Plants release, pathogens decease: Plants with documented antimicrobial activity are associated with Campylobacter and faecal indicator attenuation in stormwater biofilters

Stormwater biofilters demonstrate promising treatment of faecal microorganisms, however performance can vary with design and operational conditions. This study investigated whether plants with significant documented antimicrobial activity could improve faecal bacterial treatment within biofilters. Laboratory-scale biofilters (n = 30) were dosed with synthetic stormwater containing faecal bacteria Escherichia coli, Enterococcus faecalis and Campylobacter jejuni under south-eastern Australian climatic conditions. Systems vegetated with Melaleuca species, renowned for their in vitro antimicrobial activity, consistently enhanced removal of all tested culturable bacteria in total outflow and submerged zone water relative to other plant configurations. Within just 1-2 days of stormwater dosing, M. linariifolia submerged zones demonstrated significantly reduced bacterial concentrations compared to C. appressa (p = 0.023 and <0.001 for C. jejuni and E. coli, respectively), removing ∼1.47 log10 MPN/100 mL E. coli, ∼1.14 log10 MPN/100 mL E. faecalis and ∼0.81 log10 MPN/L C. jejuni from inflow. These trends continued even after all but one M. linariifolia replicate perished during an extended drying period (p = 0.002 and 0.003 for C. jejuni and E. coli, respectively). Through a systematic process of elimination, these observations were attributed to enhanced bacterial attenuation with elevated plant inhibitory activity. Cumulative biofilter age reinforced plant-mediated bacterial treatment (p = 0.023 for E. faecalis), ostensibly due to increased plant size/growth and net biological activity. Notably, E. coli and E. faecalis attenuation improved with prolonged antecedent drying length (14 vs. 4 days; p < 0.0001 for both), while the converse was observed for C. jejuni (not significant). This study addresses significant knowledge gaps around plant-mediated faecal microbe treatment within biofilters, providing key direction for real-world system design to optimise stormwater pathogen treatment.

The Impact of a 24-h Low and High Fermentable Oligo- Di- Mono-Saccharides and Polyol (FODMAP) Diet on Plasma Bacterial Profile in Response to Exertional-Heat Stress

Exertional-heat stress (EHS) compromises intestinal epithelial integrity, potentially leading to the translocation of pathogenic agents into circulation. This study aimed to explore the impact of EHS on the systemic circulatory bacterial profile and to determine the impact of a short-term low (LFOD) and high (HFOD) fermentable oligo- di- mono-saccharide and polyol dietary intervention before EHS on this profile. Using a double-blind randomized cross-over design, thirteen endurance runners (n = 8 males, n = 5 females), with a history of exercise-associated gastrointestinal symptoms (Ex-GIS), consumed a 24 h LFOD and HFOD before 2 h running at 60% V.O2max in 35.6 °C. Blood and fecal samples were collected pre-EHS to determine plasma microbial DNA concentration, and sample bacteria and short chain fatty acid (SCFA) profiles by fluorometer quantification, 16S rRNA amplicon gene sequencing, and gas chromatography, respectively. Blood samples were also collected post-EHS to determine changes in plasma bacteria. EHS increased plasma microbial DNA similarly in both FODMAP trials (0.019 ng·μL-1 to 0.082 ng·μL-1) (p < 0.01). Similar pre- to post-EHS increases in plasma Proteobacteria (+1.6%) and Firmicutes (+0.6%) phyla relative abundance were observed in both FODMAP trials. This included increases in several Proteobacteria genus (Delftia and Serratia) groups. LFOD presented higher fecal Firmicutes (74%) and lower Bacteroidota (10%) relative abundance pre-EHS, as a result of an increase in Ruminococcaceae and Lachnospiraceae family and respective genus groups, compared with HFOD (64% and 25%, respectively). Pre-EHS plasma total SCFA (p = 0.040) and acetate (p = 0.036) concentrations were higher for HFOD (188 and 178 μmol·L-1, respectively) vs. LFOD (163 and 153 μmol·L-1, respectively). Pre-EHS total fecal SCFA concentration (119 and 74 μmol·g-1; p < 0.001), including acetate (74 and 45 μmol·g-1; p = 0.001), butyrate (22 and 13 μmol·g-1; p = 0.002), and propionate (20 and 13 μmol·g-1; p = 0.011), were higher on HFOD vs LFOD, respectively. EHS causes the translocation of whole bacteria into systemic circulation and alterations to the plasma bacterial profile, but the FODMAP content of a 24 h diet beforehand does not alter this outcome.

Reliability of pathophysiological markers reflective of exercise-induced gastrointestinal syndrome (EIGS) in response to 2-h high-intensity interval exercise: A comprehensive methodological efficacy exploration

The study aimed to determine the test-retest reliability of exercise-induced gastrointestinal syndrome (EIGS) biomarkers, and assess the association of pre-exercise short chain fatty acid (SCFA) concentration with these biomarkers in response to prolonged strenuous exercise. Thirty-four participants completed 2 h of high-intensity interval training (HIIT) on two separate occasions with at least 5-days washout. Blood samples were collected pre- and post-exercise, and analysed for biomarkers associated with EIGS [i.e., cortisol, intestinal fatty-acid binding protein (I-FABP), sCD14, lipopolysaccharide binding protein (LBP), leukocyte counts, in-vitro neutrophil function, and systemic inflammatory cytokine profile]. Fecal samples were collected pre-exercise on both occasions. In plasma and fecal samples, bacterial DNA concentration was determined by fluorometer quantification, microbial taxonomy by 16S rRNA amplicon sequencing, and SCFA concentration by gas-chromatography. In response to exercise, 2 h of HIIT modestly perturbed biomarkers indicative of EIGS, including inducing bacteremia (i.e., quantity and diversity). Reliability analysis using comparative tests, Cohen's d, two-tailed correlation, and intraclass correlation coefficient (ICC) of resting biomarkers presented good-to-excellent for IL-1ra (r = 0.710, ICC = 0.92), IL-10 (r = 0.665, ICC = 0.73), cortisol (r = 0.870, ICC = 0.87), and LBP (r = 0.813, ICC = 0.76); moderate for total (r = 0.839, ICC = 0.44) and per cell (r = 0.749, ICC = 0.54) bacterially-stimulated elastase release, IL-1β (r = 0.625, ICC = 0.64), TNF-α (r = 0.523, ICC = 0.56), I-FABP (r = 0.411, ICC = 0.21), and sCD14 (r = 0.409, ICC = 0.38), plus fecal bacterial α-diversity; and poor for leukocyte (r = 0.327, ICC = 0.33) and neutrophil (r = 0.352, ICC = 0.32) counts. In addition, a medium negative correlation was observed between plasma butyrate and I-FABP (r = -0.390). The current data suggest a suite of biomarkers should be used to determine the incidence and severity of EIGS. Moreover, determination of plasma and/or fecal SCFA may provide some insight into the mechanistic aspects of EIGS instigation and magnitude in response to exercise.

Coronal STIR MRI sequences in unexplained limping in children under 6 years old: A single-center retrospective study of 130 cases

INTRODUCTION

Limping is a common presenting symptom in young children. Clinical examination backed up by laboratory analysis, standard radiography, and/or ultrasound may fail to determine the diagnosis, and limping may prove persistent, requiring repeated consultation. Magnetic resonance imaging (MRI) can suggest the etiology or provide welcome reassurance when normal. We advocate the use of MRI in cases of persistent unexplained limping in young children. The study hypothesis was that coronal short TI inversion recovery (STIR) MRI has good negative predictive value (NPV) in unexplained limping in children under 6 years of age.

MATERIAL AND METHOD

Coronal STIR MRI sequences were analyzed in 130 children younger than 6 years (84 boys, 46 girls) during the period April 2007 to May 2017. They extended from the lower thoracic spine down to the feet. Agreement was analyzed between the radiologist's initially suggested diagnosis and the pediatric orthopedic specialist's final diagnosis.

RESULTS

Overall, 49 scans were normal (37.7%) and 81 abnormal (62.3%). The mean age at MRI was 32.3 months. Coronal STIR MRI had 98% NPV. There was 99.2% agreement between the radiologist's diagnosis and the final diagnosis.

