Between February and April 2018, Salmonella typhimurium within a unique 5-single nucleotide polymorphism (SNP) address was isolated from 28 cases with links to a small rural area of Northeast England, with five cases prospectively identified by whole genome sequencing (WGS). Infections had a severe clinical picture with ten cases hospitalized (36%), two cases with invasive disease, and two deaths reported. Interviews determined that 24 cases (86%) had been exposed to a local independent butcher’s shop (Butcher A).

A case-control study using controls recruited by systematic digit dialling established that cases were 68 times more likely to have consumed cooked meat from Butcher A (Adjusted OR 68.1; 95% CI: 1.9–2387.6; P = 0.02). Salmonella typhimurium genetically highly related to 28 of the outbreak cases was also isolated from a sample of cooked meat on sale in the premises.

Epidemiological and microbiological investigations suggest this outbreak was likely associated with the consumption of ready-to-eat foods supplied by the implicated butcher. A relatively large number of cases were involved despite the rurality of the food business, with cases resident across the Northeast and Yorkshire identified using WGS, demonstrating the benefit of timely sequencing information to community outbreak investigations.

Background: Burkholderia multivorans are gram-negative bacteria typically found in water and soil. B. multivorans outbreaks among patients without cystic fibrosis have been associated with exposure to contaminated medical devices or nonsterile aqueous products. Acquisition can also occur from exposure to environmental reservoirs like sinks or other hospital water sources. We describe an outbreak of B. multivorans among hospitalized patients without cystic fibrosis at 2 hospitals within the same healthcare system in California (hospitals A and B) between August 2021 and July 2022. Methods: We defined confirmed case patients as patients without cystic fibrosis hospitalized at hospital A or hospital B between January 2020 to July 2022 with B. multivorans isolated from any body site matching the outbreak strain. We reviewed medical records to describe case patients and to identify common exposures. We evaluated infection control practices and interviewed staff to detect exposures to nonsterile water. Select samples from water, ice, drains, and sink splash zone surfaces were collected and cultured for B. multivorans in March 2022 and July 2022 from both hospitals. Common aqueous products used among case patients were tested for B. multivorans. Genetic relatedness between clinical and environmental samples was determined using random amplified polymorphic DNA (RAPD) and repetitive extragenic palindromic polymerase chain reaction (Rep-PCR). Results: We identified 23 confirmed case patients; 20 (87%) of these were identified at an intensive care unit (ICU) in hospital A. B. multivorans was isolated from respiratory sources in 18 cases (78%). We observed medication preparation items, gloves, and patient care items stored within sink splash zones in ICU medication preparation rooms and patient rooms. Nonsterile water and ice were used for bed baths, swallow evaluations, and ice packs. B. multivorans was cultured from ice and water dispensed from an 11-year-old ice machine in the ICU at hospital A in March 2022 but no other water sources. Additional testing in July 2022 yielded B. multivorans from ice and a drain pan from a new ice machine in the same ICU location at hospital A. All products were negative. Clinical and environmental isolates were the same strain by RAPD and Rep-PCR. Conclusions: The use of nonsterile water and ice from a contaminated ice machine contributed to this outbreak. Water-related fixtures can serve as reservoirs for Burkholderia, posing infection risk to hospitalized and immunocompromised patients. During outbreaks of water-related organisms, such as B. multivorans , nonsterile water and ice use should be investigated as potential sources of transmission and other options should be considered, especially for critically ill patients.

