Carriage and Subtypes of Foodborne Pathogens Identified in Wild Birds Residing near Agricultural Lands in California: a Repeated Cross-Sectional Study.

Current California agricultural practices strive to comanage food safety and habitat conservation on farmland. However, the ecology of foodborne pathogens in wild bird populations, especially those avian species residing in proximity to fresh produce production fields, is not fully understood. In this repeated cross-sectional study, avifauna within agricultural lands in California were sampled over 1 year. Feces, oral swabs, and foot/feather swabs were cultured for zoonotic Salmonella spp., Escherichia coli O157:H7, and non-O157 Shiga toxin-producing E. coli (STEC) and characterized by serotyping and pulsed-field gel electrophoresis. Of 60 avian species sampled, 8 species (13.3%, bird groups of sparrows, icterids, geese, wrens, and kinglets) were positive for at least one of these foodborne pathogens. At the individual bird level, the detection of foodborne pathogens was infrequent in feces (n = 583; 0.5% Salmonella, 0.34% E. coli O157:H7, and 0.5% non-O157 STEC) and in feet/feathers (n = 401; 0.5% non-O157 STEC), and it was absent from oral swabs (n = 353). Several subtypes of public health importance were identified, including Salmonella enterica serotype Newport, E. coli O157:H7, and STEC serogroups O103 and O26. In late summer and autumn, the same STEC subtype was episodically found in several individuals of the same and different avian species, suggesting a common source of contamination in the environment. Sympatric free-range cattle shared subtypes of STEC O26 and O163 with wild geese. A limited rate of positive detection in wild birds provides insights into broad risk profile for contamination considerations but cannot preclude or predict risk on an individual farm.IMPORTANCE The shedding dynamics of foodborne pathogens by wild birds on farmland are not well characterized. This yearlong study sampled wild birds for foodborne pathogens within agricultural lands in northern California. There was a low prevalence of Salmonella spp., Escherichia coli O157:H7, and non-O157 Shiga-toxin producing E. coli (prevalence, 0.34% to 0.50%) identified in bird populations in this study. However, pathogens of public health importance (such as Salmonella Newport, E. coli O157:H7, and STEC O103 and O26) were identified in fecal samples, and two birds carried STEC on their feet or feathers. Identical pathogen strains were shared episodically among birds and between wild geese and free-range cattle. This result suggests a common source of contamination in the environment and potential transmission between species. These findings can be used to assess the risk posed by bird intrusions in produce fields and enhance policy decisions toward the comanagement of food safety and farmland habitat conservation.

Prevalence and risk factors associated with Campylobacter spp. and Salmonella enterica in livestock raised on diversified small-scale farms in California.

Diversified farms are operations that raise a variety of crops and/or multiple species of livestock, with the goal of utilising the products of one for the growth of the other, thus fostering a sustainable cycle. This type of farming reflects consumers' increasing demand for sustainably produced, naturally raised or pasture-raised animal products that are commonly produced on diversified farms. The specific objectives of this study were to characterise diversified small-scale farms (DSSF) in California, estimate the prevalence of Salmonella enterica and Campylobacter spp. in livestock and poultry, and evaluate the association between farm- and sample-level risk factors and the prevalence of Campylobacter spp. on DSSF in California using a multilevel logistic model. Most participating farms were organic and raised more than one animal species. Overall Salmonella prevalence was 1.19% (95% confidence interval (CI95) 0.6-2), and overall Campylobacter spp. prevalence was 10.8% (CI95 = 9-12.9). Significant risk factors associated with Campylobacter spp. were farm size (odds ratio (OR)10-50 acres: less than 10 acres = 6, CI95 = 2.11-29.8), ownership of swine (OR = 9.3, CI95 = 3.4-38.8) and season (ORSpring: Coastal summer = 3.5, CI95 = 1.1-10.9; ORWinter: Coastal summer = 3.23, CI95 = 1.4-7.4). As the number of DSSF continues to grow, evaluating risk factors and management practices that are unique to these operations will help identify risk mitigation strategies and develop outreach materials to improve the food safety of animal and vegetable products produced on DSSF.

Prevalence of Escherichia coli O157 and Salmonella spp. in solid bovine manure in California using real-time quantitative PCR.

