Comparative effects of Teriparatide and Risedronate in glucocorticoid‐induced osteoporosis in men: 18‐month results of the EuroGIOPs trial

Data on treatment of glucocorticoid-induced osteoporosis (GIO) in men are scarce. We performed a randomized, open-label trial in men who have taken glucocorticoids (GC) for ≥3 months, and had an areal bone mineral density (aBMD) T-score ≤ –1.5 standard deviations. Subjects received 20 μg/d teriparatide (n = 45) or 35 mg/week risedronate (n = 47) for 18 months. Primary objective was to compare lumbar spine (L1–L3) BMD measured by quantitative computed tomography (QCT). Secondary outcomes included BMD and microstructure measured by high-resolution QCT (HRQCT) at the 12th thoracic vertebra, biomechanical effects for axial compression, anterior bending, and axial torsion evaluated by finite element (FE) analysis from HRQCT data, aBMD by dual X-ray absorptiometry, biochemical markers, and safety. Computed tomography scans were performed at 0, 6, and 18 months. A mixed model repeated measures analysis was performed to compare changes from baseline between groups. Mean age was 56.3 years. Median GC dose and duration were 8.8 mg/d and 6.4 years, respectively; 39.1% of subjects had a prevalent fracture, and 32.6% received prior bisphosphonate treatment. At 18 months, trabecular BMD had significantly increased for both treatments, with significantly greater increases with teriparatide (16.3% versus 3.8%; p = 0.004). HRQCT trabecular and cortical variables significantly increased for both treatments with significantly larger improvements for teriparatide for integral and trabecular BMD and bone surface to volume ratio (BS/BV) as a microstructural measure. Vertebral strength increases at 18 months were significant in both groups (teriparatide: 26.0% to 34.0%; risedronate: 4.2% to 6.7%), with significantly higher increases in the teriparatide group for all loading modes (0.005 < p < 0.015). Adverse events were similar between groups. None of the patients on teriparatide but five (10.6%) on risedronate developed new clinical fractures (p = 0.056). In conclusion, in this 18-month trial in men with GIO, teriparatide showed larger improvements in spinal BMD, microstructure, and FE-derived strength than risedronate.

Predictors of healthcare professionals' attitudes towards family involvement in safety-relevant behaviours: a cross-sectional factorial survey study.

OBJECTIVES To investigate predictors of healthcare professionals' (HCPs) attitudes towards family involvement in safety-relevant behaviours. DESIGN A cross-sectional fractional factorial survey that assessed HCPs' attitudes towards family involvement in two error scenarios relating to hand hygiene and medication safety. Each survey comprised two randomised vignettes that described the potential error, how the family member communicated with the HCP about the error and how the HCP responded to the family member's question. SETTING 5 teaching hospitals in London, the Midlands and York. HCPs were approached on a range of medical and surgical wards. PARTICIPANTS 160 HCPs (73 doctors; 87 nurses) aged between 21 and 65 years (mean 37) 102 were female. OUTCOME MEASURES HCP approval of family member's behaviour; HCP reaction to the family member; anticipated effects on the family member-HCP relationship; HCP support for being questioned about hand hygiene/medication; affective rating responses. RESULTS HCPs supported family member's intervening (88%) but only 41% agreed this would have positive effects on the family member/HCP relationship. Across vignettes and error scenarios the strongest predictors of attitudes were how the HCP (in the scenario) responded to the family member and whether an error actually occurred. Doctors (vs nurses) provided systematically more positive affective ratings to the vignettes. CONCLUSIONS Important predictors of HCPs' attitudes towards family members' involvement in patient safety have been highlighted. In particular, a discouraging response from HCP's decreased support for family members being involved and had strong perceived negative effects on the family member/HCP relationship.

The relationship between leadership practices and a medication safety regime

Errors in healthcare are commonplace and have significant impact on mortality, morbidity, and costs. Other high-risk industries are credited with strong safety records. These successes are due in part to a strong, committed organizational culture and their leadership. A consistent pattern of effective leadership behaviors; creating change, establishing a vision and strategic actions, and enabling and inspiring the organization's members to act, is present in these high-risk industries. This research examined the relationship between leadership practices and a medication safety regime. The hypothesis is strong leadership practices have a positive relationship with the degree of sophistication of a medication safety program (safety performance). Leadership was used as a surrogate for organizational culture and was measured in this research through the Kouzes and Posner's Leadership Practices Inventory. The Institute of Medicine's 14 Selected Strategies to Improve Medication Safety was used to measure the development of a medication safety regime. Leadership practices towards safety were assessed by surveying 2,478 critical care Registered Nurses in the greater Houston area. A response rate of 19% was achieved. Thirteen hospitals participated in the medication safety regime assessment. Data from 386 RN respondents from 53 institutions provided an overall description of unit (ICU) and organization (hospital) leader's practices towards safety. There is some recognition of the medical error problem and that leaders exhibit moderate levels of leadership practices to promote safety. There were no differences noted in unit and hospital leaders' behaviors, with the exception that unit leaders promote change and enable staff to act more often than hospital leaders. There were no statistically significant relationships between overall leadership, or individual leadership practices and the organization's safety performance. There was a significant relationship between leadership and safety performance when other factors in organizational culture were considered. Teaching and Magnet hospitals also exhibited stronger behaviors towards safety. Organizational culture, as measured by academic affiliation and Magnet recognition, is strongly related to safety performance as measured by the degree of development of a medication safety regime. ^

Direct and Indirect Measures of Capacity Utilization: A Nonparametric Analysis of U.S. Manufacturing

We measure the capacity output of a firm as the maximum amount producible by a firm given a specific quantity of the quasi-fixed input and an overall expenditure constraint for its choice of variable inputs. We compute this indirect capacity utilization measure for the total manufacturing sector in the US as well as for a number of disaggregated industries, for the period 1970-2001. We find considerable variation in capacity utilization rates both across industries and over years within industries. Our results suggest that the expenditure constraint was binding, especially in periods of high interest rates.

