Increased Household Secondary Attacks Rates With Variant of Concern Severe Acute Respiratory Syndrome Coronavirus 2 Index Cases.

We compared secondary attack rates in households with B.1.1.7 variant of concern (VOC) versus non-VOC index cases in a matched cohort in Ontario, Canada. The secondary attack rate for VOC index cases was 1.31 times higher than non-VOC index cases. This increase was particularly accentuated for asymptomatic or presymptomatic index cases.

Soil erosion response to land use change in a mountainous rural area of Son La Province of Vietnam.

This study investigated the changes in soil erosion associated with land use change from 2000 to 2020 in a mountainous rural area. Land use change was detected using Landsat images and soil erosion was estimated using the revised universal soil loss equation (RUSLE). The results show that deforestation and fallow cultivation caused substantial soil loss, whereas conversion from uncultivated land to cropland reduced soil erosion. A conversion from 711 ha cropland and 234 ha forestland to uncultivated land increased the average soil loss from 17 ton·ha-1·year-1 to 42 ton·ha-1·year-1 and the area of eroded soil at the very high level from 276 to 1058 ha between 2000 and 2010. In contrast, a wide expansion of cropland from 637 ha uncultivated land decreased the average soil loss from 42 ton·ha-1·year-1 to 32 ton·ha-1·year-1 and the area of eroded soil at the very high level from 1058 to 690 ha between 2010 and 2020. We suggest management measures such as forest protection, afforestation, reforestation, fruit tree development, and soil erosion control practices in coffee and maize cultivation to reduce soil erosion.

The support and information needs of adolescents and young adults with cancer when active treatment ends.

BACKGROUND: The end of active treatment is a period of high stress for young people with cancer, but limited literature exists about their information and support needs during this phase. This study aimed to understand the needs of young people with cancer, how these needs are currently being met, and how best to provide information and support at the end of active treatment. METHODS: This was a multi-stage, mixed methods study exploring the end of treatment experience from the perspectives of young people, and the healthcare professionals caring for them. Semi-structured interviews were undertaken with healthcare professionals, which informed a survey administered nationally. Subsequently, semi-structured interviews were conducted with young people. These combined results informed a co-design workshop to develop recommendations. RESULTS: Telephone interviews were conducted with 12 healthcare professionals and 49 completed the online survey. A total of 11 young people aged 19-26 years (female = 8; 73%) were interviewed. The stakeholder workshop was attended by both healthcare professionals (n = 8) and young people (n = 3). At the end of treatment young people experience numerous ongoing physical issues including pain, fatigue and insomnia; in addition to a range of psychosocial and emotional issues including anxiety, fear of recurrence and isolation. The top three priorities for end of treatment care were: earlier provision and preparation around on-going impact of cancer and cancer treatment; standardised and continued follow-up of young people's emotional well-being; and development of more information and resources specific to young people. CONCLUSION: The access and availability of appropriate information and sources of support at the end of treatment is variable and inequitable. Young people's needs would be more effectively met by timely, structured and accessible information, and support provision at the end of treatment to both prepare and enable adaptation across their transition to living with and beyond cancer. This will require both organisational and practical adjustments in care delivery, in addition to a renewed and updated understanding of what the 'end of treatment' transition process means.

Increasing plant availability of legacy phosphorus in calcareous soils using some phosphorus activators.

Legacy phosphorus (P) in soil, accumulated over several years of fertilizer application in excess of crop demand, represents a huge and largely untapped resource. P activators can increase the availability of this P to plants by accelerating its transformation into soluble P fractions. In this study, we evaluated the potentials of four "P activators" (oxalic acid, lignin, phytase and ascorbic acid) to increase plant available P in a laboratory incubation experiment with two P-deficient calcareous soils used for wheat production. Samples were analysed for Olsen P, phosphomonoesterase and with Hedley sequential P fractionation. All four treatments had significant effects on different soil P fractions. Oxalic acid mainly enhanced inorganic P (Pi) solubility from the HCl-extractable P pool. Lignin enhanced P lability from the NaOH-, HCl- and residual-P pools. Phytase and ascorbic acid principally affected the organic P fractions (Po). Oxalic acid and lignin showed most potential to improve P (H2O-P, NaHCO3-Pi and NaHCO3-Po) availability, which increased by 110-419% and 4.1-122%, respectively. These findings illustrated the potential mechanisms responsible for P release associated with different P activators and reinforced the case for their use in increasing legacy P availability for agriculture in calcareous soils.

