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Prevention of microbial contamination of the dental unit caused by suction into the turbine drive air lines.

OBJECTIVE: To determine whether a specially designed antisuction device can prevent the bacterial contamination of the drive air lines of the dental turbine that is caused by suction when the turbine is stopped. STUDY DESIGN: A dental unit with and without the antisuction device and three different types of sterilized handpieces were used in the tests. Each turbine was operated in air, then submerged into a bacterial suspension of E. coli and enterococci for 3 seconds, removed, and stopped. This procedure was repeated 10 times. Possible bacterial contamination of the drive air lines was examined by submersing the head of a sterilized handpiece with the turbine running into a nutrient broth for 30 seconds. The broth was incubated at 35 degrees C up to 2 days. RESULTS: After use of the conventional dental unit, bacterial growth of drive air lines was found in 10 of 150 broth samples. After the installation of the antisuction device no bacterial growth was found in any of the 138 samples. The difference in the contamination frequencies is statistically significant (p = 0.011, Fisher's two-sided exact test). CONCLUSIONS: The drive air lines of the turbine in the dental unit may become contaminated despite the sterilization of handpieces. The antisuction device installed into the dental unit was found to prevent the contamination. With the exception of possibly immunocompromised patients, the transmission of microbes by exhaust air may be too small to cause infections. However, transmission of oral material between patients should be prevented in dental practice.

Air↗

Current status of bacterial contamination of autologous blood for transfusion.

Autologous transfusion, although not without risk, does decrease the risk of transmitted diseases via homologous transfusion. However, strict quality control is required for autologous transfusion. In Japan, a recent enactment requires that written informed consent be obtained prior to blood transfusion, which therefore requires that clinicians provide sufficient explanation of the risks involved with this procedure. To the best of our knowledge, this is the first study to comprehensively evaluate the manner in which the safety of autologous blood transfusion can be compromised by bacterial contamination. For a 24-month period, between April 1996 and March 1998, bacterial contamination of all kinds of autologous blood samples was tested by sampling the culture immediately prior to transfusion. Subculturing, identification and susceptibility testing of the isolates were performed. From the 287 units of all kinds of autologous blood transfused, 18 were culture positive (6.3%). Positive blood cultures were obtained in two of the 59 units (3.4%) of autologous transfusion donated preoperatively (ATDP) that was infused intraoperatively, in three of the 117 units (2.6%) of hemodilution/autologous transfusion (HAT) and in three of the 81 (3.7%) of ATDP infused postoperatively. There was a high percentage (33.3%) of positive blood cultures in the cases of intraoperative blood salvage (IOBS). The total rate of positive blood cultures was 6.3% including IOBS and 3.1% excluding IOBS. The most common microorganism isolated from autologous blood was coagulase-negative Staphylococci in 12 of 18 culture-positive units (66.7%). Alpha Streptococcus uiridans was isolated in 2 units (11%) and Staphylococcus aureus was isolated in 1 unit (5.5%). However, none of the patients who received the culture-positive autotransfusion blood showed clinical signs or laboratory findings of bacteremia. Safe ATDP is threatened by bacterial contamination that can be introduced by numerous sources, such as the donors' blood, the skin at the site of venipuncture, the environment and the phlebotomist's finger. In the cases of IOBS, protection against bacterial contamination at the surgical site is crucial. Here we discuss the relevance of our findings to the efforts to minimize the risks of contamination associated with autologous blood transfusion; risks that must be communicated to the patient in the process of informed consent. Continued research is required to identify the safest method of autologous blood transfusion.

Aerobiosis↗

Cross-contamination during the preparation of frozen chickens in the kitchen.

A study was made of the extent to which frozen broilers, contaminated with indicator organisms, can cause cross-contamination in the kitchen. In 60 kitchens a number of relevant objects were sampled during the preparation of contaminated frozen broilers. The results show that cross-contamination occurred in a high proportion of the kitchens examined. In many instances the indicator organism was still present on various objects even after rinsing, 'clearing' or washing up. In view of the possible risk of a cross-contamination with Salmonella spp. the importance of instructing food preparers is emphasized. No salmonellas could be found in the sinks of the 60 kitchens examined.

Animals↗

Bacterial contamination of propofol: the effects of temperature and lidocaine.

