EMT and dissemination precede pancreatic tumor formation.

Metastasis is the leading cause of cancer-associated death but has been difficult to study because it involves a series of rare, stochastic events. To capture these events, we developed a sensitive method to tag and track pancreatic epithelial cells in a mouse model of pancreatic cancer. Tagged cells invaded and entered the bloodstream unexpectedly early, before frank malignancy could be detected by rigorous histologic analysis; this behavior was widely associated with epithelial-to-mesenchymal transition (EMT). Circulating pancreatic cells maintained a mesenchymal phenotype, exhibited stem cell properties, and seeded the liver. EMT and invasiveness were most abundant at inflammatory foci, and induction of pancreatitis increased the number of circulating pancreatic cells. Conversely, treatment with the immunosuppressive agent dexamethasone abolished dissemination. These results provide insight into the earliest events of cellular invasion in situ and suggest that inflammation enhances cancer progression in part by facilitating EMT and entry into the circulation.

EUS-guided radiofrequency ablation for pancreatic adenocarcinoma.

BACKGROUND AND AIMS: Emerging data suggest neoadjuvant chemotherapy (NAC) for resectable pancreatic ductal adenocarcinoma (PDAC) is associated with improved survival. However, less than 40% of patients demonstrate a meaningful radiographic response to NAC. EUS-guided radiofrequency ablation (EUS-RFA) has emerged as a new modality to treat PDAC. We hypothesize that NAC plus EUS-RFA can be used in the management of resectable PDAC. METHODS: This was a prospective review of PDAC patients meeting the criteria of resectable tumor anatomy who underwent NAC chemotherapy plus EUS-RFA followed by pancreatic resection. Radiographic imaging and perioperative and short-term outcomes were recorded. Surgical pathology specimens were analyzed for treatment response. RESULTS: Three eligible patients with resectable PDAC received 4 months of NAC plus EUS-RFA. One month after completing NAC and EUS-RFA, all 3 patients underwent standard pancreaticoduodenectomy without adverse events. After a 6-week recovery, all patients completed 2 months of postoperative adjuvant chemotherapy. CONCLUSIONS: In our institutional experience, this treatment protocol appears to be safe as patients tolerated the combination of chemotherapy and ablation. Patients underwent pancreatic resection with uneventful recovery. This novel neoadjuvant approach may provide a more effective alternative to chemotherapy alone.

Youth Exposure to Recreational Cannabis Legalization: Moderation of Effects by Sex and Parental Cannabis Use during Adolescence.

OBJECTIVE: Few studies of recreational cannabis legalization (RCL) have assessed adolescents both before and after RCL or considered moderators of RCL effects. The present study tested whether RCL was more strongly associated with cannabis use for girls and among youth whose parents had a history of cannabis use during adolescence. METHOD: Data were pooled from 940 adolescents from three intergenerational studies that began in Washington (where RCL was enacted in 2012), Oregon (RCL year = 2015), and New York (RCL year = 2021). Youth were assessed repeatedly from ages 13 to 18 years (k = 3,650 person-years) from 1999 to 2020 (prior to RCL in New York). Parent cannabis use at or before age 18 years (yes/no) was assessed prospectively during the parent's adolescence. Multilevel models focused on the between-subjects effects of years of youth exposure to RCL on adolescents' mean cannabis use likelihood, and interactions with child sex and parent use history. RESULTS: Child exposure to RCL was associated with a higher likelihood of cannabis use if their parents had a history of adolescent use, (Estimate [SE] = 0.67 [0.25], p = 0.008), versus no such history (Estimate [SE] = -0.05 [0.28], p = 0.855). RCL effects were not moderated by child sex. CONCLUSIONS: The effects of RCL on adolescents' cannabis use may depend on their parents' history of using the drug. Identifying other moderators of RCL effects, and understanding the mechanisms of these risks and the ways that parents and communities can offset them, are prevention priorities.

(1) Adolescents' use of cannabis may have intergenerational consequences, making it more likely their future offspring will use cannabis. (2) Whether or not recreational cannabis legalization influences adolescents' cannabis use may depend on their parents' cannabis use history. (3) Parenting in a state with liberalized cannabis policies may present new challenges and require that novel prevention resources be developed.

Prospective Intergenerational Associations between Parents' and Children's Illicit Substance Use During Adolescence.