DISCUSSION

The recently reported contribution of STIR MRI in bone and joint infections was extended to unexplained limping.

CONCLUSION

First-line MRI with coronal STIR sequences improved the diagnostic efficacy, thanks to its speed and relative lack of movement artifacts.

Riparian buffers: Disrupting the transport of E. coli from rural catchments to streams

High levels of E. coli and associated faecal microbes in waterways as a result of agricultural and residential land use can pose environmental, human health, and economic risks. This study aims to understand the impacts of land use, climatic variables, and riparian buffers on in-stream E. coli concentrations. Flow, temperature, and E. coli were monitored during three sampling campaigns within eleven independent catchments. These catchments have varying land use and extents of riparian buffer coverage. Results showed that catchments with predominantly agricultural and residential land uses (average = 349.7 MPN/100 mL) had higher E. coli concentrations than predominantly forested catchments (average = 111.8 MPN/100 mL). However, there were no statistically significant differences in E. coli concentrations between the agricultural and residential land uses. Riparian buffers appear to reduce E. coli concentrations in streams, as indicated by significant negative correlations between in-stream E. coli concentrations with the riparian buffer areal coverage (Pearson's r = -0.95, Spearman's ρ = -0.90) and the ratio of buffer length to stream length (Pearson's r = -0.87, Spearman's ρ = -0.90). We find that riparian buffers potentially disrupt transport pathways that govern E. coli movement, which in-turn can affect the concentration-discharge relationship. This reinforces the importance of protecting and restoring riparian buffers along drainage lines in agricultural and rural-residential catchments to improve downstream microbial water quality.

Plants against pathogens: Effect of significant antimicrobial-producing plants on faecal microbe inactivation throughout the soil profile of stormwater biofilters

Stormwater biofilters have demonstrated promising yet variable removal of faecal microorganisms. Significant antimicrobial-producing plants have been proposed as an inexpensive, safe and easily adaptable component of biofilter design to enhance faecal pathogen treatment. The aim of the present study was to investigate whether significant antimicrobial-producing plants improved faecal bacterial inactivation throughout the biofilter soil profile, focusing on four key treatment zones. These were specifically the top sediment/surface layer; the rhizosphere (soil directly attached to and influenced by plant roots); bulk soil (soil not directly associated with roots); and the submerged/saturated zone. Biofilters were configured with either: (1) no plant; (2) Carex appressa, the most highly recommended plant species in Australian biofilter adoption guidelines; or (3) one of two significant antimicrobial-producing Australian plant species, Melaleuca linariifolia or Melaleuca fulgens (n = 3 each). Following 16 months' maturation, systems were dosed with semi-synthetic stormwater containing faecal bacteria Escherichia coli and Enterococcus faecalis to monitor their ensuing die-off within all major biofilter treatment zones. Bacterial inactivation was generally more rapid in M. fulgens and M. linariifolia than C. appressa biofilters, with E. faecalis demonstrating an overall enhanced resistance to inactivation. Top sediment tended to exhibit the highest inactivation rates, significantly correlated with sunlight exposure. Conversely, the rhizosphere supported comparatively prolonged faecal bacterial survival. The authors recommend further investigation of melaleucas and similar highly antimicrobial-producing plants for enhanced faecal pathogen treatment within biofilters and related treatment contexts.

Interactive effect of temperature and plant species on nitrogen cycling and treatment in stormwater biofiltration systems

Stormwater biofiltration systems (also known as biofilters, bioretention, rain gardens) are engineered nature-based solutions, which help mitigate aquatic nitrogen pollution arising from storm runoff. These systems are being increasingly used in a range of climates across the world. A decline in treatment performance is frequently observed in cold weather conditions. While plant species comprise an important design factor influencing system performance, the effect of temperature on the fate of dissolved nitrogen forms, namely ammonium (NH₄⁺) and nitrate (NO₃^-), in the presence of different plant species in these systems remains unclear. A large scale laboratory experiment was undertaken that measured potential rates of nitrification, denitrification and dissimilatory nitrate reduction to ammonium (DNRA) as well as the microbial community structure to investigate nitrogen fate and hence removal under two different temperature conditions (2 °C and 15 °C) in the presence of four distinct plant species. The results indicate that lower nitrification rates (reduced by a factor of 4) coupled with potential media NH₄⁺ desorption could be contributing to reduced NH₄⁺ removal during cold conditions. Planting with species exhibiting good nutrient uptake capacity can reduce the extent of this performance decline. While NO₃^- reduction generally remains problematic during cold weather (<0 to 55% reduction), which may not be significantly different from warmer periods, the study demonstrated that the denitrification potential and gene abundance (nap, nar, NirS, norB, nosZ) to be higher than those of nitrification (amoA). Denitrification may not proceeding at optimal rates due to lack of conducive environmental conditions. Nitrogen transformation via DNRA was found to be relatively insignificant. Future studies should investigate the potential of employing cold-resilient plant species to maintain both NH₄⁺ and NO₃^- removal in cold weather conditions.

Sustainable micropollutant bioremediation via stormwater biofiltration system

Waters contaminated with micropollutants are of environmental and public health concern globally. Stormwater is a significant source of anthropogenic micropollutants to receiving waters. Hence, sustainable stormwater remediation is needed to reduce contamination of waterways. Yet designing sustainable bioremediation solutions, including those targeted to remove micropollutants, is a major scientific challenge. This study aimed to adapt the design of stormwater biofiltration systems, to improve the removal of micropollutants and understand the role of the micropollutant-degrading bacteria in this bioremediation process. We investigated the atrazine removal performance of a prototype biofiltration system, in which the filter media was supplemented with Granulated Activated Carbon (GAC). The prototype biofiltration system completely removed atrazine to below detectable limits, significantly exceeding the GAC's adsorption capacity alone, suggesting other biological processes were present. We showed that atrazine degradation capacity, measured by the kinetics of the trzN gene abundance, was accelerated in the prototype system compared to the standard system (which had no added GAC; 0.8 vs. 0.37 week-1, respectively). Notably, this high level of atrazine removal did not come at the expense of the removal performance of other typical stormwater macropollutants (e.g., nutrients, suspended solids). The prototype biofiltration system showed a proof-of-concept of sustaining microbial remediation of a model micropollutant alongside stormwater macropollutants, which could be used to reduce impacts on receiving waterways and protect our ecosystems and human health.

The Impact of Pipe Material on the Diversity of Microbial Communities in Drinking Water Distribution Systems

As many cities around the world face the prospect of replacing aging drinking water distribution systems (DWDS), water utilities must make careful decisions on new pipe material (e.g., cement-lined or PVC) for these systems. These decisions are informed by cost, physical integrity, and impact on microbiological and physicochemical water quality. Indeed, pipe material can impact the development of biofilm in DWDS that can harbor pathogens and impact drinking water quality. Annular reactors (ARs) with cast iron and cement coupons fed with chloraminated water from a municipal DWDS were used to investigate the impact of pipe material on biofilm development and composition over 16 months. The ARs were plumbed as closely as possible to the water main in the basement of an academic building to simulate distribution system conditions. Biofilm communities on coupons were characterized using 16S rRNA sequencing. In the cast iron reactors, β-proteobacteria, Actinobacteria, and α-proteobacteria were similarly relatively abundant (24.1, 22.5, and 22.4%, respectively) while in the cement reactors, α-proteobacteria and Actinobacteria were more relatively abundant (36.3 and 35.2%, respectively) compared to β-proteobacteria (12.8%). Mean alpha diversity (estimated with Shannon H and Faith's Phylogenetic Difference indices) was greater in cast iron reactors (Shannon: 5.00 ± 0.41; Faith's PD: 15.40 ± 2.88) than in cement reactors (Shannon: 4.16 ± 0.78; Faith's PD: 13.00 ± 2.01). PCoA of Bray-Curtis dissimilarities indicated that communities in cast iron ARs, cement ARs, bulk distribution system water, and distribution system pipe biofilm were distinct. The mean relative abundance of Mycobacterium spp. was greater in the cement reactors (34.8 ± 18.6%) than in the cast iron reactors (21.7 ± 11.9%). In contrast, the mean relative abundance of Legionella spp. trended higher in biofilm from cast iron reactors (0.5 ± 0.7%) than biofilm in cement reactors (0.01 ± 0.01%). These results suggest that pipe material is associated with differences in the diversity, bacterial composition, and opportunistic pathogen prevalence in biofilm of DWDS.