BACKGROUND AND OBJECTIVE: The intravenous anaesthetic propofol may become contaminated once the ampoules have been opened. The effect of lidocaine and cooling was tested on the bacterial contamination of propofol. METHODS: The study was performed in two parts. In Part 1,1920 aliquots of propofol alone, and of a propofollidocaine mixture, were drawn into sterile syringes and stored at room temperature (24-26 degrees C) or in the refrigerator (12-14 degrees C). In Part 2, 1200 aliquots from opened ampoules of propofol alone, or as a propofol-lidocaine mixture, were stored at room temperature or in the refrigerator. Samples were aerobically cultured at 0, 1, 2, 4, 8 and 12 h. RESULTS: In Part 1, diphtheroid bacillus was isolated from one aliquot (0.06%). In Part 2, there was bacterial growth in both groups; the number of contaminated ampoules increased with time and it was 20-26% at 12 h. Diphtheroid bacilli and coagulase-negative staphylococci were the most frequent micro-organisms. CONCLUSIONS: When propofol is stored in opened ampoules, the bacterial contamination rate is high. Adding lidocaine, or storing opened ampoules at 12-14 degrees C, does not affect the contamination rate, except during the first few hours. It is advisable to draw propofol aseptically into a syringe in an amount that can be used during one procedure.

Anesthetics, Intravenous↗

Handling and aflatoxin contamination of white maize in Costa Rica.

Projects funded by International Development Research Centre (IDRC) of Canada and the European Commission have enabled the examination of more than 3000 samples of maize collected from all regions of Costa Rica at different stages, from the growing crop through storage to final sale, and at different water contents. Contamination with Aspergillus flavus was frequent and about 80% of samples contained more than 20 ng aflatoxins g(-1) grain. Average contamination with aflatoxins in the Brunca Region was > 274 ng g(-1) while that in other regions was < 70 ng g(-1). Except in Brunca region, where it averaged 376 ng g(-1), contamination of grain from commercial sources was slightly less than of that from farms (< or = 15 ng g(-1)). It appeared that samples kept on the cob after harvest contained almost no aflatoxin while shelled samples were frequently highly contaminated. Experiments were therefore done in Brunca and Huetar Atlantic Regions, utilising 34 experimental maize crops to study in detail the development of A. flavus and aflatoxin from before harvest, through postharvest treatment before drying and through storage for six months. A. flavus was isolated more frequently from maize shelled immediately after harvest than from that kept on the cob until it could be dried, and from more samples from the Brunca Region than from the Huetar Atlantic Region. Samples harvested with > or = 18% water content often contains > 70% of grains infected with A. flavus but sometimes there were few grains infected. As found in the initial survey, more aflatoxin contamination developed in shelled maize than in that handled on the cob during the period from harvesting to drying, especially if the delay was more than 5 days, and more in Brunca than in Huetar. Shelled grain contained 400-800 ng aflatoxin g(-1) in Brunca but < 100 ng g(-1) in Huetar while grain kept on the cob contained < 30 ng g(-1), even with > 18% water content. Incidence of Fusarium spp. exceeded 50% except where A. flavus colonized more than 80% of grains.

Aflatoxins↗

Decreased energetic reserves, morphological changes and accumulation of metals in carabid beetles (Poecilus cupreus L.) exposed to zinc- or cadmium-contaminated food.

The prime objective of the study was to find out whether contamination of food with metals affects body size, energetic reserves and developmental instability in ground beetles (Poecilus cupreus L.: Carabidae). The transfer of Cadmium (Cd) and Zinc (Zn) from medium (nominal concentrations in the medium: 0, 40, 160, 640 or 800 mg kg(-1) for Cd and 0, 400, 1600 or 6400 mg kg(-1) for Zn) to housefly larvae to beetles was also studied. Feeding the beetles throughout their entire lifetime with Cd-contaminated housefly pupae resulted in a significant decrease in body caloric value and the size of the elytrae, tibiae and rear femora. Although body mass also decreased with increasing Cd concentration, this effect was non-significant due to large variance in all treatments. Similar trends were also found in beetles fed pupae contaminated with Zn, but the effect on body mass and caloric value was non-significant. Zn exerted significant effects only on the size of the elytrae, middle and rear tibiae, and front and rear femora. No effect on fluctuating asymmetry (FA) was found in Cd- or Zn-treated beetles. The results indicate that ground beetles exposed to metal-contaminated food have lower amounts of energy available, which may be reflected in lower energetic reserves and changed body growth. However, the metals do not cause developmental instability in the carabids studied, at least not in the first generation. The concentrations of Zn were efficiently regulated in carabids, resulting in only minor differences between the beetles exposed to different Zn treatments. In contrast, Cd accumulated both in the housefly and the beetles, and the concentrations increased significantly with increasing medium contamination level.

