Epidemiologic and Genomic Evidence for Zoonotic Transmission of SARS-CoV-2 among People and Animals on a Michigan Mink Farm, United States, 2020.

Farmed mink are one of few animals in which infection with SARS-CoV-2 has resulted in sustained transmission among a population and spillback from mink to people. In September 2020, mink on a Michigan farm exhibited increased morbidity and mortality rates due to confirmed SARS-CoV-2 infection. We conducted an epidemiologic investigation to identify the source of initial mink exposure, assess the degree of spread within the facility's overall mink population, and evaluate the risk of further viral spread on the farm and in surrounding wildlife habitats. Three farm employees reported symptoms consistent with COVID-19 the same day that increased mortality rates were observed among the mink herd. One of these individuals, and another asymptomatic employee, tested positive for SARS-CoV-2 by real-time reverse transcription PCR (RT-qPCR) 9 days later. All but one mink sampled on the farm were positive for SARS-CoV-2 based on nucleic acid detection from at least one oral, nasal, or rectal swab tested by RT-qPCR (99%). Sequence analysis showed high degrees of similarity between sequences from mink and the two positive farm employees. Epidemiologic and genomic data, including the presence of F486L and N501T mutations believed to arise through mink adaptation, support the hypothesis that the two employees with SARS-CoV-2 nucleic acid detection contracted COVID-19 from mink. However, the specific source of virus introduction onto the farm was not identified. Three companion animals living with mink farm employees and 31 wild animals of six species sampled in the surrounding area were negative for SARS-CoV-2 by RT-qPCR. Results from this investigation support the necessity of a One Health approach to manage the zoonotic spread of SARS-CoV-2 and underscores the critical need for multifaceted public health approaches to prevent the introduction and spread of respiratory viruses on mink farms.

SARS-CoV-2 viral shedding in vaccinated and unvaccinated persons: A case series.

The preclinical time course of SARS-CoV-2 shedding is not well-described. Understanding this time course will help to inform risk of SARS-CoV-2 transmission. During an outbreak in a congregate setting, we collected paired mid-turbinate nasal swabs for antigen testing and reverse-transcription polymerase chain reaction (RT-PCR) every other day from all consenting infected and exposed persons. Among 12 persons tested prospectively before and during SARS-CoV-2 infection, ten of 12 participants (83%) had completed a primary COVID-19 vaccination series prior to the outbreak. We recovered SARS-CoV-2 in viral culture from 9/12 (75%) of participants. All three persons from whom we did not recover SARS-CoV-2 in viral culture had completed their primary vaccination series. We recovered SARS-CoV-2 from viral culture in 6/9 vaccinated persons and before symptom onset in 3/6 symptomatic persons. These findings underscore the need for both non-pharmaceutical interventions and vaccination to mitigate transmission.

Thirty Years of Agrarian Change at an Upper Elevation Village in Western Nepal.

In 2016, I returned to Chimkhola, a village whose farming system I had studied in detail in the mid-1980s. Living conditions, child mortality, education levels had all improved greatly. Remissions from family members working overseas were supplanting subsistence farming. Community resources include agricultural fields and forests from 1600 to 4000 m on the southeast flank of Dhaulagiri Himal. I seek to preserve an account of the complex farming system the community used in 1986, describe how it appears to be dissolving, and speculate on the future. Unlike many parts of Nepal, in 2016 the people of Chimkhola farmed without industrial inputs, as they did in 1986. However, they reduced the area they were farming. It seems likely that, if recent trends continue, the communal system will collapse.

The rise and decline of farmers markets in greater Cincinnati.

Farmers markets can offer solutions to several of the biggest problems besetting the US food system: fair prices to farmers; healthy, fresh food for consumers; direct contacts between consumers and farmers; food for food deserts; support for local economies. Awareness of these benefits led us to study the farmers markets of Greater Cincinnati. Markets grew rapidly in the early 1980s, peaked in 2012, and declined 17% by 2018. Sixty-one percent of the markets that started since 1970 have closed. Two types of markets exist: farmer-focused markets, with farmer vendors, and consumer-focused markets, with farmers and specialist vendors. Detailed information about market management shows that managers, the majority of whom are volunteers or underpaid, have insufficient resources to be sustainable. Market decline is often blamed on an oversupply of markets, but other factors are involved: the inability of market personnel and customers to cross class and racial boundaries; the encroachment of online retailers; a scarcity of farmers; market manager failures. Individual markets need to form coalitions and gain sufficient resources from governments or private funders to employ specialists who can assist managers, expand the consumer base, and design promotion campaigns that effectively promote farmers markets in the changing retail food landscape.

Progression of Intracranial Hemorrhage After Chemical Prophylaxis Using Low-Molecular-Weight Heparin in Patients With Traumatic Brain Injury.

