A gold standard dataset and evaluation of methods for lineage abundance estimation from wastewater.

During the SARS-CoV-2 pandemic, genome-based wastewater surveillance sequencing has been a powerful tool for public health to monitor circulating and emerging viral variants. As a medium, wastewater is very complex because of its mixed matrix nature, which makes the deconvolution of wastewater samples more difficult. Here we introduce a gold standard dataset constructed from synthetic viral control mixtures of known composition, spiked into a wastewater RNA matrix and sequenced on the Oxford Nanopore Technologies platform. We compare the performance of eight of the most commonly used deconvolution tools in identifying SARS-CoV-2 variants present in these mixtures. The software evaluated was primarily chosen for its relevance to the CDC wastewater surveillance reporting protocol, which until recently employed a pipeline that incorporates results from four deconvolution methods: Freyja, kallisto, Kraken 2/Bracken, and LCS. We also tested Lollipop, a deconvolution method used by the Swiss SARS-CoV-2 Sequencing Consortium, and three additional methods not used in the C-WAP pipeline: lineagespot, Alcov, and VaQuERo. We found that the commonly used software Freyja outperformed the other CDC pipeline tools in correct identification of lineages present in the control mixtures, and that the VaQuERo method was similarly accurate, with minor differences in the ability of the two methods to avoid false negatives and suppress false positives. Our results also provide insight into the effect of the tiling primer scheme and wastewater RNA extract matrix on viral sequencing and data deconvolution outcomes.

Intravitreal Rituximab-Associated Retinal Occlusive Vasculitis.

Purpose: To describe a 90-year-old patient who was referred to a private retina specialist with gradually worsening vision and floaters in the left eye. Methods: A retrospective case report is presented. Results: The patient was treated with intravitreal rituximab injections for intraocular lymphoma with resulting vision loss to the level of hand motions from severe granulomatous uveitis and retinal occlusive vasculitis. Conclusions: Retinal occlusive vasculopathy secondary to rituximab intravitreal injections is a rare clinical entity with only a single previous case reported in the literature. However, there are reports of systemic vasculitis after systemic administration of rituximab. Clinicians should be aware of the possibility of ocular hypertension, granulomatous anterior uveitis, and/or retinal occlusive vasculitis after intravitreal rituximab use. Consideration should be given to the inflammatory risk of rituximab intravitreal injections to reduce the potential for treatment-induced vision loss.

Public Health Department Accreditation and Innovation: A Brief Report of the Approaches Used to Promote Innovation.

To examine the relationship between public health accreditation and innovation, we analyzed accredited health departments' self-reported responses to a prompt within the Public Health Accreditation Board's (PHAB's) Annual Report regarding any approaches to pursuing innovation within their health department. We found that of the 205 health departments examined, 75 (37%) described elements of the health department's approach to fostering innovation. The most common approaches to innovation included partnerships (59% of those health departments that described their innovation approaches) and leadership (27%). Other common elements, mentioned by at least 20% of health departments that provided their innovation approach, include funding, internal collaboration, training, and devoting time to innovation. Both larger health departments and state health departments were more likely than smaller health departments and local health departments to describe elements of their approach in fostering innovation, suggesting that those types of health departments may have access to resources and flexibility in staffing, both integral elements for promoting innovation.

Pseudophakic cystoid macular edema prevention and risk factors; prospective study with adjunctive once daily topical nepafenac 0.3% versus placebo.

BACKGROUND: Define the effectiveness of a topical non-steroidal anti-inflammatory drug (NSAID) added to topical steroid use after uncomplicated phacoemulsification for the prevention of pseudophakic cystoid macular edema (PCME) using a prospective, randomized, double-masked, placebo-controlled clinical study. METHODS: Eyes (1000) were randomized to placebo (497) or nepafenac 0.3% (503) used once daily, post-operatively for 5 weeks at two ophthalmology clinics. Diagnosis of PCME was made by clinical, ocular coherence tomography (OCT), and with fluorescein angiography confirmation. Correlation of PCME to NSAID use and the presence of pre-operative risk factors for PCME were assessed including, contralateral PCME, diabetic retinopathy, retinal vein occlusion, macular hole, epiretinal membrane, macular degeneration, retinal detachment repair, and prostaglandin use. RESULTS: PCME was the most common complication associated with routine cataract surgery (4.2% with PCME risk factors, 2.0% with risk factors excluded). Topical nepafenac 0.3% significantly reduces the incidence of PCME compared to placebo when used after routine cataract surgery (p = .0001). When patients with pre-operative risk factors are excluded, the incidence of PCME between treatment and placebo groups is equivalent (p = 0.31). PCME relative risk (RR) was most significant in contralateral PCME (RR 19.5), diabetic retinopathy (RR 13.1), retinal vein occlusion (RR 12.9), macular hole (RR 7.7), and epiretinal membrane (RR 5.7). Prostaglandin use and previous retinal detachment were not shown to increase risk. CONCLUSION: Pseudophakic cystoid macular edema is common after phacoemulsification cataract surgery. Topical nepafenac 0.3% reduces PCME in patients with pre-operative risk factors for PCME compared to placebo but shows no benefit in patients without pre-operative risk factors. TRIAL REGISTRATION: NIH ClincalTrials.gov retrospectively registered January 15, 2017, NCT03025945 .

Constitutional Chromoanagenesis of Distal 13q in a Young Adult with Recurrent Strokes.

