Kansas Department of Health and Environment

Microplastics (MPs), defined as plastic particles ranging from 1 µm to 5 mm, have emerged as ubiquitous environmental contaminants due to the widespread use and persistence of plastics. They originate both from the degradation of larger plastic debris and from intentionally produced small particles. MPs have been detected across environmental compartments, including freshwater systems, and even within the human body, raising concerns about potential exposure and risks. This thesis aimed to investigate the occurrence of MPs in freshwater environments and related consumption products, specifically drinking water and fish, while contributing to the advancement of reliable analytical methodologies. Pyrolysis–gas chromatography–mass spectrometry (Py-GC-MS) was employed as the primary analytical technique due to its ability to provide size-independent, quantitative, and polymer-specific data. Complementary use of micro-Fourier transform infrared spectroscopy (µ-FTIR) enabled particle-based characterization. Urban surface water in Amsterdam was analyzed across seasons and locations, revealing higher MP concentrations in summer and in densely urbanized canals. Polypropylene (PP) and polyethylene (PE) were the dominant polymers, and MP concentrations were positively correlated with suspended particulate matter. In drinking water systems, raw water contained relatively high MP concentrations, while treatment processes achieved removal efficiencies of 97–98%. Consequently, tap water contained only trace levels of MPs. Methodological challenges, particularly background contamination, highlighted the importance of strict quality control. The occurrence and potential accumulation of MPs in Nile tilapia were also investigated. Low concentrations were detected in fillet tissues, with heterogeneous distribution across samples. A controlled exposure experiment demonstrated minimal translocation of MPs into edible tissues, with most particles being excreted, suggesting limited human exposure through fish consumption. Overall, this thesis provides mass-based evidence of MP occurrence across environmental and biological matrices and demonstrates the applicability of Py-GC-MS for robust MP quantification. The findings contribute to improved methodological standardization and enhance the understanding of MP distribution and potential human exposure pathways.

Perfluoroalkyl substances (PFAS) are industrial chemicals with many applications, including food packaging. These chemicals have been detected in our environment and human tissues, raising concerns regarding their potential adverse health effects on humans. Exposure to PFAS is associated with hepatotoxicity, lipid metabolism disruption, and decreased immune response. This study aimed to investigate the toxicity mechanisms of several PFAS using 2D and 3D human liver cell-based in vitro models with increasing biological complexity. In Chapter 2, 2D cultures of in vitro human hepatocyte-like cells (HepaRG) were used to assess the impact of legacy PFAS (PFOS, PFOA, PFBA, PFDA, PFHxA, PFHxS, and PFNA) and alternative PFAS for these legacy PFAS (PMPP (Adona), HFPO-DA (GenX), and PFBS) on lipid composition using a lipidomics approach. The study showed that PFOS and PFOA increased ceramide, diacylglyceride, N-acylethanolamine, phosphatidylcholine, and triacylglyceride levels, whereas PMPP, HFPO-DA, PFBA, PFBS, PFHxA, and PFHxS decreased these lipid levels. In Chapter 3, six understudied PFAS (PFOSA, PFPeA, PFPrA, 6:2 FTOH, 6:2 FTSA, and 8:2 FTSA) were screened in vitro for their capacity to activate nuclear receptors in HEK293T reporter gene assays and to affect the expression of genes involved in lipid metabolism in HepaRG 2D cultures. The findings indicate PFOSA as the most potent among the six tested PFAS, capable of interfering with lipid metabolic pathways. In Chapter 4, we examined the impact of PFOSA, 6:2 FTSA, and 8:2 FTSA on HepG2 (2D) cultures, focusing on their influence on lipid metabolism. Subsequently, 3D spheroids of HepG2 cells were exposed to PFOSA, the most disruptive PFAS on gene expression and lipid profiles, to understand its effects on hepatic lipid metabolism, with PFOS used as reference compound. PFOSA suppressed the expression of cholesterol synthesis genes in both models. In PFOSA-exposed HepG2 monolayers, glycerophospholipid metabolism genes were suppressed and increased glycerophospholipid levels. In HepG2 3D spheroids, PFOSA inhibited genes involved in fatty acid metabolism with most CAR and NAE species levels decreased. In Chapter 5, 3D spheroid models consisting of HepaRG or HepG2 cells cocultured with primary human hepatic stellate cells (HSCs) were used to evaluate the impact of PFOSA and PFOS on lipid composition and gene expression. The cocultured spheroids (HepaRG+HSC and HepG2+HSC) were exposed to PFOSA or PFOS for 24 or 72 h. After PFAS exposure, coculture spheroids exhibited altered lipid profiles and gene expression in a time- and cell type-dependent manner. In HepG2+HSC spheroids, PFOSA stimulated lipogenesis at 24 h and promoted lipid degradation at 72 h, whereas PFOS enhanced lipogenesis at both 24 and 72 h. In HepaRG+HSC spheroids, PFOSA promoted lipogenesis at 24 and 72 h. Conversely, PFOS stimulated lipid degradation at 24 h and lipogenesis at 72 h. PFOSA was more potent than PFOS in suppressing genes involved in lipid metabolism in HepaRG+HSC and HepG2+HSC spheroids. In Chapter 6, the overall findings obtained in the previous Chapters 2 to 5 indicates that several PFAS examined in this dissertation, including PFOSA and PFOS, disrupted lipid metabolism by altering gene expression and lipid composition in 2D and 3D in vitro hepatocyte models. Therefore, the existence of approximately 15,000 PFAS structures, many of which lack toxicity data, is concerning. Although toxicity data exist for PFOA, PFOS, PFNA, and PFHxS, rodent studies suggest that other understudied PFAS may also be toxic to humans. We propose a tiered testing strategy for identifying PFAS that disrupt hepatic lipid metabolism. Testing begins with a 2D monolayer hepatocyte culture screening in Tier I, followed by testing of selected PFAS in a 3D spheroid hepatocyte monoculture in Tier II, and a 3D spheroid hepatocyte-stellate cell coculture, possessing cell-cell interactions in Tier III to confirm the mechanism.

