An Outbreak Investigation of Salmonella Typhimurium Illnesses in the United States Linked to Packaged Leafy Greens Produced at a Controlled Environment Agriculture Indoor Hydroponic Operation - 2021.

In 2021, the U.S. Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), and state partners investigated a multistate outbreak of Salmonella Typhimurium illnesses linked to packaged leafy greens from a controlled environment agriculture (CEA) operation in Illinois. Thirty-one illnesses and four hospitalizations were reported in four states, with a significant epidemiologic signal for packaged leafy greens from Farm A. A traceback investigation for leafy greens included seven points of service (POS) with food exposure data from eight ill people. Each POS was supplied leafy greens by Farm A. FDA investigators observed operations at Farm A and noted that 1) the firm did not consider their indoor hydroponic pond water as agricultural water, 2) condensate dripping from the chiller water supply line inside the building, and 3) unprotected outdoor storage of packaged soilless growth media and pallets used for finished product. FDA collected 25 product, water, and environmental samples from Farm A. The outbreak strain was recovered from a water sample collected from a stormwater drainage basin located on the property adjacent to Farm A. In addition, an isolate of Salmonella Liverpool was recovered from two indoor growing ponds within the same growing house, but no illnesses were linked to the isolate. Farm A voluntarily recalled all implicated products and provided their root cause analysis (RCA) and return-to-market plan to FDA. While the source and route of the contamination were not determined by the RCA, epidemiologic and traceback evidence confirmed the packaged salads consumed by ill persons were produced by Farm A. This was the first investigation of a multistate foodborne illness outbreak associated with leafy greens grown in a CEA operation. This outbreak demonstrated the need for growers using hydroponic methods to review their practices for potential sources and routes of contamination and to reduce food safety risks when identified.

Multinational Outbreak of Listeria monocytogenes Infections Linked to Enoki Mushrooms Imported from the Republic of Korea 2016-2020.

Keeping the global food supply safe necessitates international collaborations between countries. Health and regulatory agencies routinely communicate during foodborne illness outbreaks, allowing partners to share investigational evidence. A 2016-2020 outbreak of Listeria monocytogenes infections linked to imported enoki mushrooms required a multinational collaborative investigation among the United States, Canada, Australia, and France. Ultimately, this outbreak included 48 ill people, 36 in the United States and 12 in Canada, and was linked to enoki mushrooms sourced from one manufacturer located in the Republic of Korea. Epidemiologic, laboratory, and traceback evidence led to multiple regulatory actions, including extensive voluntary recalls by three firms in the United States and one firm in Canada. In the United States and Canada, the Korean manufacturer was placed on import alert while other international partners provided information about their respective investigations and advised the public not to eat the recalled enoki mushrooms. The breadth of the geographic distribution of this outbreak emphasizes the global reach of the food industry. This investigation provides a powerful example of the impact of national and international coordination of efforts to respond to foodborne illness outbreaks and protect consumers. It also demonstrates the importance of fast international data sharing and collaboration in identifying and stopping foodborne outbreaks in the global community. Additionally, it is a meaningful example of the importance of food sampling, testing, and integration of sequencing results into surveillance databases.

Molecular survey of pyrethroid resistance mechanisms in Mexican field populations of Rhipicephalus (Boophilus) microplus.

Susceptibility to synthetic pyrethroids (SP s) and the role of two major resistance mechanisms were evaluated in Mexican Rhipicephalus microplus tick populations. Larval packet test (LPT), knock-down (kdr) PCR allele-specific assay (PASA) and esterase activity assays were conducted in tick populations for cypermethrin, flumethrin and deltamethrin. Esterase activity did not have a significant correlation with SP s resistance. However a significant correlation (p < 0.01) was found between the presence of the sodium channel mutation, and resistance to SP s as measured by PASA and LPT respectively. Just over half the populations (16/28) were cross-resistant to flumethrin, deltamethrin and cypermethrine, 21.4% of the samples (6/28) were susceptible to all of the three pyrethroids 10.7 of the samples (3/28) were resistant to flumethrin, 3.4 of the samples (1/28) were resistant to deltamethrin only and 7.1% (2/28) were resistant to flumethrin and deltamethrin. The presence of the kdr mutation correlates with resistance to the SP s as a class. Target site insensitivity is the major mechanism of resistance to SP s in Mexican R. microplus field strains, involving the presence of a sodium channel mutation, however, esterase-based, other mutations or combination of mechanisms can also occur.