Safety, pharmacokinetics, and antiretroviral activity of multiple doses of ibalizumab (formerly TNX-355), an anti-CD4 monoclonal antibody in HIV-1 infected adults

Context: Despite tremendous strides in HIV treatment over the past decade, resistance remains a major problem. A growing number of patients develop resistance and require new therapies to suppress viral replication. ^ Objective: To assess the safety of multiple administrations of the anti-CD4 receptor (anti-CD4) monoclonal antibody ibalizumab given as intravenous (IV) infusions, in three dosage regimens, in subjects infected with human immunodeficiency virus (HIV-1). ^ Design: Phase 1, multi-center, open-label, randomized clinical trial comparing the safety, pharmacokinetics and antiviral activity of three dosages of ibalizumab. ^ Setting: Six clinical trial sites in the United States. ^ Participants: A total of twenty-two HIV-positive patients on no anti-retroviral therapy or a stable failing regimen. ^ Intervention: Randomized to one of two treatment groups in Arms A and B followed by non-randomized enrollment in Arm C. Patients randomized to Arm A received 10 mg/kg of ibalizumab every 7 days, for a total of 10 doses; patients randomized to Arm B received a total of six doses of ibalizumab; a single loading dose of 10 mg/kg on Day 1 followed by five maintenance doses of 6 mg/kg every 14 days, starting at Week 1. Patients assigned to Arm C received 25 mg/kg of ibalizumab every 14 days for a total of 5 doses. All patients were followed for safety for an additional 7 to 8 weeks. ^ Main Outcome Measures: Clinical and laboratory assessments of safety and tolerability of multiple administrations of ibalizumab in HIV-infected patients. Secondary measures of efficacy include HIV-1 RNA (viral load) measurements. ^ Results: 21 patients were treatment-experienced and 1 was naïve to HIV therapy. Six patients were failing despite therapy and 15 were on no current HIV treatment. Mean baseline viral load (4.78 log 10; range 3.7-5.9) and CD4+ cell counts (332/μL; range 89-494) were similar across cohorts. Mean peak decreases in viral load from baseline of 0.99 log10(1.11 log10, and 0.96 log 10 occurred by Wk 2 in Cohorts A, B and C, respectively. Viral loads decreased by >1.0 log10 in 64%; 4 patients viral loads were suppressed to < 400 copies/mL. Viral loads returned towards baseline by Week 9 with reduced susceptibility to ibalizumab. CD4+ cell counts rose transiently and returned toward baseline. Maximum median elevations above BL in CD4+ cell counts for Cohorts A, B and C were +257, +198 and +103 cells/μL, respectively and occurred within 3 Wks in 16 of 22 subjects. The half-life of ibalizumab was 3-3.5 days and elimination was characteristic of capacity-limited kinetics. Administration of ibalizumab was well tolerated. Four serious adverse events were reported during the study. None of these events were related to study drug. Headache, nausea and cough were the most frequently reported treatment emergent adverse events and there were no laboratory abnormalities related to study drug. ^ Conclusions: Ibalizumab administered either weekly or bi-weekly was safe, well tolerated, and demonstrated antiviral activity. Further studies with ibalizumab in combination with standard antiretroviral treatments are warranted.^

The movement toward patient safety: State action related to reporting and disclosure of healthcare-associated infections

Increasing attention has been given to the problem of medical errors over the past decade. Included within that focused attention has been a strong interest in reducing the occurrence of healthcare-associated infections (HAIs). Acting concurrently with federal initiatives, the majority of U.S. states have statutorily required reporting and public disclosure of HAI data. Although the occurrence of these state statutory enactments and other state initiatives represent a recognition of the strong concern pertaining to HAIs, vast differences in each state’s HAI reporting and public disclosure requirements creates a varied and unequal response to what has become a national problem.^ The purpose of this research was to explore the variations in state HAI legal requirements and other state mandates. State actions, including statutory enactments, regulations, and other initiatives related to state reporting and public disclosure mechanisms were compared, discussed, and analyzed in an effort to illustrate the impact of the lack of uniformity as a public health concern.^ The HAI statutes, administrative requirements, and other mandates of each state and two U.S. territories were reviewed to answer the following seven research questions: How far has the state progressed in its HAI initiative? If the state has a HAI reporting requirement, is it mandatory or voluntary? What healthcare entities are subject to the reporting requirements? What data collection system is utilized? What measures are required to be reported? What is the public disclosure mechanism? How is the underlying reported information protected from public disclosure or other legal release?^ Secondary publicly available data, including state statutes, administrative rules, and other initiatives, were utilized to examine the current HAI-related legislative and administrative activity of the study subjects. The information was reviewed and analyzed to determine variations in HAI reporting and public disclosure laws. Particular attention was given to the seven key research questions.^ The research revealed that considerable progress has been achieved in state HAI initiatives since 2004. Despite this progress, however, when reviewing the state laws and HAI programs comparatively, considerable variations were found to exist with regards to the type of reporting requirements, healthcare facilities subject to the reporting laws, data collection systems utilized, reportable measures, public disclosure requirements, and confidentiality and privilege provisions. The wide variations in state statutes, administrative rules, and other agency directives create a fragmented and inconsistent approach to addressing the nationwide occurrence of HAIs in the U.S. healthcare system. ^

