Using CHROMagar™ STEC medium exclusively does not recover all clinically relevant Shiga toxin-producing Escherichia coli in Aotearoa, New Zealand.

Diagnostic laboratories in Aotearoa, New Zealand (NZ) refer cultures from faecal samples positive for Shiga toxin genes to the national Enteric Reference Laboratory for isolation of Shiga toxin-producing Escherichia coli (STEC) for epidemiological typing. As there was variation in the culture media being referred, a panel of 75 clinical isolates of STEC, representing 28 different serotypes, was used to assess six commercially available media and provide guidance to clinical laboratories. Recommendations were subsequently tested for a 3-month period, where STEC isolations and confirmations were assessed by whole genome sequencing analysis against the culture media referred. CHROMagar™ STEC (CH-STEC; CHROMagar Microbiology, Paris, France) or CH-STEC plus cefixime-tellurite sorbitol MacConkey agar was confirmed inferior to CH-STEC plus blood agar with vancomycin, cefsulodin, and cefixime (BVCC). The former resulted in fewer STEC types (n = 18) being confirmed compared to those from a combination of CH-STEC and BVCC (n = 42). A significant (P < .05) association with an STEC's ability to grow on CH-STEC and the presence of the ter gene cluster, and eae was observed. Culturing screen positive STEC samples onto both CH-STEC and BVCC ensures a consistently higher recovery of STEC from all clinical samples in NZ than CH-STEC alone.

An Investigation into the Prevalence of Methamphetamine Related Enquiries to Local Government Environmental Health Officers.

Methamphetamine contamination of residential properties remains a serious public health concern for members of the public. External stakeholders including Environmental Health Officers (EHOs) and testing and remediation technicians are engaged on investigating whether contamination has occurred from manufacturing or smoking processes. More specifically, local council EHOs are responsible for managing clandestine drug laboratories when notified by police and also for responding to public enquiries. However, the full scope of these contaminated properties is not seen by any single stakeholder, making it very challenging to quantify these situations. To evaluate the prevalence of methamphetamine related enquiries from the general public to EHOs, this study surveyed and interviewed officers from around Australia. It was found that public enquiries were infrequent with only 6% of respondents having received enquiries in the last month, which indicates that people are seeking information from other sources. Interestingly, there were case study scenarios that also mentioned issues with awareness and the flow of information. Concerns regarding difficult cases, police notifications, and site visits were also highlighted. The results of this study provide a benchmark of how methamphetamine related cases are managed and highlight the need for trustworthy information that is available to EHOs, governments, industry members, and the public in a unified location.

Leptospirosis in Aotearoa New Zealand: Protocol for a Nationwide Case-Control Study.

BACKGROUND: In Aotearoa New Zealand, 90% of patients with notified leptospirosis (a zoonotic bacterial disease) have been men working in agricultural industries. However, since 2008, the epidemiology of notified cases has been gradually changing, that is, more women are affected; there are more cases associated with occupations traditionally not considered high risk in New Zealand; infecting serovars have changed; and many patients experience symptoms long after infection. We hypothesized that there is a shift in leptospirosis transmission patterns with substantial burden on affected patients and their families. OBJECTIVE: In this paper, we aimed to describe the protocols used to conduct a nationwide case-control study to update leptospirosis risk factors and follow-up studies to assess the burden and sources of leptospirosis in New Zealand. METHODS: This study used a mixed methods approach, comprising a case-control study and 4 substudies that involved cases only. Cases were recruited nationwide, and controls were frequency matched by sex and rurality. All participants were administered a case-control questionnaire (study 1), with cases being interviewed again at least 6 months after the initial survey (study 2). A subset of cases from two high-risk populations, that is, farmers and abattoir workers, were further engaged in a semistructured interview (study 3). Some cases with regular animal exposure had their in-contact animals (livestock for blood and urine and wildlife for kidney) and environment (soil, mud, and water) sampled (study 4). Patients from selected health clinics suspected of leptospirosis also had blood and urine samples collected (study 5). In studies 4 and 5, blood samples were tested using the microscopic agglutination test to test for antibody titers against Leptospira serovars Hardjo type bovis, Ballum, Tarassovi, Pomona, and Copenhageni. Blood, urine, and environmental samples were also tested for pathogenic Leptospira DNA using polymerase chain reaction. RESULTS: Participants were recruited between July 22, 2019, and January 31, 2022, and data collection for the study has concluded. In total, 95 cases (July 25, 2019, to April 13, 2022) and 300 controls (October 19, 2019, to January 26, 2022) were interviewed for the case-control study; 91 cases participated in the follow-up interviews (July 9, 2020, to October 25, 2022); 13 cases participated in the semistructured interviews (January 26, 2021, to January 19, 2022); and 4 cases had their in-contact animals and environments sampled (October 28, 2020, and July 29, 2021). Data analysis for study 3 has concluded and 2 manuscripts have been drafted for review. Results of the other studies are being analyzed and the specific results of each study will be published as individual manuscripts.. CONCLUSIONS: The methods used in this study may provide a basis for future epidemiological studies of infectious diseases. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/47900.

