A large outbreak of the Kappa mutation of COVID-19 in Cork, Ireland, April-May 2021.

BACKGROUND: In May 2021, the B.1.617 variant of SARS-CoV-2 emerged in Ireland, and both Delta and Kappa sub-lineages were initially deemed variants of concern (VOCs) on a precautionary basis. We describe a large outbreak of SARS-CoV-2 B.1.617.1 (Kappa mutation) linked to a private gathering among third level students in Cork, Ireland. METHODS: Surveillance data were available from the Health Service Executive COVID Care Tracker. The epidemiological sequence of infection for each new case in this outbreak was tracked and whole genome sequencing was requested on all linked cases. Enhanced public health control measures were implemented by the Department of Public Health HSE-South to contain onward spread of VOCs, including retrospective contact tracing, lengthy isolation and quarantine periods for cases and close contacts. Extensive surveillance efforts were used to describe and control onward transmission. RESULTS: There were 146 confirmed SARS-CoV-2 cases linked to the outbreak. All sequenced cases (53/146; 36%) confirmed Kappa mutation. The median age was 21 years (range 17-65). The majority (88%) had symptoms of SARS-CoV-2 infection. There were 407 close contacts; the median was 3 per case (range 0-14). There were no known hospitalisations, ICU admissions or deaths. Vaccination data was unavailable, but the outbreak pre-dated routine availability of COVID-19 vaccines among younger adults in Ireland. CONCLUSION: Enhanced public health control measures for new and emerging variants of SARS-CoV-2 may be burdensome for cases and close contacts. The overall public health benefit of enhanced controls may only become apparent when evidence on disease transmissibility and severity becomes more complete.

Covid-19 presentation among symptomatic healthcare workers in Ireland.

BACKGROUND: It is recognized that healthcare workers (HCWs) are at high risk of contracting Covid-19. It is incumbent on occupational health staff to recognize potential symptoms of Covid-19 among HCWs. AIMS: The aims of the study were to describe the presenting symptoms of HCWs who developed Covid-19 in Ireland, and to estimate the odds of specific symptoms being associated with a positive Covid-19 polymerase chain reaction (PCR) result. METHODS: A retrospective chart review of all symptomatic HCWs who self-presented for Covid-19 testing in Cork from March to May 2020 was conducted. A sex-matched case-control study was carried out to compare presenting features among those who tested positive compared to those who tested negative. Univariate and multivariable-adjusted conditional logistic regression models were run using Stata 15.0 to identify the symptoms associated with positive Covid-19 swab results. RESULTS: Three hundred and six HCWs were included in the study; 102 cases and 204 controls. Common presenting features among cases were fever/chills (55%), cough (44%) and headache (35%). The symptoms which were significantly associated with a positive Covid-19 swab result were loss of taste/smell (adjusted odds ratio [aOR] 12.15, 95% confidence interval [CI] 1.36-108.79), myalgia (aOR 2.36, 95% 1.27-4.38), fatigue (aOR 2.31, 95% CI 1.12-4.74), headache (aOR 2.11, 95% CI 1.19-3.74) and fever/chills (aOR 1.88, 95% CI 1.12-3.15). CONCLUSIONS: Fever, fatigue, myalgia, loss of taste/smell and headache were associated with increased odds of a Covid-19 diagnosis among symptomatic self-referred HCWs compared with those had negative swab results. Testing criteria for HCWs should reflect the broad range of possible symptoms of Covid-19.

Contrasting arsenic cycling in strongly and weakly stratified contaminated lakes: Evidence for temperature control on sediment-water arsenic fluxes.

Arsenic contamination of lakebed sediments is widespread due to a range of human activities, including herbicide application, waste disposal, mining, and smelter operations. The threat to aquatic ecosystems and human health is dependent on the degree of mobilization from sediments into overlying water columns and exposure of aquatic organisms. We undertook a mechanistic investigation of arsenic cycling in two impacted lakes within the Puget Sound region, a shallow weakly-stratified lake and a deep seasonally-stratified lake, with similar levels of lakebed arsenic contamination. We found that the processes that cycle arsenic between sediments and the water column differed greatly in shallow and deep lakes. In the shallow lake, seasonal temperature increases at the lakebed surface resulted in high porewater arsenic concentrations that drove larger diffusive fluxes of arsenic across the sediment-water interface compared to the deep, stratified lake where the lakebed remained ~10#x00B0;C cooler. Plankton in the shallow lake accumulated up to an order of magnitude more arsenic than plankton in the deep lake due to elevated aqueous arsenic concentrations in oxygenated waters and low phosphate: arsenate ratios in the shallow lake. As a result, strong arsenic mobilization from sediments in the shallow lake was countered by large arsenic sedimentation rates out of the water column driven by plankton settling.