Getting a grippe on severity: a retrospective comparison of influenza-related hospitalizations and deaths captured in reportable disease and administrative data sources in Ontario, Canada.

BACKGROUND: Since 2009, in Ontario, reportable disease surveillance data has been used for timely in-season estimates of influenza severity (i.e., hospitalizations and deaths). Due to changes in reporting requirements influenza reporting no longer captures these indicators of severity, necessitating exploration of other potential sources of data. The purpose of this study was to complete a retrospective analysis to assess the comparability of influenza-related hospitalizations and deaths captured in the Ontario reportable disease information system to those captured in Ontario's hospital-based discharge database. METHODS: Hospitalizations and deaths of laboratory-confirmed influenza cases reported during the 2010-11 to 2013-14 influenza seasons were analyzed. Information on hospitalizations and deaths for laboratory-confirmed influenza cases were obtained from two databases; the integrated Public Health Information System, which is the provincial reportable disease database, and the Discharge Abstract Database, which contains information on all in-patient hospital visits using the International Classification of Diseases, 10th Revision, Canada (ICD-10-CA) coding standards. Analyses were completed using the ICD-10 J09 and J10 diagnosis codes as an indicator for laboratory-confirmed influenza, and a secondary analysis included the physician-diagnosed influenza J11 diagnosis code. RESULTS: For each season, reported hospitalizations for laboratory-confirmed influenza cases in the reportable disease data were higher compared to hospitalizations with J09 and J10 diagnoses codes, but lower when J11 codes were included. The number of deaths was higher in the reportable disease data, whether or not J11 codes were included. For all four seasons, the weekly trends in the number of hospitalizations and deaths were similar for the reportable disease and hospital data (with and without J11), with seasonal peaks occurring during the same week or within 1 week of each other. CONCLUSION: In our retrospective analyses we found that hospital data provided a reliable estimate of the trends of influenza-related hospitalizations and deaths compared to the reportable disease data for the 2010-11 to 2013-14 influenza seasons in Ontario, but may under-estimate the total seasonal number of deaths. Hospital data could be used for retrospective end-of-season assessments of severity, but due to delays in data availability are unlikely to be timely estimates of severity during in-season surveillance.

Issues experienced and support provided to adolescents and young adults at the end of active treatment for cancer: A rapid review of the literature.

INTRODUCTION: The end of active treatment is a stressful period for adolescents and young adults (AYA), but little is known about AYA experiences at this time point. The aim was to describe the issues young people experienced and identify interventions to support AYA at the end of treatment. METHODS: We conducted a rapid review of published primary research to identify what is currently known about AYA experiences of the end of treatment, the issues which arise and existing interventions to support AYA at this time. RESULTS: Searches identified 540 papers of which 16 met the inclusion criteria. Five main themes were identified: physical/medical issues; psychological, social and emotional issues; information and support needs; sources of information and support; and difficulties accessing information and support. Within these broader themes, several subthemes were identified and explored further. CONCLUSION: Adolescents and young adults are under prepared for the unpredictable and ongoing nature of the physical, psychological and social issues they face at the end of cancer treatment. Enabling young people's inclusion within their relevant social and educational peer networks should be a priority. Timely, structured and equitable information/support is needed to prepare AYA for treatment ending and subsequent reintegration to "everyday" life.

The Effect of Changes in Cervical Cancer Screening Guidelines on Chlamydia Testing.

PURPOSE: Many chlamydia infections are identified through screening, which is frequently offered to females concomitantly with cervical cancer screening. Recent cervical cancer screening guidelines recommend screening less frequently and starting later. We sought to evaluate the impact of the May 2012 Ontario, Canada, cervical cancer screening guideline change on Papanicolaou (Pap) and chlamydia trachomatis (chlamydia) testing and incidence. METHODS: We extracted population-based physician billing claims data to identify Pap and chlamydia tests and public health surveillance data to identify chlamydia cases. We used interrupted time series analysis of quarterly data spanning 2 years before and after the guideline change and fitted segmented linear regression or rational functions to the outcomes using autoregressive integrated moving average models. Outcomes were stratified by sex and age group. RESULTS: Two years after the guideline change, we observed reduced chlamydia testing in females, with the greatest relative reduction (25.5%) among those aged 15 to 19 years. We also observed decreases in reported chlamydia incidence for females aged 15 to 19 years and 20 to 24 years (relative reductions of 16.8% and 14.4%, respectively). Chlamydia incidence remained the same for males, despite increased chlamydia testing. CONCLUSIONS: Recent cervical cancer screening guideline changes in Ontario were associated with reduced chlamydia testing and reported new cases of chlamydia in females. Females aged 15 to 19 years, who are at high risk for chlamydia if sexually active, and who no longer warrant cervical cancer screening, were disproportionately affected. Females should be tested for chlamydia based on risk, regardless of need for Pap testing.