A planetary health model for reducing exposure to faecal contamination in urban informal settlements: Baseline findings from Makassar, Indonesia

BACKGROUND

The intense interactions between people, animals and environmental systems in urban informal settlements compromise human and environmental health. Inadequate water and sanitation services, compounded by exposure to flooding and climate change risks, expose inhabitants to environmental contamination causing poor health and wellbeing and degrading ecosystems. However, the exact nature and full scope of risks and exposure pathways between human health and the environment in informal settlements are uncertain. Existing models are limited to microbiological linkages related to faecal-oral exposures at the individual level, and do not account for a broader range of human-environmental variables and interactions that affect population health and wellbeing.

METHODS

We undertook a 12-month health and environmental assessment in 12 flood-prone informal settlements in Makassar, Indonesia. We obtained caregiver-reported health data, anthropometric measurements, stool and blood samples from children < 5 years, and health and wellbeing data for children 5-14 years and adult respondents. We collected environmental data including temperature, mosquito and rat species abundance, and water and sediment samples. Demographic, built environment and household asset data were also collected. We combined our data with existing literature to generate a novel planetary health model of health and environment in informal settlements.

RESULTS

Across the 12 settlements, 593 households and 2764 participants were enrolled. Two-thirds (64·1%) of all houses (26·3-82·7% per settlement) had formal land tenure documentation. Cough, fever and diarrhoea in the week prior to the survey were reported among an average of 34.3%, 26.9% and 9.7% of children aged < 5 years, respectively; although proportions varied over time, prevalence among these youngest children was consistently higher than among children 5-14 years or adult respondents. Among children < 5 years, 44·3% experienced stunting, 41·1% underweight, 12.4% wasting, and 26.5% were anaemic. There was self- or carer-reported poor mental health among 16.6% of children aged 5-14 years and 13.9% of adult respondents. Rates of potential risky exposures from swimming in waterways, eating uncooked produce, and eating soil or dirt were high, as were exposures to flooding and livestock. Just over one third of households (35.3%) had access to municipal water, and contamination of well water with E. coli and nitrogen species was common. Most (79·5%) houses had an in-house toilet, but no houses were connected to a piped sewer network or safe, properly constructed septic tank. Median monthly settlement outdoor temperatures ranged from 26·2 °C to 29.3 °C, and were on average, 1·1 °C warmer inside houses than outside. Mosquito density varied over time, with Culex quinquefasciatus accounting for 94·7% of species. Framed by a planetary health lens, our model includes four thematic domains: (1) the physical/built environment; (2) the ecological environment; (3) human health; and (4) socio-economic wellbeing, and is structured at individual, household, settlement, and city/beyond spatial scales.

CONCLUSIONS

Our planetary health model includes key risk factors and faecal-oral exposure pathways but extends beyond conventional microbiological faecal-oral enteropathogen exposure pathways to comprehensively account for a wider range of variables affecting health in urban informal settlements. It includes broader ecological interconnections and planetary health-related variables at the household, settlement and city levels. It proposes a composite framework of markers to assess water and sanitation challenges and flood risks in urban informal settlements for optimal design and monitoring of interventions.

Passive Sampling of SARS-CoV-2 for Wastewater Surveillance

The shedding of pathogens by infected humans enables the use of sewage monitoring to conduct wastewater-based epidemiology (WBE). Although most WBE studies use data from large sewage treatment plants, timely data from smaller catchments are needed for targeted public health action. Traditional sampling methods, like autosamplers or grab sampling, are not conducive to quick ad hoc deployments and high-resolution monitoring at these smaller scales. This study develops and validates a cheap and easily deployable passive sampler unit, made from readily available consumables, with relevance to the COVID-19 pandemic but with broader use for WBE. We provide the first evidence that passive samplers can be used to detect SARS-CoV-2 in wastewater from populations with low prevalence of active COVID-19 infections (0.034 to 0.34 per 10,000), demonstrating their ability for early detection of infections at three different scales (lot, suburb, and city). A side by side evaluation of passive samplers (n = 245) and traditionally collected wastewater samples (n = 183) verified that the passive samplers were sensitive at detecting SARS-CoV-2 in wastewater. On all 33 days where we directly compared traditional and passive sampling techniques, at least one passive sampler was positive when the average SARS-CoV-2 concentration in the wastewater equaled or exceeded the quantification limit of 1.8 gene copies per mL (n = 7). Moreover, on 13 occasions where wastewater SARS-CoV-2 concentrations were less than 1.8 gene copies per mL, one or more passive samplers were positive. Finally, there was a statistically significant (p < 0.001) positive relationship between the concentrations of SARS-CoV-2 in wastewater and the levels found on the passive samplers, indicating that with further evaluation, these devices could yield semi-quantitative results in the future. Passive samplers have the potential for wide use in WBE with attractive feasibility attributes of cost, ease of deployment at small-scale locations, and continuous sampling of the wastewater. Further research will focus on the optimization of laboratory methods including elution and extraction and continued parallel deployment and evaluations in a variety of settings to inform optimal use in wastewater surveillance.

Electrocardiographic characteristics of patients with coronavirus disease 2019 (COVID-2019) related pneumonia at first presentation

Funding Acknowledgements

Type of funding sources: None.

Purpose

To evaluate electrocardiographic (ECG) characteristics at first presentation in patients with possible coronavirus disease (COVID-19) pneumonia.

Methods and results

356 patients presenting at the emergency room with possible COVID-19 pneumonia based on clinical presentation and computed tomography findings were included and subdivided into a COVID-19 positive group ([COVID-19-positive], n = 231, 65%) and a COVID-19 negative group ([COVID-19-negative], n = 125, 35%) based on polymerase chain reaction tests.

The study population was predominantly middle aged-elderly (67 ± 14 year; n = 235, 66% male). Mortality rate was 24% after 1-month follow-up. There were no significant (NS) differences in sex, age, and mortality between the COVID-19-positive and COVID-19-negative group. 

Atrial fibrillation (AF) was common (9%), though its prevalence was NS (regression analyses adjusted for age and sex) different in the COVID-19-positive vs. the COVID-19-negative group. ECG characteristics reflecting atrial enlargement and repolarization abnormalities were frequently present (<38% and 14% respectively). No significant differences were found between the COVID-19-positive vs. the COVID-19-negative group for the majority of morphological ECG characteristics (Figure 1 for more detailed data). 

Conclusion

AF and ECG characteristics reflecting atrial enlargement and repolarization abnormalities are commonly present in COVID-19 patients. The prevalence of these ECG characteristics however do NS differ from their COVID-19-negative counterparts.

Monitoring of diverse enteric pathogens across environmental and host reservoirs with TaqMan array cards and standard qPCR: a methodological comparison study

BACKGROUND

Multiple bacteria, viruses, protists, and helminths cause enteric infections that greatly impact human health and wellbeing. These enteropathogens are transmited via several pathways through human, animal, and environmental reservoirs. Individual qPCR assays have been extensively used to detect enteropathogens within these types of samples, whereas the TaqMan array card (TAC), which allows simultaneous detection of multiple enteropathogens, has only previously been validated in human clinical samples.

METHODS

In this methodological comparison study, we compared the performance of a custom 48-singleplex TAC relative to standard qPCR. We established the sensitivity and specificity of each method for the detection of eight enteric targets, by using spiked samples with varying levels of PCR inhibition. We then tested the prevalence and abundance of pathogens in wastewater from Melbourne (Australia), and human, animal, and environmental samples from informal settlements in Suva, Fiji using both TAC and qPCR.

