Wastewater-based Epidemiology for COVID-19 Surveillance: A Survey.

The pandemic of COVID-19 has imposed tremendous pressure on public health systems and social economic ecosystems over the past years. To alleviate its social impact, it is important to proactively track the prevalence of COVID-19 within communities. The traditional way to estimate the disease prevalence is to estimate from reported clinical test data or surveys. However, the coverage of clinical tests is often limited and the tests can be labor-intensive, requires reliable and timely results, and consistent diagnostic and reporting criteria. Recent studies revealed that patients who are diagnosed with COVID-19 often undergo fecal shedding of SARS-CoV-2 virus into wastewater, which makes wastewater-based epidemiology (WBE) for COVID-19 surveillance a promising approach to complement traditional clinical testing. In this paper, we survey the existing literature regarding WBE for COVID-19 surveillance and summarize the current advances in the area. Specifically, we have covered the key aspects of wastewater sampling, sample testing, and presented a comprehensive and organized summary of wastewater data analytical methods. Finally, we provide the open challenges on current wastewater-based COVID-19 surveillance studies, aiming to encourage new ideas to advance the development of effective wastewater-based surveillance systems for general infectious diseases.

COVID-19 Case, Death, and Vaccination Rate Disparities by Race and Ethnicity in Virginia.

This paper tracks trends in COVID-19 case, death, and vaccination rate disparities by race and ethnicity in Virginia during the COVID-19 pandemic. COVID-19 case, death, and vaccination rates were obtained from electronic state health department records from March 2020 to February 2022. Rate ratios were then utilized to quantify racial and ethnic disparities for several time periods during the pandemic. The Hispanic population had the highest COVID-19 case and age-adjusted death rates, and the lowest vaccination rates at the beginning of the pandemic in Virginia. These disparities resolved later in the pandemic. COVID-19 case and death rates among the Black population were also higher than those of the White population and these disparities remained throughout the pandemic. Racial and ethnic disparities changed over time in Virginia as vaccination coverage and public health policies evolved. Year 2 of the analysis saw lower case and death rates, and higher vaccination rates for non-White populations in Virginia. Public health strategies need to be addressed during the pandemic and developed before the next pandemic to ensure that large racial and ethnic disparities are not again present at the outset.

Does a recent hamstring muscle injury affect the timing of muscle activation during high speed overground running in professional Australian Football players?

OBJECTIVES: To investigate if the temporal characteristics of hamstring and gluteal muscle activation are altered during high speed overground running in professional Australian Football players following hamstring muscle injury. DESIGN: Cohort study. SETTING: Field-based testing. PARTICIPANTS: Elite professional Australian Football players who had sustained a hamstring muscle injury in the six months prior to testing (n = 7) and a group of players from the same club who had no history of hamstring muscle injury (n = 8). MAIN OUTCOME MEASURES: Muscle onset timing, muscle offset timing and muscle onset duration of the medial hamstrings, biceps femoris and gluteus maximus muscles during high-speed running using electromyographic data. RESULTS: No significant differences in any of the temporal aspects of muscle activation were found between groups for any of the muscles tested (p > 0.05). CONCLUSIONS: Persistent alterations to the timing of muscle activation following hamstring muscle injury that have been reported in recreational athletes were not observed during high speed running in professional athletes who have completed comprehensive rehabilitation programs.

A Vavraia-like microsporidium as the cause of deadly infection in threatened and endangered Eurycea salamanders in the United States.

BACKGROUND: Eurycea sosorum (Barton Springs salamander) and Eurycea nana (San Macros salamander) are listed as endangered and threatened species, respectively, by the U.S. Fish and Wildlife Service (USFWS) with habitats restricted to small regions near Austin, Texas, USA. The conservation efforts with the Eurycea salamanders at the captive breeding program in San Marcos Aquatic Resources Center (SMARC), a USFWS facility, have seen an unexpected and increased mortality rate over the past few years. The clinical signs of sick or dead salamanders included erythema, tail loss, asymmetric gills or brachial loss, rhabdomyolysis, kyphosis, and behavior changes, suggesting that an infectious disease might be the culprit. This study aimed to identify the cause of the infection, determine the taxonomic position of the pathogen, and investigate the potential reservoirs of the pathogen in the environment. RESULTS: Histopathological examination indicated microsporidian infection (microsporidiosis) in the sick and dead Eurycea salamanders that was later confirmed by PCR detection. We also determined the near full-length small subunit ribosomal RNA (SSU rRNA) gene from the microsporidian pathogen, which allowed us to determine its phylogenetic position, and to design primers for specific and sensitive detection of the pathogen. Phylogenetic analysis indicated that this pathogen was closely related to the insect parasites Vavraia spp. and the human opportunistic pathogen, Trachipleistophora hominis. This Vavraia-like microsporidium was present in dead salamanders at SMARC archived between 2011 and 2015 (positive rates ranging between 52.0-88.9% by PCR detection), as well as in some aquatic invertebrates at the facility (e.g. snails and small crustaceans). CONCLUSIONS: A Vavraia-like microsporidian was at least one of the major pathogens, if not solely, responsible for the sickness and mortality in the SMARC salamanders, and the pathogen had been present in the center for years. Environmental invertebrates likely served as a source and reservoir of the microsporidian pathogen. These observations provide new knowledge and a foundation for future conservation efforts for Eurycea salamanders including molecular surveys, monitoring of the pathogen, and discovery of effective treatments.