OBJECTIVE: Intergenerational studies have identified relations between adolescents' and their future offspring's cannabis and alcohol use, but rarely have examined the association for other illicit drug use. Given the low prevalence of such use in community populations, we pooled data from three prospective intergenerational studies to test this link. METHOD: Participants were 1,060 children of 937 parents who had been repeatedly assessed since early adolescence. Children and parents reported on their use of cocaine, stimulants, hallucinogens, sedatives/tranquilizers, and opiates/narcotics from ages 10 to 18 years. Intergenerational similarities in any versus no use of these drugs were formally modeled using logistic regression. Patterns also were descriptively analyzed. RESULTS: Parent illicit substance use was associated with significantly higher odds of child use (adjusted odds ratio [95% confidence interval] = 2.682 [1.328-5.416], p = 0.006). However, intergenerational continuity was modest; 87% of children whose parent used illicit drugs in adolescence did not use such drugs, and 77% of parents of children who used illicit drugs had not themselves used these drugs during adolescence. CONCLUSIONS: The use of illicit substances by parents during their teenage years poses a risk for their offspring's similar behaviors. However, the discontinuity of these behaviors across generations implies children are largely resilient to or protected from this risk, and conversely that other aspects of parents' and children's experiences or characteristics may be more powerful risks for children's illicit drug use than this transgenerational influence.

(a) Parents' use of illicit drugs during adolescence significantly increased risk that their adolescent children would use such drugs. (b) However, most parents who used illicit drugs did not have children who used illicit drugs, and conversely, the majority of adolescents who used illicit drugs did not have parents who had used such drugs in their adolescence.

Comparison of Length of Stay Between Children Admitted to an Observation Versus Inpatient Unit.

OBJECTIVES: Many children who require hospitalization are ideal candidates for care in pediatric observation units (POUs) rather than inpatient pediatric units. Differences in outcomes between children cared for in these 2 practice settings have not been thoroughly evaluated. METHODS: In this retrospective cohort study, children aged 0 to 18 years admitted to a POU at a community hospital or inpatient unit at a children's hospital were enrolled if they met specific clinical criteria. Information regarding the current illness, medical history, and hospital course was collected. Hospital length of stay (LOS) was analyzed as the primary outcome; secondary outcomes included conversion to inpatient care for the POU group and return to pediatric emergency department within 7 days. Subgroup analysis was conducted on children presenting with respiratory illnesses. Propensity scores were used as a predictor in the final model. RESULTS: One hundred eighty-one admissions, 92 to POU and 89 to an inpatient unit, were analyzed. Mean LOS was 24.4 hours (95% confidence interval [CI], 21.7-27.1) for observation and 43.2 hours (95% CI, 37.8-48.6) for inpatient (P < 0.01). Among the 126 children admitted for respiratory illnesses, the mean LOS was 32.3 hours (95% CI, 26.0-38.6) for observation and 48.1 hours (95% CI, 42.2-54.0) for inpatient (P < 0.01). Survival analysis demonstrated a 1.61 (95% CI, 1.07-2.42) fold shorter time to discharge among children admitted to observation compared with inpatient (P = 0.02) and a 1.70 (95% CI, 1.07-2.71) fold shorter time to discharge from observation compared with inpatient for respiratory illnesses (P = 0.03). Within 7 days of discharge, 2 (2%) patients from the observation group and 1 (1%) from the inpatient group returned to the pediatric emergency department. CONCLUSIONS: These findings suggest that POU may provide the means toward efficient care for children in community settings with illnesses requiring brief hospitalizations. Future work including prospective investigations is needed to ascertain the generalizability of these findings.

Testing Cross-Generational Effects of the Raising Healthy Children Intervention on Young Adult Offspring of Intervention Participants.

This study tested whether effects of a preventive intervention delivered in elementary school showed benefits for the young adult offspring of intervention recipients over 20 years later. The Raising Healthy Children (RHC) intervention, trialed in 18 public schools in Seattle, Washington, from 1980-1986 (grades 1-6), sought to build strong bonds to family and school to promote school success and avoidance of substance use and illegal behavior. Four intervention groups were constituted: full, late, parent training only, and control. Participants were followed through 2014 (age 39 years). Those who became parents were enrolled in an intergenerational study along with their oldest offspring (10 assessments between 2002 and 2018). This study includes young adult offspring (ages 18-25 years; n = 169; 52% female; 4% Asian, 25% Black, 40% multiracial, 4% Native American, 2% Native Hawaiian/Pacific Islander, 25% White, and 14% Hispanic/Latinx) of participants in the original RHC trial. Offspring outcome measures included high school noncompletion, financial functioning, alcohol misuse, cannabis misuse, cigarette use, criminal behavior, internalizing behavior, social skills, and social bonding. A global test across all young adult outcome measures showed that offspring of parents who received the full RHC intervention reported better overall functioning compared to offspring of control group parents. Analyses of individual outcomes showed that offspring of full intervention group parents reported better financial functioning than offspring of control group parents. Findings show the potential of universal preventive interventions to provide long-term benefits that reach into the next generation. ClinicalTrials.gov Identifier: NCT04075019; retrospectively registered in 2019.