FINDINGS

Both methods exhibited similarly h specificity (TAC 100%, qPCR 94%), sensitivity (TAC 92%, qPCR 100%), and quantitation accuracy (TAC 91%, qPCR 99%) in non-inhibited sample matrices with spiked gene fragments. PCR inhibitors substantially affected detection via TAC, though this issue was alleviated by ten-fold sample dilution. Among samples from informal settlements, the two techniques performed similarly for detection (89% agreement) and quantitation (R² 0·82) for the eight enteropathogen targets. The TAC additionally included 38 other enteric targets, enabling detection of diverse faecal pathogens and extensive environmental contamination that would be prohibitively labour intensive to assay by standard qPCR.

INTERPRETATION

The two techniques produced similar results across diverse sample types, with qPCR prioritising greater sensitivity and quantitation accuracy, and TAC trading small reductions in these for a cost-effective larger enteropathogen panel enabling a greater number of enteric pathogens to be analysed concurrently, which is beneficial given the abundance and variety of enteric pathogens in environments such as urban informal settlements. The ability to monitor multiple enteric pathogens across diverse reservoirs could allow better resolution of pathogen exposure pathways, and the design and monitoring of interventions to reduce pathogen load.

FUNDING

Wellcome Trust Our Planet, Our Health programme.

Study design, rationale and methods of the Revitalising Informal Settlements and their Environments (RISE) study: a cluster randomised controlled trial to evaluate environmental and human health impacts of a water-sensitive intervention in informal settlements in Indonesia and Fiji

INTRODUCTION

Increasing urban populations have led to the growth of informal settlements, with contaminated environments linked to poor human health through a range of interlinked pathways. Here, we describe the design and methods for the Revitalising Informal Settlements and their Environments (RISE) study, a transdisciplinary randomised trial evaluating impacts of an intervention to upgrade urban informal settlements in two Asia-Pacific countries.

METHODS AND ANALYSIS

RISE is a cluster randomised controlled trial among 12 settlements in Makassar, Indonesia, and 12 in Suva, Fiji. Six settlements in each country have been randomised to receive the intervention at the outset; the remainder will serve as controls and be offered intervention delivery after trial completion. The intervention involves a water-sensitive approach, delivering site-specific, modular, decentralised infrastructure primarily aimed at improving health by decreasing exposure to environmental faecal contamination. Consenting households within each informal settlement site have been enrolled, with longitudinal assessment to involve health and well-being surveys, and human and environmental sampling. Primary outcomes will be evaluated in children under 5 years of age and include prevalence and diversity of gastrointestinal pathogens, abundance and diversity of antimicrobial resistance (AMR) genes in gastrointestinal microorganisms and markers of gastrointestinal inflammation. Diverse secondary outcomes include changes in microbial contamination; abundance and diversity of pathogens and AMR genes in environmental samples; impacts on ecological biodiversity and microclimates; mosquito vector abundance; anthropometric assessments, nutrition markers and systemic inflammation in children; caregiver-reported and self-reported health symptoms and healthcare utilisation; and measures of individual and community psychological, emotional and economic well-being. The study aims to provide proof-of-concept evidence to inform policies on upgrading of informal settlements to improve environments and human health and well-being.

ETHICS

Study protocols have been approved by ethics boards at Monash University, Fiji National University and Hasanuddin University.

TRIAL REGISTRATION NUMBER

ACTRN12618000633280; Pre-results.

HIGH-FIDELITY MULTI-PHYSICS PIN-BY-PIN MODEL OF A SVEA-96 OPTIMA2 ASSEMBLY WITH TORT-TD/CTF

This paper describes the development of a 3-d high-fidelity multi-physics pin-by-pin neu-tronic and sub-channel thermal hydraulic model of a SVEA-96 Optima2 fuel assembly for the coupled code system TORT-TD/CTF. No pin power reconstruction is applied. Detailed descriptions are given on (a) the generation of few-group parameterized pin cell-homogenized cross section data using HELIOS, (b) the 3-d neutronic pin-by-pin and ther-mal-hydraulic sub-channel model of a single SVEA-96 Optima2 assembly and its qualifica-tion by Monte Carlo models using Serpent, (c) coupled steady-state results for a single as-sembly and (d) coupled steady-state and transient simulations of a 4-by-4 mini core model of SVEA-96 Optima2 assemblies in a partially rodded state.

Is the gut microbiota bacterial abundance and composition associated with intestinal epithelial injury, systemic inflammatory profile, and gastrointestinal symptoms in response to exertional-heat stress?

OBJECTIVES

The study aimed to examine if the α-diversity and relative abundance of the gastrointestinal bacterial taxa is associated with the response magnitude of markers characteristic of exercise-induced gastrointestinal syndrome in response to exertional-heat stress.

DESIGN

Cross-sectional.

METHODS

Twenty-two endurance-trained athletes completed 2h running at 60% V.O_2max in hot ambient conditions (35.2°C, 25% relative humidity). Faecal samples were collected pre-exercise to determine bacterial taxonomy by 16S rRNA amplicon sequencing (Illumina MiSeq platform). Data were processed using the QIIME2 pipeline (v2019.1) establishing taxonomic classification with >95% confidence using SILVA. Pre- and post-exercise blood samples were used to determine plasma I-FABP and cortisol concentrations, and systemic inflammatory response profile. Markers of physiological and thermoregulatory strain, and gastrointestinal symptoms were measured every 10min during exercise. Associations were determined by partial correlation controlled for body mass variables.

RESULTS

Positive associations between Tenericutes (r₍₁₈₎=0.446, p=0.049) and Verrucomicrobia (r₍₁₈₎=0.450, p=0.046) phylum, Akkermansiaceae (r₍₁₈₎=0.486, p=0.030) and Ruminococcaceae (r₍₁₈₎=0.449, p=0.047) family and aligned genus groups with I-FABP were observed. Whilst, associations between Faecalibacterium (r₍₁₂₎=0.668, p=0.009) and Ruminoclostridium-9 (r₍₁₂₎=-0.577, p=0.031) genus with systemic inflammatory profile were observed. Association between bacterial phyla, family, and genus groups were also observed for gastrointestinal symptoms and markers of thermoregulatory strain (r₍₁₈₎ >0.400, p<0.05).

CONCLUSIONS

The relative abundance of several commensal bacterial groups showed modest favourable (i.e., low perturbations) or detrimental associations with the magnitude of gastrointestinal integrity perturbations and symptoms, and potentially influences body temperature change, in response to exertional-heat stress.

Salmonella from a Microtidal Estuary Are Capable of Invading Human Intestinal Cell Lines

Faecal contamination poses health risks for the recreational users of urban estuaries. However, our understanding of the potential pathogenicity of faecal microbes in these environments is limited. To this end, a study was conducted to understand the spatial and seasonal distribution of Salmonella in water and sediments of the Yarra River estuary, Melbourne, Australia. Among 210 samples in total, culturable Salmonella were recovered from 27%, 17%, and 19% of water, bank, and bed sediment samples, respectively. The combined detection increased from 15% in winter to 32% in summer (p < 0.05) indicating seasonal variation as potential part of public health risk assessments. Further, pathogenic potential of the Salmonella isolates was characterised via the quantification of attachment and invasion capacity using human epithelial colorectal cell line Caco-2 on a subset of isolates (n = 62). While all of these isolates could attach and invade Caco-2 cells, 52% and 13% of these showed greater attachment and invasiveness, respectively, than the corresponding mean values for S. Typhimurium ATCC14028 control. Isolates from winter were on average more invasive (seven out of eight isolates with the highest invasiveness recovered from the colder sampling period) than the isolates from summer, and Salmonella collected during summer showed lower invasion (p < 0.05) compared with the control. Similar low invasion compared with the same control was observed for isolates recovered from bank sediment (p < 0.05). While the higher prevalence in summer may imply higher risks during these peak recreational periods, it is essential that this information is used in combination with quantitative microbial risk assessments to fully understand the health risks posed by Salmonella in microtidal estuaries.

