strong correlation with time of year with highest recorded numbers from January to May. Correlation analysis showed insect-generated grain dust from boring and feeding activity to be the best indicator of P. truncatus presence in stores (r = 0.70), while a moderate correlation (r = 0.48) was found between P. truncatus numbers and storage insect parasitic wasps, and grain damage levels significantly correlated with the presence of Tribolium castaneum (r = 0.60). Models were developed for predicting P. truncatus infestation and grain damage using parameter selection algorithms and decision-tree machine learning algorithms with 10-fold cross-validation. The P. truncatus population size prediction model performance was weak (r = 0.43) due to the complicated sampling and detection of the pest and eight-week long period between sampling events. The grain damage prediction model had a stronger correlation coefficient (r = 0.93) and is a good estimator for in situ stored grain insect damage. The models were developed for use under southern Africa climatic conditions and can be improved with more input data for greater precision models to build decision-support tools for maize-based production systems

Field evaluation of hermetic and synthetic pesticide-based technologies in smallholder sorghum grain storage in hot and arid climates

Field evaluation of six grain storage technologies under hot and arid conditions (32–42 oC; rainfall < 450 mm/year) in two locations in Zimbabwe were conducted over two storage seasons. The treatments included three hermetic technologies (Purdue Improved Crop Storage bags, GrainPro Super Grainbags, metal silos); three synthetic pesticide-based treatments; and an untreated control, all using threshed sorghum grain. Sampling was at eight-week intervals for 32 weeks. Highly significant differences (p<0.01) occurred between hermetic and non-hermetic treatments regarding grain damage, weight loss, insect pest populations, and grain moisture content; with the hermetic containers exhibiting superior grain protection. Weight losses were low (<3%) in hermetic treatments compared to pesticide-based treatments (3.7 to 14.2%). Tribolium castaneum developed in metal silos, deltamethrin-incorporated polypropylene bags and a pesticide treatment containing deltamethrin 0.13% and fenitrothion 1% while Sitotroga cerealella developed in a pesticide treatment containing pirimiphos-methyl 0.16% + thiamethoxam 0.036%. Mechanisms of survival and development of these pests in the tested treatments and under similar climatic conditions need further elucidation. These hermetic technologies can be successfully used by smallholder farmers in developing countries as alternatives to synthetic pesticides for protecting stored-sorghum grain under hot and arid climatic conditions to attain household food security. To our knowledge, this is the first published study on modern hermetic storage of sorghum grain under typical smallholder storage conditions and involving stakeholders