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In August 2010, the Minnesota Department of Agriculture and Minnesota Department of Health investigated an outbreak of six cases of Salmonella Newport infection occurring in northwestern Minnesota, which identified fresh blueberries as the cause. Initially, traditional traceback methods involving the review of invoices and bills of lading were used to attempt to identify the source of the outbreak. When these methods failed, novel traceback methods were used. Specifically, supplier-specific 12-digit Global Trade Item Numbers (GTINs) and shopper-card information were used to identify a single blueberry grower linked to cases, corroborating the results of a case-control study in which consuming fresh blueberries was statistically associated with illness (5 of 5 cases versus 8 of 19 controls, matched odds ratio [MOR] undefined, P = 0.02). Consuming fresh blueberries from retailer A was also statistically associated with illness (3 of 3 cases versus 3 of 18 controls, MOR undefined, P = 0.03). Based on initially incomplete evidence in this investigation, the invoices pointed to wholesaler A and grower A, based on first-in-first-out product rotation. However, when point-of-sale data were analyzed and linked to shopper-card information, a common GTIN was identified. This information led to an on-site record evaluation at retailer A, and the discovery of additional records at this location documented the supply chain from grower B to wholesaler C to retailer A, shifting the focus of the investigation from grower A to grower B. This investigation demonstrates the emerging concepts of Critical Tracking Events (CTEs) and Key Data Elements (KDE) related to food product tracing. The use of these shopper-cased data and the event data that were queried by investigators demonstrates the potential utility of consciously designed CTEs and KDEs at critical points in the supply chain to better facilitate product tracing.

Traceback methods by state regulatory agencies were used to complement traditional epidemiological cluster investigation methods and confirmed hazelnuts (also referred to as filberts) as the vehicle in a multistate outbreak of Escherichia coli O157:H7 infections. Bulk in-shell hazelnut and mixed-nut purchase locations were identified during the initial epidemiological interviews. Based on purchase dates and case onset dates, regulators in Minnesota, Michigan, and Wisconsin traced product back through the supply chain. Six (86%) retail locations received the suspect hazelnut or mixed-nut shipments from a Minnesota distributor, with one retailer (14%) receiving products from a Wisconsin distributor. Both distributors received 100% of their bulk in-shell hazelnuts and mixed nuts from a distributor in California. The California distributor received 99% of their hazelnuts from a packing company in Oregon. The California distributor received the hazelnuts in 50-lb (22.7-kg) bags and either resold them without opening the bags or used the in-shell hazelnuts in the manufacture of their in-shell mixed nuts. Records at the packing company in Oregon were incomplete or lacked sufficient detail needed to identify a suspect farm or group of suspect farms. Laboratory samples collected from human cases and subsequently recalled product matched the outbreak pulsed-field gel electrophoresis subtype of E. coli O157:H7. Hazelnut harvesting practices create a plausible route of contamination from fecal matter from domestic ruminants or wild deer. This outbreak investigation demonstrates the use of product traceback data to rapidly test an epidemiological hypothesis.

Background: Depression is common in caregivers of children with asthma and is associated with increased emergency service utilization for the child's asthma., Objective: This pilot study examined the impact of antidepressant treatment of depressed caregivers on the caregiver's depression and the child's asthma., Method: Eight depressed caregivers of children with asthma were given up to 6 months of algorithm-based antidepressant therapy., Results: Caregiver depressive symptoms and the child's asthma symptoms improved significantly., Conclusion: Unscheduled clinic visits showed a trend toward significant decrease. Larger trials are needed to confirm these findings and identify mechanisms linking improvement in caregiver depression with improvement in their child's asthma.

Objective: This study tested a multilevel biobehavioral family model proposing that negative family emotional climate contributes to child depressive symptoms, which in turn contribute to asthma disease severity. Parent-child relational insecurity is proposed as a mediator., Method: Children with asthma (N = 112; ages 7-18; 55% male) reported relational security, anxiety, and depressive symptoms. Parent(s) reported demographics, asthma history and symptoms, and family emotional expression. Asthma diagnosis was confirmed by medical history provided by parent and child together, clinical evaluation, pulmonary function tests, and methacholine challenge, with disease severity categorized by National Heart, Lung, and Blood Institute guidelines. Medication adherence was measured prospectively., Results: Path analysis indicated a good fit of data to the hypothesized model (chi2 = 0.072, p =.97, normal fit index = 0.998, root mean square error of approximation = 0.000). Negative family emotional climate predicted child depressive symptoms (beta =.21, p < .04), which predicted asthma disease severity (beta =.35, p < .001), with relational insecurity a partial mediator (beta = -.23, p < .05, beta =.46, p < .001, respectively). Depression was associated with disease severity even after controlling for adherence (r p = 0.38, p < .05)., Conclusion: Findings are consistent with the proposed family model, suggesting the clinical importance of assessing and intervening in these specific family relational processes when treating children with depression and asthma.