INTRODUCTION: Chemical prophylaxis using low-molecular-weight heparin (LMWH) is considered a standard of care for venous thromboembolism in trauma patients. Our center performs a head computed tomography (CT) scan 24 hours after initiation with prophylactic LMWH in the setting of a known traumatic brain injury (TBI). The purpose was to determine the overall incidence of ICH progression after chemoprophylaxis in patients with a TBI. METHODS: This retrospective study was performed at a Level I trauma center, from 1/1/2014 to 12/31/2017. Study patients were drawn from the institution's trauma registry based on Abbreviated Injury Score codes. RESULTS: 778 patients met all inclusion criteria after initial chart review. The proportion of patients with an observed radiographic progression of intracranial hemorrhage after LMWH was 5.8%. 3.1% of patients had a change in clinical management. Observed radiographic progression after LMWH prophylaxis and the presence of SDH on initial CT, the bilateral absence of pupillary response in the emergency department, and a diagnosis of dementia were found to have statistically significant correlation with bleed progression after LMWH was initiated. CONCLUSION: Over a 4-year period, the use of CT to evaluate for radiographic progression of traumatic intracranial hemorrhage 24 hours after receiving LMWH resulted in a change in clinical management for 3.1% of patients. The odds of intracranial hemorrhage progression were approximately 6.5× greater in patients with subdural hemorrhage on initial CT, 3.1× greater in patients with lack of bilateral pupillary response in ED, and 4.2× greater in patients who had been diagnosed with dementia.

Development and Evaluation of a TaqMan Real-Time PCR Assay for the Rapid Detection of Cross-Contamination of RD (Human) and L20B (Mouse) Cell Lines Used in Poliovirus Surveillance.

BACKGROUND: The cross-contamination of cell lines in culture is a persistent problem. Genetically modified L20B (Mouse) and RD (Human Rhabdomyosarcoma) cell lines are commonly used in poliovirus research, surveillance, and diagnostics. Cross-contamination between these cell lines leads to unreproducible results and unreliable surveillance data, negatively affecting public health. The gold standard method for cell authentication is Short Tandem Repeats analysis, which is time-consuming and expensive. The disadvantage of STR is limited detection of interspecies contamination. METHODS: This assay targets the mitochondrial cytochrome c oxidase subunit I (MTCO1) gene, a highly conserved and emergent DNA barcode region for detection of cross-contamination in RD and L20B cell lines. The MagNA Pure Compact instrument and ABI 7500 Fast Dx Real-time PCR systems were used for DNA extraction and to perform real-time PCR respectively. RESULTS: The newly developed assay is very sensitive with a limit of detection of 100 RD cells/1 million L20B/mL. The amplification efficiency and R2-value were 102.26% and 0.9969 respectively. We evaluated specificity of the assay with five human and four mouse cell lines, as well as monkey and rat cell lines. The assay showed no cross-reactivity with genomic DNA from human, mouse, rat, or monkey cell lines. The analytical sensitivity was also evaluated by spiking varying amounts of RD cells (0.001% - 10%) into L20B cells. There was no difference in CT values when running single-plex or duplex PCR reactions with similar experimental conditions. CONCLUSIONS: We have developed and validated a TaqMan real-time PCR assay, a sensitive method for the detection of cross-contamination of RD and L20B cell lines.

Increasing timely and available prenatal studies by electronic health records.

BACKGROUND: The government is encouraging the adoption of electronic medical records (EMRs). There is little information about using EMRs in the obstetric literature and none about using them in family medicine residencies. Our purpose was to assess if using an EMR was associated with improvement in the ordering and availability of prenatal tests. METHODS: A retrospective chart review comparing the rate at which prenatal laboratory values were present on the chart, ordered on time, and recorded on a prenatal flow sheet. RESULTS: Comparison of charts before and after implementation of an EMR showed statistically significant improvement in the percent of patients with all first trimester (87.5% vs 96.0%; P=.0025), quadruple screening tests (91.1% vs 98.1%; P=.012), and second trimester screening results (93.5% vs 100%; P=.044) in their charts; first trimester laboratory tests (91.6% vs 99.5%; P=.001) and second trimester ultrasounds (90.9% vs 97.3%; P=.027) being ordered on time; and first trimester results (88.2% vs 95.5%; P=.009), quad screen results (93.1% vs 98.0%; P=.0495), and second trimester ultrasounds (93.5% vs 100%; P=.003) being recorded on the American Congress of Obstetricians and Gynecologists flow sheet. CONCLUSION: Adopting an EMR was associated with an improved rate at which prenatal tests were ordered on time, present on the chart, and recorded on a prenatal flow sheet.

Helpful tips for performing musculoskeletal injections.

