Source attributed case-control study of campylobacteriosis in New Zealand.

BACKGROUND: Following an initial reduction in human campylobacteriosis in New Zealand after the implementation of poultry food chain-focused interventions during 2006-2008, further decline has been relatively small. We report a year-long study of notified campylobacteriosis cases, incorporating a case control study combined with a source attribution study. The purpose was to generate up-to-date evidence on the relative contributions of different sources of campylobacteriosis in New Zealand. METHODS: The study approach included: • A case-control study of notified cases (aged six months or more) sampled in a major urban centre (Auckland, every second case) and a mixed urban/rural area (Manawatu/Whanganui, every case), between 12 March 2018 and 11 March 2019. • Source attribution of human campylobacteriosis cases sampled from these two regions over the study period by modelling of multilocus sequence typing data of Campylobacter jejuni and C. coli isolates from faecal samples of notified human cases and relevant sources (poultry, cattle, sheep). RESULTS: Most cases (84%) were infected with strains attributed to a poultry source, while 14% were attributed to a cattle source. Approximately 90% of urban campylobacteriosis cases were attributed to poultry sources, compared to almost 75% of rural cases. Poultry consumption per se was not identified as a significant risk factor. However specific risk factors related to poultry meat preparation and consumption did result in statistically significantly elevated odds ratios. CONCLUSIONS: The overall findings combining source attribution and analysis of specific risk factors indicate that poultry meat remains a dominant pathway for exposure and infection.

Incubation period for campylobacteriosis and its importance in the estimation of incidence related to travel.

Differentiation between travel-related and domestic cases of infectious disease is important in managing risk. Incubation periods of cases from several outbreaks of campylobacteriosis in Canada, Europe, and the United States with defined exposure time of less than 24 hours were collated to provide information on the incubation period distribution. This distribution was consistent across the varied outbreaks considered, with 84% (702/832) of cases having an incubation period of four days or less and 1% having an incubation period of eight days or more. The incubation period distribution was incorporated into a model for the number of travel-related cases presenting with symptom onset at given dates after return to their country of residence. Using New Zealand notification data between 2006 and 2010 for cases who had undertaken foreign travel within 10 days prior to symptom onset, we found that 29.6% (67/227 cases; 95% confidence interval (CI): 28.3­30.8%) of these cases were likely to have been domestic cases. When cases with symptom onset prior to arrival were included, the probable domestic cases represented 11.8% (67/571; 95% CI: 11.2­12.3%). Consideration of incubation time distributions and consistent collection of travel start/end dates with symptom onset dates would assist attribution of cases to foreign travel.

The prevalence and genetic diversity of Campylobacter spp. in domestic 'backyard' poultry in Canterbury, New Zealand.

Campylobacteriosis is the most commonly notified illness in New Zealand. Whilst the importance of commercial poultry in campylobacteriosis is well established, little is known about the possible role of chickens kept at home as a direct animal/faecal contact or consumption exposure pathway. The aim of this study was to determine the prevalence and genetic diversity of Campylobacter spp. in domestic backyard chicken flocks in the Canterbury region of New Zealand. Poultry faecal samples were collected from 35 domestic 'backyard' poultry flocks from urban and rural properties around the Canterbury Region of New Zealand. A total of 291 samples were collected and tested for the presence of thermotolerant Campylobacter spp. and positive isolates were analysed using pulsed-field gel electrophoresis (PFGE) using both SmaI and KpnI enzymes. There was a high prevalence of Campylobacter spp. with 86% of flocks testing positive. Campylobacter jejuni alone, Campylobacter coli alone and both C. jejuni and C. coli were detected in 20 (57%), 2 (6%) and 8 (23%) of the flocks respectively. SmaI/KpnI PFGE analysis identified 50 different genotypes across the 35 flocks. Genotype diversity richness was highest on the lifestyle block and farm properties with 43 different genotypes isolated, whilst urban properties displayed the least richness with 12 genotypes isolated. Rural flocks tended to have more different genotypes in a given flock than urban flocks. Comparison of the genotypes with the PulseNet Aotearoa Campylobacter database showed that 28 of the genotypes had previously been isolated from human cases of campylobacteriosis. Many of these were also indistinguishable from Campylobacter spp. previously isolated from retail chicken. Therefore, contact with backyard poultry or their faecal material is a potential additional infection pathway outside of exposure to the established pathways associated with the consumption of Campylobacter-contaminated commercial meat or foods cross-contaminated from contaminated poultry.