Analysis of Variance↗

Multivariate analysis of determinants of bacterial contamination of whole-blood donations.

BACKGROUND AND OBJECTIVES: Introduction of bacteria into blood components at the collection stage seems to be a frequent occurrence. We therefore assessed determinants of bacterial contamination of whole-blood donations to gain insight into contamination mechanisms and direct prevention. MATERIALS AND METHODS: A cross-sectional study was carried out on donors accepted for whole-blood donation in four French blood banks. Each blood bank used its own two-stage procedure for phlebotomy site preparation. Contamination was identified by culturing two 15-ml samples (collected aseptically at the outset of donation) in a BacT/Alert 240 system. Determinants were assessed by logistic regression analysis. RESULTS: Bacterial contamination, mainly by skin flora, occurred in 76 (2.2%) out of 3385 donations. Significant determinants were as follows: the blood bank (odds ratio [OR] range = 3.0-5.6, P < 0.001); lack of repetition of scrub (OR = 2.7, P = 0.032); and donor age > 35 years (OR = 1.8, P = 0.036). CONCLUSION: Systematic scrub repetition should be implemented to reduce bacterial contamination by skin flora at the collection stage. Further research is required to clarify the role of different antiseptic agents and of donor age.

Adult↗

Visible and occult blood contamination of laryngeal mask airways and tracheal tubes used in adult anaesthesia.

The purpose of this study was to compare visible and occult blood contamination of 50 laryngeal mask airways and 50 tracheal tubes following routine anaesthesia for procedures not involving the oropharyngeal or nasal cavities. All airway devices were examined visually for the presence of blood before washing in 100 ml of water. A semiquantitative dipstick was used to test for the presence of blood in the washings. Laryngeal mask airways were examined visually by both authors to test agreement. The results show that occult blood contamination occurred in 78% of tracheal tubes and 76% of laryngeal mask airways, while visible blood contamination was 16% and 12%, respectively. Other studies reporting visible blood contamination of airway devices probably underestimate the true incidence of blood contamination. Oral secretions following the use of these devices should be considered as high risk for transmission of blood-born viruses. Anaesthetic and recovery staff should be protected against the risks of occupational exposure to oral secretions following the use of airway devices.

Adult↗

Image analysis method for evaluation of specific and non-specific hand contamination.

AIMS: To evaluate a quantifying image analysis method for assessing the degree of hand contamination and efficacy of hand washing procedures. METHODS AND RESULTS: Two types of experimental design were used. In one, different concentrations of pure cultures of Escherichia coli, Listeria innocua and Pseudomonas flourescens were applied to hands. In the other, hands were contaminated by handling various raw foods. Imprints of the contaminated palms were made on 24.5 x 24.5 cm agar plates using appropriate agars. After incubation, digital photographs of the plates were analysed using image analysis. In pure culture studies with selective agars, levels from 1 to 10(6) CFU cm(-2) palm could be monitored. For aerobic, mesophilic organisms from raw chicken, levels from 10(3) to 10(6) CFU cm(-2) palm were correlated linearly to image analysis data. CONCLUSIONS: The image analysis of palm imprints made on agar plates was suitable for assessing the degree of contamination from foods on the palms. Sensitivity and specificity depended on the agar used and the type of contamination encountered. SIGNIFICANCE AND IMPACT OF THE STUDY: Data capture by the image analysis method is simple and can be partly automated. Sampling time is short for the person to be tested, which makes it an attractive method for assessing hand hygiene status in larger field trials.

Agar↗

Shear bond strengths of saliva contaminated 'one-bottle' adhesives.

