Functional dependence as a contributing factor for patient hand contamination by multi-drug resistant organisms (MDROs) in acute care.

OBJECTIVE: Patient hands' contribution to disease transmission in healthcare settings is an important, understudied topic. We assessed correlation between patient functional dependence and hand contamination with multi-drug resistant organisms (MDROs) in acute-care settings. DESIGN, SETTING, AND PATIENTS: Secondary, cross-sectional analyses of 399 general medicine patients enrolled in two tertiary-care hospitals over a six-month period. Our predictor was patient functional status evaluated using Katz Activities of Daily Living scale, scored as follows: functionally independent (scored 0), moderately dependent (score 1-3), and severely dependent (score of 4 or more). Our outcome was patient hand contamination with MDROs, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus, and resistant gram-negative bacteria. RESULTS: Of 399 patients, 298 were functionally independent, 45 were moderately dependent, and 56 were severely dependent. Odds of MDRO hand contamination were 2.63 (95% CI, 1.21-5.72) times higher in the severely dependent category compared to the independent category. Patients with feeding dependence had the highest odds of hand contamination with MDROs (OR 4.76, 95% CI, 1.54-14.71), followed by continence, dressing, and toileting. In addition to patient colonization, environmental contamination with MRSA was associated with patient function, with odds 2.60 (95% CI, 1.16-5.82) times higher in severely dependent patients. CONCLUSIONS: Patients with severe functional dependence are more likely to harbor MDROs on their hands and less likely to be able to cleanse them independently. Functionally dependent patients have high room contamination with MDROs. Patient hand hygiene interventions in the hospital should target this high-risk group.

Improving the Detection and Understanding of Infectious Human Norovirus in Food and Water Matrices: A Review of Methods and Emerging Models.

Human norovirus (HuNoV) is a leading global cause of viral gastroenteritis, contributing to numerous outbreaks and illnesses annually. However, conventional cell culture systems cannot support the cultivation of infectious HuNoV, making its detection and study in food and water matrices particularly challenging. Recent advancements in HuNoV research, including the emergence of models such as human intestinal enteroids (HIEs) and zebrafish larvae/embryo, have significantly enhanced our understanding of HuNoV pathogenesis. This review provides an overview of current methods employed for HuNoV detection in food and water, along with their associated limitations. Furthermore, it explores the potential applications of the HIE and zebrafish larvae/embryo models in detecting infectious HuNoV within food and water matrices. Finally, this review also highlights the need for further optimization and exploration of these models and detection methods to improve our understanding of HuNoV and its presence in different matrices, ultimately contributing to improved intervention strategies and public health outcomes.

Tulane Virus Persistence and Microbial Stability in 3D Food Ink under Various Storage Conditions: A Pre- and Post-Printing Analysis.

3D food printers facilitate novel customization of the physicochemical properties of food. This study aimed to investigate the impact of storage conditions on the inactivation of the human norovirus surrogate, Tulane virus (TuV), within 3D printed foods. TuV-inoculated protein cookie food ink (∽ 4 log PFU/g) was distributed into 18 3D food printer capsules (50 g each); half immediately underwent extrusion. Storage of the capsules and printed food products at 20 °C (0, 6, 12, and 24 h), 4 °C (0, 1, 3, and 5d), and - 18 °C (0, 1, 3, and 5d) was completed before analysis for TuV via plaque assays in addition to aerobic plate count, yeast and mold counts, and pH and water activity (aw) measurements. A significant 3-way interaction effect was observed between time, temperature, and storage method (capsule/print) (p = 0.006). Significant findings include: (1) A greater reduction in virions was observed in capsules after 24 h at 20 °C and (2) a substantial reduction in virions at 4 °C from day 0 to day 1 was observed, independent of storage method. Microbial indicators remained steady across temperatures, with storage temperature significantly impacting pH and aw. A significant two-way interaction effect (p = 0.006) was found between microorganism type (yeast/aerobic counts) and temperature. This research seeks to provide insights for the food industry and regulatory bodies in crafting guidelines for the safe storage and handling of 3D printed foods and inks.

Anti-LAMP-2 Antibody Seropositivity in Children with Primary Systemic Vasculitis Affecting Medium- and Large-Sized Vessels.