Comparative genomics uncovered differences between clinical and environmental populations of Vibrio parahaemolyticus in New Zealand.

Vibrio parahaemolyticus has been identified as an emerging human pathogen worldwide with cases undergoing a global expansion over recent decades in phase with climate change. New Zealand had remained free of outbreaks until 2019, but different outbreaks have been reported consecutively since then. To provide new insights into the recent emergence of cases associated with outbreak clones over recent years, a comparative genomic study was carried out using a selection of clinical (mostly outbreak) and environmental isolates of V. parahaemolyticus obtained in New Zealand between 1973 and 2021. Among 151 isolates of clinical (n=60) and environmental (n=91) origin, 47 sequence types (STs) were identified, including 31 novel STs. The population of environmental isolates generated 30 novel STs, whereas only 1 novel ST (ST2658) was identified among the population of clinical isolates. The novel clinical ST was a single-locus variant of the pandemic ST36 strain, indicating further evolution of this pandemic strain. The environmental isolates exhibited a significant genetic heterogeneity compared to the clinical isolates. The whole-genome phylogeny separated the population of clinical isolates from their environmental counterparts, clearly indicating their distant genetic relatedness. In addition to differences in ancestral profiles and genetic relatedness, these two groups of isolates exhibited a profound difference in their virulence profiles. While the entire population of clinical isolates harboured the thermostable direct haemolysin (tdh) and/or the thermostable-related haemolysin (trh), only a few isolates of environmental origin possessed the same virulence genes. In contrast to tdh and trh, adhesin-encoding genes, vpadF and MSHA, showed a significantly (P<0.001) greater association with the environmental isolates compared to the clinical isolates. The effectors, VopQ, VPA0450 and VopS, which belong to T3SS1, were ubiquitous, being present in each isolate regardless of its origin. The effectors VopC and VopA, which belong to T3SS2, were rarely detected in any of the examined isolates. Our data indicate that the clinical and environmental isolates of V. parahaemolyticus from New Zealand differ in their population structures, ancestral profiles, genetic relatedness and virulence profiles. In addition, we identified numerous unique non-synonymous single-nucleotide polymorphisms (nsSNPs) in adhesins and effectors, exclusively associated with the clinical isolates tested, which may suggest a possible role of these mutations in the overall virulence of the clinical isolates.

Range of the perfluorooctanoate (PFOA) safe dose for human health: An international collaboration.

Many government agencies and expert groups have estimated a dose-rate of perfluorooctanoate (PFOA) that would protect human health. Most of these evaluations are based on the same studies (whether of humans, laboratory animals, or both), and all note various uncertainties in our existing knowledge. Nonetheless, the values of these various, estimated, safe-doses vary widely, with some being more than 100,000 fold different. This sort of discrepancy invites scrutiny and explanation. Otherwise what is the lay public to make of this disparity? The Steering Committee of the Alliance for Risk Assessment (2022) called for scientists interested in attempting to understand and narrow these disparities. An advisory committee of nine scientists from four countries was selected from nominations received, and a subsequent invitation to scientists internationally led to the formation of three technical teams (for a total of 24 scientists from 8 countries). The teams reviewed relevant information and independently developed ranges for estimated PFOA safe doses. All three teams determined that the available epidemiologic information could not form a reliable basis for a PFOA safe dose-assessment in the absence of mechanistic data that are relevant for humans at serum concentrations seen in the general population. Based instead on dose-response data from five studies of PFOA-exposed laboratory animals, we estimated that PFOA dose-rates 10-70 ng/kg-day are protective of human health.

A Review of Methods Used to Detect Methamphetamine from Indoor Air and Textiles in Confined Spaces.

Methamphetamine manufacture, use, and the resulting contamination is a significant issue that affects public health, the environment, and the economy. Third-hand exposure to methamphetamine can result in adverse health risks for individuals and first responders. Such exposures can result from the inhalation of airborne residues or from contact with contaminated objects. This review was conducted to determine the current methods used for methamphetamine extraction from indoor air and porous fabric materials. Dynamic solid phase microextraction (SPME) and sorbent sampling tubes have been applied to extract airborne methamphetamine residues from contaminated properties. SPME and solvent extraction have been applied to sample clothing and textiles for methamphetamine detection. This review demonstrates that there is limited literature on the detection of methamphetamine from indoor air and clothing. Supplementary and consistent methods to detect methamphetamine from air and porous surfaces should be developed and published to allow better assessment of the environmental risk to public health caused by third-hand exposure to methamphetamine.