A multi-site pilot test study to measure safety climate in the university work setting

Next to leisure, sport, and household activities, the most common activity resulting in medically consulted injuries and poisonings in the United States is work, with an estimated 4 million workplace related episodes reported in 2008 (U.S. Department of Health and Human Services, 2009). To address the risks inherent to various occupations, risk management programs are typically put in place that include worker training, engineering controls, and personal protective equipment. Recent studies have shown that such interventions alone are insufficient to adequately manage workplace risks, and that the climate in which the workers and safety program exist (known as the "safety climate") is an equally important consideration. The organizational safety climate is so important that many studies have focused on developing means of measuring it in various work settings. While safety climate studies have been reported for several industrial settings, published studies on assessing safety climate in the university work setting are largely absent. Universities are particularly unique workplaces because of the potential exposure to a diversity of agents representing both acute and chronic risks. Universities are also unique because readily detectable health and safety outcomes are relatively rare. The ability to measure safety climate in a work setting with rarely observed systemic outcome measures could serve as a powerful means of measure for the evaluation of safety risk management programs. ^ The goal of this research study was the development of a survey tool to measure safety climate specifically in the university work setting. The use of a standardized tool also allows for comparisons among universities throughout the United States. A specific study objective was accomplished to quantitatively assess safety climate at five universities across the United States. At five universities, 971 participants completed an online questionnaire to measure the safety climate. The average safety climate score across the five universities was 3.92 on a scale of 1 to 5, with 5 indicating very high perceptions of safety at these universities. The two lowest overall dimensions of university safety climate were "acknowledgement of safety performance" and "department and supervisor's safety commitment". The results underscore how the perception of safety climate is significantly influenced at the local level. A second study objective regarding evaluating the reliability and validity of the safety climate questionnaire was accomplished. A third objective fulfilled was to provide executive summaries resulting from the questionnaire to the participating universities' health & safety professionals and collect feedback on usefulness, relevance and perceived accuracy. Overall, the professionals found the survey and results to be very useful, relevant and accurate. Finally, the safety climate questionnaire will be offered to other universities for benchmarking purposes at the annual meeting of a nationally recognized university health and safety organization. The ultimate goal of the project was accomplished and was the creation of a standardized tool that can be used for measuring safety climate in the university work setting and can facilitate meaningful comparisons amongst institutions.^

Survey analysis on dental infection control & occupational safety from India---1999 & 2010

The objective was to study knowledge, attitudes, practice (KAP) and needs regarding infection control measures using two cross-sectional surveys from 1999 and 2010 conducted in India. Both data collection instruments had only about 35 comparable variables in common. In 1999, there were 456 respondents (dentists) who completed a self-administered survey instrument compared to 272 respondents in 2010. Both the 1999 and 2010 samples were mutually independent with no overlap, had regional differences, and therefore, were not completely comparable for changes in KAP over time. While almost all respondents from both surveys felt that education in dental safety was needed and wanted mandatory dental safety curriculum in dental schools, severe inadequacies in dental safety knowledge, protection against immunizable diseases, and practice of universal precaution were noted. Data from the study demonstrated that there is a substantial opportunity to improve the knowledge, attitude and practice of dental infection control and occupational safety in India. Few respondents (27%) reported that the infectious disease status of a patient is always known and a significant number reported that they had the right to refuse care for patients of known infectious disease status. This indicates that Stigma in treating HIV/AIDS patients remains a concern, which in turn suggests that a stronger focus on educating dentists about dental safety and on stigma and infectious disease is needed. Information obtained from this study could be utilized for developing policies oriented towards increasing dental safety educational efforts, in both dental schools as curriculum, and for practicing dentists through professional updates or continuing dental education.^

Teaching safety at a summer camp: Evaluation of a children's fire safety curriculum in an urban community setting

Objectives: The purpose of this study was to evaluate the effectiveness of the Danger Rangers Fire Safety Curriculum in increasing the fire safety knowledge of low-income, minority children in pre-kindergarten to third grade in Austin, TX during a summer day camp in 2007.^ Methods: Data was collected from child participants via teacher and researcher administered tests at pretest, posttest (immediately after the completion of the fire safety module), and at a 3 week follow-up to asses retention. In addition, a self-administered questionnaire was collected from parents pre- and post-intervention to assess home-related fire/burn risk factors. Paired t-tests were conducted using STATA 12.0 to evaluate pretest, posttest, and retention test mean scores as well as mean fire safety rules listed by grade group. McNemar's test was used to determine if there was a difference in fire-related risk factors as reported by the parents of the participants before and after the intervention. Only those who had paired data for the tests/surveys being compared were included in the analysis.^ Results: The first/second grade group and the third grade group scored significantly higher on fire safety knowledge on the posttest compared to the pretest (p<0.0001 for both groups). However, there was no significant change in knowledge scores for the pre-kindergarten to kindergarten group (p=0.14). Among the first/second grade group, knowledge levels did not significantly decline between the posttest and retention test (p=0.25). However, the third grade group had significantly lower fire safety knowledge scores on the retention test compared to the posttest (p<0.001). A similar increase was seen in the amount of fire safety rules listed after the intervention (p<0.0001 between pre and posttest for both the first/second grade and third grade groups), with no decline from the posttest to the retention test (p=0.50) for the first/second grade group, but a significant decline in the third grade group (p=0.001). McNemar's chi-square test showed a significant increase in the percentage of participants' parents reporting smoke detector testing on a regular basis and having a fire escape plan for their family after the intervention (p=0.01 and p<0.0001, respectively). However, there was no significant change in the frequency of reports of the child playing in the kitchen while the parent cooks or the house/apartment having a working smoke detector.^ Conclusion: We found that general fire safety knowledge improved and the number of specific fire safety rules increased among the first to third grade children who participated in the Danger Rangers fire safety program. However, it did not significantly increase general fire safety knowledge among the pre-k/k group. This study also showed that a program targeted towards children has the potential to influence familial risk factors by proxy. The Danger Rangers Fire Safety Curriculum should be further evaluated by conducting a randomized controlled trial, using valid measures that assess fire safety attitudes, beliefs, behaviors, as well as fire/burn related outcomes.^