Differential response to diazinon and coumaphos in a strain of Boophilus microplus (Acari: Ixodidae) collected in Mexico.

Boophilus microplus, collected from Nuevo Leon, Mexico, were found to be highly resistant to diazinon but not highly resistant to coumaphos, suggesting that different mechanisms of resistance were present in these ticks than other Mexican organophosphate (OP)-resistant ticks reported previously. When exposed to coumaphos and piperonyl butoxide or triphenylphosphate, the LCso estimate was reduced by 3.5- and 6.3-fold, respectively, suggesting that mono-oxygenases and/or esterases were involved in resistance to coumaphos. Additionally, it was determined that this strain had an Acetylycholinesterase (AChe) that was insensitive to the active form of coumaphos, coroxon, taking at least 24 min longer to reach 50% reduction in AChE activity compared with the susceptible strain. When exposed to diazinon, none of the synergists tested significantly lowered the LC50. However, it was determined that it took six times longer to reach 60% inhibition of AChE in the resistant strain compared with the susceptible strain when exposed to the active form of diazinon, diazoxon. Insensitive AChE seems to be very common in OP-resistant B. microplus. The potential benefits for the development of a field-portable AChE inhibition assay kit are discussed.

Mexican American women's adherence to hemodialysis treatment: a social constructivist perspective.

Mexican Americans have as much as a six-times greater risk of end-stage renal disease (ESRD) than non-Hispanic white Americans, and women show a faster rate of decline in diabetic renal functioning. The leading treatment for ESRD is hemodialysis, an intensive, complex treatment regimen associated with high levels of patient nonadherence. Previous studies of patient adherence have adopted a biomedical, practitioner-oriented approach focused on performance of fixed behaviors and ignoring contextual and motivational factors. The author describes a social constructivist approach to understanding how female Mexican American dialysis patients experience their disease, the treatment regimen, and the consequences of that experience. Mexican American women's perceptions and psychosocial factors were examined to understand what these women viewed as important to their realities as dialysis patients. Poverty, longer treatment history, and immigrant status emerged as factors that appeared to influence treatment nonadherence. Perceived identity losses, heightened awareness of mortality and family dysfunction emerged as themes that participants viewed as preeminent in their day-to-day lives. A social constructivist perspective is highly compatible with social work principles of person-in-environment and starting where the client is. This perspective provides a valuable framework for informing social work practice with this special population of Mexican American dialysis patients.

Psychosocial factors influencing Mexican-American women's adherence with hemodialysis treatment.

Patients frequently do not fully adhere to treatment regimens. Despite the fact that this issue has been extensively researched, patient nonadherence is still not well understood. Previous studies have tended to neglect the study of phenomenological perceptions and psychosocial influences on nonadherence behavior as well as issues unique to culturally diverse populations. This author used an interpretive approach to examine the cognitive and phenomenological dimensions of how Mexican-American women receiving dialysis treatment experience their illness (n = 26). Poverty, longer treatment history, immigrant status, perceived identity losses, and family dysfunction emerged as factors that influenced treatment nonadherence among this purposive sample. This article moves from results to implications for social work practice with this population.

Visioning family-centered care in genetics: what parents and providers have to say.

The purpose of this multisite exploratory research study involving focus groups of consumers and service providers was to generate stakeholder input for a statewide strategic plan for genetic services in the southwestern region of the United States. This article describes the qualitative methods by which the data were collected and summarizes major themes in participants' perceptions about genetic services. It also describes processes related to obtaining genetic services and characteristics of an ideal service delivery system for children affected by genetic disorders and the families that care for them. Implications for practice and policy are also reviewed.