Population structure and pathogen interaction of Escherichia coli in freshwater: Implications of land-use for water quality and public health in Aotearoa New Zealand.

Freshwater samples (n = 199) were obtained from 41 sites with contrasting land-uses (avian, low impact, dairy, urban, sheep and beef, and mixed sheep, beef and dairy) and the E. coli phylotype of 3980 isolates (20 per water sample enrichment) was determined. Eight phylotypes were identified with B1 (48.04%), B2 (14.87%) and A (14.79%) the most abundant. Escherichia marmotae (n = 22), and Escherichia ruysiae (n = 1), were rare (0.68%) suggesting that these environmental strains are unlikely to confound water quality assessments. Phylotypes A and B1 were overrepresented in dairy and urban sites (p < 0.0001), whilst B2 were overrepresented in low impact sites (p < 0.0001). Pathogens ((Salmonella, Campylobacter, Cryptosporidium or Giardia) and the presence of diarrhoeagenic E. coli-associated genes (stx and eae) were detected in 89.9% (179/199) samples, including 80.5% (33/41) of samples with putative non-recent faecal inputs. Quantitative PCR to detect microbial source tracking targets from human, ruminant and avian contamination were concordant with land-use type and E. coli phylotype abundance. This study demonstrated that a potential recreational health risk remains where pathogens occurred in water samples with low E. coli concentration, potential non-recent faecal sources, low impact sites and where human, ruminant and avian faecal sources were absent.

Nicotinic acetylcholine receptor CHRNA5 is overexpressed in head and neck squamous cell carcinoma patients with a recent tobacco smoking history.

Tobacco smoking is a major driver of head and neck squamous cell carcinoma (HNSCC) occurrence, and previous studies have shed light on the precise molecular alterations in tobacco-related HNSCCs when compared to HNSCCs associated with other risk factors (ex: human papillomavirus/HPV status). In this study, we analyzed the gene expression differences in HNSCC cases with a recent smoking history and revealed that the nicotinic acetylcholine receptor CHRNA5 is differentially overexpressed in smoking-related HNSCCs. CHRNA5 overexpression in these HNSCCs corresponds with a worse prognosis and is inversely correlated with an immune expression signature commonly associated with better prognosis. From these results, our study highlights the potential role of the nicotine-activated CHRNA5 receptor in HNSCC progression and corresponds with other recent reports highlighting the potential role of nicotine induction in promoting cancer progression.

Social determinants of health as a framework to identify and assess cross-sector funding opportunities.

OBJECTIVE: To present a content analysis and method for applying a social determinants of health (SDOH) analytical framework to legislation. DATA SOURCES AND STUDY SETTING: Secondary data include 215 sections of the American Rescue Plan Act of 2021 (ARPA) and related information from federal government websites (e.g., press releases, notices of funding announcements, and funding tables). STUDY DESIGN: Researchers conducted a qualitative content analysis of legislative text, recording all sections, appropriations, allocations, and administrators. Using an SDOH analytical framework defined by Healthy People 2030, researchers coded each section, appropriation, and allocation within the legislation. DATA COLLECTION/EXTRACTION METHODS: Researchers reviewed all ARPA sections, appropriations, and allocations separately, resulting in 328 entries. Descriptive characteristics were calculated using Tableau and Microsoft Excel. Researchers coded each appropriation or allocation using definitions and key words presented in the SDOH analytical framework. PRINCIPAL FINDINGS: Applying an SDOH analytical framework to the legislation's funding amounts reveals an overlap of investment opportunities that cross-sector initiatives can leverage. This overlap is seen primarily in two ways: (1) specific allocations and appropriations that can be used to meet multiple SDOH goals and (2) federal administrators receiving money that can be categorized according to multiple SDOHs. For example, approximately 99% of tracked ARPA funds can be used to support one or more SDOHs. Thirty-five appropriations or allocations can support programs categorized for more than one SDOH category. Eight departments received funds that could be designated for two or more SDOHs. All five SDOH categories can potentially receive funding from 3 to 11 federal administrators. CONCLUSIONS: Using an SDOH analytical framework is an innovative approach to conceptualizing and synthesizing the contents of complex legislation. This approach demonstrates funding patterns across SDOH that can encourage cross-sector collaborations. Future content analysis of legislation can employ this SDOH framework to demonstrate cross-sector initiative funding opportunities.