A unique case of Rhizopus oryzae brain abscess treated with intracavitary amphotericin.

Here we present a case of a poorly controlled diabetic who developed extensive rhinocerebral mucormycosis. Systemic and intrathecal amphotericin were not able to improve his life threatening infection. Therefore, salvage therapy with intracavitary amphotericin B deoxycholate was used to instill antifungal therapy directly into the patient's brain abscess. For proper dosing of intracavitary amphotericin B deoxycholate, we devised a formula which can be theoretically applied for all intracavitary therapies. Unfortunately, the patient's family withdrew care 6 days after starting intracavitary amphotericin and efficacy of this therapy could not be evaluated.

Health and Social Vulnerabilities Among Unstably Housed and Homeless Young Adults During the COVID-19 Pandemic.

The role of housing as a social driver of health is well-established, with stable housing being an important factor in reducing health inequities. During developmentally critical periods such as young adulthood, unstable housing and related social marginalization have profound effects on development and later health, social, and economic wellbeing. This exploratory study analyzed data from a population-based, longitudinal sample of young adults (average age 31 years) from Washington State (n = 755) to compare health and economic impacts of the early days of the COVID-19 pandemic, with a focus on housing status. Descriptive results suggest the pandemic exposed underlying vulnerabilities for young adults experiencing homelessness and housing instability, with an overall widening of inequities related to financial difficulties and increased risk for poor mental health and social isolation. Findings suggest that these vulnerabilities are magnified in the context of public health crises and strengthen the case for population-based studies investigating potential modifiable causes of housing instability to inform prevention and early intervention at the earliest possible point in a young person's development. Studies examining the severity of COVID-related hardships on young adult health and social outcomes are vital for establishing an evidence base for strategic policy action that seeks to prevent a rebound in young adult homelessness and housing instability post-pandemic. These studies would bolster both emergency preparedness responses that account for the unique needs of vulnerable populations and upstream population-level prevention approaches beginning long before the imminent risk for housing instability develops.

Establishing interprofessional clinical learning experiences in primary care safety-net sites.

This paper describes an interprofessional clinical learning experience for students within two primary care safety-net sites. An interprofessional team of faculty at one university partnered with two safety-net systems to provide students opportunities to work in an interprofessional team providing care for socially and medically complex patients. Our evaluation outcomes are student-centered, focusing on students' perceptions of caring for medically underserved populations and satisfaction with the clinical experience. Students reported positive perceptions of the interprofessional team, clinical experience, primary care, and caring for underserved populations. Strategic development of partnerships between academic and safety-net systems to offer learning opportunities can increase future healthcare providers' exposure and appreciation for interprofessional care of underserved populations.

Alignment of an interprofessional student learning experience with a hospital quality improvement initiative.

Assessment of interprofessional education (IPE) frequently focuses on students' learning outcomes including changes in knowledge, skills, and/or attitudes. While a foundational education in the values and information of their chosen profession is critical, interprofessional learning follows a continuum from formal education to practice. The continuum increases in significance and complexity as learning becomes more relationship based and dependent upon the ability to navigate complex interactions with patients, families, communities, co-workers, and others. Integrating IPE into collaborative practice is critical to enhancing students' experiential learning, developing teamwork competencies, and understanding the complexity of teams. This article describes a project that linked students with a hospital-based quality-improvement effort to focus on the acquisition and practice of teamwork skills and to determine the impact of teamwork on patient and quality outcome measures. A hospital unit was identified with an opportunity for improvement related to quality care, patient satisfaction, employee engagement, and team behaviours. One hundred and thirty-seven students from six health profession colleges at the Medical University of South Carolina underwent TeamSTEPPS® training and demonstrated proficiency of their teamwork-rating skills with the TeamSTEPPS® Team Performance Observation Tool (T-TPO). Students observed real-time team behaviours of unit staff before and after staff attended formal TeamSTEPPS® training. The students collected a total of 778 observations using the T-TPO. Teamwork performance on the unit improved significantly across all T-TPO domains (team structure, communication, leadership, situation monitoring, and mutual support). Significant improvement in each domain continued post-intervention and at 15-month follow-up, improvement remained significant compared to baseline. Student engagement in TeamSTEPPS® training and demonstration of their reliability as teamwork-observers was a valuable learning experience and also yielded an opportunity to gather unique, and otherwise difficult to attain, data from a hospital unit for use by quality managers and administrators.