Modeling Training Loads and Injuries: The Dangers of Discretization.

PURPOSE: To evaluate common modeling strategies in training load and injury risk research when modeling continuous variables and interpreting continuous risk estimates; and present improved modeling strategies. METHOD: Workload data were pooled from Australian football (n = 2550) and soccer (n = 23,742) populations to create a representative sample of acute:chronic workload ratio observations for team sports. Injuries were simulated in the data using three predefined risk profiles (U-shaped, flat and S-shaped). One-hundred data sets were simulated with sample sizes of 1000 and 5000 observations. Discrete modeling methods were compared with continuous methods (spline regression and fractional polynomials) for their ability to fit the defined risk profiles. Models were evaluated using measures of discrimination (area under receiver operator characteristic [ROC] curve) and calibration (Brier score, logarithmic scoring). RESULTS: Discrete models were inferior to continuous methods for fitting the true injury risk profiles in the data. Discrete methods had higher false discovery rates (16%-21%) than continuous methods (3%-7%). Evaluating models using the area under the ROC curve incorrectly identified discrete models as superior in over 30% of simulations. Brier and logarithmic scoring was more suited to assessing model performance with less than 6% discrete model selection rate. CONCLUSIONS: Many studies on the relationship between training loads and injury that have used regression modeling have significant limitations due to improper discretization of continuous variables and risk estimates. Continuous methods are more suited to modeling the relationship between training load and injury. Comparing injury risk models using ROC curves can lead to inferior model selection. Measures of calibration are more informative judging the utility of injury risk models.

Optimizing Preseason Training Loads in Australian Football.

PURPOSE: To investigate whether preseason training plans for Australian football can be computer generated using current training-load guidelines to optimize injury-risk reduction and performance improvement. METHODS: A constrained optimization problem was defined for daily total and sprint distance, using the preseason schedule of an elite Australian football team as a template. Maximizing total training volume and maximizing Banister-model-projected performance were both considered optimization objectives. Cumulative workload and acute:chronic workload-ratio constraints were placed on training programs to reflect current guidelines on relative and absolute training loads for injury-risk reduction. Optimization software was then used to generate preseason training plans. RESULTS: The optimization framework was able to generate training plans that satisfied relative and absolute workload constraints. Increasing the off-season chronic training loads enabled the optimization algorithm to prescribe higher amounts of "safe" training and attain higher projected performance levels. Simulations showed that using a Banister-model objective led to plans that included a taper in training load prior to competition to minimize fatigue and maximize projected performance. In contrast, when the objective was to maximize total training volume, more frequent training was prescribed to accumulate as much load as possible. CONCLUSIONS: Feasible training plans that maximize projected performance and satisfy injury-risk constraints can be automatically generated by an optimization problem for Australian football. The optimization methods allow for individualized training-plan design and the ability to adapt to changing training objectives and different training-load metrics.

Effects of nitrogenous wastes on survival of the Barton Springs salamander (Eurycea sosorum).

The objective of our study was to determine the acute toxicity of 3 common aquatic nitrogenous toxicants to the federally endangered Barton Springs salamander (Eurycea sosorum). Based on our findings, the 96-h median lethal concentrations (96-h LC50) for un-ionized ammonia-N, nitrite-N, and nitrate-N to E. sosorum are 2.0 ± 0.32, 31.7 ± 4.02, and 968.5 ± 150.6 mg/L, respectively. These results establish a benchmark for the tolerance of plethodontid salamanders to these toxicants and indicate that current water quality criteria are adequate for their protection. Environ Toxicol Chem 2017;36:3003-3007. © 2017 SETAC.

Training loads and injury risk in Australian football-differing acute: chronic workload ratios influence match injury risk.

AIMS: (1) To investigate whether a daily acute:chronic workload ratio informs injury risk in Australian football players; (2) to identify which combination of workload variable, acute and chronic time window best explains injury likelihood. METHODS: Workload and injury data were collected from 53 athletes over 2 seasons in a professional Australian football club. Acute:chronic workload ratios were calculated daily for each athlete, and modelled against non-contact injury likelihood using a quadratic relationship. 6 workload variables, 8 acute time windows (2-9 days) and 7 chronic time windows (14-35 days) were considered (336 combinations). Each parameter combination was compared for injury likelihood fit (using R2). RESULTS: The ratio of moderate speed running workload (18-24 km/h) in the previous 3 days (acute time window) compared with the previous 21 days (chronic time window) best explained the injury likelihood in matches (R2=0.79) and in the immediate 2 or 5 days following matches (R2=0.76-0.82). The 3:21 acute:chronic workload ratio discriminated between high-risk and low-risk athletes (relative risk=1.98-2.43). Using the previous 6 days to calculate the acute workload time window yielded similar results. The choice of acute time window significantly influenced model performance and appeared to reflect the competition and training schedule. CONCLUSIONS: Daily workload ratios can inform injury risk in Australian football. Clinicians and conditioning coaches should consider the sport-specific schedule of competition and training when choosing acute and chronic time windows. For Australian football, the ratio of moderate speed running in a 3-day or 6-day acute time window and a 21-day chronic time window best explained injury risk.