Chronic primary systemic vasculitis (PSV) comprises a group of heterogeneous diseases that are broadly classified by affected blood vessel size, clinical traits and the presence (or absence) of anti-neutrophil cytoplasmic antibodies (ANCA) against proteinase 3 (PR3) and myeloperoxidase (MPO). In small vessel vasculitis (SVV), ANCA are not present in all patients, and they are rarely detected in patients with vasculitis involving medium (MVV) and large (LVV) blood vessels. Some studies have demonstrated that lysosome-associated membrane protein-2 (LAMP-2/CD107b) is a target of ANCA in SVV, but its presence and prognostic value in childhood MVV and LVV is not known. This study utilized retrospective sera and clinical data obtained from 90 children and adolescents with chronic PSV affecting small (SVV, n = 53), medium (MVV, n = 16), and large (LVV, n = 21) blood vessels. LAMP-2-ANCA were measured in time-of-diagnosis sera using a custom electrochemiluminescence assay. The threshold for seropositivity was established in a comparator cohort of patients with systemic autoinflammatory disease. The proportion of LAMP-2-ANCA-seropositive individuals and sera concentrations of LAMP-2-ANCA were assessed for associations with overall and organ-specific disease activity at diagnosis and one-year follow up. This study demonstrated a greater time-of-diagnosis prevalence and sera concentration of LAMP-2-ANCA in MVV (52.9% seropositive) and LVV (76.2%) compared to SVV (45.3%). Further, LAMP-2-ANCA-seropositive individuals had significantly lower overall, but not organ-specific, disease activity at diagnosis. This did not, however, result in a greater reduction in disease activity or the likelihood of achieving inactive disease one-year after diagnosis. The results of this study demonstrate particularly high prevalence and concentration of LAMP-2-ANCA in chronic PSV that affects large blood vessels and is seronegative for traditional ANCA. Our findings invite reconsideration of roles for autoantigens other than MPO and PR3 in pediatric vasculitis, particularly in medium- and large-sized blood vessels.

Hydroponic Nutrient Solution Temperature Impacts Tulane Virus Persistence over Time.

Controlled environment agriculture (CEA), or indoor agriculture, encompasses non-traditional farming methods that occur inside climate-controlled structures (e.g., greenhouses, warehouses, high tunnels) allowing for year-round production of fresh produce such as leaf lettuce. However, recent outbreaks and recalls associated with hydroponically grown lettuce contaminated with human pathogens have raised concerns. Few studies exist on the food safety risks during hydroponic cultivation of leaf lettuce; thus, it is important to identify contributing risk factors and potential mitigation strategies to prevent foodborne transmission via hydroponically grown produce. In this study, the concentration of infectious Tulane virus (TV), a human norovirus surrogate, in hydroponic nutrient solution at 15 °C, 25 °C, 30 °C, and 37 °C was determined over a duration of 21 days to mimic the time from seedling to mature lettuce. The mean log PFU reduction for TV was 0.86, 1.80, 2.87, and ≥ 3.77 log10 at 15 °C, 25 °C, 30 °C, and 37 °C, respectively, at the end of the 21-day period. Similarly, average decimal reduction values (D-values) of TV at 15 °C, 25 °C, 30 °C, and 37 °C were 48.0, 11.3, 8.57, and 7.02 days, respectively. This study aids in the (i) identification of possible food safety risks associated with hydroponic systems specifically related to nutrient solution temperature and (ii) generation of data to perform risk assessments within CEA leaf lettuce operations to inform risk management strategies for the reduction of foodborne outbreaks, fresh produce recalls, and economic losses.

Does high school health education class satisfaction influence student perceptions of public health and pandemic response?