School Influences on Adolescent Depression: A 6-Year Longitudinal Study Amongst Catholic, Government and Independent Schools, in Victoria, Australia.

This study examined associations between school sector (Government, Catholic or Independent) and depressive symptomology over the secondary school years. Six waves of data collected annually from a representative Australian sample were examined. Multilevel piecewise linear and logistic regression controlling for a variety of demographic variables and protective factors was undertaken. In all sectors, depressive symptomology decreased between 10 and 13 years of age, but significantly increased for girls at age 13. Adolescents in Catholic schools reported significantly fewer symptoms of depression compared to those in Government and Independent schools. Adolescents in Catholic schools were less likely to report clinical levels of depressed mood compared to adolescents in Government schools.

Development of duplex qPCR targeting Carnobacterium maltaromaticum and Vagococcus salmoninarum.

In November 2018, Vagococcus salmoninarum was identified as the causative agent of a chronic coldwater streptococcosis epizootic in broodstock brook trout (Salvelinus fontinalis) at the Iron River National Fish Hatchery in Wisconsin, USA. By February 2019, the epizootic spread to adjacent raceways containing broodstock lake trout (Salvelinus namaycush), whereby fish were found to be coinfected with Carnobacterium maltaromaticum and V. salmoninarum. To differentiate these two pathogens and determine the primary cause of the lake trout morbidity, a quantitative real-time PCR (qPCR) was developed targeting the C. maltaromaticum phenylalanyl-tRNA synthase alpha subunit (pheS) gene. The qPCR was combined with a V. salmoninarum qPCR, creating a duplex qPCR assay that simultaneously quantitates C. maltaromaticum and V. salmoninarum concentrations in individual lake trout tissues, and screens presumptive isolates from hatchery inspections and wild fish from national fish hatchery source waters throughout the Great Lakes basin. Vagococcus salmoninarum and C. maltaromaticum were co-detected in broodstock brook trout from two tribal hatcheries and C. maltaromaticum was present in wild fish in source waters of several national fish hatcheries. This study provides a powerful new tool to differentiate and diagnose two emerging Gram-positive bacterial pathogens.

Adolescent Antecedents of Young Adult Homelessness: a Cross-national Path Analysis.

Adolescent and young adult health, development, and behavior lay a foundation for future population health. Increasing rates of young adult homelessness mean there is a need for research which generates evidence to support a stronger focus on population-level prevention. Using longitudinal data from a population-based sample of young adults participating in the cross-nationally matched International Youth Development Study, we examined adolescent antecedents of young adult homelessness in Washington State in the USA and in Victoria, Australia. Participants were surveyed using a modified version of the Communities That Care youth survey. Analyses of prospective, longitudinal data from 1945 participants, recruited as state-representative secondary school samples at grade 7 (average age 13, 2002) and longitudinally compared at young adulthood (average age 25, 2014), showed that young adults in Washington State reported higher rates of past year homelessness (5.24%) compared to those in Victoria (3.25%). Path modeling showed less positive family management strategies at age 13 uniquely increased risk for age 25 homelessness. This effect remained after accounting for age 15 antecedents in peer-group, school, and community environments. Friends' drug use, school suspension, academic failure, and low neighborhood attachment at age 15 mediated the association between less positive family management strategies at age 13 and age 25 homelessness. Despite observing some cross-national differences in levels of family, peer-group, school, and community antecedents, we found that these factors equally increased risk for age 25 homelessness in both states, suggesting similar cross-national influences for young adult homelessness. The findings indicate cross-nationally common adolescent antecedents for young adult homelessness that could be targeted by prevention strategies across international settings.

Oncostatin M Induces Lipolysis and Suppresses Insulin Response in 3T3-L1 Adipocytes.