Nonuniform accumulation of cadmium and copper in kidneys of wild brown trout (Salmo trutta) populations.

Cadmium and copper accumulated nonuniformly in the kidney of wild brown trout on a longitudinal gradient as follows: the concentration in head kidney < anterior portion of tail kidney < posterior portion(s) of tail kidney. Zinc accumulated uniformly along the length of the kidney. Cadmium and copper accumulation in brown trout kidneys was lowest in the head kidney, where hematopoietic tissue dominates, and greatest in posterior tail sections, where filtration tissues dominate. Sampling programs designed to monitor cadmium and copper accumulation in trout kidneys should utilize the entire kidney, including the head kidney, to create comparable data sets.

A comparison of three modes of ventilation with the use of an adult circle system in an infant lung model.

UNLABELLED: We examined the efficiency of an adult circle system with adult bellows to deliver minute ventilation (VE) to an infant test lung model. A Narkomed 2B system (North American Drager, Telford, PA) using three modes of ventilator setup were used: A = time-cycled, volume-controlled using bellows excursion to control delivered volume; B = time-cycled, pressure-controlled using inspiratory pressure limit adjustment to control delivered volume; C = time-cycled, pressure-controlled using the inspiratory flow adjustment to control delivered volume. VE was measured with two compliances (normal and low) and four endotracheal tube (ETT) sizes (2.5-, 3.0-, 3.5-, and 4.0-mm inner diameter). VE was measured at peak inspiratory pressures (PIP) of 20, 30, 40 or 50 cm H2O while respiratory rate (RR) was held constant at 20 breaths/min. VE was measured as RR was set at 20, 30, 40, or 50 breaths/min while target PIP was held constant at 20 cm H2O. Data were analyzed using the multiple regression technique. With the low compliance model, VE was nearly identical regardless of the ventilator setup. With the normal compliance model, minor differences in VE were observed, especially at the highest RR and PIP. VE was dependent on RR, PIP, and lung compliance. Overall, the ventilator setup resulted in minor changes in VE. Very high PIPs were required to deliver VE to the low compliance model. ETT size did not affect VE when lung compliance was low; however, smaller ETT size was a factor when test lung compliance was normal, decreasing delivered VE at higher PIP and RR. We conclude that with a Narkomed 2B adult circle system VE is dependent on PIP, RR, and lung compliance, but not on mode of ventilator setup. IMPLICATIONS: The results of this laboratory investigation indicate that when an adult circle system is used during infant anesthesia, the ventilation delivered depends primarily on the respiratory rate, peak inspiratory pressure, and the compliance of the lung being ventilated, rather than on the specific mode of ventilator setup.

The effect of circuit compliance on delivered ventilation with use of an adult circle system for time cycled volume controlled ventilation using an infant lung model.

This in vitro study examined the effect of circuit compliance on delivered ventilation (VE) using a time-cycled, volume controlled circle system in an infant lung model. A Bio-Tek ventilator tester set to simulate normal and abnormal lung compliance measured VE delivered by the Narkomed 2B system. Circle circuits of varied compliance (2.75, 1.22 and 0.73 microliters.cm H2O-1) were tested. Tidal volume was adjusted to peak inflation pressures (PIP) of 20, 30, 40, and 50 cm H2O with three circuits, two lung compliances, and four different size tracheal tubes (TT) (2.5, 3.5, 4, 4.5 mm ID). Data were analysed using the multiple regression technique. Delivered VE was directly related to PIP and lung compliance. Delivered VE was not affected by the choice of circuit. TT size had minimal effects on VE when lung compliance was low; TT size was a more important factor when test lung compliance was normal. Extrapolating this data to the clinical setting, adequate ventilation of infants can be achieved with an adult circle system if an appropriate PIP is chosen, regardless of the compliance of the circuit used. Infants with poor lung compliance may require very high PIP for adequate ventilation.

The mutual-participation relationship: key to facilitating self-care practices in clients and families.

The relationship among formal providers, clients, and families in home care is critical. If clients and family care givers are to develop adequate and safe self-care practices, they must be involved in mutual decision making concerning issues related to the illness and the care to be given. A relationship of mutual participation involves facilitating and negotiating goals with clients and their family members.

Establishing valid and reliable criteria: a researcher's perspective.

From a researcher's point of view, criteria used in developing measures of nursing care should achieve certain standards: They should be based on a conceptual framework that fits the study. They should be reliable and valid and should measure important aspects of nursing care. They should be relatively simple to obtain as well as qualifiable for reporting and comparative purposes.