Health and safety in the construction : subject pending to be included in the curriculum of architecture in Spain

The art of construction is a risky activity that directly affects the life and physical integrity of persons. Since the approval of Law 31/1995, of November 8, Prevention of Occupational Risks was the first legislation that established the current basis in all sectors and then transposed into Spanish law Directive 92/57/CEE called Royal Decree 1627/1997 of October 24, on minimum safety and health dispositions in construction works, measures have been proposed to develop a mixed body of scientific literature composed of researchers and professionals in the field of occupational safety and health, but even today there is still no clear and firm proposal, showing a lack of awareness in the occupational risk prevention and, therefore, a consolidation of the culture of prevention in society. Therefore, the technicians, who make up the building process, can incur in very high responsibilities, such as: Author of the project, Coordinator of Safety and Health during the preparation of the project and during the execution of works, Site Management: Site Manager. This involves the immediate creation of a general training in prevention for all architects starting when still studying, as well as specific training, appropriate and complementary to all the architects that will be devoted to the specialty of occupational safety and health in construction works. That is, first, we must make the responsible bodies aware of the urgent need to integrate risk prevention in the curricula of architecture and later in the continuing education of the profession. It is necessary that our teaching must conform to the laws on safety and health, due to the fact that the law recognizes our academic degrees and professional qualifications to perform functions in that area

The influence of economic incentives linked to road safety indicators on accidents: The case of toll concessions in Spain

The goal of this paper is to evaluate whether the incentives incorporated in toll highway concession contracts in order to encourage private operators to adopt measures to reduce accidents are actually effective at improving safety. To this end, we implemented negative binomial regression models using information about highway characteristics and accident data from toll highway concessions in Spain from 2007 to 2009. Our results show that even though road safety is highly influenced by variables that are not managed by the contractor, such as the annual average daily traffic (AADT), the percentage of heavy vehicles on the highway, number of lanes, number of intersections and average speed; the implementation of these incentives has a positive influence on the reduction of accidents and injuries. Consequently, this measure seems to be an effective way of improving safety performance in road networks.

Efficient algorithms for dynamic probabilistic safety assessment. An application to convex damage domain.

The design of nuclear power plant has to follow a number of regulations aimed at limiting the risks inherent in this type of installation. The goal is to prevent and to limit the consequences of any possible incident that might threaten the public or the environment. To verify that the safety requirements are met a safety assessment process is followed. Safety analysis is as key component of a safety assessment, which incorporates both probabilistic and deterministic approaches. The deterministic approach attempts to ensure that the various situations, and in particular accidents, that are considered to be plausible, have been taken into account, and that the monitoring systems and engineered safety and safeguard systems will be capable of ensuring the safety goals. On the other hand, probabilistic safety analysis tries to demonstrate that the safety requirements are met for potential accidents both within and beyond the design basis, thus identifying vulnerabilities not necessarily accessible through deterministic safety analysis alone. Probabilistic safety assessment (PSA) methodology is widely used in the nuclear industry and is especially effective in comprehensive assessment of the measures needed to prevent accidents with small probability but severe consequences. Still, the trend towards a risk informed regulation (RIR) demanded a more extended use of risk assessment techniques with a significant need to further extend PSA’s scope and quality. Here is where the theory of stimulated dynamics (TSD) intervenes, as it is the mathematical foundation of the integrated safety assessment (ISA) methodology developed by the CSN(Consejo de Seguridad Nuclear) branch of Modelling and Simulation (MOSI). Such methodology attempts to extend classical PSA including accident dynamic analysis, an assessment of the damage associated to the transients and a computation of the damage frequency. The application of this ISA methodology requires a computational framework called SCAIS (Simulation Code System for Integrated Safety Assessment). SCAIS provides accident dynamic analysis support through simulation of nuclear accident sequences and operating procedures. Furthermore, it includes probabilistic quantification of fault trees and sequences; and integration and statistic treatment of risk metrics. SCAIS comprehensively implies an intensive use of code coupling techniques to join typical thermal hydraulic analysis, severe accident and probability calculation codes. The integration of accident simulation in the risk assessment process and thus requiring the use of complex nuclear plant models is what makes it so powerful, yet at the cost of an enormous increase in complexity. As the complexity of the process is primarily focused on such accident simulation codes, the question of whether it is possible to reduce the number of required simulation arises, which will be the focus of the present work. This document presents the work done on the investigation of more efficient techniques applied to the process of risk assessment inside the mentioned ISA methodology. Therefore such techniques will have the primary goal of decreasing the number of simulation needed for an adequate estimation of the damage probability. As the methodology and tools are relatively recent, there is not much work done inside this line of investigation, making it a quite difficult but necessary task, and because of time limitations the scope of the work had to be reduced. Therefore, some assumptions were made to work in simplified scenarios best suited for an initial approximation to the problem. The following section tries to explain in detail the process followed to design and test the developed techniques. Then, the next section introduces the general concepts and formulae of the TSD theory which are at the core of the risk assessment process. Afterwards a description of the simulation framework requirements and design is given. Followed by an introduction to the developed techniques, giving full detail of its mathematical background and its procedures. Later, the test case used is described and result from the application of the techniques is shown. Finally the conclusions are presented and future lines of work are exposed.