Oncostatin M (OSM) is an immune cell-derived cytokine that is upregulated in adipose tissue in obesity. Upon binding its receptor (OSMR), OSM induces the phosphorylation of the p66 subunit of Src homology 2 domain-containing transforming protein 1 (SHC1), called p66Shc, and activates the extracellular signal-related kinase (ERK) pathway. Mice with adipocyte-specific OSMR deletion (OsmrFKO) are insulin resistant and exhibit adipose tissue inflammation, suggesting that intact adipocyte OSM-OSMR signaling is necessary for maintaining adipose tissue health. How OSM affects specific adipocyte functions is still unclear. Here, we examined the effects of OSM on adipocyte lipolysis. We treated 3T3-L1 adipocytes with OSM, insulin, and/or inhibitors of SHC1 and ERK and measured glycerol release. We also measured phosphorylation of p66Shc, ERK, and insulin receptor substrate-1 (IRS1) and the expression of lipolysis-associated genes in OSM-exposed 3T3-L1 adipocytes and primary adipocytes from control and OsmrFKO mice. We found that OSM induces adipocyte lipolysis via a p66Shc-ERK pathway and inhibits the suppression of lipolysis by insulin. Further, OSM induces phosphorylation of inhibitory IRS1 residues. We conclude that OSM is a stimulator of lipolysis and inhibits adipocyte insulin response. Future studies will determine how these roles of OSM affect adipose tissue function in health and disease.

Isolations of the Spring Viremia of Carp Virus in the Upper Mississippi River (USA), Including a New Host, the Quillback.

In July of 2018 and 2019, wild fish health surveys were conducted along the Wisconsin and Minnesota portions of the upper Mississippi River. Spring viremia of carp virus (SVCV) was isolated from Common Carp Cyprinus carpio as well as a newly identified host species, the Quillback Carpiodes cyprinus. Sanger sequencing of the gene encoding for the G protein revealed a high similarity of the Quillback isolate to various SVCV isolates identified from Common Carp that were collected during earlier wild fish health surveys and mortality events in the USA. Despite annual monitoring, this virus has been infrequently identified. The speculative role of native fish and invertebrates in allowing the virus to persist for long periods without detection is discussed.

A population-based study of homelessness, antisocial behaviour and violence victimisation among young adults in Victoria, Australia.

Homeless young adults are at increased risk for contact with the police and are overrepresented in the justice system. This study explored associations between homelessness, antisocial behaviour and violence victimisation using longitudinal panel data gathered through young adulthood. Data were drawn from a state representative population-based sample of young adults from Victoria, Australia participating in the International Youth Development Study (IYDS; n = 2884, 54% female). Participants were surveyed at age 21 years, with follow-up at ages 23 and 25 years. We examined changes in the prevalence of homelessness and tested hypothesised directional relationships between young adult homelessness, antisocial behaviour and violence victimisation using longitudinal cross-lagged panel models. Multiple-group modelling was used to test whether these relationships were moderated by gender. The prevalence of young adult homelessness was highest at age 21 (6.5%), declining at ages 23 (3.9%) and 25 years (2.5%). Results showed that young adult homelessness, antisocial behaviour and victimisation were related cross-sectionally, but not longitudinally. Gender did not significantly moderate these associations. Findings suggest that the state of homelessness is associated with temporary vulnerability to potentially harmful and problematic situations involving antisocial behaviour and victimisation. These situations are likely to heighten risk for contact with the police and direct physical and psychological harm.

Adult Social Environments and the Use of Combustible and Electronic Cigarettes: Opportunities for Reducing Smoking in the 30s.

INTRODUCTION: Reducing cigarette use is a major public health goal in the United States. Questions remain, however, about the potential for the social environment in the adult years-particularly in the 30s and beyond-to influence cigarette use. This study tested pathways hypothesized by the social development model to understand the extent to which social environmental factors at age 33 (eg, involvement with smokers or with physically active people) contribute to changes in cigarette use from age 30 to age 39. Both combustible and electronic cigarette use were investigated. METHODS: Data were from the Seattle Social Development Project, a longitudinal study of 808 diverse participants with high retention. Self-reports assessed social developmental constructs, combustible and electronic cigarette use, and demographic measures across survey waves. RESULTS: At age 30, 32% of the sample reported past-month cigarette use. Using structural equation modeling, results showed high stability in cigarette use from age 30 to 39. After accounting for this stability, cigarette-using social environments at age 33 predicted personal beliefs or norms about smoking (eg, acceptability and social costs), which in turn predicted combustible cigarette use at age 39. Cigarette-using environments, however, directly predicted electronic cigarette use at age 39, with no significant role for beliefs about smoking. CONCLUSIONS: Cigarette use was highly stable across the 30s, but social environmental factors provided significant partial mediation of this stability. Pathways were different for combustible and electronic cigarette use, however, with personal smoking norms playing an important role for the former but not the latter. IMPLICATIONS: This study addresses the need for longitudinal investigation of social mechanisms and cigarette use in the 30s. Findings reinforce efforts to prevent the uptake of cigarettes prior to the 30s because, once started, smoking is highly stable. But social environmental factors remain viable intervention targets in the 30s to disrupt this stability. Addressing personal norms about smoking's acceptability and social costs is likely a promising approach for combustible cigarette use. Electronic cigarettes, however, present a new challenge in that many perceived social costs of cigarette use do not readily translate to this relatively recent technology.