Understanding of Cyclic Volatile Methyl Siloxane Fate in a High Latitude Lake Is Constrained by Uncertainty in Organic Carbon-Water Partitioning.

Cyclic volatile methyl siloxanes (cVMS) are emitted to aquatic environments with wastewater effluents. Here, we evaluate the environmental behavior of three cVMS compounds (octamethylcyclotetrasiloxane (D4), decamethylcyclopentasiloxane (D5) and dodecamethylcyclohexasiloxane (D6)) in a high latitude lake (Storvannet, 70°N 23°E), experiencing intermittent wastewater emissions and high latitude environmental conditions (low temperatures and seasonal ice cover). Measured cVMS concentrations in lake water were below detection limits in both March and June 2014. However, mean concentrations in sediments were 207 ± 30, 3775 ± 973 and 848 ± 211 ng g-1 organic carbon for D4, D5 and D6, respectively. To rationalize measurements, a fugacity-based model for lakes (QWASI) was parametrized for Storvannet. The key removal process for cVMS from the lake was predicted to be advection due to the low hydraulic retention time of the lake, followed by volatilization. Predicted cVMS behavior was highly sensitive to the partition coefficient between organic carbon and water (KOC) and its temperature dependence. Predictions indicated lower overall persistence with decreasing temperature due to enhanced partitioning from sediments to water. Inverse modeling to predict steady-state emissions from cVMS concentrations in sediment provided unrealistically high emissions, when evaluated against measured concentrations in sewage. However, high concentrations of cVMS in sediment and low concentrations in water could be explained via a hypothetical dynamic emission scenario consistent with combined sewer overflows. The study illustrates the importance of considering compound-specific behavior of emerging contaminants that may differ from legacy organic contaminants.

Commentary on the adoption of a test-based versus syndromic-based approach to outbreak declaration and management in hospital and institutional settings.

At present, Ontario, like most other jurisdictions in Canada, uses a syndromic-based surveillance definition for acute respiratory infection (ARI) outbreaks in institutions and public hospitals. Confirmed outbreaks are defined as either two or more ARIs in 48 hours with any common epidemiological link and at least one that is laboratory-confirmed; or three cases of ARIs occurring within 48 hours with any common epidemiological link, and not necessarily with lab confirmation. However, with the adoption of broader test-based approaches for sick patients/residents throughout the pandemic, new challenges have surfaced regarding the declaration and management of ARI outbreaks with a variety of scenarios in respiratory testing results. Decisions, including the determination of epidemiological linkage when there are discordant/negative test results, have become more complicated with the addition of virus-specific test results for every sick individual. The ARI outbreak case definition and management guidance was updated in 2018. The purpose of this commentary is to highlight epidemiological trends in ARI outbreaks in Ontario over the 2022-2023 season compared to the 2018-2019 and 2019-2020 pre-pandemic seasons. This is followed by a discussion around some of the benefits and challenges of implementing a test-based versus syndromic-based approach to ARI outbreaks.

Neighborhood-Level Burden of Social Risk Factors on Respiratory Syncytial Virus Hospitalization in Ontario, Canada, 2016-2019.