Overview of Current Practices in the Methamphetamine Testing and Decontamination Industry: An Australian Case Study.

To better protect public health from third-hand exposure to methamphetamine, it is important to understand the techniques and current practices used within the methamphetamine testing and decontamination industry in Australia. A survey was conducted focusing on business owners that advertised testing and/or remediation services online. They were also invited to participate in a follow-up phone interview upon completion. The survey demonstrated that testing and decontamination methods were highly varied, which was expected for an industry with no regulation. Most companies offered methamphetamine testing and remediation which could be a conflict of interest. Participants also shared personal experiences, including the conduct of other industry members, demonstrating both poor practice and/or the competitive nature of the business. Participating business owners were following Australian guidelines to the best of their ability, and many are advocates for regulation to be implemented within the industry. This would address the inconsistencies between companies and establish trust for industry members and the public. It would also provide significant public health protection, which is currently lacking. A more consistent approach to the testing and remediation of methamphetamine contamination, aided by regulation, would address the significant risk to public health caused by third-hand exposure to methamphetamine.

Yersiniosis in New Zealand.

The rate of yersiniosis in New Zealand (NZ) is high compared with other developed countries, and rates have been increasing over recent years. Typically, >99% of human cases in NZ are attributed to Yersinia enterocolitica (YE), although in 2014, a large outbreak of 220 cases was caused by Yersinia pseudotuberculosis. Up until 2012, the most common NZ strain was YE biotype 4. The emergent strain since this time is YE biotype 2/3 serotype O:9. The pathogenic potential of some YE biotypes remains unclear. Most human cases of yersiniosis are considered sporadic without an identifiable source. Key restrictions in previous investigations included insufficient sensitivity for the isolation of Yersinia spp. from foods, although foodborne transmission is the most likely route of infection. In NZ, YE has been isolated from a variety of sick and healthy domestic and farm animals but the pathways from zoonotic reservoir to human remain unproven. Whole-genome sequencing provides unprecedented discriminatory power for typing Yersinia and is now being applied to NZ epidemiological investigations. A "One-Health" approach is necessary to elucidate the routes of transmission of Yersinia and consequently inform targeted interventions for the prevention and management of yersiniosis in NZ.

Current practices underestimate environmental exposures to methamphetamine: inhalation exposures are important.

Current practice for determining the exposure to methamphetamine in contaminated homes relies on the analysis of surface wipe sample to address direct contact exposures. The movement of methamphetamine into the air phase, and the potential for inhalation exposures to occur within residential homes contaminated from former clandestine manufacture or smoking of methamphetamine has been generally poorly characterised and understood. All available risk-based guidelines for determining safe levels of methamphetamine in residential properties do not include any consideration of the inhalation pathway as an exposure route. This study showed that methamphetamine can readily move from contaminated materials in a home into the air phase. This movement of methamphetamine into the air phase provides both an exposure pathway and a mechanism for the transfer of methamphetamine throughout a property. The inhalation exposure pathway has the potential to result in significant intake of methamphetamine, adding to dermal absorption and ingestion exposure routes. Guidelines that are established for the assessment of methamphetamine contaminated properties that ignore inhalation exposures can significantly underestimate exposure and result in guidelines that are not adequately protective of health. This study also demonstrates that sampling methamphetamine in air can be undertaken using commercially available sorption tubes and analytical methods.

Environmental Methamphetamine Exposures and Health Effects in 25 Case Studies.

The clandestine manufacture and use of methamphetamine can result in contamination of residential properties. It is understood that this contamination remains in homes for a significant period, however there are a lack of data available to understand the health effects of exposure to environmental methamphetamine contamination (third-hand exposure). Our study collected information from 63 individuals in 25 separate case studies where the subjects had unwittingly suffered third-hand exposure to methamphetamine from former manufacture, use, or both. Data included environmental contamination data, information on subjects' health effects, and evidence of exposure using hair analysis. This study identified a range of health effects that occur from residing in these properties, including behavioural effects or issues, sleep issues, respiratory effects, skin and eye effects, and headaches. Methamphetamine was detected in hair samples from some individuals, including children. The exposures and concomitant reported health effects covered a wide range of environmental methamphetamine levels in the properties, including low levels close to the current Australian guideline of 0.5 µg methamphetamine/100 cm2. There were no discernible differences between health effects from living in properties contaminated from former manufacture or use. This study demonstrates that residing in these properties can represent a serious public health risk.