Injections are valuable procedures for managing musculoskeletal conditions commonly encountered by family physicians. Corticosteroid injections into articular, periarticular, or soft tissue structures relieve pain, reduce inflammation, and improve mobility. Injections can provide diagnostic information and are commonly used for postoperative pain control. Local anesthetics may be injected with corticosteroids to provide additional, rapid pain relief. Steroid injection is the preferred and definitive treatment for de Quervain tenosynovitis and trochanteric bursitis. Steroid injections can also be helpful in controlling pain during physical rehabilitation from rotator cuff syndrome and lateral epicondylitis. Intra-articular steroid injection provides pain relief in rheumatoid arthritis and osteoarthritis. There is little systematic evidence to guide medication selection for therapeutic injections. The medication used and the frequency of injection should be guided by the goal of the injection (i.e., diagnostic or therapeutic), the underlying musculoskeletal diagnosis, and clinical experience. Complications from steroid injections are rare, but physicians should understand the potential risks and counsel patients appropriately. Patients with diabetes who receive periarticular or soft tissue steroid injections should closely monitor their blood glucose for two weeks following injection.

Resident knowledge acquisition during a block conference series.

OBJECTIVE: This study's objective was to determine whether attendance at lectures in a block conference format improves residents' knowledge. METHODS: Seventeen family medicine residents were tested on the content of 27 lectures delivered in a block conference format over a 6-month period. For each lecture, residents completed a pretest, a short-term posttest, and a long-term posttest (1--3 weeks and 1.5--6 months after each lecture, respectively). RESULTS: Mean short-term posttest scores were 10.3 points higher for lecture attendees than nonattendees. Mean long-term posttest scores did not differ significantly for attendees (62.2) versus nonattendees (60.0). CONCLUSIONS: Attendance at didactic lectures in a block conference format did not improve resident knowledge over the long term. These results lead us to question the value of a block conference format and raise the possibility that resident learning might be better served by maximizing clinical experiences and minimizing time in conferences.

Bilateral first metatarsal stress fractures in a field hockey player.

First metatarsal stress fractures are uncommon in young athletes, and to have them occur bilaterally is even more unusual, as in this case of a 14-year-old female field hockey player. The patient sought treatment after several days of bilateral foot pain with swelling and tenderness to palpation over the proximal aspect of the first metatarsals. Initial plain x-rays were negative, but a subsequent bone scan and MRI revealed bilateral first metatarsal stress fractures. The patient was successfully treated with relative rest and rigid-soled shoes. Clinicians should be aware that initial x-rays may not reveal first metatarsal stress fractures, and further imaging may be needed.

Differential brain activation in exclusively homosexual and heterosexual men produced by the selective serotonin reuptake inhibitor, fluoxetine.

A number of studies have shown a relationship between "sexual orientation" and size of various brain nuclei. We hypothesized that neurotransmitter differences might parallel neuroanatomical differences in the hypothalamus. We administered 40 mg of fluoxetine as a challenge to the serotonergic systems of exclusively homosexual and exclusively heterosexual men and measured cerebral metabolic changes with fluorodeoxyglucose positron emission tomography (FDG-PET). The metabolic differences we observed might reflect underlying neurochemical differences between homosexual and heterosexual men.

Traumatic extensor tendon dislocation in a boxer: a case study.

An elite collegiate boxer developed extensor tendon subluxation in the small finger of his dominant right hand. He was thought to have a radial sagittal band disruption and was allowed to complete his season with custom padding. Surgical exploration revealed intact sagittal bands with divergent dislocation of the two extensor tendons to the small finger with underlying capsular rupture. These lesions were repaired and he successfully returned to boxing. Soft tissue injuries to the dorsal MCP joint may involve the collateral ligaments, the sagittal bands, the extensor tendons, or the joint capsule. Symptoms usually involve persistent pain, swelling, and tendon subluxation or dislocation. Accurate recognition and treatment is crucial as nonoperative treatment is generally unsuccessful and surgical reconstruction is required for optimal return to function.

Upper respiratory tract infections: who plays, who sits?

In athletes with upper respiratory infections (URIs), the question of who plays and who sits can be difficult to answer. Acute exercise suppresses several aspects of the immune system. None of these immunologic changes, however, consistently correlate with the incidence of URIs in athletes. The risk of infection with exercise seems to follow a J-curve relationship, with regular, moderate exercisers having a lower risk than sedentary people, and regular, strenuous exercisers having the highest risk of all. The decision to allow an athlete to play or not can be guided by the "neck check" rules, and can also take into account nonmedical factors. The athlete with infectious mononucleosis warrants more careful attention, as there are strict guidelines for return-to-play in these individuals, to avoid the possibility of splenic rupture.

Positron emission tomography in central nervous system drug discovery and development.

Genetics, neuroscience, and imaging science have advanced greatly in the last few years. These advances can be brought together and applied in creative new ways to make available better drugs for treating neuropsychiatric disorders and for getting candidate drugs through the development process faster. One particular approach, built around [18F]fluordeoxyglucose positron emission tomography, is described.