On March 17, 2020, a member of a Skagit County, Washington, choir informed Skagit County Public Health (SCPH) that several members of the 122-member choir had become ill. Three persons, two from ...Skagit County and one from another area, had test results positive for SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). Another 25 persons had compatible symptoms. SCPH obtained the choir's member list and began an investigation on March 18. Among 61 persons who attended a March 10 choir practice at which one person was known to be symptomatic, 53 cases were identified, including 33 confirmed and 20 probable cases (secondary attack rates of 53.3% among confirmed cases and 86.7% among all cases). Three of the 53 persons who became ill were hospitalized (5.7%), and two died (3.7%). The 2.5-hour singing practice provided several opportunities for droplet and fomite transmission, including members sitting close to one another, sharing snacks, and stacking chairs at the end of the practice. The act of singing, itself, might have contributed to transmission through emission of aerosols, which is affected by loudness of vocalization (1). Certain persons, known as superemitters, who release more aerosol particles during speech than do their peers, might have contributed to this and previously reported COVID-19 superspreading events (2-5). These data demonstrate the high transmissibility of SARS-CoV-2 and the possibility of superemitters contributing to broad transmission in certain unique activities and circumstances. It is recommended that persons avoid face-to-face contact with others, not gather in groups, avoid crowded places, maintain physical distancing of at least 6 feet to reduce transmission, and wear cloth face coverings in public settings where other social distancing measures are difficult to maintain.
INTRODUCTION: Tuberculosis (TB) transmission continues to be problematic in the United States. Contact investigations are essential for identifying new infections and must prioritize limited ...resources by pursuing more infectious cases. Current infectivity measures like sputum smear grade, chest x-rays, and nucleic acid amplification tests (NAAT) are sub-optimal. Time-to-detection (TTD) of Mycobacterium tuberculosis in liquid culture has shown promising results. OBJECTIVES: Our objective is to examine the relationship between TTD and TB transmission. METHODS: This study examined a retrospective cohort of pulmonary TB cases with TTD data from 2009-2014 from the King County Laboratory, Seattle, WA. The primary outcome was transmission indicated by previously undiagnosed latent tuberculosis infection (LTBI) in household contacts. The proportion of contacts positive for LTBI was modeled using Poisson regression. TTD, highest smear grade, NAAT, and chest x-ray were assessed for their association with LTBI in contacts. RESULTS: Of 390 pulmonary TB cases, 92 had TTD and household transmission data. Overall, 76.1% of them had evidence of household transmission. Among all household contacts, 36.5% (187/512) had previously undiagnosed LTBI, including 33% of contacts related to cases with long TTD and 30% with negative smears. Short (0-7 days) TTD was significantly associated with increased LTBI risk compared to long TTD (15+ days) (RR: 1.39; MH X2 p-value: 0.025) and medium TTD (RR: 1.36; MH X2 p-value: 0.023). However Poisson modeling of transmission rates did not demonstrate a significant relationship. Multivariate analyses adjusted for highest smear, NAAT, and chest x-ray were also non-significant. All cases with short TTD were smear positive, but positive smears identified 60% more transmission events. CONCLUSIONS: In this limited study, short TTD was not a promising addition to current infectivity measures. Observational studies of TB transmission are difficult when there are high background rates of LTBI. Any future studies should take place in previously TB-naïve households.
Abstract
Freshwater mussels are declining throughout their range. Their important ecological functions along with insufficient levels of natural recruitment have prompted captive breeding for ...population augmentation and questions about the usefulness and applicability of such measures.
This article reviews the current state of captive breeding and rearing programmes for freshwater mussels in Europe. It considers the various species, strategies, and techniques of propagation, as well as the different levels of effort required according to rearing method, highlighting the key factors of success.
Within the last 30 years, 46 breeding activities in 16 European countries have been reported, mainly of
Margaritifera margaritifera
and
Unio crassus
. Some facilities propagate species that are in a very critical situation, such as
Pseudunio auricularius
,
Unio mancus
, and
Unio ravoisieri
, or multiple species concurrently. In some streams, the number of released captive‐bred mussels already exceeds the size of the remaining natural population.
