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In response to the COVID-19 pandemic, we rapidly implemented a plasma coordination center, within two months, to support transfusion for two outpatient randomized controlled trials. The center design was based on an investigational drug services model and a Food and Drug Administration-compliant database to manage blood product inventory and trial safety.
Methods:
A core investigational team adapted a cloud-based platform to randomize patient assignments and track inventory distribution of control plasma and high-titer COVID-19 convalescent plasma of different blood groups from 29 donor collection centers directly to blood banks serving 26 transfusion sites.
Results:
We performed 1,351 transfusions in 16 months. The transparency of the digital inventory at each site was critical to facilitate qualification, randomization, and overnight shipments of blood group-compatible plasma for transfusions into trial participants. While inventory challenges were heightened with COVID-19 convalescent plasma, the cloud-based system, and the flexible approach of the plasma coordination center staff across the blood bank network enabled decentralized procurement and distribution of investigational products to maintain inventory thresholds and overcome local supply chain restraints at the sites.
Conclusion:
The rapid creation of a plasma coordination center for outpatient transfusions is infrequent in the academic setting. Distributing more than 3,100 plasma units to blood banks charged with managing investigational inventory across the U.S. in a decentralized manner posed operational and regulatory challenges while providing opportunities for the plasma coordination center to contribute to research of global importance. This program can serve as a template in subsequent public health emergencies.
Enteric bacterial infections are common among people who travel internationally. During 2017–2020, the Centers for Disease Control and Prevention investigated 41 multistate outbreaks of nontyphoidal Salmonella and Shiga toxin-producing Escherichia coli linked to international travel. Resistance to one or more antimicrobial agents was detected in at least 10% of isolates in 16 of 30 (53%) nontyphoidal Salmonella outbreaks and 8 of 11 (73%) Shiga toxin-producing E. coli outbreaks evaluated by the National Antimicrobial Resistance Monitoring System. At least 10% of the isolates in 14 nontyphoidal Salmonella outbreaks conferred resistance to one or more of the clinically significant antimicrobials used in human medicine. This report describes the epidemiology and antimicrobial resistance patterns of these travel-associated multistate outbreaks. Investigating illnesses among returned travellers and collaboration with international partners could result in the implementation of public health interventions to improve hygiene practices and food safety standards and to prevent illness and spread of multidrug-resistant organisms domestically and internationally.
Consumption of unpasteurised milk in the United States has presented a public health challenge for decades because of the increased risk of pathogen transmission causing illness outbreaks. We analysed Foodborne Disease Outbreak Surveillance System data to characterise unpasteurised milk outbreaks. Using Poisson and negative binomial regression, we compared the number of outbreaks and outbreak-associated illnesses between jurisdictions grouped by legal status of unpasteurised milk sale based on a May 2019 survey of state laws. During 2013–2018, 75 outbreaks with 675 illnesses occurred that were linked to unpasteurised milk; of these, 325 illnesses (48%) were among people aged 0–19 years. Of 74 single-state outbreaks, 58 (78%) occurred in states where the sale of unpasteurised milk was expressly allowed. Compared with jurisdictions where retail sales were prohibited (n = 24), those where sales were expressly allowed (n = 27) were estimated to have 3.2 (95% CI 1.4–7.6) times greater number of outbreaks; of these, jurisdictions where sale was allowed in retail stores (n = 14) had 3.6 (95% CI 1.3–9.6) times greater number of outbreaks compared with those where sale was allowed on-farm only (n = 13). This study supports findings of previously published reports indicating that state laws resulting in increased availability of unpasteurised milk are associated with more outbreak-associated illnesses and outbreaks.
During the summer of 2016, the Hawaii Department of Health responded to the second-largest domestic foodborne hepatitis A virus (HAV) outbreak in the post-vaccine era. The epidemiological investigation included case finding and investigation, sequencing of RNA positive clinical specimens, product trace-back and virologic testing and sequencing of HAV RNA from the product. Additionally, an online survey open to all Hawaii residents was conducted to estimate baseline commercial food consumption. We identified 292 confirmed HAV cases, of whom 11 (4%) were possible secondary cases. Seventy-four (25%) were hospitalised and there were two deaths. Among all cases, 94% reported eating at Oahu or Kauai Island branches of Restaurant Chain A, with 86% of those cases reporting raw scallop consumption. In contrast, a food consumption survey conducted during the outbreak indicated 25% of Oahu residents patronised Restaurant Chain A in the 7 weeks before the survey. Product trace-back revealed a single distributor that supplied scallops imported from the Philippines to Restaurant Chain A. Recovery, amplification and sequence comparison of HAV recovered from scallops revealed viral sequences matching those from case-patients. Removal of product from implicated restaurants and vaccination of those potentially exposed led to the cessation of the outbreak. This outbreak further highlights the need for improved imported food safety.
