Potential to be more effective: Reduction in lower urgency emergency department presentations during the COVID-19 period in New South Wales, Australia.

OBJECTIVE: Diverting lower urgency ED presentations to more suitable healthcare is a key goal of several healthcare systems. During the early stages of the COVID-19 pandemic in 2020, there was a substantial drop in ED presentations in New South Wales (NSW), potentially because of lower risk of illness and injury through social restrictions, or ED avoidance for lower urgent care. The present study aimed to better understand the impact of social restrictions during the pandemic on ED presentations, to inform potential shifts to alternative modes of care in emergency medicine. METHODS: We conducted a quasi-experimental study of public ED presentations in NSW. We compared changes in weekly ED presentation counts by urgency, during and after the period of tightest social restrictions in contrast to the baseline period. Expected weekly counts were estimated using segmented quasi-Poisson regression, accounting for age and seasonality. RESULTS: Lower urgency presentations fell more than mid-high urgency presentations, both during and after the period of tightest social restrictions. Lower urgency presentations reduced 30.9% compared to the baseline period during tightest restrictions, in contrast to 20.9% reduction for mid-high urgency presentations. Lower urgency presentations remained 14.4% lower after the tightest restrictions compared to the baseline period, whereas mid-high urgency presentations returned to usual levels. CONCLUSIONS: This finding suggests that reducing lower urgency ED presentation beyond the COVID-19 pandemic maybe feasible, by supporting alternative, more appropriate sources of care.

Increased Axial Length Corresponds to Decreased Retinal Light Dose: A Parsimonious Explanation for Decreasing AMD Risk in Myopia.

Purpose: A recent systematic review indicated that higher sunlight exposure increased risk of AMD. The Beaver Dam study and the Pathologies Oculaires Liées à L'âge study both noted that wearing hats and/or sunglasses significantly decrease some AMD lesions, suggesting that reduced retinal light dose (RLD) may be related to reduced AMD risk. Given that myopes also have reduced AMD risk, we hypothesize its link to decreased RLD. Methods: Using a one-surface schematic eye and ray-tracing, spectacle power, vertex distance, corneal power, anterior chamber depth, and axial length to calculate relative light flux through the pupil and resultant image size on the retina in a randomly selected group of 71 eyes from the Reykjavik Eye Study. Pupil size is unaffected by refractive error; thus, RLD can be calculated. We verified this using a more complete set of ocular biometric variables and ray-tracing included in an optical design software (Opticsoft II). Results: RLD is inversely proportional to axial length. Comparing the two methods for calculating RLD using a Bland-Altman plot demonstrated equivalence. The ray-tracing method indicated that the retina of a hyperope with a 21-mm axial length would always be receiving 1.8× more photons per square millimeter than the retina of a myope with a 27-mm axial length. Conclusions: RLD is inversely proportional to axial length, as is AMD risk. The RLD for our 21-mm axial length wearing a pair of inexpensive commercial sunglasses would be equivalent to the RLD for a 27-mm myope. This may explain the decreased AMD risk in highly myopic individuals.

Funding New Zealand's public healthcare system: time for an honest appraisal and public debate.

Successive New Zealand governments have claimed that the cost of funding the country's public healthcare services is excessive and unsustainable. We contest that these claims are based on a misrepresentation of healthcare spending. Using data from the New Zealand Treasury and the Organisation for Economic Cooperation and Development (OECD), we show how government spending as a whole is low compared with most other OECD countries and is falling as a proportion of GDP. New Zealand has a modest level of health spending overall, but government health spending is also falling as a proportion of GDP. Together, the data indicate the New Zealand Government can afford to spend more on healthcare. We identify compelling reasons why it should do so, including forecast growing health need, signs of increasing unmet need, and the fact that if health needs are not met the costs still have to be borne by the economy. The evidence further suggests it is economically and socially beneficial to meet health needs through a public health system. An honest appraisal and public debate is needed to determine more appropriate levels of healthcare spending.

Effect of calcium chloride addition and draining pH on the microstructure and texture of full fat Cheddar cheese during ripening.

Calcium chloride is commonly added to cheese-milk to improve coagulum formation and to increase cheese yield but high concentrations of calcium ions can have adverse effects. In this study, confocal laser scanning microscopy and cryo-scanning electron microscopy were coupled with textural and chemical analyses to observe microstructural and biochemical changes that occur in cheese during ripening when calcium chloride is added or the draining pH altered. For the cheese prepared with no additional calcium at a draining pH of 6.0, the cheese porosity increased with ripening time and the number of protein vertices in the microscopy images declined, indicative of protein solubilisation. As the amount of CaCl2 added was increased, however, these changes became less significant. Our findings show that calcium chloride addition can be used, together with a lower draining pH, to alter the manufacturing process without significantly impacting on the quality of the mature cheese.