BACKGROUND: The COVID-19 pandemic significantly affected high school students. Little is known about the mediators of student perceptions of infection prevention and public health entities. We piloted a survey to evaluate the relationship between student perceptions of COVID-19 topics and satisfaction with their most recent health class. METHODS: Students from one private high school in southeast Michigan completed a survey in early 2022. The primary outcomes were 4 domains: vaccination knowledge, intervention effectiveness, intervention impact, and willingness to readopt an intervention. We assessed the associations between health class satisfaction and these outcomes using multiple linear regression. RESULTS: One-hundred ninety students reported their health class satisfaction and were eligible for analysis. Students reported high confidence in vaccines (93%) but limited knowledge of COVID-19 vaccination (45%). Students perceived COVID-19 interventions as highly effective (range, 72% [hand hygiene]-93% [vaccination]) and reported a willingness to readopt them (range, 73% [stay-at-home orders]-96% [vaccination]). Health class satisfaction (54%) was positively associated with composite scores on vaccination knowledge and intervention effectiveness. DISCUSSION: Assessing students' intrapandemic perspectives on infection prevention illuminated areas of strength (ie, intervention confidence) and areas for improvement (ie, intervention knowledge and institutional confidence). CONCLUSIONS: Students reported favorable perceptions regarding common infection prevention interventions. Future work should investigate the role of educational satisfaction in mediating confidence in public health interventions and institutions.

From bytes to bites: Advancing the food industry with three-dimensional food printing.

The rapid advancement of three-dimensional (3D) printing (i.e., a type of additive manufacturing) technology has brought about significant advances in various industries, including the food industry. Among its many potential benefits, 3D food printing offers a promising solution to deliver products meeting the unique nutritional needs of diverse populations while also promoting sustainability within the food system. However, this is an emerging field, and there are several aspects to consider when planning for use of 3D food printing for large-scale food production. This comprehensive review explores the importance of food safety when using 3D printing to produce food products, including pathogens of concern, machine hygiene, and cleanability, as well as the role of macronutrients and storage conditions in microbial risks. Furthermore, postprocessing factors such as packaging, transportation, and dispensing of 3D-printed foods are discussed. Finally, this review delves into barriers of implementation of 3D food printers and presents both the limitations and opportunities of 3D food printing technology.

Post-acute sequelae of SARS-CoV-2 (PASC) in nursing home residents: A retrospective cohort study.

BACKGROUND: Post-acute sequelae of SARS-CoV-2 (PASC) describes a syndrome of physical and cognitive decline that persists after acute symptoms of infection resolve. Few studies have explored PASC among nursing home (NH) residents. METHODS: A retrospective cohort study was conducted at two NHs in Michigan. COVID-positive patients were identified from March 21, 2020 to October 26, 2021. The comparison group were patients who lived at the same NH but who were never infected during the study period. Minimum Data Set was used to examine trajectories of functional dependence (Activity of Daily Living [ADL] composite score) and cognitive function (Brief Interview for Mental Status [BIMS]). Linear mixed-effects models were constructed to estimate short-term change in function and cognition immediately following diagnosis and over time for an additional 12 months, compared to pre-COVID and non-COVID trajectories and adjusting for sex, age, and dementia status. RESULTS: We identified 171 residents (90 COVID-19 positive, 81 non-COVID) with 719 observations for our analyses. Cohort characteristics included: 108 (63%) ≥ 80 yrs.; 121 (71%) female; 160 (94%) non-Hispanic white; median of 3 comorbidities (IQR 2-4), with no significant differences in characteristics between groups. COVID-19 infection affected the trajectory of ADL recovery for the first 9 months following infection, characterized by an immediate post-infection decrease in functional status post-infection (-0.60 points, p = 0.002) followed by improvement toward the expected functional trajectory sans infection (0.04 points per month following infection, p = 0.271). CONCLUSIONS: NH residents experienced a significant functional decline that persisted for 9 months following acute infection. Further research is needed to determine whether increased rehabilitation services after COVID-19 may help mitigate this decline.

A comprehensive examination of microbial hazards and risks during indoor soilless leafy green production.