An Australian incremental guideline for particulate matter (PM2.5) to assist in development and planning decisions.

OBJECTIVES: Many large-scale developments in Australia, such as road infrastructure, are subject to community concern due to their ongoing emission of particulate matter that may lead to adverse health impacts. The assessment of these impacts is guided by planning and health policies, but these policies have limitations. The objective of this paper is to provide an approach to setting an incremental guideline that can be used by regulators and health professionals to assess the impact of particulate matter from a development on a population, specifically the impact of particulate matter less than or equal to 2.5 micrometres in diameter (PM2.5). Type of program or service: Environmental health policy. METHODS: The calculation of PM2.5 concentrations and life days lost using concentration response functions and life tables. RESULTS: We calculated annual incremental concentrations of PM2.5 for a 1 in 1 000 000 increased risk of mortality, a 1 in 100 000 increased risk of mortality and a 1 in 10 000 increased risk of mortality along with associated life days lost. These values can be used to assess the acceptability of PM2.5 health impacts from a development. LESSONS LEARNT: An incremental annual PM2.5 concentration of up to 0.02 µg/m³ could be considered negligible, while concentrations between 0.02 and 1.7 µg/m³ could be considered acceptable/tolerable, with concentrations greater than 1.7 µg/m³ considered unacceptable.

Household Contamination with Methamphetamine: Knowledge and Uncertainties.

Contamination of residential homes with methamphetamine is an emerging issue of significant concern to public health. Cooking or smoking methamphetamine in a residential property contaminates the house, furnishings and personal possessions within it, with subsequent exposure through ingestion, dermal absorption and/or inhalation causing adverse health effects. Current guidelines identifying levels of methamphetamine contamination that require remediation vary between countries. There is also no international standard protocol for measuring levels of contamination and research has shown that different materials give rise to different recovery rates of methamphetamine. There are a number of currently used remediation methods; however, they have varying levels of success with limited studies comparing their long-term efficacies. Most importantly, there are few guidelines available that are based on a transparent, health risk-based approach, and there are many uncertainties on exposures and health effects, making it difficult to ensure the health of people residing in homes that have been used to cook or smoke methamphetamine are sufficiently protected. This manuscript presents the current state of knowledge regarding the contamination of residential homes with methamphetamine and identifies the current gaps in knowledge and priority areas for future research. The current regulatory approach to public health protection associated with exposure to residential premises contaminated with methamphetamine in Australia, New Zealand and the USA is also discussed.

Contamination of Homes with Methamphetamine: Is Wipe Sampling Adequate to Determine Risk?

Contamination of domestic dwellings from methamphetamine cooking or smoking is an increasing public health problem in many countries. To evaluate the extent of contamination, sampling generally focusses on the collection of surface wipe samples from walls and other surfaces of a potentially contaminated home. Here, we report the contamination levels of many household materials and items sampled from a home that was suspected to be the premises used to cook methamphetamine, it was then sold, lived in for several years by the new owners and then left unattended for several more years. Although the time since the cooking had taken place was significant (over five years), the levels of contamination were extremely high in both household items that were part of the house when cooking was taking place (blinds, carpets, walls, etc.) and also in articles brought to the house post-cooking (rugs, toys, beds, etc.). Both wipe sampling and analysis of bulk samples indicate that the methamphetamine is not breaking down or being removed and is transferred from contaminated to non-contaminated objects. These results raise questions about the adequacy of characterising contamination and of making decisions about the extent of remediation required based solely on surface wipe samples. Without fully understanding the extent of contamination that is present, not only on surfaces but within the building materials, it is difficult to ensure that the correct and most effective remedial approaches are taken to appropriately determine and address the risks to inhabitants.

Oligodendrocyte-encoded Kir4.1 function is required for axonal integrity.

Glial support is critical for normal axon function and can become dysregulated in white matter (WM) disease. In humans, loss-of-function mutations of KCNJ10, which encodes the inward-rectifying potassium channel KIR4.1, causes seizures and progressive neurological decline. We investigated Kir4.1 functions in oligodendrocytes (OLs) during development, adulthood and after WM injury. We observed that Kir4.1 channels localized to perinodal areas and the inner myelin tongue, suggesting roles in juxta-axonal K+ removal. Conditional knockout (cKO) of OL-Kcnj10 resulted in late onset mitochondrial damage and axonal degeneration. This was accompanied by neuronal loss and neuro-axonal dysfunction in adult OL-Kcnj10 cKO mice as shown by delayed visual evoked potentials, inner retinal thinning and progressive motor deficits. Axon pathologies in OL-Kcnj10 cKO were exacerbated after WM injury in the spinal cord. Our findings point towards a critical role of OL-Kir4.1 for long-term maintenance of axonal function and integrity during adulthood and after WM injury.