The occurrence of Escherichia coli O157 and Salmonella spp. in solid bovine manure was investigated through a multi-county survey in California. Solid bovine manure samples (n = 91) were collected from 13 dairy farms located in multiple counties in California between June 2016 and August 2017. To quantify pathogens, DNA was extracted from bacteria in manure samples. Afterwards, the prevalence and levels of E. coli O157 and Salmonella spp. in solid bovine manure were determined by real-time quantitative PCR (qPCR). The prevalence of E. coli O157 and Salmonella spp. in solid bovine manure was 15·4 and 6·6% respectively. Escherichia coli O157 and Salmonella spp. levels in positive samples ranged from 3·1 to 5·3 log CFU per g and from positive (the population was <3 log CFU per g) to 5·2 log CFU per g respectively. Surface samples of manure piles had higher prevalence and levels of E. coli O157 and Salmonella spp. than subsurface samples, while no seasonal effects on pathogen occurrence were observed. Our results indicated that solid bovine manure is a source of E. coli O157 and Salmonella spp. and the application of untreated manure as biological soil amendments may pose potential risks to public health. SIGNIFICANCE AND IMPACT OF THE STUDY: Our findings suggested that the presence of Escherichia coli O157 and Salmonella spp. in solid bovine manure may pose potential risks if untreated manure is applied as biological soil amendments. Considering the large-scale sampling used in this study, the observations provide a holistic assessment in terms of pathogen prevalence in solid bovine manure.

Risk factors for Escherichia coli O157 on beef cattle ranches located near a major produce production region.

Our goal was to identify climate variables and management practices associated with the presence of E. coli O157 in rangeland cow-calf operations located in a major leafy green production region in the California Central Coast. E. coli O157 was present in 2·6% (68/2654) of faecal, 1·5% (3/204) of water and 1·1% (1/93) of sediment samples collected on eight ranches over 2.5 years. Five (62·5%) ranches were positive at least once during the study. The odds of detecting E. coli O157 in faecal samples was higher during periods of higher maximum soil temperature, higher maximum relative humidity, and larger herd sizes, but decreased as wind speed increased. Molecular subtyping of isolates from cattle faeces and streams/sediments suggested minimal movement of strains between ranches. The findings suggest that E. coli O157 prevalence is relatively low on cow-calf ranches in this region, spatially constrained, but may vary by weather conditions and herd size.

Detection of Salmonella enterica Serovar Montevideo and Newport in Free-ranging Sea Turtles and Beach Sand in the Caribbean and Persistence in Sand and Seawater Microcosms.

Salmonellae are Gram-negative zoonotic bacteria that are frequently part of the normal reptilian gastrointestinal flora. The main objective of this project was to estimate the prevalence of non-typhoidal Salmonella enterica in the nesting and foraging populations of sea turtles on St. Kitts and in sand from known nesting beaches. Results suggest a higher prevalence of Salmonella in nesting leatherback sea turtles compared with foraging green and hawksbill sea turtles. Salmonella was cultured from 2/9 and identified by molecular diagnostic methods in 3/9 leatherback sea turtle samples. Salmonella DNA was detected in one hawksbill turtle, but viable isolates were not recovered from any hawksbill sea turtles. No Salmonella was detected in green sea turtles. In samples collected from nesting beaches, Salmonella was only recovered from a single dry sand sample. All recovered isolates were positive for the wzx gene, consistent with the O:7 serogroup. Further serotyping characterized serovars Montevideo and Newport present in cloacal and sand samples. Repetitive-element palindromic PCR (rep-PCR) fingerprint analysis and pulsed-field gel electrophoresis of the 2014 isolates from turtles and sand as well as archived Salmonella isolates recovered from leatherback sea turtles in 2012 and 2013, identified two distinct genotypes and four different pulsotypes, respectively. The genotyping and serotyping were directly correlated. To determine the persistence of representative strains of each serotype/genotype in these environments, laboratory-controlled microcosm studies were performed in water and sand (dry and wet) incubated at 25 or 35°C. Isolates persisted for at least 32 days in most microcosms, although there were significant decreases in culturable bacteria in several microcosms, with the greatest reduction in dry sand incubated at 35°C. This information provides a better understanding of the epizootiology of Salmonella in free-ranging marine reptiles and the potential public health risks associated with human interactions with these animals in the Caribbean.

Expired ipecac syrup efficacy.

A controlled prospective study to evaluate the efficacy of expired ipecac syrup was conducted at two regional poison control centers in New England. During a 6-month period, 200 study patients treated with expired ipecac syrup and 200 control patients treated with unexpired ipecac syrup were evaluated. There were no statistical differences between the control and study groups in patient characteristics (age and sex) and product characteristics (general class, emetic potential, pretreatment, previously opened bottles, and manufacturer). In both control and study groups, emesis occurred in 100% of cases with 90% of patients vomiting with the first dose. The mean time to emesis was 24.7 minutes and 24.8 minutes in the study and control groups, respectively. Expired preparations ranged from 1 month to greater than 4 years postexpiration, with the duration of expiration not altering the mean time to emesis. Mean time to emesis between the two groups was also not affected by manufacturer, pretreatment with milk, or whether the ipecac syrup bottle was previously opened. We conclude that expired ipecac syrup (up to 4 years postexpiration date) is an effective emetic.