Objective: This study was designed to assess the prevalence of depressive symptoms in children with asthma and the association between depression and asthma activity., Method: Children ages 7 to 17 (n = 129) were recruited from a hospital emergency department after presenting for asthma symptoms. The majority of subjects were from disadvantaged, inner city families. Subjects' asthma disease activity was assessed using the revised National Heart, Lung, and Blood Institute guidelines, and subjects' emotional status was assessed by a combination of self-, parent-, and clinician-reported measures. Parental emotional status was assessed by self-report., Results: Depressive symptoms within the clinical range were reported in 26% of subjects and 43% of mothers, although symptom severity varied across scales. Self-reported depressive symptoms were more strongly correlated with asthma activity (r = 0.25) than clinician-reported (r = 0.14) or parent-reported symptoms (r = 0.12/0.18). Depressive symptoms in parents were correlated with child's depression scores but not with their asthma activity., Conclusions: Depressive symptoms were common and associated with asthma activity in this inner city population of asthmatic children. Self-reported depressive symptoms were more strongly associated with child's asthma activity than either parental depression or parental/clinician ratings of the child's depression.

Objective: Research relating depression/hopelessness to cholinergic activation suggests the hypothesis that sad emotional states evoke patterns of autonomic reactivity that predispose to cholinergically mediated airway constriction in asthma. A corollary hypothesis is that positive (e.g., happy) emotional states evoke opposing effects. The purpose of the current study is to assess whether specific emotional states (sadness and happiness) can be reliably induced, physiologically differentiated, and related to asthma-relevant physiologic (autonomic) reactivity and pulmonary function in asthmatic children., Method: Twenty-four children, aged 8 to 17 years, with moderate to severe asthma, viewed the movie E.T., The Extra-Terrestrial while having their heart and respiration rate and oxygen saturation continuously recorded. Specific scenes were identified and preselected to evoke sadness, happiness, and a mixture of happiness and sadness. Self-report of emotion and indices of physiologic response were analyzed for these targeted scenes., Results: Sadness was associated with greater heart rate variability and instability of oxygen saturation compared with happiness, with mixed results for mixed happiness and sadness., Conclusion: Results support sadness as evoking patterns of autonomic influence consistent with cholinergically mediated airway constriction. Happiness appears to effect autonomic patterns that would tend to relieve airway constriction.

Objective: The purpose of this study was to determine the suitability of a newly developed experimental paradigm, designed to assess relationships among emotional responsivity, physiologic (autonomic) reactivity, airway reactivity, and pulmonary function in asthmatic children under controlled conditions of ecologically valid emotional stimulation., Method: Twenty-four children, aged 8 through 17, with moderate to severe asthma viewed the movie, E.T., the Extra-Terrestrial, while having their heart and respiration rate and oxygen saturation continuously measured and recorded. Airway reactivity was assessed by the methacholine challenge test, and pre- and postmovie pulmonary function by spirometry. Self-report of emotion was recorded for targeted scenes., Results: Findings indicated that emotional responsivity and physiologic reactivity to the movie were associated with increased airway reactivity and with decreased pulmonary function., Conclusions: The pattern of results suggests cholinergically mediated psychophysiologic pathways of emotional influence in the asthmatic process for some asthmatic children. A heuristic biopsychosocial model of these pathways is presented.

It has been demonstrated that anesthesia primarily affects the reticular activating system and psychological studies on patients undergoing anesthesia demonstrated a verbal memory defect. This study was performed in order to determine whether metabolic (uremic) encephalopathy follows the Jacksonian dissolution hypothesis and disrupts cortical function or whether it acts like an anesthetic, causes dysfunction in phylogenetically older systems and thereby produces a memory defect. Twenty-four uremic subjects were tested for memory function, language function, and intellectual function, and compared to 12 control subjects. The greatest difference between the groups was in immediate memory function suggesting that uremia probably acts in a manner similar to anesthesia (by causing dysfunction in the reticular activating system). It is postulated that poor arousal interferes with rehearsal and rehearsal is probably an important component of immediate memory.