Campylobacter in an Urban Estuary: Public Health Insights from Occurrence, HeLa Cytotoxicity, and Caco-2 Attachment Cum Invasion

Aquatic recreation in urban estuaries worldwide is often restricted by fecal pollution. Variability in the occurrence of fecal pathogens and their differential virulence potentials within these estuaries may result in variable public health risks. To address this hypothesis, Campylobacter were isolated from the Yarra River estuary, Australia and then characterized via HeLa cell cytotoxicity and attachment to and the invasion of Caco-2 monolayers. Overall, 54% (n=216) of estuarine samples (water and sediment combined) yielded biochemically confirmed culturable Campylobacter; higher detection was recorded in water (92%, n=90) than in the bank and bed sediments combined (27%, n=126). The seasonality of occurrence was not significant. HeLa cell cytotoxicity revealed that estuarine Campylobacter had low cytotoxin titers; the 95% confidence interval (CI) ranged between 61 and 85, which was markedly lower than the mean value (~386) for the C. jejuni 11168 reference pathogenic strain. The Caco-2 attachment of estuarine Campylobacter isolates (n=189) revealed that the 95%CI for the attachment efficiency of the test strains ranged between 0.09 and 0.1%, with only 3.7% having a higher efficiency than the 5^th percentile value for C. jejuni 11168. None of the estuarine strains exhibited Caco-2 invasion capabilities. In contrast to the common assumption during quantitative microbial/risk assessments (QMRAs) that all environmental strains are pathogenic, the present results revealed that Campylobacter within the Yarra River estuary had very low virulence potential. Since this is the first study to use human epithelial cell lines to characterize estuary-borne pathogens, these results generate valuable insights for a better understanding of the public health risks in urban estuaries that will underpin more robust QMRAs.

New prebiotic chemistry inspired filter media for stormwater/greywater disinfection

Greywater and stormwater have received significant attention due to increasing water scarcity. Passive filtration such as biofiltration has been a popular treatment method with its low energy input and environmental friendliness. However, pathogen removal capacity needs improvement to achieve safe water quality. In this study, a prebiotic chemistry inspired copolymer based on aminomalononitrile and 3,4,5-trihydroxybenzaldehyde (AMNT30) was introduced to develop antimicrobial media for passive filtration. The AMNT30 polymer provided an adhesive coating on zeolite substrates following a spontaneous polymerisation process at room temperature. AMNT30 coated media were investigated for metal loading capacity, surface morphology, E. coli removal and metal leaching after filtration of different water sources (i.e. stormwater, greywater, and deionised water) at low/high conductivity. The coating enhanced metal ion loading on the surface and demonstrated that >8 log reduction of E. coli can be achieved for silver loaded materials compared to a 1 log reduction for copper loaded materials. The coating also increased the stability of the metals on the media irrespective of inflow characteristics. This study provided the first example using AMNT30 to create antimicrobial water purification media. It is expected that this technology will find applications in the water treatment industry.

Comparative thermohydraulic analyses of VVER 1000 active core for two different construction types of assemblies

The OECD/NEA Benchmark on NPP Kalinin Unit 3 “Switching-off of one of the four operating main circulation pumps at nominal power” based on measurements is at its end phase. A new benchmark is starting based on measurements from the NPP Rostov Unit 2 “Reactivity compensation with diluted boron by stepwise insertion of control rod cluster into the VVER-1000 core”. The Rostov-2 core is loaded with assemblies of a new modern type “TVS-2M” which differs in construction in comparison with the “TVSA”-type implemented in the Kalinin-3 core. The goal of the performed study is to determine the thermohydraulic differences, during steady-state operation, between the two cores based on loads with different assembly types. Results of steady-state simulations are compared for Kalinin-3 and Rostov-2 cores, taken from the respective Benchmarks specifications. To ensure that the observed differences are coming only from the fuel assembly construction, the same axial power density is used for all cases. Calculations are done with an under-development version of the GRS system code ATHLET, which has sub-channel modeling capabilities. Thus, in addition to the typical assembly-wise models, calculations with seven assemblies modeled at the sub-channel (pin-by-pin) level were also performed and analyzed. This work will help the Benchmarks' Rostov-2 participants to set up more accurate core thermohydraulic models.

Rise of the killer plants: investigating the antimicrobial activity of Australian plants to enhance biofilter-mediated pathogen removal

BACKGROUND

Biofilters are soil-plant based passive stormwater treatment systems which demonstrate promising, although inconsistent, removal of faecal microorganisms. Antimicrobial-producing plants represent a safe, inexpensive yet under-researched biofilter design component that may enhance treatment reliability. The mechanisms underlying plant-mediated microbial removal in biofilters have not been fully elucidated, particularly with respect to antimicrobial production. The aim of this study was therefore to inform biofilter vegetation selection guidelines for optimal pathogen treatment by conducting antimicrobial screening of biofilter-suitable plant species. This involved: (1) selecting native plants suitable for biofilters (17 species) in a Victorian context (southeast Australia); and (2) conducting antimicrobial susceptibility testing of selected plant methanolic extracts (≥ 5 biological replicates/species; 86 total) against reference stormwater faecal bacteria (Salmonella enterica subsp. enterica ser. Typhimurium, Enterococcus faecalis and Escherichia coli).

RESULTS

The present study represents the first report on the inhibitory activity of polar alcoholic extracts from multiple tested species. Extracts of plants in the Myrtaceae family, reputed for their production of antimicrobial oils, demonstrated significantly lower minimum inhibitory concentrations (MICs) than non-myrtaceous candidates (p < 0.0001). Melaleuca fulgens (median MIC: 8 mg/mL; range: [4-16 mg/mL]), Callistemon viminalis (16 mg/mL, [2-16 mg/mL]) and Leptospermum lanigerum (8 mg/mL, [4-16 mg/mL]) exhibited the strongest inhibitory activity against the selected bacteria (p < 0.05 compared to each tested non-myrtaceous candidate). In contrast, the Australian biofilter gold standard Carex appressa demonstrated eight-fold lower activity than the highest performer M. fulgens (64 mg/mL, [32-64 mg/mL]).

CONCLUSION

Our results suggest that myrtaceous plants, particularly M. fulgens, may be more effective than the current vegetation gold standard in mediating antibiosis and thus improving pathogen treatment within biofilters. Further investigation of these plants in biofilter contexts is recommended to refine biofilter vegetation selection guidelines.

Roles of ventral versus dorsal pathways in language production: An awake language mapping study

Human language is organized along two main processing streams connecting posterior temporal cortex and inferior frontal cortex in the left hemisphere, travelling dorsal and ventral to the Sylvian fissure. Some views propose a dorsal motor versus ventral semantic division. Others propose division by combinatorial mechanism, with the dorsal stream responsible for combining elements into a sequence and the ventral stream for forming semantic dependencies independent of sequential order. We acquired data from direct cortical stimulation in the left hemisphere in 17 neurosurgical patients and subcortical resection in a subset of 10 patients as part of awake language mapping. Two language tasks were employed: a sentence generation (SG) task tested the ability to form sequential and semantic dependencies, and a picture-word interference (PWI) task manipulated semantic interference. Results show increased error rates in the SG versus PWI task during subcortical testing in the dorsal stream territory, and high error rates in both tasks in the ventral stream territory. Connectivity maps derived from diffusion imaging and seeded in the tumor sites show that patients with more errors in the SG than in the PWI task had tumor locations associated with a dorsal stream connectivity pattern. Patients with the opposite pattern of results had tumor locations associated with a more ventral stream connectivity pattern. These findings provide initial evidence using fiber tract disruption with electrical stimulation that the dorsal pathways are critical for organizing words in a sequence necessary for sentence generation, and the ventral pathways are critical for processing semantic dependencies.

Relationship between sugarcane culm and leaf biomass composition and saccharification efficiency

BACKGROUND

Lignocellulosic biomass is recognized as a promising renewable feedstock for the production of biofuels. However, current methods for converting biomass into fermentable sugars are considered too expensive and inefficient due to the recalcitrance of the secondary cell wall. Biomass composition can be modified to create varieties that are efficiently broken down to release cell wall sugars. This study focused on identifying the key biomass components influencing plant cell wall recalcitrance that can be targeted for selection in sugarcane, an important and abundant source of biomass.