Increased exposure of plankton to arsenic in contaminated weakly-stratified lakes.

Arsenic, a priority Superfund contaminant and carcinogen, is a legacy pollutant impacting aquatic ecosystems in urban lakes downwind of the former ASARCO copper smelter in Ruston, WA, now a Superfund site. We examined the mobility of arsenic from contaminated sediments and arsenic bioaccumulation in phytoplankton and zooplankton in lakes with varying mixing regimes. In lakes with strong seasonal thermal stratification, high aqueous arsenic concentrations were limited to anoxic bottom waters that formed during summer stratification, and arsenic concentrations were low in oxic surface waters. However, in weakly-stratified lakes, the entire water column, including the fully oxic surface waters, had elevated concentrations of arsenic (up to 30µgL-1) during the summer. We found enhanced trophic transfer of arsenic through the base of the aquatic food web in weakly-stratified lakes; plankton in these lakes accumulated up to an order of magnitude more arsenic on multiple sampling days than plankton in stratified lakes with similar levels of contamination. We posit that greater bioaccumulation in weakly-stratified lakes was due to elevated arsenic in oxic waters. Aquatic life primarily inhabits oxic waters and in the oxic water column of weakly-stratified lakes arsenic was speciated as arsenate, which is readily taken up by phytoplankton because of its structural similarities to phosphate. Our study indicates that mobilization of arsenic from lake sediments into overlying oxic water columns in weakly-stratified lakes leads to increased arsenic exposure and uptake at the base of the aquatic food web.

The connected health of cardiovascular medicine: current status and future directions.

The technologies of cardiovascular connected health stand to dramatically alter the management and prevention of cardiovascular disease, a worldwide leading cause of death. The American Heart Association has outlined seven key health metrics including physical activity, adequate blood pressure control, weight and a healthy diet, which lie at the core of cardiovascular disease management. Controlling these metrics has been demonstrated to result in substantial reductions in cardiovascular mortality. These metrics are ideally suited to a connected health management strategy involving enhanced patient empowerment and augmented physician engagement. As more patients and healthcare providers adopt technologies that allow for self-monitoring and point-of-care diagnostics, the physician has access to a greater depth of data concerning their patient's health and how best to influence it.

Cystic fibrosis in an era of genomically guided therapy.

Although affecting only 4-5% of those with cystic fibrosis (CF), the G551D-CFTR mutation is the target of the recently approved 'orphan drug', ivacaftor. The promise of such genomically guided therapies heralds a new era in the management of CF. A phase 3 trial demonstrated significant improvements in forced expiratory volume in 1 s (FEV(1)) from baseline, average weight gain, concentration in sweat chloride and reductions in pulmonary exacerbations [Ramsey, B.W., et al. A CFTR potentiator in patients with CF and the G551D mutation. N. Engl. J. Med., 2011. 365: 1663-1672.)]. Ivacaftor is among a group of recently approved, novel, mutation guided 'orphan drug' therapies that have established clinical benefits within their respective disease categories. They do not, however, offer a cure. Pharmaceutical and biotech companies have leveraged the incentivized benefits of the Orphan Drug Act to develop more of these drugs for orphan disorders affecting populations of <200 000 patients. With marked clinical efficacy via DNA sequence guidance, these drugs have also set a precedent in terms of the substantial annual costs and if this trend continues, such expenditures may become unsustainable. This paper explores the genomic pathophysiology of CF and how therapies such as ivacaftor provide benefit to those with the disease but at a considerably elevated price point.

Diversity patterns amongst herbivorous dinosaurs and plants during the Cretaceous: implications for hypotheses of dinosaur/angiosperm co-evolution.