Low load exercises targeting the gluteal muscle group acutely enhance explosive power output in elite athletes.

The purpose of this study was to investigate the acute effect of 3 warm-up protocols on peak power production during countermovement jump (CMJ) testing. The intention was to devise and compare practical protocols that could be applied as a warm-up immediately before competition matches or weight training sessions. A group of 22 elite Australian Rules Football players performed 3 different warm-up protocols over 3 testing sessions in a randomized order. The protocols included a series of low load exercises targeting the gluteal muscle group (GM-P), a whole-body vibration (WBV) protocol (WBV-P) wherein the subjects stood on a platform vibrating at 30 Hz for 45 seconds, and a no-warm-up condition (CON). The CMJ testing was performed within 5 minutes of each warm-up protocol on an unloaded Smith machine using a linear encoder to measure peak power output. Peak power production was significantly greater after the GM-P than after both the CON (p < 0.05) and WBV-P (p < 0.01). No significant differences in peak power production were detected between the WBV-P and CON. These results have demonstrated that a low load exercise protocol targeting the gluteal muscle group is effective at acutely enhancing peak power output in elite athletes. The mechanisms for the observed improvements are unclear and warrant further investigation. Coaches may consider incorporating low load exercises targeting the gluteal muscle group into the warm-up of athletes competing in sports requiring explosive power output of the lower limbs.

Muscle onset can be improved by therapeutic exercise: a systematic review.

OBJECTIVES: To determine whether therapeutic exercise can improve the timing of muscle onset following musculoskeletal pathology, and examine what exercise prescription parameters are being used to achieve these effects. PARTICIPANTS: People with a musculoskeletal pathology. MAIN OUTCOME MEASURE: Muscle onset timing as measured by electromyography. RESULTS: Sixteen investigations were identified containing 19 therapeutic exercise groups. Three exercise modes were identified including: isolated muscle training, instability training, and general strength training. Isolated muscle training is consistently shown to have a positive effect on the muscle onset timing of transversus abdominus in people with low back pain. There is some evidence from cohort studies that instability training may change muscle onset timing in people with functional ankle instability, however controlled trials suggest that no effect is present. General strength training shows no effect on muscle onset timing in people with low back or neck pain, although one cohort study suggests that a positive effect on gluteus maximus may be present in people with low back pain. CONCLUSION: Therapeutic exercise training is likely to improve muscle onset timing. Additionally, isolated muscle training appears to be the best exercise mode to use to achieve these effects.

Hip adductor muscle strength is reduced preceding and during the onset of groin pain in elite junior Australian football players.

Groin pain is a condition with a high prevalence in young Australian football players. It is considered that early identification of this condition allows for optimal management. Eighty-six players from two elite under-age Australian football sides were screened weekly for hip adductor muscle strength, using a hand-held dynamometer and for the onset of groin pain. The maximum variation in the average hip adductor muscle strength values of the sample was a 2.6% decrease from baseline in week 7 of the study. Twelve players (14% of the sample studied) reported groin pain for two consecutive weeks and were considered to have an onset of groin injury. The mean hip adductor muscle strength of these players was decreased significantly from baseline by an average of 11.75+/-2.50% at the week of pain onset (F=264.76 (1,11), p<0.001), and 5.82+/-5.16% in the week preceding the onset of pain (F=14.03 (1,10), p=0.004). These results confirm that hip adductor muscle strength is decreased both preceding and during the onset of groin injury in elite under-age Australian footballers.

Prevention and management of osteitis pubis in the Australian Football League: a qualitative analysis.

OBJECTIVES: To examine current practices and develop a set of recommendations for the management of osteitis pubis in the Australian Football League (AFL). DESIGN: A qualitative study using in-depth interviews to gather data and thematic coding to analyze findings. SETTING: Participants were interviewed in their workplace or at a convenient meeting point. PARTICIPANTS: Thirty-six medical and fitness staff from the 16 AFL clubs. RESULTS: Respondents from all clubs viewed osteitis pubis as an overuse injury and recognized that the key to prevention is balancing pelvic integrity and load. Osteitis pubis was described as the end result of a continuum of groin pathology, and recognition of predisposing factors and early detection were identified as the key elements of optimal management. Management strategies included rest, training modification, cross-training, correction of predisposing factors, physical therapy and a progression back to competition. Most clubs also conduct generic prevention and education programs. CONCLUSIONS: Overall, respondents perceived that awareness and management of osteitis pubis is currently at a high level in the AFL. Management of osteitis pubis requires the balancing of pelvic integrity and mechanical load through the pelvis and the early identification of warning signs.