Analysis of road safety incentives applied in PPP road = Análisis de incentivos a la seguridad aplicados en concesiones de carreteras

En este artículo se recoge cómo se ha regulado este aspecto tradicionalmente en concesiones y cómo se viene haciendo más recientemente, comparando para tres concesiones europeas puestas en servicio en los últimos años, las bonificaciones con el beneficio social que corresponden a cada nivel de reducción de la accidentalidad en la carretera. Los resultados arrojan que los incentivos aplicados, tanto antiguamente como los más recientes, son anodinos por dos motivos: porque son muy inferiores al beneficio social derivado de ellos y porque aparentemente son muy inferiores al coste de las actuaciones de mejora de la seguridad vial. Road safety is one of the most important issues in PPP roads. At this respect, to achieve a property regulation it is necessary to introduce objective and explicit incentives in the contracts. Besides, these incentives must be focused at the net social benefit. This paper explains how road safety has been introduced traditionally in PPP road contracts and how it is been doing it nowadays, comparing for three recent concessions of Europe, the bonuses and the social benefit associated to each reduction of accidents in the roads. As a result, it can be affirmed that the incentives applied, both traditional and the most ones, are unremarkable for two reasons: because they are much lower than the social benefit derived from them and because they apparently are well below the cost of measures to improve road safety.

Efecto de la fertilización orgánica y mineral en las propiedades del suelo, la emisión de los principales gases de efecto invernadero y en las diferentes fases fenológicas del cultivo de café (Coffea arabica L.)