Limitations of access have long restricted exploration and investigation of the cavities beneath ice shelves to a small number of drillholes. Studies of sea-ice underwater morphology are limited largely to scientific utilization of submarines. Remotely operated vehicles, tethered to a mother ship by umbilical cable, have been deployed to investigate tidewater-glacier and ice-shelf margins, but their range is often restricted. The development of free-flying autonomous underwater vehicles (AUVs) with ranges of tens to hundreds of kilometres enables extensive missions to take place beneath sea ice and floating ice shelves. Autosub2 is a 3600 kg, 6.7 m long AUV, with a 1600 m operating depth and range of 400 km, based on the earlier Autosub1 which had a 500 m depth limit. A single direct-drive d.c. motor and five-bladed propeller produce speeds of 1–2 m s−1. Rear-mounted rudder and stern-plane control yaw, pitch and depth. The vehicle has three sections. The front and rear sections are free-flooding, built around aluminium extrusion space-frames covered with glass-fibre reinforced plastic panels. The central section has a set of carbon-fibre reinforced plastic pressure vessels. Four tubes contain batteries powering the vehicle. The other three house vehicle-control systems and sensors. The rear section houses subsystems for navigation, control actuation and propulsion and scientific sensors (e.g. digital camera, upward-looking 300 kHz acoustic Doppler current profiler, 200 kHz multibeam receiver). The front section contains forward-looking collision sensor, emergency abort, the homing systems, Argos satellite data and location transmitters and flashing lights for relocation as well as science sensors (e.g. twin conductivity–temperature–depth instruments, multibeam transmitter, sub-bottom profiler, AquaLab water sampler). Payload restrictions mean that a subset of scientific instruments is actually in place on any given dive. The scientific instruments carried on Autosub are described and examples of observational data collected from each sensor in Arctic or Antarctic waters are given (e.g. of roughness at the underside of floating ice shelves and sea ice).
To determine the length and position of a thyroidectomy scar that is cosmetically most appealing to naïve raters.
Methods:
Images of thyroidectomy scars were reproduced on male and female necks using digital imaging software. Surgical variables studied were scar position and length. Fifteen raters were presented with 56 scar pairings and asked to identify which was preferred cosmetically. Twenty duplicate pairings were included to assess rater reliability. Analysis of variance was used to determine preference.
Results:
Raters preferred low, short scars, followed by high, short scars, with long scars in either position being less desirable (p < 0.05). Twelve of 15 raters had acceptable intra-rater and inter-rater reliability.
Conclusion:
Naïve raters preferred low, short scars over the alternatives. High, short scars were the next most favourably rated. If other factors influencing incision choice are considered equal, surgeons should consider these preferences in scar position and length when planning their thyroidectomy approach.
The Dark Energy Survey is undertaking an observational programme imaging 1/4 of the southern hemisphere sky with unprecedented photometric accuracy. In the process of observing millions of faint stars and galaxies to constrain the parameters of the dark energy equation of state, the Dark Energy Survey will obtain pre-discovery images of the regions surrounding an estimated 100 gamma-ray bursts over 5 yr. Once gamma-ray bursts are detected by, e.g., the Swift satellite, the DES data will be extremely useful for follow-up observations by the transient astronomy community. We describe a recently-commissioned suite of software that listens continuously for automated notices of gamma-ray burst activity, collates information from archival DES data, and disseminates relevant data products back to the community in near-real-time. Of particular importance are the opportunities that non-public DES data provide for relative photometry of the optical counterparts of gamma-ray bursts, as well as for identifying key characteristics (e.g., photometric redshifts) of potential gamma-ray burst host galaxies. We provide the functional details of the DESAlert software, and its data products, and we show sample results from the application of DESAlert to numerous previously detected gamma-ray bursts, including the possible identification of several heretofore unknown gamma-ray burst hosts.
We tested a hypothesis that there is no genetic correlation between general factors of intelligence and personality, despite both having been selected for in human evolution. This was done using twin samples from Australia, the United States, the Netherlands, Great Britain, and Croatia, comprising altogether 1,748 monozygotic and 1,329 same-sex dizygotic twin pairs. Although parameters in the model-fitting differed among the twin samples, the genetic correlation between the two general factors could be set to zero, with a better fit if the U.S. sample was excepted.
A heuristic greedy algorithm is developed for efficiently tiling spatially dense redshift surveys. In its first application to the Galaxy and MassAssembly (GAMA) redshift survey we find it rapidly improves the spatial uniformity of our data, and naturally corrects for any spatial bias introduced by the 2dF multi-object spectrograph. We make conservative predictions for the final state of the GAMA redshift survey after our final allocation of time, and can be confident that even if worse than typical weather affects our observations, all of our main survey requirements will be met.