RESULTS

Biomass composition and the amount of glucan converted into glucose after saccharification were measured in leaf and culm tissues from seven sugarcane genotypes varying in fiber composition after no pretreatment and dilute acid, hydrothermal and ionic liquid pretreatments. In extractives-free sugarcane leaf and culm tissue, glucan, xylan, acid-insoluble lignin (AIL) and acid-soluble lignin (ASL) ranged from 20 to 32%, 15% to 21%, 14% to 20% and 2% to 4%, respectively. The ratio of syringyl (S) to guaiacyl (G) content in the lignin ranged from 1.5 to 2.2 in the culm and from 0.65 to 1.1 in the leaf. Hydrothermal and dilute acid pretreatments predominantly reduced xylan content, while the ionic liquid (IL) pretreatment targeted AIL reduction. The amount of glucan converted into glucose after 26 h of pre-saccharification was highest after IL pretreatment (42% in culm and 63.5% in leaf) compared to the other pretreatments. Additionally, glucan conversion in leaf tissues was approximately 1.5-fold of that in culm tissues. Percent glucan conversion varied between genotypes but there was no genotype that was superior to all others across the pretreatment groups. Path analysis revealed that S/G ratio, AIL and xylan had the strongest negative associations with percent glucan conversion, while ASL and glucan content had strong positive influences.

CONCLUSION

To improve saccharification efficiency of lignocellulosic biomass, breeders should focus on reducing S/G ratio, xylan and AIL content and increasing ASL and glucan content. This will be key for the development of sugarcane varieties for bioenergy uses.

Electrochemical oxidation for stormwater disinfection: How does real stormwater chemistry impact on pathogen removal and disinfection by-products level?

Preliminary laboratory work has shown that electrochemical oxidation (ECO) is a promising technology for disinfection of harvested stormwater. This paper focuses on understanding how stormwater chemistry (e.g. pH, chloride, bicarbonate, ammonia and total organic carbon - that can vary substantially between sites) impacts the disinfection performance of ECO. Real stormwater samples from four different urban catchments were collected and tested for ECO performance in disinfecting stormwater pathogens using a boron doped diamond anode under the current density of 4.2 mA/cm². Results showed that total disinfection of indigenous Escherichia coli (E. coli), as well as three different stormwater pathogens (Enterococci, Campylobacter and C. perfringens) was achievable for all four tested stormwater within 30 min. Compared to the synthetic stormwater, lower disinfection rates were observed in real stormwater which has more complex chemistry. Stormwater chloride concentration was the only tested parameter that had significant impact on the treatment performance, with higher initial stormwater chloride concentration leading to an increased disinfection rate. Disinfection by-products in the treated stormwater were well below the Australian Drinking Water Guideline value for health, with its production level positively correlated to the pH values of stormwater.

Salmonella enterica Serovar Typhimurium and Escherichia coli Survival in Estuarine Bank Sediments

Estuarine bank sediments have the potential to support the survival and growth of fecal indicator organisms, including Escherichia coli. However, survival of fecal pathogens in estuarine sediments is not well researched and therefore remains a significant knowledge gap regarding public health risks in estuaries. In this study, simultaneous survival of Escherichia coli and a fecal pathogen, Salmonella enterica serovar Typhimurium, was studied for 21 days in estuarine bank sediment microcosms. Observed growth patterns for both organisms were comparable under four simulated scenarios; for continuous-desiccation, extended-desiccation, periodic-inundation, and continuous-inundation systems, logarithmic decay coefficients were 1.54/day, 1.51/day, 0.14/day, and 0.20/day, respectively, for E. coli, and 1.72/day, 1.64/day, 0.21/day, and 0.24/day for S. Typhimurium. Re-wetting of continuous-desiccated systems resulted in potential re-growth, suggesting survival under moisture-limited conditions. Key findings from this study include: (i) Bank sediments can potentially support human pathogens (S. Typhimurium), (ii) inundation levels influence the survival of fecal bacteria in estuarine bank sediments, and (iii) comparable survival rates of S. Typhimurium and E. coli implies the latter could be a reliable fecal indicator in urban estuaries. The results from this study will help select suitable monitoring and management strategies for safer recreational activities in urban estuaries.

Plant-Microbe Interactions Drive Denitrification Rates, Dissolved Nitrogen Removal, and the Abundance of Denitrification Genes in Stormwater Control Measures

The microbial community and function along with nitrate/nitrite (NOx) removal rates, and nitrogen (N) partitioning into "uptake", "denitrification", and "remaining" via isotope tracers, were studied in soil bioretention mesocolumns (8 unique plant species). Total denitrification gene reads per million (rpm) were positively correlated with % denitrified ( r = 0.69) but negatively correlated with total NOx removal following simulated rain events ( r = -0.79). This is likely due to plant-microbe interactions. Plant species with greater root volume, plant and microbial assimilation %, and NOx removal % had lower denitrification genes and rates. This implies that although microorganisms have access to N, advantageous functions, like denitrification, may not increase. At the conclusion of the 1.5-year experiment, the microbial community was strongly influenced by plant species within the Top zone dominated by plant roots, and the presence or absence of a saturated zone influenced the microbial community within the Bottom zone. Leptospermum continentale was an outlier from the other plants and had much lower denitrification gene rpm (average 228) compared to the other species (range: 277 to 413). The antimicrobial properties and large root volume of Leptospermum continentale likely caused this denitrification gene depression.

Stormwater constructed wetlands: A source or a sink of Campylobacter spp

Stormwater constructed wetlands are not well characterised for their ability to remove pathogens which can pose public health risks during stormwater harvesting activities. This study investigated the behaviour of faecal indicator organism Escherichia coli (E. coli) and reference pathogen Campylobacter spp. in stormwater constructed wetlands, using a case study system located in Melbourne, Australia. Grab sampling and event-based monitoring revealed influent concentrations of E. coli were typical of other urban stormwater studies, yet Campylobacter concentrations were orders of magnitude above those urban stormwater studies used to develop the Australian Guidelines for Water Recycling, reached levels typical of raw domestic wastewater. The wetland consistently removed E. coli from stormwater (mean log removal 0.96, range 0.19-1.79), while Campylobacter spp. concentrations were often higher in outflow than inflow (mean log removal 0.05, range -0.9-1.25). These results indicate that E. coli is a poor indicator for this reference pathogen. The log reductions of both organisms also failed to meet the criteria specified for any end-use, as listed in the Australian Guidelines for Water Recycling, suggesting further treatment is required prior to harvesting. Finally, this study proposed that direct faecal deposition by waterfowl faeces was a microbial source to stormwater wetlands and that this was partly responsible for the varied microbial removal rates observed. Overall, this work validates the need for further characterisation of pathogens in raw urban stormwater, and the ability for water sensitive urban design features, such as wetlands, to remove both indicator and pathogenic microorganisms.

What's the risk? Identifying potential human pathogens within grey-headed flying foxes faeces

Pteropus poliocephalus (grey-headed flying foxes) are recognised vectors for a range of potentially fatal human pathogens. However, to date research has primarily focused on viral disease carriage, overlooking bacterial pathogens, which also represent a significant human disease risk. The current study applied 16S rRNA amplicon sequencing, community analysis and a multi-tiered database OTU picking approach to identify faecal-derived zoonotic bacteria within two colonies of P. poliocephalus from Victoria, Australia. Our data show that sequences associated with Enterobacteriaceae (62.8% ± 24.7%), Pasteurellaceae (19.9% ± 25.7%) and Moraxellaceae (9.4% ± 11.8%) dominate flying fox faeces. Further colony specific differences in bacterial faecal colonisation patterns were also identified. In total, 34 potential pathogens, representing 15 genera, were identified. However, species level definition was only possible for Clostridium perfringens, which likely represents a low infectious risk due to the low proportion observed within the faeces and high infectious dose required for transmission. In contrast, sequences associated with other pathogenic species clusters such as Haemophilus haemolyticus-H. influenzae and Salmonella bongori-S. enterica, were present at high proportions in the faeces, and due to their relatively low infectious doses and modes of transmissions, represent a greater potential human disease risk. These analyses of the microbial community composition of Pteropus poliocephalus have significantly advanced our understanding of the potential bacterial disease risk associated with flying foxes and should direct future epidemiological and quantitative microbial risk assessments to further define the health risks presented by these animals.