Produce grown under controlled environment agriculture (CEA) is often assumed to have a reduced risk of pathogen contamination due to the low chance of exposure to outdoor contaminant factors. However, the 2021 outbreak and numerous recalls of CEA-grown lettuce and microgreens demonstrate the possibility of pathogen introduction during indoor production when there is a failure in the implementation of food safety management systems. Indoor production of commercial leafy greens, such as lettuce and microgreens, is performed across a range of protective structures from primitive household setups to advanced and partially automatized growing systems. Indoor production systems include hydroponic, aquaponic, and aeroponic configurations. Hydroponic systems such as deep water culture and nutrient film technique comprised of various engineering designs represent the main system types used by growers. Depending on the type of leafy green, the soilless substrate, and system selection, risk of microbial contamination will vary during indoor production. In this literature review, science-based pathogen contamination risks and mitigation strategies for indoor production of microgreens and more mature leafy greens are discussed during both pre-harvest and post-harvest stages of production.

Association of patient clinical and gut microbiota features with vancomycin-resistant enterococci environmental contamination in nursing homes: a retrospective observational study.

BACKGROUND: Preventing transmission is crucial for reducing infections with multidrug-resistant organisms (MDROs) in nursing homes. To identify resident characteristics associated with MDRO spread, we investigated associations between patient characteristics and contamination of their proximate room surfaces with vancomycin-resistant enterococci (VRE). METHODS: In this retrospective observational study, we used demographic and clinical data (including data on comorbidities, physical independence, catheter use within the past 30 days, and antibiotic exposure within the past 30 days) and surveillance cultures of patient body sites and room surfaces at enrolment and during weekly follow-up visits within the first month, and monthly thereafter (up to 6 months), in six US nursing homes collected in a previous clinical trial (September, 2016, to August, 2018). We did 16S rRNA gene sequencing on perirectal surveillance swabs to investigate the association between the gut microbiota and the culture status of participants and their rooms. FINDINGS: We included 245 participants (mean age 72·5 years [SD 13·6]; 111 [45%] were men, 134 [55%] were women, 132 [54%] were non-Hispanic white, and 112 [46%] were African American). We collected 2802 participant samples and 5592 environmental samples. At baseline, VRE colonisation was present in 49 (20%) participants, with environmental surfaces being contaminated in 36 (73%) of these patients. Hand contamination among VRE-colonised participants was more common in those with environmental contamination compared with those without (50 [51%] of 99 vs seven [13%] of 55; p<0·0001). We found a correlation between hand contamination and both groin and perirectal colonisation and contamination of various high-touch room surfaces (Cohen's κ 0·43). We found participant microbiota composition to be associated with antibiotic receipt within the past 30 days (high-risk antibiotics p=0·011 and low-risk antibiotics p=0·0004) and participant VRE colonisation status, but not environmental contamination among VRE-colonised participants (participant only vs uncolonised p=0·071, both participant and environment vs uncolonised p=0·025, and participant only vs participant and environment p=0·29). Multivariable analysis to identify independent factors associated with VRE-colonised participants contaminating their environment identified antibiotic exposure (adjusted odds ratio 2·75 [95% CI 1·22-6·16]) and male sex (2·75 [1·24-6·08]) as being associated with increased risk of environmental contamination, and physical dependence as being associated with a reduced risk of environmental contamination (0·91 [0·83-0·99]). INTERPRETATION: Our data support antibiotic use and interaction with proximal surfaces by physically independent nursing home residents as under-appreciated drivers of environmental contamination among VRE-colonised residents. Integrating resident hand-hygiene education and antimicrobial stewardship will strengthen efforts to reduce MDROs in nursing homes. FUNDING: US Centers for Disease Control and Prevention, National Institute of Health, Canadian Institutes of Health Research, and University of Michigan.

Cultivating Food Safety Together: Insights About the Future of Produce Safety in the U.S. Controlled Environment Agriculture Sector.