Student interview teams provided essential surge capacity for the conduct of routine enteric disease surveillance and outbreak activities during the COVID-19 pandemic response, for states with that resource available. This case study describes how student interview teams based in Colorado and Washington supported enteric disease interviewing for public health agencies in Nebraska, Wyoming, Kansas, and California, and demonstrates the feasibility and value of interstate student interview team work to provide enteric and other communicable disease surge capacity. In collaboration with their respective state health agencies, the Colorado School of Public Health Enteric Disease Interview Team (EDIT) and the University of Washington Student Epidemic Action Leaders (SEAL) team amended scopes of work and procedures for hiring and onboarding, training, work management and engagement, communication, and evaluation to offer enteric disease interviewing support to the Nebraska Department of Health and Human Services, the Wyoming Department of Health, the Kansas Department of Health and Environment, and the California Department of Public Health. EDIT was assigned 467 enteric interviews in Nebraska, 193 in Wyoming, and 33 in Kansas; and the SEAL team was assigned 133 interviews from 26 clusters in California, with response rates of 68%, 79%, 58%, and 53%, respectively. The median time from case assignment to first interview for EDIT interviews was less than or equal to 1 day. The completeness of all interviews was satisfactory. Enteric disease epidemiologists from host state health departments and students reported valuing the interstate work. Establishing interstate student interview team support requires coordination but is possible and can be effective in providing essential surge capacity for states without a student interview team. It also provides intangible benefits such as strengthening relationships between states and affiliated university programs and providing professional experiences and networking opportunities for students.

To learn the knowledge, attitudes, and practices of veterinarians and technicians in Kansas regarding the occupational risk of tularemia, personal protection, patient diagnosis and management, zoonotic risk communication, and public health reporting. Kansas veterinarians and technicians serving cats and dogs completed an online survey between June and September 2024. The survey was completed by 109 veterinarians and 19 technicians. Forty-three percent (47 of 109) of veterinarians reported diagnosing tularemia in cats and 13% (14 of 109) in dogs. Seven percent (8 of 109) of veterinarians reported having had tularemia. When performing procedures with a high risk of exposure, such as lancing abscesses in tularemia suspects, glove use was 100% but additional personal protective equipment was inconsistent, including eye protection (81 of 116 [70%]) and surgical face mask (69 of 116 [59%]). Antibody titer and PCR were common diagnostics, but 42% (26 of 62) of veterinarians reported never submitting a confirmatory test, with owner finances being the primary hurdle. Veterinarians and technicians have inconsistent knowledge about reporting regulations, but 91% (58 of 64) discuss tularemia's public health risk with pet owners. Veterinarians are not only diagnosing tularemia in their patients but also contracting the disease themselves. Education should be targeted toward diagnostics, protection, and reporting. Veterinary personnel play an essential One Health role in the prevention and control of tularemia in Kansas through environmental tick and wildlife management, diagnosis and treatment of sick pets, and education about transmission and protection precautions for people. Designating tularemia as reportable in animals would allow determination of disease trends and more rapid public health follow-up.