Life-course predictors of homelessness from adolescence into adulthood: A population-based cohort study.

INTRODUCTION: Internationally, the prevalence of young adult homelessness is concerning. Few data on life-course predictors from longitudinal studies exist, limiting our capacity to inform prevention strategies at the population-level. METHODS: Data were drawn from a state representative population-based sample of young adults from Victoria, Australia participating in the International Youth Development Study (IYDS; N = 927, 54% female). Participants were recruited in state-representative secondary school samples at Grade 7 (age 13, 2002), with follow-up in Grades 9 (age 15) and 11 (age 17) and at ages 21, 23 and 25. Using longitudinal path modelling, we conducted a series of analyses testing life-course predictors of young adult homelessness across multiple socializing contexts, and the interrelationships among them. RESULTS: The rate of young adult homelessness was 5.5%. Path modelling showed higher levels of family conflict at ages 13 and 15 uniquely predicted homelessness by age 25. This effect remained after accounting for other risk factors in peer-group (e.g., interactions with antisocial peers), school (e.g., low academic performance), and community contexts (e.g., low neighborhood attachment). Peer drug use and interaction with antisocial peers at age 15 mediated the association between family conflict at age 13 and homelessness by age 25. CONCLUSIONS: Findings point to the vulnerability of early adolescents to family conflict. This vulnerability heightens risk for young adult homelessness. Findings strengthen the case for both primary prevention programs that build healthy relationships between family members from early on in adolescence and for investment in homelessness prevention at key developmental periods.

Vagococcus salmoninarum II-qPCR, tropism and egg-associated transmission.

Vagococcus salmoninarum was identified as the causative agent of a chronic epizootic in broodstock "coaster" brook trout (Salvelinus fontinalis) at the Iron River National Fish Hatchery. The epizootic spanned more than a year, was unresponsive to multiple florfenicol treatments, and resulted in >50% mortality of the affected fish. The decision was made to cull the remaining fish during spawning, which presented an opportunity to more thoroughly examine V. salmoninarum sampling methods, organ tropism and vertical transmission. A newly developed qPCR targeting the pheS gene was used in concert with bacterial culture to show that V. salmoninarum indeed disproportionately affects females and has a tropism for female reproductive tissues. The study demonstrates that some female reproductive tissues (e.g. ovarian fluid, unfertilized eggs) are also an effective option for non-lethal detection. Despite the widespread presence of V. salmoninarum in ovarian fluid and on egg surfaces, we found no evidence of intra-ova transmission.

Vagococcus salmoninarum I-A chronic coldwater streptococcosis in broodstock brook trout (Salvelinus fontinalis) in Wisconsin, USA.

In 2018, Vagococcus salmoninarum was isolated from two lots of broodstock "coaster" brook trout (Salvelinus fontinalis) containing ~1,500 fish at the Iron River National Fish Hatchery, at which time it was identified as the causative agent of a chronic coldwater streptococcosis epizootic. Clinical signs included exophthalmia, lethargy, erratic swimming and loss of equilibrium. Female fish experienced disproportionately higher morbidity and mortality than male co-inhabitants, and routinely retained eggs following spawning. The most consistent gross clinical sign was heart pallor and turbid pericardial effusion. An attempted treatment using florfenicol was ineffective at halting the epizootic, which spanned more than a year and resulted in >50% mortality before remaining fish were culled. As there is no previous documentation of V. salmoninarum at this hatchery or in this species, it is still unclear what circumstances led to this epizootic. The inability to treat this chronic disease led to the loss of valuable broodstock, hampering ongoing fishery conservation efforts in the Great Lakes Basin.