The aim of this study was to investigate the effect of saliva contamination on the bond strengths of three one-bottle bonding systems. The dentin of 90 recently extracted, non-carious human molar teeth was exposed and ground wet on 500 grit silicon carbide (SIC) paper to establish a bonding surface in superficial dentin. Specimens were randomly assigned to nine groups of 10 teeth each. Three testing conditions are: (i) contamination with fresh saliva (pH 5.5) after acid etching, (ii) contamination with fresh saliva after bonding application, and (iii) no contamination. Three adhesive systems are: syntac single component, prime & bond NT, and gluma one bond. Cylinders of composite were applied via PTFE (polytetrafluroethylene) split mould and light cured to the dentin surfaces. All specimens were thermocycled (5000 cycles) between baths of 5 and 55 degrees C. Shear bond strengths were measured using an Instron Universal testing machine at a crosshead speed of 1 mm min-1. Two-way ANOVA was used to analyse the data. The results of this study indicated that the saliva contamination of dentin has no adverse effect on the bonding efficiency of one-bottle adhesive systems (P > 0.05). No statistically significant differences were found between the shear bond strengths of tested adhesives.

Adhesives↗

Retrograde contamination and practical handling of urine-meters: a comparison of three systems for the measurement of hourly diuresis in an experimental bladder-drainage model and in clinical use.

OBJECTIVE: To compare three different urine metering systems for their ability to prevent retrograde contamination in an in vitro model of a closed urinary drainage system and for qualities important to their practical handling in a clinical setting. PATIENTS, MATERIALS AND METHODS: Using three urine-meters (the Braun Ureofix 511, the Kendall Curity 4000 and the Unoplast Unometer 500) the in vitro model was constantly flushed with a solution of Mueller-Hinton broth diluted with saline. On the first day, the urine collecting bag was inoculated with 10(8) cells of Pseudomonas aeruginosa. The system was operated for 12 days with daily sampling of the model bladder to detect any contamination. After 12 days the experiment was stopped and sampling performed at various locations, including the urine-meter and the tubing. Nine of each type of urine-meter were tested, i.e. three in three different experiments. In the clinical study, 45 patients were randomized to each of the three urine-meters and the nurses attending them were asked to complete a questionnaire on the practical handling of the urine-meters. RESULTS: When the urine-meters was omitted from the model system, the 'bladder' became contaminated with the test bacteria within 3 days. None of the nine Unometer 500 systems became contaminated, compared with four of each of the other two systems (P < 0.05). In clinical use, the Unometer 500 and Ureofix 511 were easier to suspend and empty than was the Curity 4000. The Unometer 500 was significantly easier to handle when the collecting bag was emptied. CONCLUSION: Urine-meters can prevent retrograde contamination in a closed bladder-drainage model, but the degree of prevention depends upon the type of urine-meter. In daily practice, there were differences in the ease of suspension of the systems and in the emptying of the urine-meter and collecting bag.

Attitude of Health Personnel↗

Bacterial contamination of bone marrow grafts intended for autologous and allogeneic bone marrow transplantation. Incidence and clinical significance.

In a series of 100 bone marrow harvests, the incidence of bacterial contamination of the bone marrow graft was 17 percent. Ex vivo manipulation of some of the grafts prior to infusion may have caused additional bacterial contamination. All isolated bacteria were common skin flora, and no serious sequelae were observed in the patients receiving the culture-positive bone marrow grafts. Samples of harvested bone marrows purposely contaminated with an isolate of Staphylococcus epidermidis demonstrated a bactericidal property that was maximal early after bone marrow collection. Bone marrow collection and ex vivo manipulation may result in considerable bacterial contamination. Procedures must be developed to assure that marrow collection and processing do not result in clinically significant contamination.

Bacteria↗

Contamination of breast milk obtained by manual expression and breast pumps in mothers of very low birthweight infants.

The objective of this study was to compare the rates of bacterial contamination of expressed breast milk (EBM) obtained by manual expression and breast pumps in mothers of very low birthweight (VLBW) infants (<1501 g). This was a randomized, controlled study carried out on 28 mothers of such babies and 92 specimens of EBM were collected: 41 specimens from 13 mothers assigned to the manual group and 51 specimens from 15 mothers in the breast-pump group. EBM was cultured quantitatively by the Miles and Misra method. Breast milk expressed by breast pumps (86.3% or 44/51 specimens) had a significantly higher rate of bacterial contamination than milk expressed by the manual method (61.0% or 25/41 specimens) (P= 0.005). When breast milk was expressed in the hospital, there was no significant difference in contamination rates between the two methods. When breast milk was expressed at home, the rates of bacterial contamination by staphylococci (P= 0.003) and Gram-negative bacilli (P= 0.002) were significantly higher in the breast-pump group than the manual group. In conclusion, the rate of bacterial contamination of EBM of mothers of VLBW infants was high, especially when EBM was obtained by the breast pump or when expression was carried out at home.