Controlled environment agriculture (CEA) is a rapidly growing sector that presents unique challenges and opportunities in ensuring food safety. This manuscript highlights critical gaps and needs to promote food safety in CEA systems as identified by stakeholders (n=47) at the Strategizing to Advance Future Extension andResearch (S.A.F.E.R.) CEA conference held in April 2023 at The Ohio State University's Ohio CEA Research Center. Feedback collected at the conference was analyzed using an emergent thematic analysis approach to determine key areas of focus. Research-based guidance is specific to the type of commodity, production system type, and size. Themes include the need for improved supply chain control, cleaning, and sanitization practices, pathogen preventive controls and mitigation methods and training and education. Discussions surrounding supply chain control underscored the significance of the need for approaches to mitigate foodborne pathogen contamination. Effective cleaning and sanitization practices are vital to maintaining a safe production environment, with considerations such as establishing standard operating procedures, accounting for hygienic equipment design, and managing the microbial communities within the system. Data analysis further highlights the need for risk assessments, validated pathogen detection methods, and evidence-based guidance in microbial reduction. In addition, training and education were identified as crucial in promoting a culture of food safety within CEA. The development of partnerships between industry, regulatory, and research institutions are needed to advance data-driven guidance and practices across the diverse range of CEA operations and deemed essential for addressing challenges and advancing food safety practices in CEA. Considering these factors, the CEA industry can enhance food safety practices, foster consumer trust, and support its long-term sustainability.

Aqueous Ozone Efficacy for Inactivation of Foodborne Pathogens on Vegetables Used in Raw Meat-Based Diets for Companion Animals.

The present study evaluates the efficacy of a batch wash ozone sanitation system (BWOSS) and spray wash ozone sanitation system (SWOSS) against Listeria monocytogenes (two strains) and Salmonella enterica subsp. enterica (three serovars) inoculated on the surface of carrots, sweet potatoes, and butternut squash, commonly used in raw meat-based diets (RMBDs) marketed for companion animals such as dogs and cats. Produce either remained at room temperature for 2 h or were frozen at -20°C and then tempered overnight at 4°C to mimic the preprocessing steps of a raw pet food processing operation ('freeze-temper') prior to ozone treatment. Two ozone concentrations (0 and 5 ppm) were applied for either 20 s or 60 s for BWOSS and 20 s for SWOSS. Based on an ANOVA, BWOSS data showed no significant difference (P > 0.05) in microbial reduction between 0 and 5 ppm ozone concentration across all treatment durations for each produce type. BWOSS resulted in mean microbial reductions of up to 1.56 log CFU/mL depending on the treatment time and produce type. SWOSS data were analyzed using a generalized linear model with Quasipoisson errors. Freeze-tempered produce treated with SWOSS had a higher bacterial log reduction at 5 ppm ozone compared to 0 ppm ozone (P = 0.0013) whereas room temperature produce treated with SWOSS did not show any significant difference in microbial reduction between ozone concentrations. The potential to mitigate microbial cross-contamination was also investigated during SWOSS treatment. The results indicate that 5 ppm ozone decreased pathogens in the rinsate and proximal surfaces by 0.63-1.66 log CFU/mL greater than no ozone depending on the pathogen and sample. Overall, data from this study indicate that SWOSS would be more effective compared to BWOSS in reducing the microbial load present on the surface of root tubers and squash subjected to freezing and thawing and has the potential to mitigate cross-contamination within RMDB manufacturing environments.

Growing Safer Greens: Exploring Food Safety Practices and Challenges in Indoor, Soilless Production Through Thematic Analysis of Leafy Greens Grower Interviews.

Indoor, soilless production-often referred to more broadly as controlled environment agriculture (CEA)-is increasingly used for the cultivation of leafy greens. Minimal information is currently available regarding food safety practices during production and distribution of leafy greens grown within indoor, soilless environments in the United States (U.S.). This study aimed to describe production challenges and implementation of good agricultural practices among CEA growers. Data collection methods included semi-structured interviews (N = 25) and a supplemental online survey completed by growers (N = 12) in the U.S. Out of 18 total responses (i.e., multiple responses allowed per completed survey), survey data indicated that lettuce (n = 5; 27.8%) was the most commonly grown leafy green, followed by culinary herbs (n = 3; 16.7%) and arugula (n = 3; 16.7%). Most growers (n = 7; 58.3%) grew other agricultural products, specifically other crops in addition to leafy greens. Revenue from sales ranged from US$500 000 per year. Meanwhile, nearly half (n = 5; 45.5%) of respondents (N = 11) were uncertain whether their produce was subject to the FSMA Produce Safety Rule. Most survey respondents used vertical farming techniques (5 out of 11; 45.5%) or some variety of greenhouse (4 out of 11; 36.4%). Based on 35 total responses, leafy greens were most commonly sold to "Commercial Restaurants" (n = 7; 20.0%), "Grocery Stores" (n = 7; 20.0%), "Institutional Foodservice Establishments (hospitals, schools, childcare, long-term care)" (n = 6; 17.1%), and "Wholesaler/Distributers" (n = 6; 17.1%). The 11 interview questions elucidated three major themes: contextual, barriers to risk management and regulatory compliance, and research needs. Thirteen subthemes were identified, and an example of a subtheme within each major theme, respectively, includes worker hygiene and training, regulatory and certification environment, and risk assessments of individual issues.