Current Stormwater Harvesting Guidelines Are Inadequate for Mitigating Risk from Campylobacter During Nonpotable Reuse Activities

Campylobacter is a pathogen frequently detected in urban stormwater worldwide. It is one of the leading causes of enteric disease in many developed countries and is the leading cause of enteric disease in Australia. Prior to harvesting stormwater, adequate treatment is necessary to mitigate risks derived from such harmful pathogens. The goal of this research was to estimate the health risks associated with the exposure to Campylobacter when harvesting urban stormwater for toilet flushing and irrigation activities, and the role treatment options play in limiting risks. Campylobacter data collected from several urban stormwater systems in Victoria, Australia, were the inputs of a Quantitative Microbial Risk Assessment model. The model included seven treatment scenarios, spanning wetlands, biofilters, and more traditional treatment trains including those recommended by the Australian Guidelines for Water Recycling. According to our modeling and acceptable risk thresholds, only two treatment scenarios could supply water of sufficient quality for toilet flushing and irrigation end-uses: (1) using stormwater biofilters coupled with UV-treatment and (2) a more conventional coagulation, filtration, UV, and chlorination treatment plant. Importantly, our modeling results suggest that current guidelines in place for stormwater reuse are not adequate for protecting against exposure to Campylobacter. However, more research is required to better define whether the Campylobacter detectable in stormwater are pathogenic to humans.

Source tracking using microbial community fingerprints: Method comparison with hydrodynamic modelling

Urban estuaries around the world are experiencing contamination from diffuse and point sources, which increases risks to public health. To mitigate and manage risks posed by elevated levels of contamination in urban waterways, it is critical to identify the primary water sources of contamination within catchments. Source tracking using microbial community fingerprints is one tool that can be used to identify sources. However, results derived from this approach have not yet been evaluated using independent datasets. As such, the key objectives of this investigation were: (1) to identify the major sources of water responsible for bacterial loadings within an urban estuary using microbial source tracking (MST) using microbial communities; and (2) to evaluate this method using a 3-dimensional hydrodynamic model. The Yarra River estuary, which flows through the city of Melbourne in South-East Australia was the focus of this study. We found that the water sources contributing to the bacterial community in the Yarra River estuary varied temporally depending on the estuary's hydrodynamic conditions. The water source apportionment determined using microbial community MST correlated to those determined using a 3-dimensional hydrodynamic model of the transport and mixing of a tracer in the estuary. While there were some discrepancies between the two methods, this investigation demonstrated that MST using bacterial community fingerprints can identify the primary water sources of microorganisms in an estuarine environment. As such, with further optimization and improvements, microbial community MST has the potential to become a powerful tool that could be practically applied in the mitigation of contaminated aquatic systems.

Presence and survival of culturable Campylobacter spp. and Escherichia coli in a temperate urban estuary

Urban estuaries throughout the world typically contain elevated levels of faecal contamination, the extent of which is generally assessed using faecal indicator organisms (FIO) such as Escherichia coli. This study assesses whether the bacterial FIO, E. coli is a suitable surrogate for Campylobacter spp., in estuaries. The presence and survival dynamics of culturable E. coli and Campylobacter spp. are compared in the water column, bank sediments and bed sediments of the Yarra River estuary (located in Melbourne, Australia). The presence of E. coli did not necessarily indicate detectable levels of Campylobacter spp. in the water column, bed and bank sediments, but the inactivation rates of the two bacteria were similar in the water column. A key finding of the study is that E. coli and Campylobacter spp. can survive for up to 14days in the water column and up to 21days in the bed and bank sediments of the estuary. Preliminary data presented in this study also suggests that the inactivation rates of the two bacteria may be similar in bed and bank sediments. This undermines previous hypotheses that Campylobacter spp. cannot survive outside of its host and indicates that public health risks can persist in aquatic systems for up to three weeks after the initial contamination event.

Evaluation of Techniques for Measuring Microbial Hazards in Bathing Waters: A Comparative Study

Recreational water quality is commonly monitored by means of culture based faecal indicator organism (FIOs) assays. However, these methods are costly and time-consuming; a serious disadvantage when combined with issues such as non-specificity and user bias. New culture and molecular methods have been developed to counter these drawbacks. This study compared industry-standard IDEXX methods (Colilert and Enterolert) with three alternative approaches: 1) TECTA™ system for E. coli and enterococci; 2) US EPA’s 1611 method (qPCR based enterococci enumeration); and 3) Next Generation Sequencing (NGS). Water samples (233) were collected from riverine, estuarine and marine environments over the 2014–2015 summer period and analysed by the four methods. The results demonstrated that E. coli and coliform densities, inferred by the IDEXX system, correlated strongly with the TECTA™ system. The TECTA™ system had further advantages in faster turnaround times (~12 hrs from sample receipt to result compared to 24 hrs); no staff time required for interpretation and less user bias (results are automatically calculated, compared to subjective colorimetric decisions). The US EPA Method 1611 qPCR method also showed significant correlation with the IDEXX enterococci method; but had significant disadvantages such as highly technical analysis and higher operational costs (330% of IDEXX). The NGS method demonstrated statistically significant correlations between IDEXX and the proportions of sequences belonging to FIOs, Enterobacteriaceae, and Enterococcaceae. While costs (3,000% of IDEXX) and analysis time (300% of IDEXX) were found to be significant drawbacks of NGS, rapid technological advances in this field will soon see it widely adopted.

Into the deep: Evaluation of SourceTracker for assessment of faecal contamination of coastal waters

Faecal contamination of recreational waters is an increasing global health concern. Tracing the source of the contaminant is a vital step towards mitigation and disease prevention. Total 16S rRNA amplicon data for a specific environment (faeces, water, soil) and computational tools such as the Markov-Chain Monte Carlo based SourceTracker can be applied to microbial source tracking (MST) and attribution studies. The current study applied artificial and in-laboratory derived bacterial communities to define the potential and limitations associated with the use of SourceTracker, prior to its application for faecal source tracking at three recreational beaches near Port Phillip Bay (Victoria, Australia). The results demonstrated that at minimum multiple model runs of the SourceTracker modelling tool (i.e. technical replicates) were required to identify potential false positive predictions. The calculation of relative standard deviations (RSDs) for each attributed source improved overall predictive confidence in the results. In general, default parameter settings provided high sensitivity, specificity, accuracy and precision. Application of SourceTracker to recreational beach samples identified treated effluent as major source of human-derived faecal contamination, present in 69% of samples. Site-specific sources, such as raw sewage, stormwater and bacterial populations associated with the Yarra River estuary were also identified. Rainfall and associated sand resuspension at each location correlated with observed human faecal indicators. The results of the optimised SourceTracker analysis suggests that local sources of contamination have the greatest effect on recreational coastal water quality.

Genetic associations with brain cortical thickness in multiple sclerosis

Multiple sclerosis (MS) is characterized by temporal and spatial dissemination of demyelinating lesions in the central nervous system. Associated neurodegenerative changes contributing to disability have been recognized even at early disease stages. Recent studies show the importance of gray matter damage for the accrual of clinical disability rather than white matter where demyelination is easily visualized by magnetic resonance imaging (MRI). The susceptibility to MS is influenced by genetic risk, but genetic factors associated with the disability are not known. We used MRI data to determine cortical thickness in 557 MS cases and 75 controls and in another cohort of 219 cases. We identified nine areas showing different thickness between cases and controls (regions of interest, ROI) (eight of them were negatively correlated with Kurtzke's expanded disability status scale, EDSS) and conducted genome-wide association studies (GWAS) in 464 and 211 cases available from the two data sets. No marker exceeded genome-wide significance in the discovery cohort. We next combined nominal statistical evidence of association with physical evidence of interaction from a curated human protein interaction network, and searched for subnetworks enriched with nominally associated genes and for commonalities between the two data sets. This network-based pathway analysis of GWAS detected gene sets involved in glutamate signaling, neural development and an adjustment of intracellular calcium concentration. We report here for the first time gene sets associated with cortical thinning of MS. These genes are potentially correlated with disability of MS.

