An outbreak of Streptococcus equi subspecies zooepidemicus associated with consumption of fresh goat cheese

BACKGROUND: Streptococcus equi subspecies zooepidemicus is a rare infection in humans associated with contact with horses or consumption of unpasteurized milk products. On October 23, 2003, the National Public Health Institute was alerted that within one week three persons had been admitted to Tampere University Central Hospital (TaYS) because of S. equi subsp. zooepidemicus septicaemia. All had consumed fresh goat cheese produced in a small-scale dairy located on a farm. We conducted an investigation to determine the source and the extent of the outbreak. METHODS: Cases were identified from the National Infectious Disease Register. Cases were persons with S. equi subsp. zooepidemicus isolated from a normally sterile site who had illness onset 15.9-31.10.2003. All cases were telephone interviewed by using a standard questionnaire and clinical information was extracted from patient charts. Environmental and food specimens included throat swabs from two persons working in the dairy, milk from goats and raw milk tank, cheeses made of unpasteurized milk, vaginal samples of goats, and borehole well water. The isolates were characterized by ribotyping and pulsed-field gel electrophoresis (PFGE). RESULTS: Seven persons met the case definition; six had septicaemia and one had purulent arthritis. Five were women; the median age was 70 years (range 54–93). None of the cases were immunocompromized and none died. Six cases were identified in TaYS, and one in another university hospital in southern Finland. All had eaten goat cheese produced on the implicated farm. S. equi subsp. zooepidemicus was isolated from throat swabs, fresh goat cheese, milk tank, and vaginal samples of one goat. All human and environmental strains were indistinguishable by ribotyping and PFGE. CONCLUSION: The outbreak was caused by goat cheese produced from unpasteurized milk. Outbreaks caused by S. equi subsp. zooepidemicus may not be detected if streptococcal strains are only typed to the group level. S. equi subsp. zooepidemicus may be a re-emerging disease if unpasteurized milk is increasingly used for food production. Facilities using unpasteurized milk should be carefully monitored to prevent this type of outbreaks

The ABCflux database : Arctic-boreal CO2 flux observations and ancillary information aggregated to monthly time steps across terrestrial ecosystems

Past efforts to synthesize and quantify the magnitude and change in carbon dioxide (CO2) fluxes in terrestrial ecosystems across the rapidly warming Arctic-boreal zone (ABZ) have provided valuable information but were limited in their geographical and temporal coverage. Furthermore, these efforts have been based on data aggregated over varying time periods, often with only minimal site ancillary data, thus limiting their potential to be used in large-scale carbon budget assessments. To bridge these gaps, we developed a standardized monthly database of Arctic-boreal CO2 fluxes (ABCflux) that aggregates in situ measurements of terrestrial net ecosystem CO2 exchange and its derived partitioned component fluxes: gross primary productivity and ecosystem respiration. The data span from 1989 to 2020 with over 70 supporting variables that describe key site conditions (e.g., vegetation and disturbance type), micrometeorological and environmental measurements (e.g., air and soil temperatures), and flux measurement techniques. Here, we describe these variables, the spatial and temporal distribution of observations, the main strengths and limitations of the database, and the potential research opportunities it enables. In total, ABCflux includes 244 sites and 6309 monthly observations; 136 sites and 2217 monthly observations represent tundra, and 108 sites and 4092 observations represent the boreal biome. The database includes fluxes estimated with chamber (19 % of the monthly observations), snow diffusion (3 %) and eddy covariance (78 %) techniques. The largest number of observations were collected during the climatological summer (June-August; 32 %), and fewer observations were available for autumn (September-October; 25 %), winter (December-February; 18 %), and spring (March-May; 25 %). ABCflux can be used in a wide array of empirical, remote sensing and modeling studies to improve understanding of the regional and temporal variability in CO2 fluxes and to better estimate the terrestrial ABZ CO2 budget. ABCflux is openly and freely available online (Virkkala et al., 2021b, https://doi.org/10.3334/ORNLDAAC/1934).Peer reviewe

Sairaanhoitajaopiskelijoiden ammattitaitoa edistävän harjoittelun ohjausrunko Kolmiosairaalan infektiosairauksien osastolle