Live insects have been shipped from the Belleville laboratory for many years by rail in wooden chests insulated with cork, lined with metal and cooled with natural ice. These chests were cumbersome and had to be re-iced en route or heavy mortality resulted. In 1959, a more reliable method was developed for shipping adult Aphidoletes thompsoni Moehn (Diptera: Cecidomyjidae), a predator of the balsam woolly aphid, Adelges piceae (Ratz.) (Homoptera: Aphididae) by air express. It incorporates the use of a lightweight container and a patented coolant in cans. Although it was developed specifically for A. thompsoni it was also used successfully for shipping other species.
Near Belleville, Ontario, it was necessary to take quantitative samples of predators in shallow pools in field studies of the natural control of mosquitoes. To expedite this work a light-weight sampling cage was constructed. Its description follows.
The cage (Fig. 1, top) consists of an enclosure (A) and two sorting trays (B and C). The enclosure, covering one-half square metre, is of four screened frames, each 12 inches high. Each frame is of aluminum extrusions (Higgins-Homeshield Limited, Toronto, Ontario) of the types shown in details F and G. The extended flange on extrusion G, used at the right-hand side of each frame, provides a means of overlapping and fastening at the comers of the enclosure. After the frames are fastened together to form a square, pointed angle-aluminum legs (D) 16 inches long are fastened to each inside corner. Small braces are alio fastened across each corner to hold the enclosure in shape.
While little is known about hawksbill turtles Eretmochelys imbricata in the eastern Pacific Ocean, available information suggests that the population has declined substantially in recent decades and could be near extirpation in the region. To evaluate the current status of the population more effectively and to determine the feasibility of recovery efforts, a workshop of regional marine turtle specialists was held in June 2008 in Los Cóbanos, El Salvador. An international working group, Iniciativa Carey del Pacífico Oriental (ICAPO; Eastern Pacific Hawksbill Initiative in English), was established to consolidate information, promote conservation projects and raise awareness about the species. We present information derived from the workshop and compiled by the ICAPO working group since that time. Considering only records from 1 January 2007 to 31 May 2009 it appears that El Salvador hosts the majority of known hawksbill turtle nesting activity in the eastern Pacific, with 79.6% (n = 430) of all nesting observation records, and Mexico hosts the majority of records of hawksbill turtles at sea, with 60.3% (n = 44) of all in-water observation records. Although current abundance is very low, the pervasiveness of the species in the region suggests potential for conservation and recovery. Despite a historical paucity of research focusing on this population, the relatively large and steadily increasing number of records as a result of concerted efforts demonstrates the viability of the ICAPO network as an instrument to promote conservation of this species in the eastern Pacific.
Groups of volunteers were immunized subcutaneously with one of three inacti vated influenza virus A/USSR/77 (HlNl) vaccine preparations; a whole virus vaccine, a surface-antigen subunit adsorbed vaccine, or an aqueous surface-antigen subunit vaccine. The reactions to immunization were recorded, and the antibody response was measured 1 month later. A fourth group of volunteers were inoculated intranasally with live attentuated A/USSR/77 (H1N1) influenza virus; the reactions and antibody response of these volunteers were also measured. One month after immunization, the incidence of infection by challenge with homologous live attentuated virus was determined for all groups of volunteers. The results showed that all four vaccines used were relatively non-reactogenic, and that inactivated vaccines induced higher titres of serum antibody than the live attenuated vaccine. All the vaccines induced significant protection against challenge virus infection which was directly related to the level of serum HI antibody response.
Groups of volunteers were immunized with one of three influenza virus vaccines, and the resistance to challenge infection with attenuated influenza A (H1N1) virus was measured 8 months later. The vaccines were aqueous subunit influenza A/USSR/77 (H1N1) vaccine, aqueous subunit influenza B/Hong Kong/73 vaccine, or attenuated influenza virus A (H1N1) vaccine. The B virus vaccine was included as a control to assess the incidence of natural A virus infection during the study period. A proportion of the B virus vaccinees had pre-existing A (H1N1) virus antibody and were used to study the immunity conferred by natural infection to the live virus challenge. The serum antibody responses were measured at 1 and 8 months after immunization. The results showed that all the vaccines induced serum HI antibody in a proportion of the volunteers; however, after 1 month, higher titres of serum antibody were found in volunteers given inactivated A vaccine than in those given live attenuated A virus vaccine. Eight months post-immunization the titres of serum antibody in volunteers given inactivated vaccine had declined significantly, but there were no changes in the antibody titres of those given live virus vaccine. The incidence of infection by the challenge virus at 8 months post-immunization was directly related to the serum antibody titres 1 month post-immunization; no evidence was obtained to suggest that those given live virus vaccine had a more solid immunity than those given inactivated vaccine.