Constitutional chromoanagenesis events, which include chromoanasynthesis and chromothripsis and result in highly complex rearrangements, have been reported for only a few individuals. While rare, these phenomena have likely been underestimated in a constitutional setting as technologies that can accurately detect such complexity are relatively new to the mature field of clinical cytogenetics. G-banding is not likely to accurately identify chromoanasynthesis or chromothripsis, since the banding patterns of chromosomes are likely to be misidentified or oversimplified due to a much lower resolution. We describe a patient who was initially referred for cytogenetic testing as a child for speech delay. As a young adult, he was referred again for recurrent strokes. Chromosome analysis was performed, and the rearrangement resembled a simple duplication of 13q32q34. However, SNP microarray analysis showed a complex pattern of copy number gains and a loss consistent with chromoanasynthesis involving distal 13q (13q32.1q34). This report emphasizes the value of performing microarray analysis for individuals with abnormal or complex chromosome rearrangements.

Types, Subtypes, and Severity of Substantiated Child Neglect in U.S. Army Communities.

BACKGROUND: Neglect has been linked to short-term and long-term deleterious outcomes in children, but has received little attention in the research literature. OBJECTIVE: Identify types, subtypes, and severity of child neglect in a sample of substantiated cases at 4 U.S. Army installations. Describe demographic correlates of victims and offenders by type and subtype. PARTICIPANTS: Data were collected from archived clinical records. A stratified random sample of 100 substantiated child neglect case files were selected per site (N = 400). Data from a single child per case file were used. RESULTS: 5 types and 17 subtypes of neglect were represented, singly or in combination, with varying severity. Lack of Supervision was most common (n = 177, 35.3%), followed by Emotional Neglect (n = 159, 31.8%), Failure to Provide Physical Needs (n = 131, 26.2%), Moral-Legal Neglect (n = 20, 4%), and Educational Neglect (n = 13; 2.6%). Child neglect occurred mostly among young children and in young enlisted families. CONCLUSIONS: Current results highlight the need to focus on types, subtypes, and severity of neglect incidents that provide specific understanding of child risk to better inform policy. Further study should examine specific risk factors and their relationship to neglect types and severity outcomes.

The relationship between local public health agency administrative variables and county health status rankings in Kentucky.

OBJECTIVES: The purpose of this research study was to determine whether specific local public health agency (LPHA) characteristics were associated with favorable county health status. Specifically, financial and administrative comparisons were made to determine whether variables such as budget size or number of employees, among others, were associated with community health status among the 120 counties in Kentucky. Other financial and administrative variables collected from LPHA data were also investigated in this study. METHODS: Administrative and financial data were collected for each local public health agency in Kentucky. This was matched with data on the health status of Kentucky counties from the 2010 University of Wisconsin MATCH (Mobilizing Action Towards Community Health Assessment) counties in select measures of health. MATCH data used included measures of health outcomes, specifically socioeconomic status (SES), mortality, and morbidity. Logistic regressions were used to determine the relationship, if any, between variations in the health agency data variables, SES, and health status. RESULTS: Analysis suggests that SES is the strongest link to county health status. Several other variables that appear to have statistically significant association with health status include the education level of the director, whether the LPHA employees received a raise, whether the LPHA had an associated Home Health agency, and the amount of money used from their reserve account to balance the LPHA budget. CONCLUSIONS: For many years, public health in Kentucky has measured the number of clinical visits and other LPHA services but failed to determine specific characteristics and variables that influence community health status. This study suggests that LPHAs in Kentucky can advance public health practice by having well-educated directors, giving annual incremental raises, and utilizing the agency reserve funds to meet budget shortfalls in the short run. Furthermore, LPHAs with an associated home health agency may need to reassess their impact and need in their community, considering the negative effect it may have on county health status.

Clinical correlates of pain with amniocentesis.

OBJECTIVE: The purpose of this study was to determine whether sensory or affective dimensions of pain with genetic amniocentesis are associated with identifiable clinical correlates. STUDY DESIGN: Women completed the short-form McGill Pain Questionnaire after second-trimester genetic amniocentesis. The effect of maternal weight, parity, previous amniocentesis, previous surgery, history of menstrual cramps, maternal anxiety, presence of fibroid tumors, and depth and location of needle insertion on pain intensity was determined. The T-test, correlation matrix, Kruskal-Wallis test, and multiple logistic regression were used for analysis; a probability value of <.05 was considered significant. RESULTS: One hundred twenty-one women were enrolled: 19.3% reported no pain, 42.9% described the pain as mild, 31.1% described the pain as discomforting, and 6.7% described the pain as distressing or horrible. Mean intensity of pain was 1.6+/-1.3 (on a scale of 0-7). Pain was most often described as sharp, cramping, fearful, and stabbing. Anxiety and pain were increased in women with an indication of abnormal serum screen as compared with women with advanced maternal age. Anxiety and a history of menstrual cramps were associated with increased affective dimensions of pain and had moderate correlation with quantified pain intensity. A history of previous amniocentesis and needle insertion in the lower one third of the uterus were associated with increased pain. Maternal weight, parity, previous surgery, fibroid tumors, and depth of needle insertion were not correlated with perceived pain. Presence or absence of an accompanying person was not associated with pain intensity. CONCLUSION: Women report mild pain or discomfort with genetic amniocentesis. Increased pain is associated with increased maternal anxiety, a history of menstrual cramps, a previous amniocentesis, and insertion of the needle in the lower uterus.