Persistence of Salmonella enterica subsp. enterica ser. Javiana, Listeria monocytogenes, and Listeria innocua in Hydroponic Nutrient Solution.

This study aimed to determine the persistence of Salmonella Javiana, Listeria monocytogenes, and Listeria innocua in nonsterile, hydroponic nutrient solution (NS) at 15, 25, 30, and 37°C over a 21-day period to mimic time from seedling to mature lettuce. Bacteria were inoculated in modified Hoagland's NS at 106 CFU/mL and maintained at 15, 25, 30, and 37°C. Samples were collected at various time points, and bacteria were quantified. A mixed model was used to determine the effect of bacteria type, time (day), and temperature on bacteria concentration (log CFU/mL). The least-squares means were calculated to compare the mean log CFU/mL, and the mean values were compared with Tukey-Kramer honest significant difference test with a significance level of P = 0.05. Statistical analysis indicated that a 3-way interaction effect between temperature, time, and bacteria type had a significant impact on bacterial persistence in NS (P < 0.0001). At all temperatures, S. Javiana persisted in NS throughout the 21-day study period, compared to L. innocua and L. monocytogenes where persistence was limited to between 1 and 14 days. Similarly, decimal reduction values (D-values) of S. Javiana indicated longer persistence in NS than L. innocua and L. monocytogenes at most temperatures. For instance, at 15°C and 25°C, D-values for S. Javiana were estimated at 82 and 26 d, respectively, compared to D-values of 3.6 and ∼3 d for L. monocytogenes. Data indicate that the temperature of NS has a differential effect on the persistence of S. Javiana and Listeria spp. This study furthers the understanding of potential food safety risks associated with hydroponic systems and will contribute to the refinement of further studies to aid in the development of operation-specific risk profiles.

Transfer rates of Salmonella Typhimurium, Listeria monocytogenes, and a human norovirus surrogate impacted by macronutrient composition of food inks in 3D food printing systems.

3D food printers (3DFPs) allow for the customization of the physiochemical properties of foods in new ways. Transfer kinetics of foodborne pathogens between surfaces and food inks have not been evaluated in 3DFPs. This study aimed to determine if the macromolecular composition of food inks would impact the transfer rate of foodborne pathogens from the stainless steel food ink capsule to the 3D printed food. Salmonella Typhimurium, Listeria monocytogenes, and a human norovirus surrogate, Tulane virus (TuV), were inoculated onto the interior surface of stainless steel food ink capsules and dried for 30 min. Subsequently, 100 g of one of the following prepared food inks was extruded: (1) pure butter, (2) a powdered sugar solution, (3) a protein powder solution, and (4) a 1:1:1 ratio of all three macromolecules. Pathogen enumeration was completed for both the soiled capsules and the printed food products and resulting transfer rates were estimated using a generalized linear model with quasibinomial errors. A significant two-way interaction effect was found between microorganism type and food ink type (P = 0.0002). Tulane virus was typically transferred the most, and no significant differences between L. monocytogenes and S. Typhimurium were observed for any food matrix or across food matrices. Among food matrices, the complex mixture transferred fewer microorganisms in all instances, while butter, protein, and sugar were all statistically indistinguishable. This research seeks to further develop the field of 3DFP safety and to advance the understanding of the role of macromolecular composition in pathogen transfer kinetics, which have not previously been explored in pure matrices.

Efficacy of Manufacturer Recommendations for the Control of Salmonella Typhimurium and Listeria monocytogenes in Food Ink Capsules Utilized in 3D Food Printing Systems.