Rapid identification of dairy mesophilic and thermophilic sporeforming bacteria using DNA high resolution melt analysis of variable 16S rDNA regions.

Due to their ubiquity in the environment and ability to survive heating processes, sporeforming bacteria are commonly found in foods. This can lead to product spoilage if spores are present in sufficient numbers and where storage conditions favour spore germination and growth. A rapid method to identify the major aerobic sporeforming groups in dairy products, including Bacillus licheniformis group, Bacillus subtilis group, Bacillus pumilus group, Bacillus megaterium, Bacillus cereus group, Geobacillus species and Anoxybacillus flavithermus was devised. This method involves real-time PCR and high resolution melt analysis (HRMA) of V3 (~70 bp) and V6 (~100 bp) variable regions in the 16S rDNA. Comparisons of HRMA curves from 194 isolates of the above listed sporeforming bacteria obtained from dairy products which were identified using partial 16S rDNA sequencing, allowed the establishment of criteria for differentiating them from each other and several non-sporeforming bacteria found in samples. A blinded validation trial on 28 bacterial isolates demonstrated complete accuracy in unambiguous identification of the 7 different aerobic sporeformers. The reliability of HRMA method was also verified using boiled extractions of crude DNA, thereby shortening the time needed for identification. The HRMA method described in this study provides a new and rapid approach to identify the dominant mesophilic and thermophilic aerobic sporeforming bacteria found in a wide variety of dairy products.

Genotyping of dairy Bacillus licheniformis isolates by high resolution melt analysis of multiple variable number tandem repeat loci.

In dairy foods, the sporeformer Bacillus licheniformis can be the cause of spoilage or specification compliance issues. Currently used methods for genotyping B. licheniformis have limited discrimination with only 2 or 3 different subgroups being identified. Here, we have developed a multi-locus variable number tandem repeat analysis (MLVA) method and combined it with high resolution melt analysis (MLV-HRMA) for genotyping B. licheniformis. Five repetitive loci were identified and used as markers for genotyping 52 isolates from two milk powder processing plants and retail samples. Nineteen genotypes could be identified using both MLVA and MLV-HRMA leading to Hunter-Gaston discrimination indices (D-value) of 0.93 each. It was found that all 5 MLVA loci were stable following 10 days of sub-culturing of 8 representative isolates. All isolates were also genotyped using previously used methods including randomly amplified polymorphic DNA-PCR (RAPD) and partial rpoB sequencing. Five different RAPD profiles and 5 different partial rpoB sequence types were identified resulting in corresponding D-values of 0.6 and 0.46, respectively. Analysis of the genotypes from dairy samples revealed that dairy B. licheniformis isolates are more heterogeneous than previously thought and that this new method can potentially allow for more discriminatory tracking and monitoring of specific genotypes.

Genotyping of present-day and historical Geobacillus species isolates from milk powders by high-resolution melt analysis of multiple variable-number tandem-repeat loci.

Spores of thermophilic Geobacillus species are a common contaminant of milk powder worldwide due to their ability to form biofilms within processing plants. Genotyping methods can provide information regarding the source and monitoring of contamination. A new genotyping method was developed based on multilocus variable-number tandem-repeat (VNTR) analysis (MLVA) in conjunction with high-resolution melt analysis (MLV-HRMA) and compared to the currently used method, randomized amplified polymorphic DNA PCR (RAPD-PCR). Four VNTR loci were identified and used to genotype 46 Geobacillus isolates obtained from retailed powder and samples from 2 different milk powder processing plants. These 46 isolates were differentiated into 16 different groups using MLV-HRMA (D = 0.89). In contrast, only 13 RAPD-PCR genotypes were identified among the 46 isolates (D = 0.79). This new method was then used to analyze 35 isolates obtained from powders with high spore counts (>10(4) spores · g(-1)) from a single processing plant together with 27 historical isolates obtained from powder samples processed in the same region of Australia 17 years ago. Results showed that three genotypes can coexist in a single processing run, while the same genotypes observed 17 years ago are present today. While certain genotypes could be responsible for powders with high spore counts, there was no correlation to specific genotypes being present in powder plants and retailed samples. In conclusion, the MLV-HRMA method is useful for genotyping Geobacillus spp. to provide insight into the prevalence and persistence of certain genotypes within milk powder processing plants.

Population genomics and phylogeography of an Australian dairy factory derived lytic bacteriophage.