Background: Beyond clinical risk factors, little is known about the impact of social determinants on respiratory syncytial virus (RSV) burden. Our study aimed to estimate RSV-related hospitalization rates across sociodemographic and housing characteristics. Methods: We conducted a population-based study of all RSV-related hospitalizations in Ontario, Canada, between September 1, 2016, and August 31, 2019, using validated hospital discharge codes and census data. Crude and age-standardized annualized RSV incidence rates and rate ratios (RRs) were estimated for a range of individual-level demographics and neighborhood-level measures of marginalization and housing characteristics. Results: Overall, the annual RSV-related hospitalization rate was 27 per 100 000, with the highest rates observed in children age <12 months (1049 per 100 000) and 12-23 months (294 per 100 000) and adults age ≥85 years (155 per 100 000). Higher RSV-related hospitalization rates were associated with increasing marginalization quintile (Q) of material resources (RR, 1.4; Q5: 33 per 100 000 vs Q1: 24 per 100 000) and household instability (RR, 1.5; Q5: 31 per 100 000 vs Q1: 22 per 100 000). Conclusions: The burden of RSV-related hospitalization was greatest in young children and older adults, with variation by sociodemographic and housing factors. Understanding the role of these social factors is crucial for informing equitable preventive program delivery.

Determining Domains of Practice for Youth Support Co-Coordinator Work in Teenage/Young Adult Cancer Care in United Kingdom.

Purpose: Youth support coordinators (YSCs) provide youth-focused psychosocial support to teenagers and young adults (TYA) with cancer, within multidisciplinary teams (MDTs) in National Health Service (NHS) specialist cancer environments. This action research project aimed to provide insight into the work of YSCs with TYA with cancer, within MDTs in clinical settings, and to develop a knowledge and skill framework for YSCs. Methods: An action research approach was taken involving two focus groups, with Health Care Professionals (n = 7) and TYA with cancer (n = 7), and a questionnaire with YSCs (n = 23). Data were analyzed using a thematic analysis approach. A research steering group ensured consistency with the participatory methodology. Results: The positive value of YSC contribution to patients and MDT was echoed across the data sets. Four domains of practice were identified for inclusion in a YSC knowledge and skill framework: (1) adolescent development; (2) the TYA with cancer; (3) working with TYA with cancer; and (4) professional practice of YSC work. Conclusion: Findings highlight the interdependence of YSC domains of practice. For example, the impact of cancer and its treatment must be considered alongside biopsychosocial knowledge relating to adolescent development. Similarly, skills for running youth-focused activities need adapting to the professional cultures, rules, and practices of working in health care systems. Further questions and challenges are raised, such as the value and challenge of therapeutic conversations; practice supervision; and the complexities of the "insider/outsider" perspectives YSCs bring. These insights potentially have important transferability to other areas of adolescent health care.

Nursing home crowding and its association with outbreak-associated respiratory infection in Ontario, Canada before the COVID-19 pandemic (2014-19): a retrospective cohort study.

BACKGROUND: Studies conducted during the COVID-19 pandemic have shown that crowding in nursing homes is associated with high incidence of SARS-CoV-2 infections, but this effect has not been shown for other respiratory pathogens. We aimed to measure the association between crowding in nursing homes and outbreak-associated respiratory infection incidence and related mortality before the COVID-19 pandemic. METHODS: We conducted a retrospective cohort study of nursing homes in Ontario, Canada. We identified, characterised, and selected nursing homes through the Ontario Ministry of Long-Term Care datasets. Nursing homes that were not funded by the Ontario Ministry of Long-Term Care and homes that closed before January, 2020 were excluded. Outcomes consisting of respiratory infection outbreaks were obtained from the Integrated Public Health Information System of Ontario. The crowding index equalled the mean number of residents per bedroom and bathroom. The primary outcomes were the incidence of outbreak-associated infections and mortality per 100 nursing home residents per year. We examined the incidence of infections and deaths as a function of the crowding index by use of negative binomial regression with adjustment for three home characteristics (ie, ownership, number of beds, and region) and nine mean resident characteristics (ie, age, female sex, dementia, diabetes, chronic heart failure, renal failure, cancer, chronic obstructive pulmonary disease, and activities of daily living score). FINDINGS: Between Sept 1, 2014, and Aug 31, 2019, 5107 respiratory infection outbreaks in 588 nursing homes were recorded, of which 4921 (96·4%), involving 64 829 cases of respiratory infection and 1969 deaths, were included in this analysis. Nursing homes with a high crowding index had higher incidences of respiratory infection (26·4% vs 13·8%; adjusted rate ratio per one resident per room increase in crowding 1·89 [95% CI 1·64-2·17]) and mortality (0·8% vs 0·4%; 2·34 [1·88-2·92]) than did homes with a low crowding index. INTERPRETATION: Respiratory infection and mortality rates were higher in nursing homes with high crowding index than in homes with low crowding index, and the association was consistent across various respiratory pathogens. Decreasing crowding is an important safety target beyond the COVID-19 pandemic to help to promote resident wellbeing and decrease the transmission of prevalent respiratory pathogens. FUNDING: None.