The late Carboniferous to Triassic Karoo Supergroup of Madagascar is a sequence of predominantly continental clastic sediments deposited during a long period of regional crustal extension. In the Morondava Basin of western Madagascar the lower two divisions of the Karoo sediments – the Sakoa and the Sakamena – are deposits of fluvial and lacustrine sedimentation systems supplied from the Precambrian metamorphic basement terrain to the east. East–west crustal extension produced a series of graben and half-graben structures after the Sakoa period which were reactivated after the Sakamena. The position and orientation of these half graben, which were marginal to a larger rift system to the west, were partly controlled by the steep NNE–SSW mylonitic fabric in the metamorphic basement. Palaeocurrents in the braided river deposits of the Sakoa and Lower Sakamena indicate flow to the southwest and west in both sequences. The rivers followed a regional palaeoslope to the southwest/west and were apparently not significantly influenced by the local structural trends which were oriented perpendicular to this slope. The absence of local structural control is attributed to extensive erosional events which followed each tectonic episode and preceded the onset of further sedimentation which took place on an essentially peneplained surface. The tectonic episodes brought about changes in base level which caused this part of the basin to fluctuate between erosion and deposition.
The effects of temperature on reported cases of a number of foodborne illnesses in England and Wales were investigated. We also explored whether the impact of temperature had changed over time. Food poisoning, campylobacteriosis, salmonellosis, Salmonella Typhimurium infections and Salmonella Enteritidis infections were positively associated (P<0·01) with temperature in the current and previous week. Only food poisoning, salmonellosis and S. Typhimurium infections were associated with temperature 2–5 weeks previously (P<0·01). There were significant reductions also in the impact of temperature on foodborne illnesses over time. This applies to temperature in the current and previous week for all illness types (P<0·01) except S. Enteritidis infection (P=0·079). Temperature 2–5 weeks previously diminished in importance for food poisoning and S. Typhimurium infection (P<0·001). The results are consistent with reduced pathogen concentrations in food and improved food hygiene over time. These adaptations to temperature imply that current estimates of how climate change may alter foodborne illness burden are overly pessimistic.
In 12 field experiments in England (1985, 1991 and 1992), on soils infested with potato pale cystnematode (Globodera pallida), oxamyl increased yields of susceptible and partially-resistant potatoes and lessened nematode multiplication at some sites but not others. Attempts to explain these site differences were unsuccessful. In a heavily infested peaty loam, large amounts of aldicarb or oxamyl, smaller amounts of both conjointly or 6·8 kg oxamyl/ha incorporated in the top 10 cm of the soil were needed to prevent G. pallida multiplication on susceptible Wilja potatoes. In three experiments, 1,3-dichloropropene at 250 or 225 1/ha increased tuber yields more than oxamyl did but had little or no effect on G. pallida multiplication. Ethoprophos at 11 kg/ha or fosthiezate at 4 kg/ha lessened G. pallida multiplication on Désirée potatoes in a silt loam soil but not in a peaty loam soil.
The multiplication of G. pallida was reliably controlled in ten experiments by partially-resistant Morag or Santé potatoes. Soil population densities of G. pallida were greatly decreased by one or two crops of Cara potatoes uprooted when the first female nematodes were visible on the roots.
It is concluded that granular nematicides and 1,3-dichloropropene are best employed to lessen injury to susceptible and partially-resistant potatoes and that G. pallida increase is best controlled by partially-resistant potatoes protected by a nematicide. Soil infestation levels can be decreased rapidly by soil fumigation or trap cropping with Cara potatoes.
Studies on the effects of solvents on germinability of seeds of various crops established the optimum conditions for immersing seeds in several solvents. Reduction in germinability, in vitro and in soil, of seeds of cotton, bean, pea, soya bean, and sugar beet after immersion in acetone, dichloromethane, or ethanol for various periods up to 24 h depended upon the length of immersion and the seed type and solvent used. Soya-bean and sugar-beet seeds were the least sensitive to the solvents whereas bean and cotton seeds were the most sensitive. Various cultivars of the same crop behaved similarly. The amount of seed germination in vitro was similar to that in soil. Solvent combinations consisting of acetone with dimethylsulphoxide, dichloroethane. polyethylene glycol, or triethanolamine did not affect cotton-seed germination in soil whereas soya-bean seeds were adversely affected by some materials. The amount of solvent taken up by the seeds and the amount of oxidizable matter extracted by the solvent depended upon the solvent and the crop. Maximum absorption of solvent occurred within 1 h. The amount of oxidizable material diffusing from seeds immersed in solvents was not correlated with the amount of solvent uptake or extent of seed germination.