Adult↗

[Recreational drugs and environmental contaminants in mother 's milk].

In Germany and many other countries breast milk contamination in particular with persistent organochlorines and lead declined substantially by 50-70% or more during the last decade. Generally also mercury compounds, cadmium and other environmental contaminants do not pose a toxic threat to the fully breast fed infant, which, according to the current knowledge, could outweigh the advantages of breast-feeding. Industrial regions, large cities and frequent consumption of contaminated fish are factors still positively correlated with elevated breast milk contamination. However, recent study results do not support routine measurement of milk contaminants for decision making on prolonged breast-feeding (more than 4-6 months). Exposure to recreational drugs including tobacco smoking and alcohol drinking is preventable. In case of ongoing abuse decisions on breast-feeding restrictions must be taken individually.

Breast Feeding↗

Evaluation of some screening methods for the analysis of contaminants in recycled polyethylene terephthalate flakes.

A range of different analytical techniques were used to test recycled polyethylene terephthalate (PET) flakes for potential chemical contaminants. The techniques used were headspace gas chromatography coupled to mass spectrometry (GC-MS), liquid extraction followed by GC-MS, supercritical-fluid extraction followed by GC-MS, and migration testing followed by elemental analysis using inductively coupled plasma mass spectroscopy (ICP-MS). The PET samples were 50 representative samples taken from 600 that had been collected throughout Europe and which had been screened for potential contaminants using a single technique of high-temperature GC-MS. Six of the 50 samples tested had been spiked with a selection of model contaminants, three samples were virgin PET flakes and two of the samples were from supercleaning processes. All samples were analysed 'blind' in this exercise. The qualitative results showed that most of the contaminants came from the first use, being flavour-aroma compounds from soft drinks. The quantitative analysis found concentrations under a few mg kg(-1) in the polymer, except for the spiked samples. Element migrations were low and only calcium, silicon and sodium had median migrations above 50 microg l(-1). This in-depth analysis of recycled PET flakes did not identify any significant contaminants that had not already been detected by the high-temperature static GC-MS screening method, thus demonstrating its utility.

Beverages↗

Post-consumer contamination in high-density polyethylene (HDPE) milk bottles and the design of a bottle-to-bottle recycling process.

Six hundred conventional recycled HDPE flake samples, which were recollected and sorted in the UK, were screened for post-consumer contamination levels. Each analysed sample consisted of 40-50 individual flakes so that the amount of analysed individual containers was in the range 24,000-30,000 post-consumer milk bottles. Predominant contaminants in hot-washed flake samples were unsaturated oligomers, which can be also be found in virgin high-density polyethylene (HDPE) pellet samples used for milk bottle production. In addition, the flavour compound limonene, the degradation product of antioxidant additives di-tert-butylphenol and low amounts of saturated oligomers were found in higher concentrations in the post-consumer samples in comparison with virgin HDPE. However, the overall concentrations in post-consumer recycled samples were similar to or lower than concentration ranges in comparison with virgin HDPE. Contamination with other HDPE untypical compounds was rare and was in most cases related to non-milk bottles, which are <2.1% of the input material of the recycling process. The maximum concentration found in one sample of 1 g was estimated as 130 mg kg(-1), which corresponds to a contamination of 5200-6500 mg kg(-1) in the individual bottle. The recycling process investigated was based on an efficient sorting process, a hot-washing of the ground bottles, and a further deep-cleaning of the flakes with high temperatures and vacuum. Based on the fact that the contamination levels of post-consumer flake samples are similar to virgin HDPE and on the high cleaning efficiency of the super-clean recycling process especially for highly volatile compounds, the recycling process investigated is suitable for recycled post-consumer HDPE bottles for direct food-contact applications. However, hand-picking after automatically sorting is recommended to decrease the amount of non-milk bottles. The conclusions for suitability are valid, provided that the migration testing of recyclate contains milk bottles up to 100% and that both shelf-life testing and sensorial testing of the products are successful, which are topics of further investigations.