In this study, we present the full genomic sequences and evolutionary analyses of a serially sampled population of 28 Lactococcus lactis-infecting phage belonging to the 936-like group in Australia. Genome sizes were consistent with previously available genomes ranging in length from 30.9 to 32.1 Kbp and consisted of 55-65 open reading frames. We analyzed their genetic diversity and found that regions of high diversity are correlated with high recombination rate regions (P value = 0.01). Phylogenetic inference showed two major clades that correlate well with known host range. Using the extended Bayesian Skyline model, we found that population size has remained mostly constant through time. Moreover, the dispersion pattern of these genomes is in agreement with human-driven dispersion as suggested by phylogeographic analysis. In addition, selection analysis found evidence of positive selection on codon positions of the Receptor Binding Protein (RBP). Likewise, positively selected sites in the RBP were located within the neck and head region in the crystal structure, both known determinants of host range. Our study demonstrates the utility of phylogenetic methods applied to whole genome data collected from populations of phage for providing insights into applied microbiology.

Food fermentations: microorganisms with technological beneficial use.

Microbial food cultures have directly or indirectly come under various regulatory frameworks in the course of the last decades. Several of those regulatory frameworks put emphasis on "the history of use", "traditional food", or "general recognition of safety". Authoritative lists of microorganisms with a documented use in food have therefore come into high demand. One such list was published in 2002 as a result of a joint project between the International Dairy Federation (IDF) and the European Food and Feed Cultures Association (EFFCA). The "2002 IDF inventory" has become a de facto reference for food cultures in practical use. However, as the focus mainly was on commercially available dairy cultures, there was an unmet need for a list with a wider scope. We present an updated inventory of microorganisms used in food fermentations covering a wide range of food matrices (dairy, meat, fish, vegetables, legumes, cereals, beverages, and vinegar). We have also reviewed and updated the taxonomy of the microorganisms used in food fermentations in order to bring the taxonomy in agreement with the current standing in nomenclature.

Characterization and genomic analysis of phage asccphi28, a phage of the family Podoviridae infecting Lactococcus lactis.

Bacteriophage asccphi28 infects dairy fermentation strains of Lactococcus lactis. This report describes characterization of asccphi28 and its full genome sequence. Phage asccphi28 has a prolate head, whiskers, and a short tail (C2 morphotype). This morphology and DNA hybridization to L. lactis phage P369 DNA showed that asccphi28 belongs to the P034 phage species, a group rarely encountered in the dairy industry. The burst size of asccphi28 was found to be 121 +/- 18 PFU per infected bacterial cell after a latent period of 44 min. The linear genome (18,762 bp) contains 28 possible open reading frames (ORFs) comprising 90% of the total genome. The ORFs are arranged bidirectionally in recognizable functional modules. The genome contains 577 bp inverted terminal repeats (ITRs) and putatively eight promoters and four terminators. The presence of ITRs, a phage-encoded DNA polymerase, and a terminal protein that binds to the DNA, along with BLAST and morphology data, show that asccphi28 more closely resembles streptococcal phage Cp-1 and the phi29-like phages that infect Bacillus subtilis than it resembles common lactococcal phages. The sequence of this phage is the first published sequence of a P034 species phage genome.

Modeling of the generic spatial heterodyne spectrometer and comparison with conventional spectrometer.

We describe the modeling of the generic spatial heterodyne spectrometer. This instrument resembles a somewhat modified Michelson interferometer, in which the power spectrum of the input source is determined by performing a one-dimensional Fourier transform on the output intensity profile. Code has been developed to analyze the performance of this type of spectrometer by determining the dependence of both spectral resolution and throughput on parameters such as aperture and field of view. An example of a heterodyne spectrometer is developed to illustrate the techniques employed in the modeling and a comparison undertaken between its performance and that of a conventional spectrometer. Unlike the traditional Fourier transform infrared system, the heterodyne spectrometer has the very desirable feature of having no moving components.

Wavelength-dispersive device based on a Fourier-transform Michelson-type arrayed waveguide grating.

We propose a new type of arrayed waveguide grating (AWG) device that operates as a Fourier-transform (FT) spectrometer without the need of scanning elements. The large input aperture size typical of a FT spectrometer eliminates the requirement for a narrow single-mode input waveguide while still achieving high spectral resolution with a markedly increased light-gathering capability (etendue). An example of the device with a resolution of 0.07 nm (approximately 10 GHz) and designed for a silicon-on-insulator platform is presented. The calculated spectra show no noticeable deterioration for aperture widths as large as 40 microm, yielding more than a 50-fold increase in aperture size compared with conventional AWG or echelle grating based devices at the equivalent resolution.