Gemcitabine-associated posterior reversible encephalopathy syndrome: MR imaging and MR spectroscopy findings.

A 55 year old female receiving gemcitabine for stage IV non-small cell carcinoma of the lung developed the clinical-radiologic syndrome of posterior reversible encephalopathy syndrome (PRES). She had clinical manifestations of headaches, increasing somnolence and tonic-clonic seizures. The fluid-attentuated inversion recovery (FLAIR) MR imaging sequence conspicuously showed bihemispheric, symmetrical cortical and subcortical white matter hyperintensities that preponderantly involved the parietal and occipital lobes. Diffusion-weighted imaging (DWI) sequence reflected the preponderant existence of vasogenic edema in the involved areas. MR spectroscopy showed no significant N-acetyl aspartate (NAA) depletion or lactate elevation prospectively, indicating the absence of significant neuronal loss and reversibility of the brain parenchymal changes. The clinical and radiologic manifestations essentially resolved completely with discontinuation of the drug.

Salmonella Oranienburg isolated from horses, wild turkeys and an edible home garden fertilized with raw horse manure.

In July 2010, a horse from a rural farm (Farm A) in coastal Northern California was diagnosed with Salmonella Oranienburg infection following referral to a veterinary hospital for colic surgery. Environmental sampling to identify potential sources and persistence of Salmonella on the farm was conducted from August 2010 to March 2011. Salmonella was cultured using standard enrichment and selective plating. Pure colonies were confirmed by biochemical analysis, serotyped and compared by pulsed-field gel electrophoresis (PFGE) analysis. A total of 204 clinical and environmental samples at Farm A were analysed, and Salmonella spp. was isolated from six of eight (75%) horses, an asymptomatic pet dog, two of seven (28.6%) water samples from horse troughs, nine of 20 (45%) manure storage pile composites, 16 of 71 (22.5%) wild turkey faeces and four of 39 (10.3%) soil samples from the family's edible home garden. Well water and garden vegetable samples and horse faecal samples from a neighbouring ranch were negative. S. Oranienburg with a PFGE pattern indistinguishable from the horse clinical strain was found in all positive sample types on Farm A. The investigation illustrates the potential for widespread dissemination of Salmonella in a farm environment following equine infections. We speculate that a recent surge in the wild turkey population on the property could have introduced S. Oranienburg into the herd, although we cannot rule out the possibility wild turkeys were exposed on the farm or to other potential sources of Salmonella. Findings from the investigation indicated that raw horse manure applied as fertilizer was the most likely source of garden soil contamination. Viable S. Oranienburg persisted in garden soil for an estimated 210 days, which exceeds the 120-day standard between application and harvest currently required by the National Organic Program. The study underscores the need to educate the public about potential food safety hazards associated with using raw animal manure to fertilize edible home gardens.

Isolation of Campylobacter from feral swine (Sus scrofa) on the ranch associated with the 2006 Escherichia coli O157:H7 spinach outbreak investigation in California.

We report the isolation of Campylobacter species from the same population of feral swine that was investigated in San Benito County, California, during the 2006 spinach-related Escherichia coli O157:H7 outbreak. This is the first survey of Campylobacter in a free-ranging feral swine population in the United States. Campylobacter species were cultured from buccal and rectal-anal swabs, colonic faeces and tonsils using a combination of selective enrichment and antibiotic-free membrane filtration methods. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF-MS, Bruker Daltonics, Inc., Billerica, MA, USA) was used to identify species followed by confirmatory multiplex PCR or 16S rRNA sequencing. Genetic relatedness of Campylobacter jejuni and Campylobacter coli strains was determined by multilocus sequence typing (MLST) and porA allele sequencing. Altogether, 12 (40%) of 30 feral swine gastrointestinal and oral cavity specimens were positive, and six species were isolated: Campylobacter coli, Campylobacter fetus, Campylobacter hyointestinalsis, Campylobacter jejuni, Campylobacter lanienae and Campylobacter sputorum. Campylobacter jejuni subtypes were closely related to MLST sequence type 21 (ST-21) and had identical porA sequences. Campylobacter coli subtypes were unrelated to isolates in the pubMLST/porA database. This feral swine population lived in close association with a 'grassfed' beef cattle herd adjacent to spinach and other leafy green row crop fields. The findings underscore the importance of protecting raw vegetable crops from faecal contamination by wild or feral animals. The study also illustrates a potential risk of Campylobacter exposure for hunters during handling and processing of wild swine meat.

Balancing radiation dose and image quality: clinical applications of neck volume CT.

