Silent superbug killers in a river near you how factory farms contaminate public water courses on three continents

Water downstream from factory farms harbours an invisible threat to people's health which could eclipse the COVID-19 crisis. The threat? Antibiotic Resistance Genes (ARGs) which are driving antimicrobial resistance the world's superbug crisis - projected to kill up to 10 million people annually by 2050. This publication reports the presence of ARGs in animal waste discharged from industrial farms into public waterways or onto soil (or crops) in four countries. Gauge community impact and sentiment regarding the issue was also highlighted. The water and sediment from public water courses connected to effluent discharges from 6-10 pig farms were tested in each of four countries (Canada, Spain, Thailand and the USA).

Imaging Cascade - the Importance of Pre-Procedural 3-D Planning in Transcatheter Left Atrial Appendage Closure

Background With the COVID-19 pandemic and referral from out-reach centers, there has been a change in practice of assessing left atrial appendage (LAA) via TEE on the day of LAA closure (LAAC). We present a challenging case of inadequate LAAC with WATCHMAN FLX due to suboptimal TEE images. Follow up TEE and CT revealed a much larger LAA ostium that was mostly uncovered. Case An 84 yo male with AF and recent hepatic hematoma, was referred for LAAC. LAA dimensions were measured using a technically difficult intraprocedural (IP) 2D TEE and a 24mm Watchman FLX was successfully implanted. Follow up 3D TEE at 45 days revealed incomplete LAAC with a large PDL. Retrospective review of fluoroscopic images revealed unrecognized filling of a posterior LAA lobe. Decision-making Anticoagulation (AC) was continued for 3 more months, and Cardiac CT was performed which showed persistent under-coverage of the LAA with large PDL of 16.5 x 11.3 mm (159mm2). A much larger ostium was measured on 45 days TEE (27 mm max 2 D dimension) and 145 days CT (18 X 25 mm) vs. 12.9 mm on IP-TEE. AC was continued with consideration of a 2nd adjacent device placement in future. Conclusion TEE on the day of LAAC although implemented in several centers, has its limitations. In the presence of sub-optimal image quality, it can lead to incorrect device sizing and incomplete LAAC as in our case. Cardiac CT with 3D evaluation or 3D TEE are crucial for pre-planning to achieve successful device implantation. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

Fear, Political Legitimization, and Racism: Examining Anti-Asian Xenophobia During the COVID-19 Pandemic

Unfortunately, there is a long history linking pandemics to Anti-Asian prejudice and xenophobia;these negative outcomes have been particularly pronounced during the COVID-19 pandemic. Some scholars have suggested that these relationships are driven by fear, wherein individuals respond to disease threat by "othering” that threat. Other research has implicated the role of the state, including the political rhetoric of former President Trump, in exacerbating bias by enabling a divisive political environment. Yet, very few existing studies have been able to assess the nature of these impacts or examine the mechanisms behind observed increases in xenophobia. To that end, this research presents results from a survey administered in May 2020 to respondents residing in the U.S., which assessed COVID-19-related attitudes and behaviors, as well as anti-Asian prejudicial attitudes. Using these data, we assessed the direct and interactive relationship between perceptions of risk (i.e., fear), exposure to COVID-19 information, support for Trump, and anti-Asian prejudice. Results reveal that fear—and support for Trump—are associated with increased anti-Asian prejudice, but that exposure to more information about COVID-19 is associated with decreased prejudice;we also note complex interactions between each of these factors. © The Author(s) 2022.