El cultivo de café es de gran importancia a nivel mundial (ICO, 2011), y en el Ecuador ha sido uno de los cultivos más importantes en la generación de divisas (COFENAC, 2011). Sin embargo en los sistemas productivos de este país se puede apreciar el uso inapropiado de fertilizantes, lo que conlleva a una pérdida de nutrientes, por lo que es importante estudiar las dosis adecuadas para la fertilización tanto mineral como orgánica. El objetivo del trabajo fue evaluar el efecto de la fertilización mineral y orgánica en diferentes dosis en un monocultivo de café en la provincia de Loja, sobre las propiedades del suelo, la emisión de los principales gases que provocan el efecto invernadero y la fenología y productividad del cultivo. En la provincia de Loja (Ecuador) se seleccionó un área de 2.520 m2 en la que se establecieron 21 parcelas de café arábigo (Coffea arabica L.) var. caturra y se aplicó tres tratamientos con tres repeticiones de fertilización mineral y tres orgánicos con dosis: bajas minerales (MIN 1= 157 Kg NPK ha-1 año-1 para el primer año y 425 Kg NPK ha-1 año-1 para el segundo año), medias minerales (MIN 2= 325 Kg NPK ha-1 año-1 para el primer año y 650 Kg NPK ha-1 año-1 en el segundo año) y altas minerales (MIN 3= 487 y 875 Kg NPK ha-1 año-1 para el primer y segundo año respectivamente), bajas orgánicas (ORG 1= 147 Kg NPK ha-1 año-1 en el primer año y 388 Kg NPK ha-1 año-1 en el año dos), medias orgánicas (ORG 2= 265 Kg NPK ha-1 año-1 para el primer año y 541 Kg NPK ha-1 año-1 en el segundo año), altas orgánicas (ORG 3= 368 Kg NPK ha-1 año-1 para el primer año y 727 Kg NPK ha-1 año-1 en el segundo año) y fertilización cero (TES = sin fertilización). Se usó urea, roca fosfórica y muriato de potasio en la fertilización mineral y humus (Bioabor) en la orgánica, más un tratamiento testigo, cada tratamiento tuvo tres repeticiones. El tiempo de evaluación de los fertilizantes aplicados fue de dos años consecutivos, la fertilización se la realizó dos veces por año y en base a análisis del suelo y demandas nutricionales del cultivo. para determinar las características del suelo se realizó muestreos de suelos en cada parcela a una profundidad de 20 cm de estas muestras los parámetro iniciales determinados fueron: color (Munsell), textura (método del hidrómetro), pH (relación 1:2,5 suelo-agua), Materia orgánica (Walkey y Black), Nitrógeno (Micro Kjendahl), Fósforo (Bray y Kurtz), Potasio (Olsen), estos procesos se repitieron cada seis meses para poder evaluar los cambios de que se producen debido a la fertilización mineral y orgánica en el cultivo. Las emisiones de gases efecto invernadero desde el suelo al ambiente se determinaron por el método de cámara cerrada (Rondón, 2000) y la concentración por cromatografía de gases. Las mediciones fisiológicas (altura de planta, ancho de copa, grosor de tallo y producción) se las evaluó cada dos meses, a excepción de la producción que fue anual al término de cada cosecha. Además se realizó el análisis económico de la productividad del cultivo. El análisis estadístico de datos se lo realizó con el programa SPSS v. 17.0. Las medias fueron comprobadas mediante ANOVAS de un factor con test de Tukey (P < 0,05). El beneficio económico se estimó en términos de ingresos y gastos totales que se presentaron en el ensayo. Los resultados obtenidos al término del ensayo indican que los tratamientos MIN 2 y MIN 3 produjeron cambios más significativos en comparación con los otros tratamientos establecidos en la mejora de fertilidad del suelo, el pH ha sido menos afectado en la acidificación en comparación con los tratamientos orgánicos que se han acidificado mayormente; la materia orgánica (MO) tuvo incrementos considerablemente bueno en estos dos tratamientos, sin embargo fueron superados por los tratamientos de fertilización orgánica; el nitrógeno total (Nt )y el potasio (K) también presentaron mejores valores al termino del ensayo y el fósforo (P) mostro incrementos buenos aunque un poco menores que los de los tratamientos ORG 2 y ORG 3. En lo que respecta a las emisiones de gases efecto invernadero, los flujos acumulados de óxido nitroso (N2O) en los dos años han aumentado en todos los tratamientos en comparación con el tratamiento Testigo, pero de manera considerable y con mayores flujos en el tratamiento MIN 3 y MIN 2 que se podrían considerarse los de mayor contaminación por N2O al ambiente lo que se le atribuye a las dosis de fertilización mineral aplicadas en el periodo de investigación, los tratamiento MIN 1 y todos los tratamientos orgánicos muestran menores emisiones al ambiente. Las emisiones de metano (CH4) no muestran mayores diferencias de emisiones entre tratamientos, siendo los mayores emisores los tratamientos ORG 3 y ORG 2 posiblemente debido al abono orgánico y añadido al suelo; para las emisiones de dióxido de carbono (CO2) de manera similar al CH4 el tratamiento ORG 3 fue el que presento mayores emisiones, los flujos de CO2 al ambiente de los otros tratamientos fueron menores y no presentaron diferencias significativas entre ellos. La variables fisiológicas en todos los casos apoyaron al desarrollo de las plantas de café, esto al ser comparadas con el tratamiento Testigo, sin embargo las que alcanzaron las mayores altitudes, anchos de copas y diámetro de tallo fueron las plantas del tratamiento MIN 3, seguido del MIN 3, no mostrando significancia entre ellos, y para los tratamientos orgánicos el que presento muy buenos resultados en estas variables ha sido el ORG 3, el cual no presento diferencias significativas con el MIN 2, lo cual comprueba que la fertilización mineral es más efectiva en este caso frente a la orgánica. Para el primer año de producción el tratamiento mineral con fertilización MIN 3 es el que obtuvo mayor producción no presentando diferencia estadística con el tratamiento con el MIN 2, no obstante fueron significativamente mayores que los otros tratamientos. Vale indicar que también el tratamiento MIN 1 y el tratamiento ORG 3 han presentado una producción considerable de café no mostrando diferencias estadísticas entre ellos. Para el segundo año la producción el cultivo mostró mayores rendimientos que el primer año de evaluación en todos los tratamientos, esto debido a la fisiología propia del cultivo y por otra parte se atribuye a la adición de fertilizantes que se ha realizado durante todo el ensayo; de manera similar al anterior los tratamientos MIN 3 y MIN 2 obtuvieron mejores rendimientos, no enseñando diferencias estadísticas significativas entre ellos, no obstante el tratamiento mineral dosis MEDIA no presentó significancia estadística con el ORG 3. El benéfico económico ha resultado mayor en el tratamiento MIN 3 y MIN 2, aunque el tratamiento MIN 2, es el que obtiene la mejor relación costo-beneficio; los tratamientos ORG 2 y ORG 3 y Testigo has producido beneficios negativos para el productor. En cuanto a la parte