BACKGROUND AND PURPOSE: The advancement of multidetector CT technology has resulted in improved image quality as well as an increase in ionizing radiation dose to patient. The purpose of this study was to assess radiation dose and overall image quality of CT examination of the neck between fixed-tube current and automatic tube current modulation (ATCM) at 2 separate noise index levels. MATERIALS AND METHODS: A total of 84 patients underwent neck CT with use of a 64-section multidetector row CT (MDCT) scanner. Patients were divided into 3 groups: fixed-tube current (n = 28), ATCM with a noise index of 11.4 (n = 28), and ATCM with a noise index of 20.2 (n = 28). All other scan parameters remained constant. Scan coverage length and transclavicular distance were measured. Two radiologists blinded to the scanning parameters assessed overall image quality, noise level, and streak artifacts using a 5-point grading scale. The radiation dose in dose-length product (DLP) and CT dose index (CTDI) was recorded. RESULTS: Compared with a fixed-tube current technique, ATCM with a noise index of 11.4 reduced CTDI by 20% (P < .01 x 10(-6)), and ATCM with a noise index of 20.2 reduced CTDI by 34% (P < .01 x 10(-12)). Although the difference in image quality between the fixed-tube current technique and the noise index reached statistical significance (P < .05), the magnitude of the difference was small, with average scores of 3.79 (+/-0.59) and 3.57 (+/-0.53), respectively. CONCLUSION: Compared with the fixed-tube current technique, ATCM resulted in significant reduction of radiation dose without substantially reducing the image quality of the CT of the neck. Judicious monitoring of radiation dose to patients has to be balanced with diagnostic image quality.

Dramatic increase in incidence of insulin dependent diabetes mellitus in Western Australia.

OBJECTIVES: To document and suggest possible reasons for a dramatic increase in the incidence of insulin dependent diabetes mellitus (IDDM) in Western Australia in 1992. PATIENTS: Children aged 0-14 years with IDDM diagnosed in Western Australia from 1985 to 1992 inclusive. DESIGN: A population-based register in Western Australia, using name-identified data from two separate ascertainment sources, provided numerator data. Denominator data were estimated from census figures collected in 1986 and 1991 by the Australian Bureau of Statistics. The completeness of case ascertainment was estimated by the capture-recapture method. RESULTS: Case ascertainment for 1985-1992 was estimated as 99.6% complete. Between 1985 and 1991 the incidence of IDDM in the 0-14 year age group varied between 11.8 and 15.5 per 100,000 person-years without a significant increase. In 1992, however, based on the previous seven years, 52 cases would have been expected but 84 cases were observed, an incidence of 22.2 per 100,000 person-years. The increase in incidence occurred across all age groups and in both sexes. Place of residence at diagnosis, the prevalence of islet cell antibody positivity at diagnosis and the proportion of new cases with a first degree relative with IDDM were no different in 1992 than in preceding years. CONCLUSION: This is the first report of a significant increase in the incidence of IDDM in Australia. It appears to be a period, rather than a cohort, effect and provides further evidence for environmental antigens as disease triggers.

Clinical perspectives on seabather's eruption, also known as 'sea lice'.

Seabather's eruption is usually a benign clinical syndrome that resolves spontaneously, although severe symptoms and long-term sequelae have been identified. Recent research has implicated the larvae of a jellyfish, Linuche unguiculata, as the cause of this syndrome; confirmation by serological and experimental studies is pending. Clinical signs and symptoms are consistent with this etiology. Outbreaks occur when jellyfish larvae are transported to shore by ocean currents. Treatment is symptomatic and involves use of antihistamines and steroids.

Effective strategies and programs to increase minority participation in the health professions for the 21st century.

Efforts in the 1960s and early 1970s aggressively met the national health care challenge to increase minority enrollment in health professions schools. These efforts resulted from an academic and community-based collaboration supported by public and private funding. This review was undertaken to inventory the strategies and programs of that period and to highlight effective strategies. A literature review of minority program studies was conducted to catalog specific strategies and programmatic activities. Criteria used to evaluate effectiveness were also assessed. Publication of any studies and evaluations of these programs are limited; longitudinal studies are scarce. Evaluative criteria of that time combined quantitative and qualitative measures that were not applied uniformly and consistently. The inventory of programmatic activity ranged from career awareness days to establishment of health career "magnet" schools. The review found that three strategies--awareness development, enrichment/reinforcement, and prematriculation--were effectively applied in programs across all areas of the health professions studied, that is, MODVOPP (medicine, optometry, dentistry, veterinary science, osteopathy, podiatry, and pharmacy), nursing, and allied health. Today these strategies continue to be effectively applied, but the hostile social climate and dwindling funding threaten the progress made. Revitalization of past efforts is imperative.