Adverse Health Effects Associated with Living in a Former Methamphetamine Drug Laboratory - Victoria, Australia, 2015.

The manufacture of methamphetamine in clandestine drug laboratories occurs in various locations, including residential houses and apartments. Unlike the controlled manufacture of chemicals and drugs, clandestine manufacture results in the uncontrolled storage, use, generation, and disposal of a wide range of chemicals and the deposit of methamphetamine drug residues on indoor surfaces (1). These residues have been found at high levels on porous and nonporous surfaces and have been shown to persist for months to years (1). Persons exposed to these environments often have poorly defined exposures and health effects. It is commonly assumed that these levels of exposure are low compared with those related to illicit drug use or therapeutic use of amphetamine-based drugs for managing behavioral issues such as attention deficit hyperactivity disorder (2). In 2015, a family that was unknowingly exposed to methamphetamine residues in a house in Australia was found to have adverse health effects and elevated methamphetamine levels in hair samples, highlighting the potential for public health risks for persons who might live in methamphetamine-contaminated dwellings. This case study highlights the importance of the identification and effective decontamination of former clandestine drug laboratories.

Exposures associated with clandestine methamphetamine drug laboratories in Australia.

The clandestine manufacture of methamphetamine in residential homes may represent significant hazards and exposures not only to those involved in the manufacture of the drugs but also to others living in the home (including children), neighbours and first responders to the premises. These hazards are associated with the nature and improper storage and use of precursor chemicals, intermediate chemicals and wastes, gases and methamphetamine residues generated during manufacture and the drugs themselves. Many of these compounds are persistent and result in exposures inside a home not only during manufacture but after the laboratory has been seized or removed. Hence new occupants of buildings formerly used to manufacture methamphetamine may be unknowingly exposed to these hazards. Children are most susceptible to these hazards and evidence is available in the literature to indicate that these exposures may result in immediate and long-term adverse health effects. The assessment of exposure within the home can be undertaken by measuring contaminant levels or collecting appropriate biological data from individuals exposed. To gain a better understanding of the available data and key issues associated with these approaches to the characterisation of exposure, a review of the published literature has been undertaken.

Direct detection and identification of acid-fast bacteria from smear-positive broth cultures using a pyrosequencing method.

Broth culture is a standard method for detection of acid-fast bacteria (AFB) (e.g., Mycobacterium and Nocardia) from patient specimens. Direct nucleic acid-based identification from smear-positive broths expedites the infectious disease diagnosis. We developed and evaluated the performance of a pyrogram-based technique (direct-broth-pyrosequencing [DBP]) to identify AFB directly from smear-positive broths. One hundred thirteen AFB-positive broths from patient specimens were tested. Bacterial DNA was amplified by polymerase chain reaction and sequenced using the PyroMark ID system. The DBP method correctly identified the AFB species/group in 109 (97%) of the 113 broths, including 15 Mycobacterium species and 4 Nocardia species. Three broths that yielded indeterminate results were found to be AFB-AFB mixed broths and required purified colonies on solid media for definite identification. The 4th broth was repeatedly identified by sequencing to be Mycobacterium intracellulare, even though the organism was not isolated and the AccuProbe was negative. This method did not identify the AFB organisms from broths containing 2 AFB organisms, but did not produce false identification. No cross-reaction was observed when AFB-positive broths were spiked with non-AFB microorganisms, indicating that the DBP method was specific to AFB. The DBP method gives rapid (within 8 h), accurate AFB identification directly from broth cultures and provides another useful AFB identification tool in a clinical laboratory.

Exploring the experiences and expectations of year 1 children's nursing students.

BACKGROUND: Attrition among children's nursing students remains high despite the field of practice attracting large numbers of applicants. While previous studies have examined nursing students as a group, this study specifically examines the children's nursing student experience. AIM: To explore the expectations and early experiences of children's nursing students. METHOD: A phenomenological approach was adopted. Four focus groups were conducted at the beginning and end of the first year of a three-year programme. FINDINGS: The students defined children's nursing by the age and needs of the client group. They had expected practice experience would solely be within the acute setting. The acquisition and confidence in undertaking psychomotor skills was of importance to this group of students. CONCLUSION: The students' unmet expectations may have a negative effect on their experience of the programme and therefore potentially on their decision to continue on the programme.