Palaeobiologists frequently attempt to identify examples of co-evolutionary interactions over extended geological timescales. These hypotheses are often intuitively appealing, as co-evolution is so prevalent in extant ecosystems, and are easy to formulate; however, they are much more difficult to test than their modern analogues. Among the more intriguing deep time co-evolutionary scenarios are those that relate changes in Cretaceous dinosaur faunas to the primary radiation of flowering plants. Demonstration of temporal congruence between the diversifications of co-evolving groups is necessary to establish whether co-evolution could have occurred in such cases, but is insufficient to prove whether it actually did take place. Diversity patterns do, however, provide a means for falsifying such hypotheses. We have compiled a new database of Cretaceous dinosaur and plant distributions from information in the primary literature. This is used as the basis for plotting taxonomic diversity and occurrence curves for herbivorous dinosaurs (Sauropodomorpha, Stegosauria, Ankylosauria, Ornithopoda, Ceratopsia, Pachycephalosauria and herbivorous theropods) and major groups of plants (angiosperms, Bennettitales, cycads, cycadophytes, conifers, Filicales and Ginkgoales) that co-occur in dinosaur-bearing formations. Pairwise statistical comparisons were made between various floral and faunal groups to test for any significant similarities in the shapes of their diversity curves through time. We show that, with one possible exception, diversity patterns for major groups of herbivorous dinosaurs are not positively correlated with angiosperm diversity. In other words, at the level of major clades, there is no support for any diffuse co-evolutionary relationship between herbivorous dinosaurs and flowering plants. The diversification of Late Cretaceous pachycephalosaurs (excluding the problematic taxon Stenopelix) shows a positive correlation, but this might be spuriously related to poor sampling in the Turonian-Santonian interval. Stegosauria shows a significant negative correlation with flowering plants and a significant positive correlation with the nonflowering cycadophytes (cycads, Bennettitales). This interesting pattern is worthy of further investigation, and it reflects the decline of both stegosaurs and cycadophytes during the Early Cretaceous.

Weight lifting and aortic dissection: more evidence for a connection.

BACKGROUND/AIMS: In 2003, we reported on a small number of patients in whom acute aortic dissection appeared to be causally related to intense weight lifting. If additional cases could be identified, the phenomenon of weight lifting induced aortic dissection would be further substantiated. We now report a substantially larger number of cases in which aortic dissection is associated with intense physical exertion. METHODS: Additional cases of acute aortic dissection occurring at the time of intense physical exertion were accumulated and analyzed. Cases were culled from retrospective review of a large university data base and from reports forwarded to our attention from around the country. We determined type of activity bringing on symptoms, age and sex of the patients, location of the dissection (ascending or descending aorta), aortic size, therapy, and survival. RESULTS: We identified 31 patients in whom acute aortic dissection occurred in the context of severe physical exertion, predominantly weight lifting or similar activities. All patients except one were males. Mean age was 47.3 (range = 19-76). All except four dissections were in the ascending aorta. Only three patients (9.7%) had a family history of aortic disease. Mean aortic diameter on the initial imaging study was 4.63 cm. Twenty-six of the 31 cases were diagnosed ante-mortem and 5 post-mortem. Overall, 10 of the 31 patients (32.2%) died. Of 24 patients reaching surgical therapy, 20 (83.3%) survived. CONCLUSION: Weight lifting related acute aortic dissection appears to be a real phenomenon, with increasing evidence for the association of extreme exertion with this catastrophic aortic event. Moderate aortic dilatation confers vulnerability to exertion-related aortic dissection. Individuals with known aortic dilatation should be cautioned to refrain from weight lifting or strenuous exertion. Routine echocardiographic screening of individuals engaging in heavy strength training should be considered, in order to prevent this tragic loss of life.

Evaluating the FRIENDS program: a cognitive-behavioral group treatment for anxious children and their parents.

Conducted the 1st randomized clinical trial evaluating the efficacy of the FRIENDS program, a family-based group cognitive-behavioral treatment (FGCBT) for anxious children. Children (n = 71) ranging from 6 to 10 years of age who fulfilled diagnostic criteria for separation anxiety (SAD), generalized anxiety disorder (GAD), or social phobia (SOP) were randomly allocated to FRIENDS or to a 10-week wait-list control group. The effectiveness of the intervention was evaluated at posttreatment and 12-month follow-up. Results indicated that 69% of children who completed FGCBT were diagnosis-free, compared to 6% of children completing the wait-list condition. At 12-month follow-up, 68% of children were diagnosis-free. Beneficial treatment effects were also evident on the self-report measures completed by the children and their mothers. Parents and children reported high treatment satisfaction. Results suggest that FRIENDS is an effective treatment for clinically anxious children. Limitations of this study and directions for future research are discussed.

Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder: preliminary findings.

The effectiveness of a 14-week cognitive-behavioral family treatment protocol for childhood obsessive-compulsive disorder (OCD) was piloted using a volunteer sample of seven children aged 10-14 years. The primary outcome measures were diagnostic status, symptom severity, and global functioning which were assessed at pre- and post-treatment, and at three-month follow-up. A series of self-report measures assessing obsessive-compulsive symptomatology, depression, and family factors were also completed at pre- and post-treatment. The results indicated that six participants no longer met criteria for OCD at post-treatment, with a mean reduction of 60% in symptom severity. Self-reported obsessive-compulsive symptomatology and family involvement in the disorder also significantly decreased across time. The findings support the efficacy of cognitive-behavioral treatment with a structured family component for childhood OCD. Further research investigating the comparative efficacy of treatment with and without family involvement is warranted.

Did dinosaurs invent flowers? Dinosaur-angiosperm coevolution revisited.

Angiosperms first appeared in northern Gondwana during the Early Cretaceous, approximately 135 million years ago. Several authors have hypothesised that the origin of angiosperms, and the tempo and pattern of their subsequent radiation, was mediated by changes in the browsing behaviour of large herbivorous dinosaurs (sauropods and ornithischians). Moreover, the taxonomic and ecological radiation of angiosperms has been associated with the evolution of complex jaw mechanisms among ornithischian dinosaurs. Here, we review critically the evidence for dinosaur-angiosperm interactions during the Cretaceous Period, providing explicit spatiotemporal comparisons between evolutionary and palaeoecological events in both the dinosaur and angiosperm fossil records and an assessment of the direct and indirect evidence for dinosaur diets. We conclude that there are no strong spatiotemporal correlations in support of the hypothesis that dinosaurs were causative agents in the origin of angiosperms; however, dinosaur-angiosperm interactions in the Late Cretaceous may have resulted in some coevolutionary interactions, although direct evidence of such interactions is scanty at present. It is likely that other animal groups (insects, arboreal mammals) had a greater impact on angiosperm diversity during the Cretaceous than herbivorous dinosaurs. Elevated levels of atmospheric CO2 might have played a critical role in the initial stages of the angiosperm radiation.

Cognitive-behavioral treatment of anxiety disorders in children: long-term (6-year) follow-up.

Authors evaluated the long-term effectiveness of cognitive-behavioral therapy (CBT) for childhood anxiety disorders. Fifty-two clients (aged 14 to 21 years) who had completed treatment an average of 6.17 years earlier were reassessed using diagnostic interviews, clinician ratings, and self- and parent-report measures. Results indicated that 85.7% no longer fulfilled the diagnostic criteria for any anxiety disorder. On a majority of other measures, gains made at 12-month follow-up were maintained. Furthermore, CBT and CBT plus family management were equally effective at long-term follow-up. These findings support the long-term clinical utility of CBT in treating children and adolescents suffering from anxiety disorders.

Practitioner review: psychological management of anxiety disorders in childhood.

Many anxiety problems begin in childhood and are a common form of psychological problem that can be highly distressing and associated with a range of social impairments. Thus, skills for conceptualising, assessing, and treating childhood anxiety problems should be in the repertoire of all child mental health specialists. This paper reviews psychosocial treatments for the most common anxiety disorders in children and adolescents. Developmental models of anxiety disorders emphasise maximum risk in children with shy or inhibited temperaments who are exposed to high family anxiety and avoidance, and/or acutely distressing experiences. As children mature these temperamental and environmental experiences are internalised to low self-competence and high threat expectancy. Both individual or group-based interventions utilising cognitive-behavioural strategies to address multiple risk factors are highly efficacious and family involvement can contribute to positive outcomes. Guidelines for assessment and treatment are presented, and suggestions are made for effectively managing clinical process.

The influence of family and experimental context on cognition in anxious children.