QUANTIFYING THE IMPACT OF COVID-19 RESTRICTIONS ON EMISSIONS USING INVERSE MODELLING AND MEASUREMENTS

An inversion system that uses a Bayesian approach to combine measurements and ADMS-Urban modelled data by adjusting individual source emissions, subject to estimated uncertainty in the measurements and emissions, has previously been applied to optimising road traffic emissions in Cambridge. In this study the system has been applied specifically to the impact of interventions, in particular the impact of COVID-19 lockdowns on NOX emissions from road traffic and other sources in London. The ADMS-Urban model was used to calculate a priori hourly NOX concentrations at 195 receptors in London representing 115 reference monitors and 80 Breathe London Network AQMesh sensors. Input data included hourly meteorological measurements from Heathrow Airport, hourly NOX concentrations from 4 rural background monitoring sites and buildings road centreline data from Ordnance Survey. A priori emissions were obtained from the London Atmospheric Emissions Inventory (LAEI) for 35 point sources, approximately 70,000 major road sources and 2,500 1km grid cells representing minor road, heating and other sources. The analysis period was 1 January 2020 to 30 April 2021. Estimated uncertainties of 4 and 12 µg/m3 were applied to reference and sensor measurements respectively, while emissions uncertainties of 100%, 50%, 20% were applied to road traffic, fuels and other emissions respectively. Road traffic emissions were assumed to have error covariance of 40% of their emissions uncertainty. Measured NOX concentrations in London reduced significantly during lockdown, with the greatest reduction (around 60%) at kerbside and roadside sites in Central London. However, poor dispersal conditions led to increased concentrations at times when restrictions were tightest. In contrast, inversion system results demonstrate that NOX emissions from road traffic dropped by around 60% in London compared with pre-lockdown levels and that this reduction occurred when the strictest lockdown measures were in force. The results also show that NOX road traffic emissions were still approximately 30% lower than pre-lockdown levels at the end of April 2021. This analysis demonstrates that lower cost sensors such as AQMesh can provide valuable insight into the effects of policy measures (in this case lockdown restrictions), if their increased uncertainty compared with reference monitors is accounted for. © British Crown Copyright (2022)

A hypermutator strain of Pseudomonas aeruginosa in a COVID-19 patient with ventilator-associated pneumonia

Background. P. aeruginosa is a cause of hospital-acquired and ventilatorassociated pneumonia. Hypermutator P. aeruginosa strains have been described in patients with cystic fibrosis and chronic respiratory infections but are rare in patients with acute P. aeruginosa infection. This case describes a hypermutator strain of P. aeruginosa found in a patient with COVID-19-associated acute respiratory distress syndrome (ARDS). Methods. Serial respiratory and blood cultures were collected. Short-read sequencing libraries were prepared using the Illumina Nextera XT kit, and wholegenome sequencing was performed using the Illumina NextSeq platform. Long-read sequencing libraries were prepared from unsheared genomic DNA using ligation sequencing kit SQK-LSK109 and sequenced on the Oxford MinION platform. Single nucleotide variants were identified by aligning reads from each isolate to the complete genome of the first available clinical isolate. Hypermutator assays were performed by measuring the mutation frequency rate for rifampin resistance. Antibiotic minimal inhibitory concentrations (MICs) were performed. Growth curves were performed with a starting OD600 of 0.1 with measurements taken every 30 minutes for 24 hours. Results. Seventeen respiratory and five blood isolates were obtained throughout 62 days of hospitalization. Fourteen of the 22 isolates exhibited hypermutator phenotypes by rifampin resistance assays, which demonstrated rapid accumulation of mutations. All five bloodstream isolates were hypermutators. MIC testing noted increased resistance to aminoglycosides, fluoroquinolones, and aztreonam in the hypermutator isolates. All bloodstream isolates descended from a single progenitor noted on whole-genome sequencing. Each hypermutator strain contained a mutation in the mismatch repair gene mutL, previously associated with the hypermutator phenotype. Genetic Tree of Patient Isolates The genetic tree highlights hypermutator versus non-hypermutator single nucleotide variants Conclusion. This case was notable for multiple isolates of hypermutator P. aeruginosa that persisted over weeks. The patient's COVID-19 infection and acute respiratory distress syndrome may have facilitated persistence of the P. aeruginosa lineage, allowing a hypermutator lineage to emerge.

USING DIGITAL TECHNOLOGIES FOR COLLABORATIVE CONCEPTUAL DESIGN

Since the COVID-19 worldwide pandemic outbreak, and the requirement to 'stay at home' and 'work from home', we, as a collaborative species have been forced to find ways of computer-supported collaboration. Going beyond global design and distributed design. We now find ourselves as a human race, not with a desire to collaborate using computers, or with a requirement, but it is now a necessity. In many ways, a paradigm shift has occurred. This research investigates the use of novel technology to support student teams in the conceptual design phase of an engineering design project. A review of published literature identified a lack of understanding in the impact that a digital distributed environment can have on the outcomes of a collaborative ideation task. The literature suggested there would be little to no change between working in a collocated and digital distributed environment. An experiment was designed that asked 16 participants working in pairs to complete an ideation task in both a synchronous traditional collocated environment and a synchronous digital distributed environment. The results from the experiment suggest that conducting the ideation task within a digital environment has a negative effect on the outcomes of the ideation task. © Proceedings of the 24th International Conference on Engineering and Product Design Education: Disrupt, Innovate, Regenerate and Transform, E and PDE 2022. All rights reserved.