Application of multimedia models for understanding the environmental behavior of volatile methylsiloxanes: Fate, transport, and bioaccumulation.

Multimedia fate and transport models (MFTMs) describe how chemicals behave in the environment based on their inherent properties and the characteristics of receiving systems. We critically review the use of MFTMs for understanding the behavior of volatile methylsiloxanes (VMS). MFTMs have been used to predict the fate of VMS in wastewater treatment, rivers, lakes, marine systems, and the atmosphere, and to assess bioaccumulation and trophic transfers. More widely, they have been used to assess the overall persistence, long-range transport potential (LRTP), and the propensity for atmosphere-surface exchange. The application of MFTMs for VMS requires particularly careful selection of model inputs because the properties of VMS differ from those of most organic compounds. For example, although n-octanol/water partition coefficient (KOW ) values are high, air:water partition coefficient (KAW ) values are also high and n-octanol/air partition coefficient (KOA ) values are relatively low. In addition, organic carbon/water partition coefficient (KOC ) values are substantially lower than expectations based on KOW . This means that most empirical relationships between KOC and KOW are not appropriate. Good agreement between modeled and measured concentrations in air, sediment, and biota indicates that our understanding of environmental fate is reasonable. VMS compounds are "fliers" that principally partition to the atmosphere, implying high LRTP, although they have low redeposition potential. They are degraded in air (half-lives 3-10 days) and, thus, have low overall persistence. In water, exposure can be limited by hydrolysis, volatilization, and partitioning to sediments (where degradation half-lives are likely to be high). In food webs, they are influenced by metabolism in biota, which tends to drive trophic dilution (i.e., trophic magnification factors are often but not always <1). Key remaining uncertainties include the following: (i) the strength and direction of the temperature dependence for KOC ; (ii) the fate of atmospheric reaction products; and (iii) the magnitude of emissions to wastewater. Integr Environ Assess Manag 2022;18:599-621. © 2021 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Effect of Pre-Slaughter Practises and Early Post-Mortem Interventions on Sheep Meat Tenderness and Its Impact on Microbial Status.

Tenderness, together with flavour, is the main quality trait that defines consumer acceptance of sheep meat. The factors affecting tenderness can be grouped as those influenced before slaughter, in the early post-mortem intervention and, finally, during the aging period. These factors have been extensively studied with respect to tenderness, but the impact of early post-mortem interventions and subsequent aging on the microbial quality of the final products has not been broadly reviewed to date. In this review, the authors summarize the most recent knowledge on lamb meat tenderness management and how such practices may impact the final meat quality, especially its microbial status. The impacts of pre-slaughter factors (age, sex, diet, genotype and transport) and post-mortem interventions (chilling regime, electrical stimulation, or hanging method), are described and comprehensively discussed.

Assessing secondary attack rates among household contacts at the beginning of the influenza A (H1N1) pandemic in Ontario, Canada, April-June 2009: a prospective, observational study.

BACKGROUND: Understanding transmission dynamics of the pandemic influenza A (H1N1) virus in various exposure settings and determining whether transmissibility differed from seasonal influenza viruses was a priority for decision making on mitigation strategies at the beginning of the pandemic. The objective of this study was to estimate household secondary attack rates for pandemic influenza in a susceptible population where control measures had yet to be implemented. METHODS: All Ontario local health units were invited to participate; seven health units volunteered. For all laboratory-confirmed cases reported between April 24 and June 18, 2009, participating health units performed contact tracing to detect secondary cases among household contacts. In total, 87 cases and 266 household contacts were included in this study. Secondary cases were defined as any household member with new onset of acute respiratory illness (fever or two or more respiratory symptoms) or influenza-like illness (fever plus one additional respiratory symptom). Attack rates were estimated using both case definitions. RESULTS: Secondary attack rates were estimated at 10.3% (95% CI 6.8-14.7) for secondary cases with influenza-like illness and 20.2% (95% CI 15.4-25.6) for secondary cases with acute respiratory illness. For both case definitions, attack rates were significantly higher in children under 16 years than adults (25.4% and 42.4% compared to 7.6% and 17.2%). The median time between symptom onset in the primary case and the secondary case was estimated at 3.0 days. CONCLUSIONS: Secondary attack rates for pandemic influenza A (H1N1) were comparable to seasonal influenza estimates suggesting similarities in transmission. High secondary attack rates in children provide additional support for increased susceptibility to infection.