Examined the influence of family on anxious children's cognition. Research by Barrett, Rapee, Dadds, and Ryan (1996) found anxious children reported increased avoidance after interacting with their parents. They labelled this finding the FEAR effect-Family Enhancement of Avoidant Responses. Whilst some subsequent studies have found similar results, others have not. These contradictory findings question whether the direction of parental influence on anxious children is determined by the perceived demands of the experimental context. Anxious children (N = 101) and their parents were asked to interpret seven ambiguous situations and to discuss what their child would do if the scenario actually occurred. Study 1 found that children in the anxious group and an externalizing control group were more likely to interpret ambiguous situations as threatening than nonclinic children were. Study 2 sought to examine changes in the children's responses from pre- to postfamily discussion, and to identify variables associated with the FEAR effect in anxious families. Interestingly, anxious children whose families completed the discussion task after they (children) had been offered treatment were more likely to show a FEAR effect than anxious families who completed the task as part of assessment. Study 3 examined predictors of enhanced avoidance in anxious families. Treatment context and maternal distress were correlated with the child's increased avoidance following family discussion. Limitations of these studies and directions for future research are discussed.

Treatment of childhood anxiety: developmental aspects.

This review focuses on research on the cognitive-behavioral treatment of childhood anxiety disorders. Early forms of therapy for childhood anxiety were borrowed from adult treatment models. More recently, there has been a recognition of the need to design treatment from a child-based perspective. Consequently, several cognitive-behavioral programs designed specifically for children and youth have been both developed and evaluated. The importance of parental involvement has also been recognised in these treatment innovations. However, a number of developmental factors have yet to be given adequate consideration in both the research and practice of childhood anxiety treatment. The article highlights some of these factors including issues of individual, family and cultural variation.

The role of the family in childhood obsessive-compulsive disorder.

While obsessive-compulsive disorder is widely recognized to have a strong genetic component, psychosocial factors are also acknowledged to be important. The primary focus of this paper is on familial factors associated with OCD in children and adolescents. It explores the family context as a possible risk factor in the development and maintenance of the disorder, including parental modeling, expressed emotion, parenting style, and family accommodation of the child's symptoms. The involvement of the family in the treatment of the disorder is also reviewed. Finally, future directions for research investigating familial factors in childhood OCD are presented.

Early intervention and prevention of anxiety disorders in children: results at 2-year follow-up.

The Queensland Early Intervention and Prevention of Anxiety Project evaluated a child- and family-focused group intervention for preventing anxiety problems in children. This article reports on 12- and 24-month follow-up data to previously reported outcomes at posttreatment and at 6-month follow-up. A total of 1,786 7- to 14-year-olds were screened for anxiety problems using teacher nominations and children's self-report. After diagnostic interviews, 128 children were selected and assigned to either a 10-week school-based child- and parent-focused psychosocial intervention or a monitoring group. Both groups showed improvements immediately at postintervention and at 6-month follow-up; the improvement was maintained in the intervention group only reducing the rate of existing anxiety disorder and preventing the onset of new anxiety disorders. At 12 months, the groups converged, but the superiority of the intervention group was evident again at 2-year follow-up. Severity of pretreatment diagnoses, gender, and parental anxiety predicted poor initial response to intervention, whereas pretreatment severity was the only predictor of chronicity at 24 months. Overall, follow-up results show that a brief school-based intervention for children can produce durable reductions in anxiety problems.

Evaluation of cognitive-behavioral group treatments for childhood anxiety disorders.

Undertook an evaluation of a cognitive-behavioral group family-based intervention for childhood anxiety disorders in Brisbane, Australia. The treatment aimed to provide children and their families with skills in the management of anxiety and avoidance, problem solving, and mutual family support. Children (n = 60) ranging from 7 to 14 years old who fulfilled diagnostic criteria for separation anxiety, overanxious disorder, or social phobia were randomly allocated to 3 treatment conditions: group cognitive-behavioral therapy (GROUP-CBT), group cognitive-behavioral therapy plus family management (GROUP-FAM), and wait list (WL). The effectiveness of the interventions was evaluated at posttreatment and 12-month follow-up. Results indicated that across treatment conditions, 64.8% of children no longer fulfilled diagnostic criteria for an anxiety disorder in comparison with 25.2% of children on the wait list. At 12-month FU, 64.5% of children in the GROUP-CBT group and 84.8% of children in the GROUP-FAM group were diagnosis free. Comparisons of children receiving GROUP-CBT with those receiving GROUP-FAM on self-report measures and clinician ratings indicated marginal added benefits from GROUP-FAM treatment. Results show that CBT interventions for childhood anxiety disorders can be effectively administered in a group format.