Rearing efforts range from highly intensive laboratory incubation to lower intensity methods using in‐river mussel cages or silos. Most breeding efforts are funded by national and EU LIFE(+) grants, are well documented, and consider the genetic integrity of the propagated mussels. Limited long‐term funding perspectives, the availability of experienced staff, water quality, and feeding/survival during early life stages are seen as the most important challenges.
Successful captive breeding programmes need to be combined with restoration of the habitats into which the mussels are released. This work will benefit from an evidence‐based approach, knowledge exchange among facilities, and an overall breeding strategy comprising multiple countries and conservation units.
Few children and adolescents meet federal nutrition or physical activity recommendations, and many experience poor or inadequate sleep and negative health effects from screen use and social media. ...These lifestyle factors exacerbate physical and mental health risks for children and adolescents. This clinical report provides guidance to help pediatricians address the nutritional, physical activity, sleep, media and screen use, and social-emotional factors that affect child and adolescent health and wellness. The recommendations in this clinical report aim to promote health and wellness practices for infants, children, and adolescents across several domains of influence, including the individual, interpersonal, institutional, community, and public policy levels.
Primary open-angle glaucoma (POAG) is a degenerative eye disease for which early treatment is critical to mitigate visual impairment and irreversible blindness. POAG-associated loci individually ...confer incremental risk. Genetic risk score(s) (GRS) could enable POAG risk stratification. Despite significantly higher POAG burden among individuals of African ancestry (AFR), GRS are limited in this population. A recent large-scale, multi-ancestry meta-analysis identified 127 POAG-associated loci and calculated cross-ancestry and ancestry-specific effect estimates, including in European ancestry (EUR) and AFR individuals. We assessed the utility of the 127-variant GRS for POAG risk stratification in EUR and AFR Veterans in the Million Veteran Program (MVP). We also explored the association between GRS and documented invasive glaucoma surgery (IGS).
Cross-sectional study.
MVP Veterans with imputed genetic data, including 5830 POAG cases (445 with IGS documented in the electronic health record) and 64 476 controls.
We tested unweighted and weighted GRS of 127 published risk variants in EUR (3382 cases and 58 811 controls) and AFR (2448 cases and 5665 controls) Veterans in the MVP. Weighted GRS were calculated using effect estimates from the most recently published report of cross-ancestry and ancestry-specific meta-analyses. We also evaluated GRS in POAG cases with documented IGS.
Performance of 127-variant GRS in EUR and AFR Veterans for POAG risk stratification and association with documented IGS.
GRS were significantly associated with POAG (P < 5 × 10
) in both groups; a higher proportion of EUR compared with AFR were consistently categorized in the top GRS decile (21.9%-23.6% and 12.9%-14.5%, respectively). Only GRS weighted by ancestry-specific effect estimates were associated with IGS documentation in AFR cases; all GRS types were associated with IGS in EUR cases.
Varied performance of the GRS for POAG risk stratification and documented IGS association in EUR and AFR Veterans highlights (1) the complex risk architecture of POAG, (2) the importance of diverse representation in genomics studies that inform GRS construction and evaluation, and (3) the necessity of expanding diverse POAG-related genomic data so that GRS can equitably aid in screening individuals at high risk of POAG and who may require more aggressive treatment.
The Phenome-Wide Association Study (PheWAS) is increasingly used to broadly screen for potential treatment effects, e.g., IL6R variant as a proxy for IL6R antagonists. This approach offers an ...opportunity to address the limited power in clinical trials to study differential treatment effects across patient subgroups. However, limited methods exist to efficiently test for differences across subgroups in the thousands of multiple comparisons generated as part of a PheWAS. In this study, we developed an approach that maximizes the power to test for heterogeneous genotype-phenotype associations and applied this approach to an IL6R PheWAS among individuals of African (AFR) and European (EUR) ancestries. We identified 29 traits with differences in IL6R variant-phenotype associations, including a lower risk of type 2 diabetes in AFR (OR 0.96) vs EUR (OR 1.0, p-value for heterogeneity = 8.5 × 10
), and higher white blood cell count (p-value for heterogeneity = 8.5 × 10
). These data suggest a more salutary effect of IL6R blockade for T2D among individuals of AFR vs EUR ancestry and provide data to inform ongoing clinical trials targeting IL6 for an expanding number of conditions. Moreover, the method to test for heterogeneity of associations can be applied broadly to other large-scale genotype-phenotype screens in diverse populations.
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