Monitoring fluvial water chemistry for trend detection: hydrological variability masks trends in datasets covering fewer than 12 years.

This paper sub-samples four 35 year water quality time series to consider the potential influence of short-term hydrological variability on process inference derived from short-term monitoring data. The data comprise two time series for nitrate (NO(3)-N) and two for DOC (using water colour as a surrogate). The four catchments were selected not only because of their long records, but also because the four catchments are very different: upland and lowland, agricultural and non-agricultural. Multiple linear regression is used to identify the trend and effects of rainfall and hydrological 'memory effects' over the full 35 years, and then a moving-window technique is used to subsample the series, using window widths of between 6 and 20 years. The results suggest that analyses of periods between six and eleven years are more influenced by local hydrological variability and therefore provide misleading results about long-term trends, whereas periods of longer than twelve years tend to be more representative of underlying system behaviour. This is significant: if such methods for analysing monitoring data were used to validate changes in catchment management, a monitoring period of less than 12 years might be insufficient to demonstrate change in the underlying system.

Beyond flu: Trends in respiratory infection outbreaks in Ontario healthcare settings from 2007 to 2017, and implications for non-influenza outbreak management.

BACKGROUND: Outbreaks cause significant morbidity and mortality in healthcare settings. Current testing methods can identify specific viral respiratory pathogens, yet the approach to outbreak management remains general. OBJECTIVES: Our aim was to examine pathogen-specific trends in respiratory outbreaks, including how attack rates, case fatality rates and outbreak duration differ by pathogen between hospitals and long-term care (LTC) and retirement homes (RH) in Ontario. METHODS: Confirmed respiratory outbreaks in Ontario hospitals and LTC/RH reported between September 1, 2007, and August 31, 2017, were extracted from the integrated Public Health Information System (iPHIS). Median attack rates and outbreak duration and overall case fatality rates of pathogen-specific outbreaks were compared in both settings. RESULTS: Over the 10-year surveillance period, 9,870 confirmed respiratory outbreaks were reported in Ontario hospitals and LTC/RH. Influenza was responsible for most outbreaks (32% in LTC/RH, 51% in hospitals), but these outbreaks were shorter and had lower attack rates than most non-influenza outbreaks in either setting. Human metapneumovirus, while uncommon (<4% of outbreaks) had high case fatality rates in both settings. CONCLUSION: Attack rates and case fatality rates varied by pathogen, as did outbreak duration. Development of specific outbreak management guidance that takes into account pathogen and healthcare setting may be useful to limit the burden of respiratory outbreaks.

Association of Age and Pediatric Household Transmission of SARS-CoV-2 Infection.

Importance: As a result of low numbers of pediatric cases early in the COVID-19 pandemic, pediatric household transmission of SARS-CoV-2 remains an understudied topic. Objective: To determine whether there are differences in the odds of household transmission by younger children compared with older children. Design, Setting, and Participants: This population-based cohort study took place between June 1 and December 31, 2020, in Ontario, Canada. Private households in which the index case individual of laboratory-confirmed SARS-CoV-2 infection was younger than 18 years were included. Individuals were excluded if they resided in apartments missing suite information, in households with multiple index cases, or in households where the age of the index case individual was missing. Exposures: Age group of pediatric index cases categorized as 0 to 3, 4 to 8, 9 to 13, and 14 to 17 years. Main Outcomes and Measures: Household transmission, defined as households where at least 1 secondary case occurred 1 to 14 days after the pediatric index case. Results: A total of 6280 households had pediatric index cases, and 1717 households (27.3%) experienced secondary transmission. The mean (SD) age of pediatric index case individuals was 10.7 (5.1) years and 2863 (45.6%) were female individuals. Children aged 0 to 3 years had the highest odds of transmitting SARS-CoV-2 to household contacts compared with children aged 14 to 17 years (odds ratio, 1.43; 95% CI, 1.17-1.75). This association was similarly observed in sensitivity analyses defining secondary cases as 2 to 14 days or 4 to 14 days after the index case and stratified analyses by presence of symptoms, association with a school/childcare outbreak, or school/childcare reopening. Children aged 4 to 8 years and 9 to 13 years also had increased odds of transmission (aged 4-8 years: odds ratio, 1.40; 95% CI, 1.18-1.67; aged 9-13 years: odds ratio, 1.13; 95% CI, 0.97-1.32). Conclusions and Relevance: This study suggests that younger children may be more likely to transmit SARS-CoV-2 infection compared with older children, and the highest odds of transmission was observed for children aged 0 to 3 years. Differential infectivity of pediatric age groups has implications for infection prevention within households, as well as schools/childcare, to minimize risk of household secondary transmission. Additional population-based studies are required to establish the risk of transmission by younger pediatric index cases.