COVID-19 virtual dilemma: Parents' perspectives on math learning at home

This qualitative study explored the parental support of K-12 students with mathematics during the COVID-19 pandemic. A digital, open-ended survey was completed by parents or caregivers to examine the role they played in their student's school day with a specific focus on the challenges and successes of mathematics learning. The survey was administered after six to eight weeks of remote instruction with at least four weeks of remote instruction remaining. Parents supported learning by teaching, facilitating, promoting independence, and providing resources. Parents mentioned several challenges and some successes during at home mathematics learning. Challenges included student motivation, lack of tools, gaps in learning, and technology access. While some parents reported no successes, others mentioned completing work, reviewing and mastering concepts, and building confidence. © 2021, IGI Global.

Environmental Contamination with SARS-CoV-2 in Nursing Homes

Background. The COVID-19 pandemic has disproportionately affected nursing home (NH) patients, accounting for 5% of all cases and 32% of all COVID-19 deaths nationwide. Little is known about the frequency and persistence of SARSCoV-2 environmental contamination in NHs. We characterize SARS-CoV-2 contamination in the rooms of COVID-19 patients and common areas in and around COVID-19 units. Methods. A prospective cohort study was conducted at four NHs in Michigan between October 2020 and January 2021. Clinical research personnel obtained swab specimens from high-touch room surfaces of COVID-19 infected patients, up to three times per patient. Weekly swab specimens from six high-touch surfaces in common areas were also obtained. Demographic and clinical data were collected from patient clinical records. Our primary outcome of interest was the probability of SARS-CoV-2 detection from specific environmental surfaces in COVID-19 patient rooms. Results. One hundred four patients with COVID-19 were enrolled and followed for 241 visits. Patient characteristics included: 61.5% over the age of 80;67.3% female;89.4% non-Hispanic white;50.1% short-stay. The study population had significant disabilities in activities of daily living (ADL;81.7% dependent in four or more ADLs) and comorbidities including dementia (55.8%), diabetes (40.4%) and heart failure (32.7) (Table 1). Over the 3-month study period, 2087 swab specimens were collected (1896 COVID-19 patient room surfaces, 191 common area swabs). Figure 1 shows contamination rates at sites proximate and distant to the patient bed. SARS-CoV-2 positivity was 28.4% (538/1896 swabs) on patient room surfaces and 3.7% (7/191 swabs) on common area surfaces. Over the course of follow-up, 89.4% (93/104) of patients had SARS-CoV-2 contamination in their room at least once (Figure 2). Environmental contamination detected on enrollment correlated with contamination of the same site during follow-up. Functional independence increased the odds of proximate contamination. Conclusion. We conclude that environmental contamination of surfaces in the rooms of COVID-19 patients is nearly universal and persistent. Patients with greater independence are more likely than fully dependent patients to contaminate their immediate environment.

TROPISM OF SARS-COV-2 FOR BARRETT'S ESOPHAGUS MAY INCREASE SUSCEPTIBILITY TO DEVELOPING COVID-19

Background and Aims: In addition to pulmonary and thrombotic sequalae, gastrointestinal (GI) manifestations of COVID-19 are common. Although enterocytes express ACE2 and TMPRSS2, the proteins that determine SARS-CoV-2 tropism, prior studies have suggested that the virus is inactivated by gastric acid and other luminal fluids as it transits the gastrointestinal tract. However, we reason here that individuals with intestinal metaplasia of the esophagus and stomach might have ectopic, proximal SARS-CoV-2 receptor expression that would predispose them to infection from ingested oral secretions or respiratory sputum. Methods: Histology, immunohistochemistry, and immunofluorescence were performed on human tissue and organoid cultures derived from biopsied human Barrett’s esophagus. Organoid cultures were infected with a chimeric virus expressing the SARS-CoV-2 spike protein (rVSV-eGFP-SARS-CoV-2). Both fixed and live cells were imaged by light, epifluorescence, and live confocal microscopy. Results: Unlike normal esophagus and stomach, Barrett’s esophagus and gastric intestinal metaplasia both strongly express apical ACE2 and TMPRSS2 at the protein level. Organoids derived from Barrett’s esophagus are readily infected by the chimeric rVSV-eGFP-SARSCoV- 2 virus as demonstrated by the GFP fluorescence observed in both epifluorescence as well as three-dimensional, time-lapse confocal imaging of live infected organoids. We observed that fluorescence persisted for greater than 2 weeks in culture suggesting ongoing viral infection and intestinal identity correlated with increased viral entry. Conclusions: SARS-CoV-2 has a previously undescribed tropism for Barrett’s esophagus and gastric intestinal metaplasia, placing these individuals at higher risk of infection via the orogastric route.