ambiental se considera que los mejores tratamientos en cuanto ha cuidado ambiental serían los tratamientos MIN 1 y ORG 1, sin embargo a nivel de producción y rentabilidad para el productor baja. ABSTRACT Coffee growing has great importance worldwide (ICO, 2011), and in Ecuador, it has been one of the most important crops to generate income (COFENAC, 2011). However, in the productive systems of this country, the inappropriate use of fertilizers has been observed which produces loss of nutrients, thus it is important to study suitable doses for mineral and organic fertilizing. The purpose of the study was to evaluate the effect of mineral and organic fertilizing at different doses in a coffee monoculture in the province of Loja on soil characteristics, emission of the main gasses that produce the greenhouse effect and the phenology and productivity of crops. In the province of Loja (Ecuador) an area of 2.520 m2 was chosen, where 21 plots of Arabica coffee (Coffea arabica L.), the caturra variety were cultivated and three treatments with three repetitions each one for mineral and organic fertilization were used with doses that ranged from: mineral low (MIN 1= 157 Kg NPK ha-1 año-1 for the first year y 425 Kg NPK ha-1 año-1 for the second year), mineral medium (MIN 2= 325 Kg NPK ha-1 año-1 for the first year y 650 Kg NPK ha-1 año-1 I the second year) y mineral high (MIN 3= 487 y 875 Kg NPK ha-1 año-1 for the first and second year respectively), organic low (ORG 1= 147 Kg NPK ha-1 año-1 in the first year y 388 Kg NPK ha-1 año-1 in the second year), organics medium (ORG 2= 265 Kg NPK ha-1 año-1 for the first year y 541 Kg NPK ha-1 año-1 in the second year), organics high (ORG 3= 368 Kg NPK ha-1 año-1 for the first year and 727 Kg NPK ha-1 año-1 in the second year) y fertilization zero (TES = no fertilization).; urea, phosphoric rock and muriate of potash were used in the mineral fertilization and humus (Bioabor) in the organic, plus a blank treatment. Time to evaluate the applied fertilizers was for two consecutive years, fertilization was done twice per year based on soil analysis and nutritional requirements of the crops. In order to determine the characteristics of the soil, samples of soil in each plot with a depth of 20 cm were done; from these samples, the determined initial parameters were: color (Munsell), texture (hydrometer method), pH (soil-water 1:2,5 relation), organic matter (Walkey y Black), nitrogen (Micro Kjendahl), phosphorus (Bray y Kurtz), potassium (Olsen); these processes were repeated each six months in order to evaluate the changes that are produced due to mineral and organic fertilization in the crops. The emissions of greenhouse gasses from the soil to the atmosphere were determined by using enclosure method (Rondón, 2000) and the concentration, by using gas chromatography during the whole testing. The physiological measures (plant height, width of the top of the tree, thickness of the stem and production) were evaluated each two months, except for production which was annual at the end of each harvest. Moreover, the economic analysis of the productivity of the crops was done. The statistical analysis of the data was done using SPSS v. 17.0. The means were proved by ANOVAS with a factor of a Tukey test (P < 0,05). The economic benefit was estimated in terms of incomes and total expenses which were presented in the essay. The results obtained at the end of the essay show that the MIN 2 and MIN 3 treatments produced more meaningful changes in comparison with the other treatments used to improve soil fertility; pH was less affected in the acidification compared with the organic treatments which were greatly acidified; organic matter (MO) had increased considerably in these two treatments; however, they were surpassed by the organic treatments of fertilization; total nitrogen (Nt) and potassium (K) also presented better results at the end of the essay and phosphorus (P) showed good increasing figures although a little lower compared with ORG 2 and ORG 3 treatments. Regarding the emission of the greenhouse gasses, the fluxes accumulated from nitrous oxide (N2O) in two years increased in all the treatments in comparison with the blank treatment, but in a greater form and with higher fluxes in the MIN 3 and MIN 2 treatments which can be considered as the ones with greater contamination of N2O in the atmosphere, this can be due to the applied mineral doses to fertilize during the process; MIN 1 treatments and all the organic ones showed lower emission to the atmosphere. Methane emissions (CH4) did not show major differences in emissions in the treatments, being the greater emissions the ORG 3 and ORG 2 treatments; this is possibly due to the organic compost added to the soil; regarding carbon dioxide (CO2) emissions, in a similar way to CH4, the ORG 3 treatment was the one that presented greater emissions, the CO2 emissions to the atmosphere in the other treatments were lower and did not present meaningful differences among them. The physiological variables in all the cases helped coffee crops grow, this was observed when compared with the blank treatment; however, plants that reached the greatest height, width of top and diameter of stem were the plants of the MIN 3 treatment, followed by MIN 3, which did not show much significance among them, and for the organic treatments, the one that presented great results in these variables was ORG 3, which did not show meaningful differences compared with MIN 2, which proves that mineral fertilization is more effective in this case compared with the organic. In the first year of production, the mineral treatment with MIN 3 fertilization obtained greater production and thus did not show statistical difference with MIN 2 treatment, although the other treatments were greater. It is worth mentioning that MIN 1 treatment and ORG 3 treatment presented a meaningful production of coffee, not showing statistical differences among them. For the second year, the production of the crops showed greater profits than in the first year of evaluation in all the treatments, this was due to the physiological properties of the crops and on the other hand, it might be due to the addition of fertilizers during the whole essay; in a similar way, MIN 3 and MIN 2 performed better, not showing greater statistical differences among them, although the mineral treatment MEDIUM doses did not show statistical difference compared with ORG 3. The economic benefit was greater in the MIN 3 and MIN 2 treatments, although MIN 2 treatment is the one that shows the best cost-benefit ratios; ORG 2 and ORG 3 treatments and the blank produced negative benefits for the producer. Regarding the environment, the best treatments to care for the atmosphere are considered to be MIN 1 and ORG 1 treatments; however, regarding production volume and profitability they were low for the producer.

