The burden of Legionnaires' disease in New Zealand (LegiNZ): a national surveillance study.

BACKGROUND: Legionnaires' disease is under-diagnosed because of inconsistent use of diagnostic tests and uncertainty about whom to test. We assessed the increase in case detection following large-scale introduction of routine PCR testing of respiratory specimens in New Zealand. METHODS: LegiNZ was a national surveillance study done over 1-year in which active case-finding was used to maximise the identification of cases of Legionnaires' disease in hospitals. Respiratory specimens from patients of any age with pneumonia, who could provide an eligible lower respiratory specimen, admitted to one of 20 participating hospitals, covering a catchment area of 96% of New Zealand's population, were routinely tested for legionella by PCR. Additional cases of Legionnaires' disease in hospital were identified through mandatory notification. FINDINGS: Between May 21, 2015, and May 20, 2016, 5622 eligible specimens from 4862 patients were tested by PCR. From these, 197 cases of Legionnaires' disease were detected. An additional 41 cases were identified from notification data, giving 238 cases requiring hospitalisation. The overall incidence of Legionnaires' disease cases in hospital in the study area was 5·4 per 100 000 people per year, and Legionella longbeachae was the predominant cause, found in 150 (63%) of 238 cases. INTERPRETATION: The rate of notified disease during the study period was three-times the average over the preceding 3 years. Active case-finding through systematic PCR testing better clarified the regional epidemiology of Legionnaires' disease and uncovered an otherwise hidden burden of disease. These data inform local Legionnaires' disease testing strategies, allow targeted antibiotic therapy, and help identify outbreaks and effective prevention strategies. The same approach might have similar benefits if applied elsewhere in the world. FUNDING: Health Research Council of New Zealand.

Murine typhus and febrile illness, Nepal.

Murine typhus was diagnosed by PCR in 50 (7%) of 756 adults with febrile illness seeking treatment at Patan Hospital in Kathmandu, Nepal. Of patients with murine typhus, 64% were women, 86% were residents of Kathmandu, and 90% were unwell during the winter. No characteristics clearly distinguished typhus patients from those with blood culture-positive enteric fever.

Time-resolved and multiple-angle Thomson scattering on gas-puff Z-Pinch plasmas at pinch time.

A 526.5 nm Thomson scattering diagnostic laser enables probing of the plasma conditions of neon gas-puff z-pinch implosions with temporal resolution. Splitting the laser into two 2.5 J pulses, both 2.3 ns in duration and separated by 4 ns, allows observation of sub-nanosecond time-resolved spectra for a total time of 7 ns. Collection optics were set at 90° and 30° to the laser, observing the same on-axis scattering volume with a radial extent of 0.4 mm. The spectra from both angles were collected by using the same streak camera, using a coupling system that allowed us to obtain temporal, spectral, and angular resolution in the same image. By comparing the ion-acoustic spectra from the two angles, we determined electron temperature and a range of possible electron densities. Measurements made in the 1-3 ns period before pinch time show best fit (determined by a least-squares method) electron densities of around 2 × 1019 cm-3, increasing to 1.5 × 1020 cm-3 in the 3 ns following the start of the x-ray burst (t = 0 ns) from the pinch. The electron temperature increases from 300 eV to 500 eV at t = 0 ns before decreasing to below 300 eV after pinch time. With the present parameters (probe beam, collection angles, and electron temperature and density), this diagnostic method is too insensitive to electron density to provide more than a constraint on that parameter. Plasma regimes in which this technique could determine electron density with some precision are calculated.

Quantifying patient bacterial exposure risk from reusable phlebotomy tourniquets in a New Zealand secondary level hospital.

AIM: This study aimed to assess for the presence of multi-drug resistant organisms (MDROs) on tourniquets and quantify the number of bacteria to which patients might be exposed with each blood collection episode. METHODS: Tourniquets were randomly sampled in a 246-bed, secondary level, New Zealand hospital, which is currently non-endemic for MDROs. A 6-cm length of each tourniquet sampled was applied to the surface of an agar plate and the colony forming units (CFUs) were enumerated. All colonies were then screened for MDROs using standard methods. CFU counts per linear centimetre were multiplied by a range of patient arm circumference measurements. Comparison was also made between non-disinfected tourniquets left on the wards and phlebotomy service tourniquets after daily decontamination with a proprietary disinfectant. RESULTS: The median exposure risk from non-disinfected tourniquets was 173 CFUs per collect (95% CI, 104-861). None of the general ward tourniquets grew any MDROs but four out of five dedicated, single-patient reusable isolation room tourniquets grew MRSA. Disinfected tourniquets had few if any CFUs and CFU counts were significantly lower than non-disinfected tourniquets (P = 0.0001). CONCLUSION: The quantitative risk from reusable tourniquets appears low in the setting of MDRO non-endemicity, with the application of standard infection control practices.

A doubly curved elliptical crystal spectrometer for the study of localized x-ray absorption in hot plasmas.

X-ray absorption spectroscopy is a powerful tool for the diagnosis of plasmas over a wide range of both temperature and density. However, such a measurement is often limited to probing plasmas with temperatures well below that of the x-ray source in order to avoid object plasma emission lines from obscuring important features of the absorption spectrum. This has excluded many plasmas from being investigated by this technique. We have developed an x-ray spectrometer that provides the ability to record absorption spectra from higher temperature plasmas than the usual approach allows without the risk of data contamination by line radiation emitted by the plasma under study. This is accomplished using a doubly curved mica crystal which is bent both elliptically and cylindrically. We present here the foundational work in the design and development of this spectrometer along with initial results obtained with an aluminum x-pinch as the object plasma.

Study of nanosecond pulsed magnetic fields using temporally resolved Faraday rotation through a magneto-optical waveguide.

We have measured magnetic fields up to 17.7 T with a rise time of 75 ns using temporally resolved Faraday rotation of a single longitudinal mode laser beam through a magneto-optically active bulk waveguide. We believe this to be the first time that such large, rapidly varying magnetic fields have been measured with this class of materials (multicomponent terbium borate glass). As there was no measurable lag between the magnetic field inferred from the angle of rotation of the laser beam and the electromagnetically measured field, our sample of terbium borate glass has a spin-lattice relaxation time of a few tens of nanoseconds at most at approximately room temperature (300 K). The highest peak magnetic fields were measured in wire-array Z-pinch experiments on a 0.5 MA pulsed power machine.

Determination of the size and structure of an X-pinch x-ray source from the diffraction pattern produced by microfabricated slits.

X-pinch plasma emits subnanosecond bursts of x rays in the 3-10-keV energy range from a small source. As such, it has been used for high-resolution point-projection imaging of small, dense, rapidly changing plasmas as well as for submillimeter-thick biological samples. In addition to the effect of source size on geometric resolution, a small source size can also provide high spatial coherence of x rays, enabling the rays to be used for imaging weakly absorbing objects with excellent spatial resolution by a method called phase-contrast imaging. To determine the source size, we microfabricated gold slits and imaged them in a point-projection radiography configuration. The shape of the shadow image pattern depends on the source size and energy band of the x rays, the shape and material used for the slits, and the geometry of the experiment. Experimental results have been compared with wave-optics calculations of the expected image pattern as a function of all the parameters listed above. For example, assuming a Gaussiansource distribution, an effective source size in 2.5-4.1 A radiation (1 A = 0.1 nm) of 1.2 +/- 0.5 microm (full width at half-maximum) was determined for a 20-microm Mo wire X pinch. Characterization of the size and structure of the x-ray bursts from X pinches by the use of different wire materials and different slit structures is made.