Marketing platforms dominate consumer understanding of shockwave therapy for erectile dysfunction

INTRODUCTION AND OBJECTIVE: Despite a paucity of evidence, a number of “regenerative” therapies have emerged as putative treatments for erectile dysfunction (ED). Shockwave therapy, in particular, has received significant attention in direct-to-consumer marketing and is often advertised by non-urologists. However, the nomenclature surrounding shockwave therapy has led to ambiguity. Focused shock wave therapy (fSWT) has become conflated with radial or acoustic wave therapy (rWT), though they differ in mechanism of wave generation and tissue penetration. GAINSWave, a prominent marketing platform for acoustic wave therapy, has also pervaded the marketplace. We aim to characterize the relative impact of direct-to-consumer marketing of shockwave therapy by quantifying the frequency of internet search queries for various shockwave options for ED. METHODS: Population-level Google Search trends in the United States (www.google.com/trends) were used to characterize interest in various forms of shockwave therapy for ED. Search trends for fSWT, rSWT, and GAINSWave were analyzed (Figure 1). Google Search data are tabulated on a relative scale of 0-100, with 100 representing the most frequently searched term over a time interval. Monthly search data were compiled over a 6 year period (1/1/14 through 2/28/20), ending just before the COVID-19 pandemic. Yearly averages were computed to quantify macro-level changes in patient interest. RESULTS: Trends in Google Search interest in various forms of shockwave therapy for erectile dysfunction are depicted in Figure 1. Queries for GAINSWave dominated public interest, increasing by 187- fold from 2016 to 2020. The introduction of GAINSWave represents an inflection point for the entire shockwave market: searches for shockwave therapy increased by 782% from 2016 to 2020. CONCLUSIONS: Direct-to-consumer marketing of shockwave therapy has upended the traditional role of physicians in counseling patients regarding evidence-based treatments for ED. The increase in public interest in GAINSWave underscores its success as a marketing platform. The urological community should consider strategies to correct misinformation, such as search-engine optimization, social media, and educational outreach.

Communication and culture: A multispecies endeavour within a shared habitat

COVID-19 can be seen as feedback for anthropocentric social, economic and environmental decision-making that disrespects other living systems. The paper makes a case that respects for multiple species, and the onus of beneficence should be applied to all living systems of which we are a strand. Human beings are not exceptional insofar as they are able to communicate, make decisions, demonstrate a sense of community and show empathy or to make political calculations. What does this mean for the way we live our lives? Respect for persons needs to include animals, plants and the earth. It is time to rethink rights and responsibilities to protect habitat. Goodall stresses that the loss of habitat leads to species that have never been in contact before (and thus without any resistance) causing cross species infections. © 2021 John Wiley & Sons, Ltd.

Integration and analysis of multi-modal geospatial secondary data to inform management of at-risk archaeological sites

Climate change poses an imminent physical risk to cultural heritage sites and their surrounding landscape through intensifying environmental processes such as damaging wetting and drying cycles that disrupt archaeological preservation conditions, and soil erosion which threatens to expose deposits and alter the archaeological context of sites. In the face of such threats, geospatial techniques such as GIS, remote sensing, and spatial modelling have proved invaluable tools for archaeological research and cultural heritage monitoring. This paper presents the application of secondary multi-source and multi-temporal geospatial data within a processing framework to provide a comprehensive assessment of geophysical risk to the Roman fort of Magna, Carvoran, UK. An investigation into the ancient hydraulic system at Magna was carried out with analysis of vegetation change over time, and spatio-temporal analysis of soil erosion risk at the site. Due to COVID-19 restrictions in place at the time of this study, these analyses were conducted using only secondary data with the aim to guide further archaeological research, and management and monitoring strategies for the stakeholders involved. Results guided inferences about the ancient hydraulic system, providing insights regarding how to better manage the site at Magna in the future. Analysis of soil erosion allowed the identification of hot spot areas, indicating a future increase in rates of erosion at Magna and suggesting a seasonal period of higher risk of degradation to the site. Results have proven that freely available multi-purpose national-scale datasets are sufficient to create meaningful insights into archaeological sites where physical access to the site is inhibited. This infers the potential to carry out preliminary risk assessment to inform future site management practices. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.