Disclosures: None

Background: The Centers for Disease Control and Prevention’s Emerging Infections Program conducts active laboratory- and population-based surveillance for carbapenem-resistant Enterobacterales (CRE) and extended spectrum beta-lactamase-producing Enterobacterales (ESBL-E). To better understand the U.S. epidemiology of these organisms among children, we determined the incidence of pediatric CRE and ESBL-E cases and described their clinical characteristics. Methods: Surveillance was conducted among children <18 years of age for CRE from 2016–2020 in 10 sites, and for ESBL-E from 2019–2020 in 6 sites. Among catchment-area residents, an incident CRE case was defined as the first isolation of Escherichia coli, Enterobacter cloacae complex, Klebsiella aerogenes, K. oxytoca, or K. pneumoniae in a 30-day period resistant to ≥1 carbapenem from a normally sterile site or urine. An incident ESBL-E case was defined as the first isolation of E. coli, K. pneumoniae, or K. oxytoca in a 30-day period resistant to any third-generation cephalosporin and non-resistant to all carbapenems from a normally sterile site or urine. Case records were reviewed. Results: Among 159 CRE cases, 131 (82.9%) were isolated from urine and 19 (12.0%) from blood; median age was 5 years (IQR 1–10) and 94 (59.1%) were female. Combined CRE incidence rate per 100,000 population by year ranged from 0.47 to 0.87. Among 207 ESBL-E cases, 160 (94.7%) were isolated from urine and 6 (3.6%) from blood; median age was 6 years (IQR 2–15) and 165 (79.7%) were female. Annual ESBL incidence rate per 100,000 population was 26.5 in 2019 and 19.63 in 2020. Incidence rates of CRE and ESBL-E were >2-fold higher in infants (children <1 year) than other age groups. Among those with data available, CRE cases were more likely than ESBL-E cases to have underlying conditions (99/158 [62.7%] versus 59/169 [34.9%], P<0.0001), prior healthcare exposures (74/158 [46.8%] versus 38/169 [22.5%], P<0.0001), and be hospitalized for any reason around time of their culture collection (75/158 [47.5%] versus 38/169 [22.5%], P<0.0001); median duration of admission was 18 days [IQR 3–103] for CRE versus 10 days [IQR 4–43] for ESBL-E. Urinary tract infection was the most frequent infection for CRE (89/158 [56.3%]) and ESBL-E (125/169 [74.0%]) cases. Conclusion: CRE infections occurred less frequently than ESBL-infections in U.S. children but were more often associated with healthcare risk factors and hospitalization. Infants had highest incidence of CRE and ESBL-E. Continued surveillance, infection prevention and control efforts, and antibiotic stewardship outside and within pediatric care are needed

Disclosure: None

Two introduced carnivores, the European red fox Vulpes vulpes and domestic cat Felis catus, have had extensive impacts on Australian biodiversity. In this study, we collate information on consumption of Australian birds by the fox, paralleling a recent study reporting on birds consumed by cats. We found records of consumption by foxes on 128 native bird species (18% of the non-vagrant bird fauna and 25% of those species within the fox’s range), a smaller tally than for cats (343 species, including 297 within the fox’s Australian range, a subset of that of the cat). Most (81%) bird species eaten by foxes are also eaten by cats, suggesting that predation impacts are compounded. As with consumption by cats, birds that nest or forage on the ground are most likely to be consumed by foxes. However, there is also some partitioning, with records of consumption by foxes but not cats for 25 bird species, indicating that impacts of the two predators may also be complementary. Bird species ≥3.4 kg were more likely to be eaten by foxes, and those <3.4 kg by cats. Our compilation provides an inventory and describes characteristics of Australian bird species known to be consumed by foxes, but we acknowledge that records of predation do not imply population-level impacts. Nonetheless, there is sufficient information from other studies to demonstrate that fox predation has significant impacts on the population viability of some Australian birds, especially larger birds, and those that nest or forage on the ground.