We describe a feline sporotrichosis cluster and zoonotic transmission between one of the affected cats and a technician at a veterinary clinic in Kansas, USA. Increased awareness of sporotrichosis and the potential for zoonotic transmission could help veterinary professionals manage feline cases and take precautions to prevent human acquisition.

Medical students attending university for the first time experience a new environment, full of significant social, cultural, and intellectual challenges. Moreover, drug abuse and bullying among university students are major global concerns. The aim of the current study was to assess the impact of medicolegal issues on undergraduate and postgraduate students. It is a cross-sectional survey-based study, with each set of questions investigating cognitive functions, aggression, personality, and exposure to medicolegal issues. Males and those with a chronic disease have been significantly exposed to medicolegal issues; exposed students were significantly older than nonexposed ones. The scores of aggression were significantly higher among exposed and male students. The cognitive scores were higher for the students from rural areas than in urban areas, and females were more neurotic than males. The current study recommends conducting campaigns to educate university students on the importance of formally disclosing unethical behaviors and listening to the victims to facilitate overcoming their negative feelings. As many victims feel comfortable disclosing victimization to their friends, we recommend conducting peer educational programs to help friends support their colleagues regarding unethical misconduct.

Syndromic surveillance (SyS) is an important public health tool using de-identified healthcare discharge data from emergency department (ED) and urgent care settings to rapidly identify new health threats and provide insight into current community well-being. While SyS is directly fed by clinical documentation such as chief complaint or discharge diagnosis, the degree to which clinicians are aware their documentation directly influences public health investigations is unknown. The primary objective of this study was to evaluate the degree to which clinicians practicing in Kansas EDs or urgent care settings were aware that certain de-identified aspects of their documentation are used in public health surveillance and to identify barriers to improved data representation. We distributed an anonymous survey August-November 2021 to clinicians practicing at least part time in emergency or urgent care settings in Kansas. We then compared responses from emergency medicine (EM)-trained physicians to non-EM trained physicians. Descriptive statistics were used for analysis. A total of 189 respondents across 41 Kansas counties responded to the survey. Of those surveyed, 132 (83%) were unaware of SyS. Knowledge did not differ significantly by specialty, practice setting, urban region, age, nor by experience level. Respondents were unaware of which aspects of their documentation were visible to public health entities, or how quickly records were retrievable. When asked about improving documentation for SyS, lack of clinician awareness (71.5%) was perceived as a greater barrier than electronic health record platform usability or time available to document (61% and 59%, respectively). This survey suggests that most practitioners in EM have not heard of SyS and are unaware of the invaluable role certain aspects of their documentation play in public health. Critical information that would be captured and coded into a key syndrome is often missing, but clinicians are unaware of what types of information may be most useful in their documentation, and where to document that information. Lack of knowledge or awareness was identified by clinicians as the single greatest barrier to enhancing surveillance data quality. Increased awareness of this important tool may lead to enhanced utility for timely and impactful surveillance through improved data quality and collaboration between EM practitioners and public health.

Heat stroke is a problem that occurs primarily in the out-of-hospital environment. “Cool first, transport second” has been emphasized in consensus statements and systematic reviews regarding the treatment of exertional heat stroke by both EMS and the sports medicine/athletic training communities. However, there remains little guidance on cooling recommendations for the out-of-hospital care of non-exertional heat stroke or classic heat stroke. There is no consensus on the safety or feasibility of cooling classic heat stroke patients in the out-of-hospital environment using cold-water immersion. This case series describes the successful application of on-scene cold-water immersion for five classic heat stroke patients guided by real-time core temperature monitoring.