Field study of the composition of greywater and comparison of microbiological indicators of water quality in on-site systems.

Thirty on-site greywater systems were sampled to determine greywater characteristics and practices in the field. Kitchen greywater was present at eight sites and urine was included at seven sites. These non-traditional sources resulted in significantly higher concentrations of enterococci and 5-day biochemical oxygen demand (BOD5) in greywater. Even with the removal of these sources, the concentrations of microbial indicators indicated high levels of contamination could occur across all greywater sources, including "light" greywater. Using multiple microbial indicators showed that all samples had the potential for faecal contamination. Bacteroidales markers were confirmed in treated greywater and in each greywater source, highlighting the potential for human faecal contamination. Although Escherichia coli was absent in treated greywater recycled to the house, other microbial indicators were present; hence, caution is required in using E. coli concentrations as the sole indicator of microbiological water quality. High BOD5 or total suspended solid concentrations exceeded the levels recommended for effective disinfection. Subsurface irrigation, which is assumed to provide a five-log reduction in exposure, is a suitable reuse option for non-disinfected greywater. Only half the occupants had a good understanding of their greywater systems and 25 % of systems were poorly maintained. Elevated microbial indicator contamination of greywater sludge is a potential hazard during maintenance.

The connection between neurosciences and dialysis: a quick neurological assessment for hemodialysis nurses.

Stroke is a significant medical emergency and occurs frequently in patients receiving renal replacement therapy. In 2005, the Registered Nurses Association of Ontario (RNAO) published Nursing Best Practice Guidelines for Stroke, highlighting the necessity and expectation that all nurses, regardless of specialty, are able to perform an abbreviated neurological assessment, identify the symptoms of stroke, and respond to these as a medical emergency. This article highlights the significance of neurovascular disease in persons who receive renal replacement therapy, and serves as an educational review for dialysis nurses to increase their neurological functional assessment skills. The outlined abbreviated neurological assessment parallels the Canadian Neurological Scale, and is based on the practice recommendations published in the RNAO Nursing Best Practice Guidelines in 2005.

Evaluation of human adenovirus and human polyomavirus as indicators of human sewage contamination in the aquatic environment.

Discharge of inadequately treated human wastewater into surface waters used for recreation, drinking water, irrigation and shellfish cultivation may present a public health hazard due to the potential shedding of high concentrations of pathogenic viruses from the human gastrointestinal tract. Human adenovirus (HAdV) and human polyomavirus (HPyV) are ubiquitous in humans and have excellent survival characteristics in the environment, so are potential candidates for indicators of human sewage contamination. Using qPCR assays, the prevalence and quantity of HAdV and HPyV JC and BK were determined in influent and effluent wastewater and receiving waters (river, urban stream, estuarine), then compared with norovirus (NoV) presence, a significant human pathogen which is not necessarily ubiquitously excreted into the environment. HAdV and HPyV were frequently detected in high concentrations in wastewater and wastewater-contaminated waters confirming their use as potential indicators for the presence of human sewage. Overall, there was a correlation between the presence of HAdV and HPyV with NoV but there were some notable exceptions including the higher frequency of NoV compared to HAdV and HPyV in estuarine waters impacted by wastewater overflows. We found that HAdV and HPyV detection by qPCR was a suitable tool for evaluating water quality and that their detection can aid in determining pollution sources, thus providing useful information for health risk assessments.

Groundwater biofilm dynamics grown in situ along a nutrient gradient.

This paper describes the in situ response of groundwater biofilms in an alluvial gravel aquifer system on the Canterbury Plains, New Zealand. Biofilms were developed on aquifer gravel, encased in fine mesh bags and suspended in protective columns in monitoring wells for at least 20 weeks. Four sites were selected in the same groundwater system where previous analyses indicated a gradient of increasing nitrate down the hydraulic gradient from Sites 1 to 4. Measurements during the current study classified the groundwater as oligotrophic. Biofilm responses to the nutrient gradients were assessed using bioassays, with biomass determined using protein and cellular and nucleic acid staining and biofilm activity using enzyme assays for lipid, carbohydrate, phosphate metabolism, and cell viability. In general, biofilm activity decreased as nitrate levels increased from Sites 1 to 4, with the opposite relationship for carbon and phosphorus concentrations. These results showed that the groundwater system supported biofilm growth and that the upper catchment supported efficient and productive biofilms (high ratio of activity per unit biomass).