Background: Effective medical device reprocessing (MDR) is essential in preventing the spread of microorganisms and maintaining patient safety. Alberta Health Services (AHS) is an Alberta-wide, integrated health system, responsible for delivering health services to >4.3 million people living in the province. In 2010, periodic province-wide MDR reviews were initiated by the provincial health system to verify that the cleaning, disinfection, and sterilization of reusable critical and semicritical medical devices met established standards. To date, there have been 3 review cycles; in cycle 3, a follow-up process for tracking and reporting corrective actions was initiated. Methods: As in previous MDR review cycles, cycle 3 included the use of a standardized suite of tools to measure compliance with standards set by Accreditation Canada, the Canadian Standards Association, and the Government of Alberta. Each cycle involved a review of MDR areas completed by trained reviewers. Interrater reliability among reviewers was maintained through training and debriefings following reviews to ensure agreement. Following reviews, reports were generated for areas, zones, and AHS. As part of the corrective actions and follow-up process, identified deficiencies were categorized into 5 themes. Corrective actions were tracked and periodic reports were generated showing the progress of deficiency resolution. Resolution rates (number of resolved deficiencies divided by total number of of deficiencies) were calculated for each of the identified themes as well as overall for cycle 3. Results: Overall compliance for cycle 3 was 93%. Cycle 3 reviews revealed that more than half of the deficiencies (58%) were identified previously in cycle 2. The resolution rates ranged from 78% to 95% for identified deficiencies for 4 of the 5 themes: documentation, technique, PPE/attire/hand hygiene, and other. The theme related to physical infrastructure showed a considerably lower resolution rate of 49%. The corrective action follow-up process showed increased overall resolution rate from 59% at the start of the follow-up process to 82% at its completion. When this resolution rate was applied to the initial survey compliance rate for cycle 3, overall compliance increased to 99%. Conclusions: Monitoring quality of MDR practices is essential in maintaining and improving patient safety. The standardized provincial review process identified common themes and a coordinated approach to support the resolution of many identified deficiencies. Most of those deficiencies were resolved; however, those deficiencies related to physical infrastructure of the MDR department continue to be seen across review cycles. This review process with follow up of these deficiencies can help bring attention to organization leadership and Funding: authorities during budget cycles.

Funding: None

Disclosures: None

Two new flat-backed archipolypodan millipede taxa, Orsadesmus rubecollus n. gen. and sp. and Zanclodesmus willetti n. gen. and sp., are described from the Upper Devonian of Clinton County, Pennsylvania, and Miguasha, Québec, respectively. These new taxa are placed in the new family Zanclodesmidae within the order Archidesmida. Archidesmida have previously only been described from the United Kingdom, and their presence in North America confirms a geographic continuum in the millipede fauna across the Old Red Sandstone Continent during the Devonian.

Two new xyloiuloid millipedes (Diplopoda: Chilognatha: Juliformia) are described and placed in the new family Gaspestriidae: Gaspestria genselorum n. gen and sp. from the Emsian of Québec and New Brunswick and Sigmastria dilata n. gen. and sp. from the Pragian of the Midland Valley of Scotland. These new millipedes extend the stratigraphic range of xyloiuloid millipedes, which previously were only described from the Pennsylvanian of Europe and North America. All xyloiuloid millipede families are placed within the superfamily Xyloiuloidea which is left incertae sedis within Juliformia due to a lack of preservation of diagnostic characters that would allow placement within an extant order. The presence in the Lower Devonian of the superorder Juliformia, universally agreed among diplopod taxonomists to represent the most derived clade of Diplopoda, indicates that most of millipede cladogenesis leading to high-rank extant clades had to have occurred by this time, much earlier than previously indicated by the fossil record. A stratocladogram for Myriapoda is constructed, and in combination with data from the plant fossil record and nuclear protein-encoding genes, new hypotheses regarding timing of millipede high-rank cladogenesis in the Paleozoic are formulated. These include terrestrialization of Diplopoda no later than the Ordovician along with the origin of the lineage leading to Penicillata and Arthropleuridea, followed by a period of relative stasis until the Middle Silurian, at which point there was a rapid radiation of Diplopoda, producing most of the high-rank clades by the Lower Devonian.

