Flexibility as Risk Management Option Implemented in the Bridge Repair

This study was conducted to determine the risk of Listeria contamination in frozen ready-to-eat roasted and steamed chicken meat in a chicken plant in Thailand. Environmental surfaces were divided into three zones. Zone 1 included surfaces in direct contact with products. Zones 2 and 3 included indirect contact surfaces; zone 2 was next to zone 1, and zone 3 was located next to zone 2 and relatively far from the product. A mathematical model for the probability of product contamination after contact with contaminated zone 1 surfaces was established. This model was augmented by an already established model for the probability of Listeria contamination on zone 1 surfaces. Sensitivity analysis revealed that the prevalence of Listeria on zone 1 surfaces before cleaning and sanitizing, production time, and concentration and contact time of sanitizer were correlated with contamination of both products. Alternative risk management measures for reducing the risk of Listeria contamination were developed using sanitizer concentrations of 0.25 to 1.25% (vol/vol), sanitizer contact times of 5 to 20 min, and production times of 5 to 20 h. The plant's risk manager chose a 0.25% (vol/vol) sanitizer concentration, a contact time of 20 min, and a production time of 20 h. After implementation of the selected risk management option, the prevalence of Listeria on roasted and steamed products was reduced by 2.19 and 2.01%, respectively. The prevalence of Listeria in zones 1, 2, and 3 was also reduced by 3.13, 11.24, and 25.66%, respectively.

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Misophonia: An Evidence-Based Case Report

American Journal of Audiology ◽

10.1044/2020_aja-19-00111 ◽

2020 ◽

Vol 29 (4) ◽

pp. 685-690

Author(s):

C. S. Vanaja ◽

Miriam Soni Abigail

Keyword(s):

Quality Of Life ◽

Case Report ◽

Case History ◽

Pure Tone ◽

Physiological Responses ◽

Evidence Based ◽

Management Option ◽

Pure Tone Audiogram

Purpose Misophonia is a sound tolerance disorder condition in certain sounds that trigger intense emotional or physiological responses. While some persons may experience misophonia, a few patients suffer from misophonia. However, there is a dearth of literature on audiological assessment and management of persons with misophonia. The purpose of this report is to discuss the assessment of misophonia and highlight the management option that helped a patient with misophonia. Method A case study of a 26-year-old woman with the complaint of decreased tolerance to specific sounds affecting quality of life is reported. Audiological assessment differentiated misophonia from hyperacusis. Management included retraining counseling as well as desensitization and habituation therapy based on the principles described by P. J. Jastreboff and Jastreboff (2014). A misophonia questionnaire was administered at regular intervals to monitor the effectiveness of therapy. Results A detailed case history and audiological evaluations including pure-tone audiogram and Johnson Hyperacusis Index revealed the presence of misophonia. The patient benefitted from intervention, and the scores of the misophonia questionnaire indicated a decrease in the severity of the problem. Conclusions It is important to differentially diagnose misophonia and hyperacusis in persons with sound tolerance disorders. Retraining counseling as well as desensitization and habituation therapy can help patients who suffer from misophonia.

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