Intermediate hosts of Toxoplasma gondii and food safety:epidemiology, genetics and parasite survival in meat-producing animals in Italy

Toxoplasma gondii is a coccidian parasite with a global distribution. The definitive host is the cat (and other felids). All warm-blooded animals can act as intermediate hosts, including humans. Sexual reproduction (gametogony) takes place in the final host and oocysts are released in the environment, where they then sporulate to become infective. In intermediate hosts the cycle is extra-intestinal and results in the formation of tachyzoites and bradyzoites. Tachyzoites represent the invasive and proliferative stage and on entering a cell it multiplies asexually by endodyogeny. Bradyzoites within tissue cysts are the latent form. T. gondii is a food-borne parasite causing toxoplasmosis, which can occur in both animals and humans. Infection in humans is asymptomatic in more than 80% of cases in Europe and North-America. In the remaining cases patients present fever, cervical lymphadenopathy and other non-specific clinical signs. Nevertheless, toxoplasmosis is life threatening if it occurs in immunocompromised subjects. The main organs involved are brain (toxoplasmic encephalitis), heart (myocarditis), lungs (pulmonary toxoplasmosis), eyes, pancreas and parasite can be isolated from these tissues. Another aspect is congenital toxoplasmosis that may occur in pregnant women and the severity of the consequences depends on the stage of pregnancy when maternal infection occurs. Acute toxoplasmosis in developing foetuses may result in blindness, deformation, mental retardation or even death. The European Food Safety Authority (EFSA), in recent reports on zoonoses, highlighted that an increasing numbers of animals resulted infected with T. gondii in EU (reported by the European Member States for pigs, sheep, goats, hunted wild boar and hunted deer, in 2011 and 2012). In addition, high prevalence values have been detected in cats, cattle and dogs, as well as several other animal species, indicating the wide distribution of the parasite among different animal and wildlife species. The main route of transmission is consumption of food and water contaminated with sporulated oocysts. However, infection through the ingestion of meat contaminated with tissue cysts is frequent. Finally, although less frequent, other food products contaminated with tachyzoites such as milk, may also pose a risk. The importance of this parasite as a risk for human health was recently highlighted by EFSA’s opinion on modernization of meat inspection, where Toxoplasma gondii was identified as a relevant hazard to be addressed in revised meat inspection systems for pigs, sheep, goats, farmed wild boar and farmed deer (Call for proposals -GP/EFSA/BIOHAZ/2013/01). The risk of infection is more highly associated to animals reared outside, also in free-range or organic farms, where biohazard measure are less strict than in large scale, industrial farms. Here, animals are kept under strict biosecurity measures, including barriers, which inhibit access by cats, thus making soil contamination by oocysts nearly impossible. A growing demand by the consumer for organic products, coming from free-range livestock, in respect of animal-welfare, and the desire for the best quality of derived products, have all led to an increase in the farming of free-range animals. The risk of Toxoplasma gondii infection increases when animals have access to environment and the absence of data in Italy, together with need for in depth study of both the prevalence and genotypes of Toxoplasma gondii present in our country were the main reasons for the development of this thesis project. A total of 152 animals have been analyzed, including 21 free-range pigs (Suino Nero race), 24 transhumant Cornigliese sheep, 77 free-range chickens and 21 wild animals. Serology (on meat juice) and identification of T. gondii DNA through PCR was performed on all samples, except for wild animals (no serology). An in-vitro test was also applied with the aim to find an alternative and valid method to bioassay, actually the gold standard. Meat samples were digested and seeded onto Vero cells, checked every day and a RT-PCR protocol was used to determine an eventual increase in the amount of DNA, demonstrating the viability of the parasite. Several samples were alos genetically characterized using a PCR-RFLP protocol to define the major genotypes diffused in the geographical area studied. Within the context of a project promoted by Istituto Zooprofilattico of Pavia and Brescia (Italy), experimentally infected pigs were also analyzed. One of the aims was to verify if the production process of cured “Prosciutto di Parma” is able to kill the parasite. Our contribution included the digestion and seeding of homogenates on Vero cells and applying the Elisa test on meat juice. This thesis project has highlighted widespread diffusion of T. gondii in the geographical area taken into account. Pigs, sheep, chickens and wild animals showed high prevalence of infection. The data obtained with serology were 95.2%, 70.8%, 36.4%, respectively, indicating the spread of the parasite among numerous animal species. For wild animals, the average value of parasite infection determined through PCR was 44.8%. Meat juice serology appears to be a very useful, rapid and sensitive method for screening carcasses at slaughterhouse and for marketing “Toxo-free” meat. The results obtained on fresh pork meat (derived from experimentally infected pigs) before (on serum) and after (on meat juice) slaughter showed a good concordance. The free-range farming put in evidence a marked risk for meat-producing animals and as a consequence also for the consumer. Genotyping revealed the diffusion of Type-II and in a lower percentage of Type-III. In pigs is predominant the Type-II profile, while in wildlife is more diffused a Type-III and mixed profiles (mainly Type-II/III). The mixed genotypes (Type-II/III) could be explained by the presence of mixed infections. Free-range farming and the contact with wildlife could facilitate the spread of the parasite and the generation of new and atypical strains, with unknown consequences on human health. The curing process employed in this study appears to produce hams that do not pose a serious concern to human health and therefore could be marketed and consumed without significant health risk. Little is known about the diffusion and genotypes of T. gondii in wild animals; further studies on the way in which new and mixed genotypes may be introduced into the domestic cycle should be very interesting, also with the use of NGS techniques, more rapid and sensitive than PCR-RFLP. Furthermore wildlife can become a valuable indicator of environmental contamination with T. gondii oocysts. Other future perspectives regarding pigs include the expansion of the number of free-range animals and farms and for Cornigliese sheep the evaluation of other food products as raw milk and cheeses. It should be interesting to proceed with the validation of an ELISA test for infection in chickens, using both serum and meat juice on a larger number of animals and the same should be done also for wildlife (at the moment no ELISA tests are available and MAT is the reference method for them). Results related to Parma ham do not suggest a concerning risk for consumers. However, further studies are needed to complete the risk assessment and the analysis of other products cured using technological processes other than those investigated in the present study. For example, it could be interesting to analyze products such as salami, produced with pig meat all over the Italian country, with very different recipes, also in domestic and rural contexts, characterized by a very short period of curing (1 to 6 months). Toxoplasma gondii is one of the most diffuse food-borne parasites globally. Public health safety, improved animal production and protection of endangered livestock species are all important goals of research into reliable diagnostic tools for this infection. Future studies into the epidemiology, parasite survival and genotypes of T. gondii in meat producing animals should continue to be a research priority.