Exploring Young People's Experience of Ending Active Cancer Treatment: When the "Little Cancer Treatment Bubble" Pops.

BACKGROUND: The end of active cancer treatment is described as a stressful period for adolescents and young adults (AYAs). However, research evidence describing the experience of AYAs as they transition from active treatment into follow-up care is scarce. OBJECTIVE: We aimed to understand AYAs' experiences within the first 12 months of ending active treatment. METHODS: Data were collected using semistructured interviews, which were digitally recorded and transcribed verbatim. Qualitative analysis of transcripts was used to identify key themes/subthemes. RESULTS: Eleven AYAs (8 female participants), diagnosed with cancer aged 17 to 25 years and 19 to 26 years at point of interview, participated. At time of interview, 7 were within 6 months of treatment completion, and in 4 participants, treatment ended 6 to 12 months prior. Three main themes were identified: (1) challenges of social reintegration and self-identity, (2) expectations versus the lived experience of ending treatment, and (3) sudden loss of the safe "bubble" of treatment. CONCLUSIONS: Adolescents and young adults were underprepared for and challenged by the unexpected emotional and physical consequences of ending active cancer treatment. IMPLICATIONS FOR PRACTICE: Young people require information and support to prepare for ending active treatment and reintegration to everyday life. Preparation for the short- and long-term physical, social, and psychological impact of a cancer diagnosis even when treatment ends will assist young people in managing this transition. Further research is required to develop and test interventions to provide timely, structured, and equitable information and support at the end of treatment to better prepare AYAs for the challenges they may face as treatment ends.

Estimated epidemiologic parameters and morbidity associated with pandemic H1N1 influenza.

BACKGROUND: In the face of an influenza pandemic, accurate estimates of epidemiologic parameters are required to help guide decision-making. We sought to estimate epidemiologic parameters for pandemic H1N1 influenza using data from initial reports of laboratory-confirmed cases. METHODS: We obtained data on laboratory-confirmed cases of pandemic H1N1 influenza reported in the province of Ontario, Canada, with dates of symptom onset between Apr. 13 and June 20, 2009. Incubation periods and duration of symptoms were estimated and fit to parametric distributions. We used competing-risk models to estimate risk of hospital admission and case-fatality rates. We used a Markov Chain Monte Carlo model to simulate disease transmission. RESULTS: The median incubation period was 4 days and the duration of symptoms was 7 days. Recovery was faster among patients less than 18 years old than among older patients (hazard ratio 1.23, 95% confidence interval 1.06-1.44). The risk of hospital admission was 4.5% (95% CI 3.8%-5.2%) and the case-fatality rate was 0.3% (95% CI 0.1%-0.5%). The risk of hospital admission was highest among patients less than 1 year old and those 65 years or older. Adults more than 50 years old comprised 7% of cases but accounted for 7 of 10 initial deaths (odds ratio 28.6, 95% confidence interval 7.3-111.2). From the simulation models, we estimated the following values (and 95% credible intervals): a mean basic reproductive number (R0, the number of new cases created by a single primary case in a susceptible population) of 1.31 (1.25-1.38), a mean latent period of 2.62 (2.28-3.12) days and a mean duration of infectiousness of 3.38 (2.06-4.69) days. From these values we estimated a serial interval (the average time from onset of infectiousness in a case to the onset of infectiousness in a person infected by that case) of 4-5 days. INTERPRETATION: The low estimates for R0 indicate that effective mitigation strategies may reduce the final epidemic impact of pandemic H1N1 influenza.