Pleurojulid millipedes, known since the turn of the last century to be relatively abundant in the Westphalian D (Carboniferous: Pennsylvanian) Gaskohl of Nýřany, Czech Republic, are here also identified as an important component of the Pennsylvanian (Westphalian D) Mazon Creek millipede fauna preserved in ironstone nodules. Pleurojulids reach lengths approaching 10 cm, have as many as 69 body segments, medium-sized heads, and large ocellaria with upwards of 40 ocelli. Pleurojulids have previously been interpreted as having either a juliform-like or a colobognathan-like trunk-ring architecture. In order to distinguish between these two hypotheses, almost all pleurojulid specimens in museum collections were surveyed to document the deformation pattern of exoskeletal elements to aid in reconstruction of the trunk-ring architecture. The Nýřany specimens are completely flattened while the Mazon Creek specimens retain a degree of three-dimensionality. In order to assess how trunk-ring architecture controls patterns of deformation, a variety of extant millipedes were experimentally compressed. The distribution of exoskeletal elements in pleurojulid fossils was most similar to that seen in compressed extant polyzoniid millipedes. Based on the available evidence, pleurojulid trunk-ring architecture is reconstructed as semicircular in cross section, consisting of arched diplotergites, free pleurites firmly articulated to the lateral margins of the tergites and held in a near horizontal position, and free sternites. Pleurojulida are hypothesized to be basal helminthomorph, the sister group to Colobognatha, though inclusion in Helminthomorpha is equivocal. The taxonomy of previously described pleurojulid millipedes from Nýřany is revised and newly recognized specimens from Mazon Creek specimens are described. Two genera are recognized within the new order Pleurojulida: Pleurojulus and Isojulus. Two species of Pleurojulus are recognized: P. biornatus and P. levis. Pleurojulus aculeatus and P. pinguis are synonymized with P. levis. Only one species of Isojulus, I. constans, is recognized with I. setipes, I. marginatus synonymized with it along with Pleurojulus longipes and P. falcifer.

A new scolopendromorph centipede (Myriapoda: Chilopoda), Cratoraricrus oberlii n. gen. and sp., is described from the Nova Olinda Member of the Lower Cretaceous Crato Formation of northeast Brazil. The specimen is tentatively referred to the Scolopendridae based on possession of bisegmented tarsi and paramedian longitudinal grooves on the sternites. This specimen represents one of only four verifiable Mesozoic taxa.

New millipede specimens from the Paleozoic of Scotland are described, including Archidesmus macnicoli Peach, 1882, from the Lower Devonian (Lochkovian) Tillywhandland Quarry SSSI and three new taxa—Albadesmus almondi, Pneumodesmus newmani, and Cowiedesmus eroticopodus—from the mid Silurian (late Wenlock—early Ludlow) Cowie Formation at Cowie Harbour. Cowiedesmus eroticopodus new species is placed within the new Cowiedesmidae within the new order Cowiedesmida. Kampecaris tuberculata Brade-Birks from the Lower Devonian (Siegenian) of the Lanark Basin near Dunure is shown not to be a kampecarid myriapod, redescribed as Palaeodesmus tuberculata and placed order incertae sedis within Archipolypoda. Anthracodesmus macconochiei Peach is also redescribed and tentatively placed order incertae sedis within Archipolypoda. Archidesmus macnicoli, Albadesmus almondi, and Palaeodesmus tuberculata are each demonstrated to have broad sternites with laterally placed coxal sockets and paramedian pores containing paired valves. These pores are interpreted as having housed eversible vesicles. Some specimens of Archidesmus macnicoli and Cowiedesmus eroticopodus are male and have a pair of modified legs on trunk segment 8, identified as leg pairs 10 and 11, respectively. The presence of modified anterior legs restricted to segment 8 increases the range of variability known in modified appendage location in male millipedes and compounds existing uncertainty about using the presence of gonopods on trunk segment 7 as a synapomorphy of Helminthomorpha. An affinity between Archidesmida and Cowiedesmida is suggested based on possession of modified legs on segment 8 and Archidesmida + Cowiedesmida is placed along with Euphoberiida in Archipolypoda based on possession of free, broad sternites with bivalved paramedian pores and fused pleurotergites. The oldest known evidence of spiracles is demonstrated in Pneumodesmus newmani, proving that the oldest known millipedes were fully terrestrial.