Opinnäytetyön tarkoituksena oli tuottaa sairaanhoitajaopiskelijoiden ammattitaitoa edistävän harjoittelun ohjausrunko Kolmiosairaalan infektiosairauksien osastolle. Tavoitteena oli kehittää sairaanhoitajaopiskelijoiden ammattitaitoa edistävän harjoittelun ohjausta. Opinnäytetyössä tutkimuskysymyksinä olivat mitkä ovat keskeiset sairaanhoitajaopiskelijan ohjauksen sisällöt harjoittelun alku-, keski- ja loppuvaiheessa. Opinnäytetyö rajattiin käsittelemään vain perustason ammattitaitoa edistävän harjoittelun sisältöä. Tämä opinnäytetyö on sidottuna Kolmiosairaala- hankkeeseen, Laurea-ammattikorkeakoulun ja Helsingin ja Uudenmaan sairaanhoitopiirin (HUS) yhteiseen hankkeeseen. Hanke pyrkii kehittämään ohjausta sairaalassa. Tutkimuksen kohderyhmänä olivat Kolmiosairaalan infektio-osastolla työskentelevät sairaanhoitajat. Haastattelut toteutettiin puolistrukturoituina yksilöhaastatteluina. Haastateltuja hoitajia oli kaksi, jotka molemmat toimivat opiskelijoiden vastuuohjaajina osastolla. Aineistoanalyysi tehtiin aineistolähtöisellä sisällönanalyysillä. Aineistonkeruun jälkeen osastolle luotiin ohjausrunko sairaanhoitajaopiskelijoiden ammattitaitoa edistävää harjoittelua varten. Alkuvaiheen harjoittelujaksosta sairaanhoitajaopiskelija on hyvin tiiviissä yhteistyössä vastuuohjaajansa kanssa, kun taas keskivaiheessa hänelle annetaan enemmän tilaa ja vastuuta harjoittaa tulevaa ammattiaan. Loppuvaiheessa harjoittelua opiskelijalta toivotaan jo oma-aloitteisuutta ja tilanteiden lukua sekä potilaan kokonaishoidon ymmärrystä. Opinnäytetyön tuloksissa yllättävää oli se, että ohjauksen sisällöt eivät niinkään vaihtele harjoittelujakson vaiheesta riippuen, vaan ohjausmenetelmät muuttuvat. Tulevaisuudessa olisi hyvä kehittää myös hoitotyön osaamista syventävän ammattitaitoa edistävän harjoittelun sairaanhoitajaopiskelijoille ohjausrunko ja perehtyä myös ohjausmenetelmiin. Näin mahdollistettaisiin myös opinnoissa pidemmällä olevien opiskelijoiden tasavertainen ohjaus sekä saataisiin tarkempaa tietoa opiskelijaohjauksen menetelmiin ja sisältöihin liittyen.The purpose of this thesis was to produce a guideline for nursing students’ practical training at the infection ward in Triangle hospital. The goal was to improve the guidance of nursing students’ practical training. Research questions used in this thesis were that “What are the main contents of guidance in the beginning of the practical training, in the middle of the practical training and during the end of the practical training”. Thesis was defined to discuss only nursing students who are executing the basic practical training and the contents of the basic practical training. This thesis is bounded in Triangle Hospital Project which is a shared project by Laurea-vocational high school and HUS (Helsinki and Uusimaa’s Hospital District). The project is strived to improve instructions at the hospital. The target group of the research was nurses who work at the infection ward at the Triangle hospital. Interviews were taken by a half structured individual interview. Two nurses participated to the interview. Both of them work as personal supervisors. Qualitative research method was used in this thesis. After collecting data, a guideline for nursing students in practical training was created. In the be-ginning of the practical training, students work closely with their personal supervisors. In the middle point of the practical training, students are given more space and responsibility to practice their future profession. In the end of the practical training students are expected to be unprompted and assessing situations and realizing the patient’s treatment as a whole. Surprising was that the content of the guidance did not change during the practical training but only the style of the guidance. In the future it would be important to investigate guidance methods and create a guideline also for nursing students who are closer to graduation. That would enable balanced guidance also for students who are close to graduation. In addition, more detailed information from the guidance methods and content could be collected