Influence of wastewater treatment process and the population size on human virus profiles in wastewater.

Human adenovirus (AdV and AdV species F), enterovirus (EV) and norovirus (NoV) concentrations entering wastewater treatment plants (WWTP) serving different-sized communities, and effectiveness of different treatment processes in reducing concentrations were established. Data was combined to create a characteristic and unique descriptor of the individual viral composition and termed as the sample virus profile. Virus profiles were generally independent of population size and treatment process (moving bed biofilm reactors, activated sludge, waste stabilisation ponds). AdV and EV concentrations in wastewater were more variable in small (<4000) and medium-sized (10,000-64,000) WWTP than in large-sized (>130,000 inhabitants) plants. AdV and EV concentrations were detected in influent of most WWTP (AdV range 1.00-4.08 log(10) infectious units (IU)/L, 3.25-8.62 log(10) genome copies/L; EV range 0.7-3.52 log(10) plaque forming units (PFU)/L; 2.84-6.67 log(10) genome copies/L) with a reduced median concentration in effluent (AdV range 0.70-3.26 log(10) IU/L, 2.97-6.95 log(10) genome copies/L; EV range 0.7-2.15 log(10)PFU/L, 1.54-5.28 log(10) genome copies/L). Highest culturable AdV and EV concentrations in effluent were from a medium-sized WWTP. NoV was sporadic in all WWTP with GI and GII concentrations being similar in influent (range 2.11-4.64 and 2.19-5.46 log(10) genome copies/L) as in effluent (range 2.18-5.06 and 2.88-5.46 log(10) genome copies/L). Effective management of WWTP requires recognition that virus concentration in influent will vary - particularly in small and medium plants. Irrespective of treatment type, culturable viruses and NoV are likely to be present in non-disinfected effluent, with associated human health risks dependent on concentration and receiving water usage.

Taking integrated care management to the street: can we find the road to our triple aim?

Hudson Health Plan, through a Chronic Illness Demonstration Project, is investigating the value that integrated behavioral and medical health case management brings to stakeholders of a comprehensive assessment and patient assistance program. The New York State Department of Health funds the pilot program dubbed the Westchester Cares Action Program. Hudson Health Plan and its behavioral health vendor, Beacon Health Strategies, are engaged in a 3-year study aimed at improving quality of life and health outcomes while reducing costs for 250 of New York State's highest utilizing, most costly "fee-for service" patients. This article describes the program, the team, and the tools that the program uses. It also discusses the challenges, successes, and lessons learned during its first 15 months of operation.

Screening for depression in chronic hemodialysis patients: comparison of the Beck Depression Inventory, primary nurse, and nephrology team.

Depression in patients with end-state renal disease (ESRD) is both underdiagnosed and treated, which may contribute to an increase in morbidity and mortality. Efforts aimed at screening, diagnosing, and treating depression could potentially modify outcomes in this population. The purpose of this study was to compare the prevalence of depression, as measured by the Beck Depression Inventory (BDI-II), the primary nurse, and nephrology team, among a cohort of patients receiving chronic hemodialysis (HD). A secondary objective was to identify patient variables associated with depression. Patients were screened for depression at the same time point, using the BDI-II, the primary nurse and the nephrology team. Depression was defined as a BDI-II score > or =14. Agreement between the BDI-II score, nurse, and nephrology team assessment of depression was compared using a kappa score and receiver-operating characteristic (ROC) curves were generated. One hundred and twenty-four of an eligible 154 patients completed the study. Depression as measured by a BDI-II> or =14, the nurse and the team was diagnosed in 38.7%, 41.9%, and 24.2% of patients, respectively. With the BDI-II as the gold standard, the nurses' diagnosis of depression had an agreement of 74.6% vs. only 24.2% agreement with the nephrology team. A previous history of malignancy was the only variable associated with the diagnosis of depression. Depression is common among patients on HD, supporting the need for a routine depression-screening program. The primary dialysis nurse is in a key position to identify patients with depression and should be considered as an integral part of the nephrology team.