The U.S. Geological Survey (USGS) has been producing reference materials since the 1950s. Over 50 materials have been developed to cover bulk rock, sediment, and soils for the geological community. These materials are used globally in geochemistry, environmental, and analytical laboratories that perform bulk chemistry and/or microanalysis for instrument calibration and quality assurance testing. To answer the growing demand for higher spatial resolution and sensitivity, there is a need to create a new generation of microanalytical reference materials suitable for a variety of techniques, such as scanning electron microscopy/X-ray spectrometry (SEM/EDS), electron probe microanalysis (EPMA), laser ablation inductively coupled mass spectrometry (LA-ICP-MS), and secondary ion mass spectrometry (SIMS). As such, the microanalytical reference material (MRM) needs to be stable under the beam, be homogeneous at scales of better than 10–25 micrometers for the major to ultra-trace element level, and contain all of the analytes (elements or isotopes) of interest. Previous development of basaltic glasses intended for LA-ICP-MS has resulted in a synthetic basaltic matrix series of glasses (USGS GS-series) and a natural basalt series of glasses (BCR-1G, BHVO-2G, and NKT-1G). These materials have been useful for the LA-ICP-MS community but were not originally intended for use by the electron or ion beam community. A material developed from start to finish with intended use in multiple microanalytical instruments would be useful for inter-laboratory and inter-instrument platform comparisons.

This article summarizes the experiments undertaken to produce a basalt glass reference material suitable for distribution as a multiple-technique round robin material. The goal of the analytical work presented here is to demonstrate that the elemental homogeneity of the new glass is acceptable for its use as a reference material. Because the round robin exercise is still underway, only nominal compositional ranges for each element are given in the article.

Evidence suggests violence and aggression are key reasons for admission to Psychiatric Intensive Care Units (PICUs). Research and national guidelines highlight the potential benefits of anger management interventions in this setting, however such interventions are often only offered in a minimal number of units. This paper describes the implementation of a two session cognitive behaviour therapy informed anger management intervention within a PICU setting. Twelve service users completed the sessions. There was a statistically significant reduction in the frequency of violent and aggressive incidents instigated by these patients in the two week period post intervention compared to the two weeks prior. It is possible that participation in anger management sessions contributed to the reduction in violence and aggression; however, large scale, longer term research is necessary controlling for other contributing variables, in order to establish the true effectiveness of this approach.

The connection between obesity and disordered haemostasis is well established, but incompletely understood. There is a strong link between inhibition of fibrinolysis and obesity, and elevation of the plasma inhibitor, plasminogen activator inhibitor-1 (PAI-1), is regarded as a central factor. Here we explore the increased risk of atherothrombotic disorders in obese subjects, and the evidence for metabolic and genetic causes. There is a clear relationship between plasma PAI-1 and obesity, and adipose tissue synthesises PAI-1, as has been shown in mouse and rat models, and more recently in human material. This tissue also produces several effector molecules that can up regulate PAI-1. These molecules include transforming growth factor b, tumour necrosis factor a, angiotensin II and interleukin 6, all of which up regulate PAI-1 in various cell types. The issue of whether adipose tissue directly contributes to plasma PAI-1, or whether it primarily contributes indirectly, its products stimulating other cells to produce PAI-1 that feeds into the plasma pool, is not yet resolved. Finally, we briefly examine other proteins of haemostasis that are products of adipose tissue. Further studies are needed to define the regulation of these proteins, in adipose tissue itself and in other cells influenced by its products, in order to extend recent insights into the links between obesity and haemostasis.

The sea urchin egg has proved a reliable and robust system for measuring intracellular calcium release in response to three independent mechanisms: inositol 1,4,5 trisphosphate, cyclic ADP-ribose and the recently identified molecule, nicotinic acid adenine dinucleotide phosphate (NAADP). These calcium release mechanisms have been studied in homogenates of Lytechinus pictus and Spongylocentrotus purpuratus, which are two sea urchin species located off the west coast of the USA. A new calcium-release model from a species of sea urchin present off the coasts of Britain, Psammechinus miliaris is characterized and described. Although the Ca2+-release characteristics in this species do not differ from those of the other two sea urchin species, it may provide a more economical and convenient model for European scientists.

Microdecemplex rolfei, gen. and sp. nov., a new microarthropleuridean less than 5 mm long, is described from the Middle Devonian Panther Mountain Formation of New York State, U.S.A. The specimens consist of organically preserved cuticle, with some preserving the only cephalic structures known for arthropleurideans. A new order, Microdecemplicida, and a new family, Microdecemplicidae, are established. The probable phylogenetic position of the Microdecemplicida as one of the basal clades of Diplopoda is proposed.