The adoption of 3D food printing systems has allowed for the personalization of food properties such as color, shape, and texture. This study aimed to determine if manufacturer cleaning recommendations for stainless steel food ink capsules utilized in 3D food printers adequately control foodborne pathogens of concern, as the recommendations have not been tested. A cocktail of ∼9 log10 CFU/mL each of Salmonella Typhimurium and Listeria monocytogenes was inoculated onto the interior surface of the capsules. Capsules were either unsoiled or soiled with one of the following: butter, protein powder solution, powdered sugar solution, or a mixture containing all three food components. The prepared capsules underwent one of three hygienic protocols: manual washing (MW), a dishwasher speed cycle (DSC), or a dishwasher heavy cycle (DHC). The interaction effect between DSC and the soil mixture was significant (P = 0.01), with the combination achieving an estimated mean log reduction of 5.28 (95% CI: 4.61, 6.05) for L. monocytogenes and 6.69 (95% CI: 6.03, 7.41) for S. Typhimurium. The DSC was the least effective method of cleaning when compared with MW and the DHC. No significant differences were found by placing capsules on the right or left side of the dishwasher (P > 0.1). The interaction effect between wash type and capsule position was significant (P = 0.0007), with the soil mixture and DSC combination achieving an estimated mean log reduction of 3.48 (95% CI: 2.72, 4.45) for the front-most position versus 7.92 (95% CI: 6.72, 9.31) for the back-most position. Soil matrix, cleaning protocol, and capsule position all significantly impact capsule cleanability and therefore food safety risk. The DHC is recommended, and the corners should be avoided during dishwasher loading. The current study provides practical information for consumers, restaurants, industry, and regulatory industries regarding the best practices for cleaning 3D food printers.

Evaluating the Alignment and Quality of Microgreens Training Materials Available on the Internet: A Content Analysis.

Interest in microgreens, young, edible seedlings of a variety of vegetables, spices, and herbs, is growing worldwide. A recent national survey of the U.S. microgreen industry reported 48% of 176 growers learned to grow microgreens by viewing websites and videos on the internet. However, it is unknown if the content related to growing microgreens is aligned with regulations and clearly presented. The aim of this research was to conduct a content analysis to determine alignment with the Food Safety and Modernization Act Produce Safety Rule (PSR)and the presentation quality of existing microgreen training materials available on the internet. Microgreen training materials were collected using two search engines - Google and YouTube. A deductive approach was used to inform the development of three coding manuals to evaluate the training materials meeting the eligibility criteria. One was used to determine the alignment of the content and was based on the PSR. The other two manuals were used to determine the presentation quality of Google and YouTube training materials according to CDC's Quality E-learning Checklist. A total of 223 training materials (86 Google and 137 YouTube), which fulfilled the inclusion criteria, were selected for the analysis. The results of the alignment with the PSR revealed that both sources minimally covered food safety principles with several areas minimally or not addressing specific information (e.g., water testing, worker training, environmental monitoring, and record keeping). In addition, some food safety information was unclear or presented conflicting information (e.g., requirement of washing microgreens, cleaning and sanitization methods, seed treatment methods, and waste management). The Google and YouTube quality scoring systems resulted in a mean quality score of 15.81 and 22 of a maximum score of 28, respectively. These findings indicate the quality and alignment with the PSR of microgreen training materials need to be improved.

Surface Inactivation of a SARS-CoV-2 Surrogate with Hypochlorous Acid is Impacted by Surface Type, Contact Time, Inoculum Matrix, and Concentration.

Indirect contact with contaminated surfaces is a potential transmission route for COVID-19. Therefore, it is necessary to investigate convenient and inexpensive surface sanitization methods, such as HOCl, against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The SARS-CoV-2 surrogate, Phi6 (~ 7 log PFU/mL), was prepared in artificial saliva and tripartite matrices, spot inoculated on coupons of either stainless steel or vinyl, and allowed to dry. The coupons were sprayed with either 500 ppm or 1000 ppm HOCl, and remained on the surface for 0 s (control), 5 s, 30 s, or 60 s. Samples were enumerated via the double agar overlay assay. Statistical analysis was completed in R using a generalized linear model with Quasipoisson error approximations. Time, concentration, surface type, and inoculum matrix were all significant contributors to log reduction at P = 0.05. Significant three-way interactions were observed for 1000 ppm, vinyl, and 60 s (P = 0.03) and 1000 ppm, tripartite, and 60 s (P = 0.0121). A significant two-way interaction between vinyl and 60 s was also observed (P = 0.0168). Overall, increased HOCl concentration and exposure time led to increased Phi6 reduction. Notably, the highest estimated mean log reduction was 3.31 (95% CI 3.14, 3.49) for stainless steel at 60 s and 1000 ppm HOCl in artificial saliva, indicating that this method of sanitization may not adequately reduce enveloped viruses to below infective thresholds.