Environmental monitoring of waterborne Campylobacter: evaluation of the Australian standard and a hybrid extraction-free MPN-PCR method

Campylobacter is the leading agent of diarrheal disease worldwide. This study evaluates a novel culture-PCR hybrid (MPN-PCR) assay for the rapid enumeration of Campylobacter spp. from estuarine and wastewater systems. To first evaluate the current, culture-based, Australian standard, an inter-laboratory study was conducted on 69 subsampled water samples. The proposed Most-Probable Number (MPN)-PCR method was then evaluated, by analysing 147 estuarine samples collected over a 2 year period. Data for 14 different biological, hydrological and climatic parameters were also collated to identify pathogen-environment relationships and assess the potential for method specific bias. The results demonstrated that the intra-laboratory performance of the MPN-PCR was superior to that of AS/NZS (σ = 0.7912, P < 0.001; κ = 0.701, P < 0.001) with an overall diagnostic accuracy of ~94%. Furthermore, the analysis of both MPN-PCR and AS/NZS identified the potential for the introduction of method specific bias during assessment of the effects of environmental parameters on Campylobacter spp. numbers.

Transfusion transmitted infections in solid organ transplantation

While the risk of infectious disease transmission through blood transfusion has been greatly reduced as a result of improved screening methods, transfusion-transmissible infections remain a concern for transplant recipients, especially those receiving multiple transfusions. Although transfusion and transplant recipients are at risk for similar infections, the current reporting requirements for infections transmitted by transfusions and organ transplantation vary greatly and remain distinctly separate with no communication between reporting systems. This article reviews 23 past reports of transfusion-transmitted infections in organ recipients acquired through transfusions. While cytomegalovirus was a major focus of such reports in the 1980s, more recent reports have focused on West Nile virus transmission. Additionally, this article highlights challenges in determining transfusion-transmitted infection risk in transplant recipients related to the current reporting systems.

The transcriptomic response of Acinetobacter baumannii to colistin and doripenem alone and in combination in an in vitro pharmacokinetics/pharmacodynamics model

OBJECTIVES

Colistin remains a last-line treatment for MDR Acinetobacter baumannii and combined use of colistin and carbapenems has shown synergistic effects against MDR strains. In order to understand the bacterial responses to these antibiotics, we analysed the transcriptome of A. baumannii following exposure to each.

METHODS

RNA sequencing was employed to determine changes in the transcriptome following treatment with colistin and doripenem, both alone and in combination, using an in vitro pharmacokinetics (PK)/pharmacodynamics model to mimic the PK of both antibiotics in patients.

RESULTS

After treatment with colistin (continuous infusion at 2 mg/L), >400 differentially regulated genes were identified, including many associated with outer membrane biogenesis, fatty acid metabolism and phospholipid trafficking. No genes were differentially expressed following treatment with doripenem (Cmax 25 mg/L, t1/2 1.5 h) for 15 min, but 45 genes were identified as differentially expressed after 1 h of growth under this condition. Treatment of A. baumannii with both colistin and doripenem together for 1 h resulted in >450 genes being identified as differentially expressed. More than 70% of these gene expression changes were also observed following colistin treatment alone.

CONCLUSIONS

These data suggest that colistin causes gross damage to the outer membrane, facilitates lipid exchange between the inner and outer membrane and alters the normal asymmetric outer membrane composition. The transcriptional response to colistin was highly similar to that observed for an LPS-deficient strain, indicating that many of the observed changes are responses to outer membrane instability resulting from LPS loss.

Analysis of JSI TRIGA MARK II reactor physical parameters calculated with TRIPOLI and MCNP

New computational model of the JSI TRIGA Mark II research reactor was built for TRIPOLI computer code and compared with existing MCNP code model. The same modelling assumptions were used in order to check the differences of the mathematical models of both Monte Carlo codes. Differences between the TRIPOLI and MCNP predictions of keff were up to 100pcm. Further validation was performed with analyses of the normalized reaction rates and computations of kinetic parameters for various core configurations.

Integrated conceptual modelling of faecal contamination in an urban estuary catchment

Urban stormwater is regarded as a key input of faecal contamination in receiving water bodies and therefore, a major concern for health risks associated with aquatic recreation. Wastewater leakages, cross connections and overflows, together with faeces washed from surfaces during rainfall events, are possible origins of faecal contamination which enter these water bodies through stormwater drains. This paper applies conceptual models to a case study of the Yarra River estuary to understand the relative importance of fluxes derived from an urban creek and the 219 urban stormwater pipes which drain directly to the estuary as compared with other inputs, such as the Yarra River itself. Existing hydrologic-microorganism models were used for the estimation of the inputs from riverine and urban stormwater fluxes. These predictions were applied as boundary conditions for a new, highly simplified, model which accounts for the transport and survival of faecal microorganisms in the estuary. All models were calibrated using a rich dataset, containing over 2,000 measured Escherichia coli concentrations. Mass balances from the riverine and stormwater models indicate the limited influence of urban stormwater drains on the estuary during dry weather; less than 0.05% to 10% (5th and 95th percentile; median 0.5%) of the total daily E. coli load entering the estuary was derived from urban stormwater drains. While wet weather contributions from stormwater drains could be more significant (2% to 50%; 5th and 95th percentile), the average contribution remained marginal (median 10%). Sensitivity testing of the estuarine microorganism model by switching off stormwater boundary conditions resulted in minimal model efficiency reduction; this may reflect the low average daily contribution from urban stormwater drains. While these results confirm previous studies which show that E. coli loads derived from stormwater drains are dwarfed by other inputs, it is essential to note that these results also demonstrate that some conditions reveal the opposite; high proportions from stormwater are possible when combined with low riverine inputs and high urban rainfall. Furthermore, this study focuses on the overall impacts of direct urban stormwater inputs on the faecal contamination levels within the estuary, and localized impacts would certainly require further investigation.

Patterns of arteriosclerotic lesions of the lower extremity in a West Indian population based on angiographic findings and ethnicity

INTRODUCTION

This study aimed to determine whether ethnic differences show different patterns of arterial disease in the lower limb.

METHODS

A prospective analysis of 100 consecutive patients with 160 lower limb arteriograms was performed looking at the pattern of disease with relation to ethnicity in Trinidad and Tobago.

RESULTS

There were 53 male and 47 female patients with an age range of 43-90 years (mean: 66 years). Of the 100 patients, 45 were of East Indian descent, 36 of Afro-Caribbean descent, 14 of mixed descent and 5 had other backgrounds. There were 32 smokers and 69 diabetics. The most commonly affected artery in East Indians was the anterior tibial artery (ATA, 70%) followed by the peroneal artery (60%), superficial femoral artery (SFA, 60%), posterior tibial artery (PTA, 57%) and tibioperoneal trunk (TPT, 39%). In Afro-Caribbeans, the most commonly affected artery was the ATA (79%) followed by the PTA (74%), peroneal artery (66%) and TPT (55%). The mixed group showed the PTA (85%) to be most diseased followed by the peroneal artery (75%), ATA (70%), SFA (70%), dorsalis pedis artery (DPA, 60%) and TPT (50%). Overall, the most diseased vessel in all groups was the ATA (73%) followed by the PTA (66%), peroneal artery (64%), SFA (59%), TPT (46%), DPA (38%), popliteal artery (31%) and medial plantar artery (MPA, 29%), with the proximal vessels not being affected severely.

CONCLUSIONS

Ethnic divisions were only statistically significant (p<0.05) with East Indians showing worse disease in the profunda femoris artery and Afro-Caribbeans showing worse disease in the PTA, DPA and MPA. This suggests that environmental factors may play a significant role in the disease process including smoking and dietary factors rather than purely genetics.