Animals↗

Justifying the need to prescribe limits for toxic metal contaminants in food-grade silver foils.

The use of silver foils in various food preparations is a common practice in Middle Eastern and South East Asian countries. The FAO/WHO Joint Expert Committee on Food Additives (JECFA) has included silver in the list of food additives, but specifications were not prepared. Indian food legislation has included food-grade silver foil and laid down a purity requirement of 99.9%. This leaves an unspecified margin of 0.1% or 1000 microg g(-1) for contaminants. Therefore, a study to investigate the levels of metallic contaminants in food-grade silver foil was undertaken. Of 178 foils analysed, 161 (90%) contained silver, whilst 10% were fraudulently made up of aluminium. In the case of silver foils, 46% of the samples adhered to the desired purity requirement of 99.9%, while 54% had a lower silver content. Copper was present in 86.3% of the silver foils, while chromium, nickel and lead contamination was found in over 54% of samples. Cadmium levels were detected in 28% of the silver foils and manganese was present in 6.8% of samples. In silver foils showing metal contaminants, average levels were found for nickel (487 microg g(-1)), lead (301 microg g(-1)), copper (324 microg g(-1)), chromium (83 microg g(-1)), cadmium (97 microg g(-1)) and manganese (43 microg g(-1)), which being appreciable justify the need to prescribe limits for some metals in food-grade silver foil as well as for silver powder used in confectioneries and medicinal preparations. The work reported here should encourage manufacturers to use high-purity raw materials and take suitable precautions to reduce unwarranted exposure of consumers to toxic metal contaminants.

Aluminum↗

Effects of Fusarium toxin-contaminated wheat and feed intake level on the biotransformation and carry-over of deoxynivalenol in dairy cows.

An experiment was carried out to examine the effects of feeding Fusarium toxin-contaminated wheat (8.21 mg deoxynivalenol (DON) and 0.09 mg zearalenone (ZON) per kg dry matter) at different feed intake levels on the biotransformation and carry-over of DON in dairy cows. For this purpose, 14 ruminal and duodenal fistulated dairy cows were fed a diet containing 60% concentrate with a wheat portion of 55% (Fusarium toxin-contaminated wheat (mycotoxin period) or control wheat (control period)) and the ration was completed with maize- and grass silage (50 : 50) on a dry matter basis. Daily DON intakes ranged from 16.6 to 75.6 mg in the mycotoxin period at dry matter intakes of 5.6-20.5 kg. DON was almost completely biotransformed to de-epoxy DON (94-99%) independent of the DON/feed intake, and the flow of DON and de-epoxy DON at the duodenum related to DON intake ranged from 12 to 77% when the Fusarium toxin-contaminated wheat was fed. In the serum samples, de-epoxy DON was detected in the range of 4-28 ng ml-1 in the mycotoxin period, while concentrations of DON were all below the detection limit. The daily excretion of DON and de-epoxy DON in the milk of cows fed the contaminated wheat varied between 1 and 10 microg and between 14 and 104 microg, respectively. The total carry-over rates as the ratio between the daily excretion of DON and de-epoxy DON into milk and DON intake were in the ranges of 0.0001-0.0002 and 0.0004-0.0024, respectively. Total carry-over rates of DON as DON and de-epoxy DON into the milk increased significantly with increasing milk yield. In the urine samples, de-epoxy DON was the predominant substance as compared with DON with a portion of the total DON plus de-epoxy DON concentration to 96% when the Fusarium toxin-contaminated wheat was fed, whereas the total residues of DON plus de-epoxy DON in faeces ranged between 2 and 18% of DON intake in the mycotoxin period. The degree of glucuronidation of de-epoxy DON was found to be approximately 100% in serum. From 33 to 80% of DON and from 73 to 92% of de-epoxy DON, and from 21 to 92% of DON and from 86 to 100% of de-epoxy DON were glucuronidated in the milk and urine, respectively. It is concluded that DON is very rapidly biotransformed to de-epoxy DON in the rumen and only negligible amounts of DON and de-epoxy DON were transmitted into the milk within the range of 5.6-20.5 kg day-1 dry matter intake and milk yields (fat corrected milk) between 10 and 42 kg day-1.

Animal Feed↗