Performance of Manufacturer Cleaning Recommendations Applied to 3D Food Ink Capsules for the Control of a Human Norovirus Surrogate.

With the widespread availability of 3D food printing systems for purchase, users can customize their food in new ways. Manufacturer recommendations for cleaning these machines remain untested with regard to the prevention of foodborne pathogen transmission. This study aimed to determine if manufacturer cleaning recommendations for food ink capsules utilized in 3D food printers are adequate to control human norovirus (HuNoV). A HuNoV surrogate, Tulane virus (TuV; ~ 6 log10 PFU/mL), was inoculated onto the interior surface of stainless steel food ink capsules. Capsules were either unsoiled or soiled with one of the following: butter, protein powder solution, powdered sugar solution, or a mixture containing all three food components. The capsules were allowed to dry and then one of three hygienic protocols was applied: manual washing (MW), a dishwasher speed cycle (DSC), or a dishwasher heavy cycle (DHC). The interaction effect between DSC and pure butter was a significant predictor of log reduction (P = 0.0067), with the pure butter and DSC combination achieving an estimated mean log reduction of 4.83 (95% CI 4.13, 5.59). The DSC was the least effective method of cleaning when compared with MW and the DHC. The 3-way interaction effects between wash type, soil, and capsule position were a significant predictor of log reduction (P = 0.00341). Capsules with butter in the DSC achieved an estimated mean log reduction of 2.81 (95% CI 2.80, 2.83) for the front-most position versus 6.35 (95% CI 6.33, 6.37) for the back-most position. Soil matrix, cleaning protocol, and capsule position all significantly impact capsule cleanability and potential food safety risk. The DHC is recommended for all capsules, and the corners should be avoided when placing capsules into the dishwasher. The current study seeks to provide recommendations for users of additive manufacturing and 3D food printing including consumers, restaurants, industry, and regulatory industries.

Association Between HLA-DPB1 and Antineutrophil Cytoplasmic Antibody-Associated Vasculitis in Children.

OBJECTIVE: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare, life-threatening inflammation of blood vessels that can affect both adults and children. Compared to adult-onset disease, AAV is especially rare in children, with an annual prevalence of 0.5-6.4 cases per million children. The etiology of AAV remains largely unknown, and both environmental and genetic factors are likely involved. The present study was undertaken to explore the genetic susceptibility factors recently identified in adult patients, including HLA-DP and HLA-DQ, in pediatric patients. METHODS: We performed a genome-wide association study of pediatric AAV in patients of European ancestry (n = 63 AAV cases, n = 315 population-matched controls). RESULTS: We identified a significant genetic association between pediatric AAV and the HLA-DPB1*04:01 allele (P = 1.5 × 10-8 , odds ratio [OR] 3.5), with a stronger association observed in children with proteinase 3-ANCA positivity than in children with myeloperoxidase-ANCA positivity. Among the HLA alleles, the HLA-DPB1*04:01 allele was the most highly associated with AAV, although not significantly, in a follow-up adult AAV cohort (P = 2.6 × 10-4 , OR 0.4). T cell receptor and interferon signaling pathways were also shown to be enriched in the pediatric AAV cohort. CONCLUSION: The HLA-DPB1 locus showed an association with pediatric AAV, as similarly shown previously in adult AAV. Despite the difference in the age of onset, these findings suggest that childhood- and adult-onset vasculitis share a common genetic predisposition. The identification of genetic variants contributing to AAV is an important step to improved classification tools and treatment strategies.