Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Outbreak at a College With High Coronavirus Disease 2019 (COVID-19) Vaccination Coverage-Connecticut, August 2021-September 2021.

BACKGROUND: During August 2021-September 2021, a Connecticut college experienced a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant outbreak despite high (99%) vaccination coverage, indoor masking policies, and twice-weekly testing. The Connecticut Department of Public Health investigated characteristics associated with infection and phylogenetic relationships among cases. METHODS: A case was a SARS-CoV-2 infection diagnosed by a viral test during August 2021-September 2021 in a student. College staff provided enrollment and case information. An anonymous online student survey collected demographics, SARS-CoV-2 case and vaccination history, and activities preceding the outbreak. Multivariate logistic regression identified characteristics associated with infection. Phylogenetic analyses compared 115 student viral genome sequences with contemporaneous community genomes. RESULTS: Overall, 199 of 1788 students (11%) had laboratory-confirmed SARS-CoV-2 infection; most were fully vaccinated (194 of 199, 97%). Attack rates were highest among sophomores (72 of 414, 17%) and unvaccinated students (5 of 18, 28%). Attending in-person classes with an infectious student was not associated with infection (adjusted odds ratio [aOR], 1.0; 95% confidence interval [CI], .5-2.2). Compared with uninfected students, infected students were more likely to be sophomores (aOR, 3.3; 95% CI, 1.1-10.7), attend social gatherings before the outbreak (aOR, 2.8; 95% CI, 1.3-6.4), and complete a vaccine series ≥180 days prior (aOR, 5.5; 95% CI, 1.8-16.2). Phylogenetic analyses suggested a common viral source for most cases. CONCLUSIONS: SARS-CoV-2 infection in this highly vaccinated college population was associated with unmasked off-campus social gatherings, not in-person classes. Students should stay up to date on vaccination to reduce infection.

Factors associated with HIV acquisition in the context of humanitarian crises: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to describe the global evidence on factors associated with HIV acquisition among individuals affected by humanitarian crises. INTRODUCTION: Humanitarian crises are described as an event or series of events originating from natural causes or human intervention that represent a critical threat to the health, safety, security, and well-being of a community. Humanitarian crises have generated a continued rise in the number of displaced persons worldwide. This forcible displacement may increase the risk of acquiring HIV among the affected populations through poverty, food insecurity, social instability, and lack of access to health services during and after a crisis. Understanding factors that may contribute to HIV acquisition among these populations will allow stakeholders to better provide HIV prevention services and programs in humanitarian settings and to prioritize research efforts. INCLUSION CRITERIA: This review will consider studies that investigate factors associated with HIV acquisition in populations affected by humanitarian crises caused by natural disasters and human-made complex emergencies. Studies of any design or methodology that contain empirical data will be eligible for inclusion. METHODS: The proposed review will be conducted in accordance with the JBI methodology for scoping reviews. MEDLINE, Embase, Global Health, Scopus, and gray literature will be systematically searched. Studies published in English from 1990 will be included. Titles and abstracts of identified citations will be screened independently and assessed for eligibility by two authors. Potentially relevant full-text studies and data will be extracted using a data extraction form. Data will be presented in tabular form, figures, and a narrative summary.

Addressing harms of screening - A review of outcomes in Cochrane reviews and suggestions for next steps.

OBJECTIVE: To investigate if Cochrane reviews that assess screening interventions address their major harms. STUDY DESIGN AND SETTING: A systematic search for Cochrane reviews that assess screening interventions was performed. Two authors independently screened abstracts, assessed full-texts, and extracted data from included reviews. For each review, two authors judged whether each predefined harm was relevant. When the harm was judged as of questionable relevance, the review was excluded from the denominator in our calculations. RESULTS: Forty-seven reviews were included. Overdiagnosis was addressed in 6 of 39 (15%), overtreatment in 7 of 43 (16%), and psychosocial consequences in 30 of 47 (64%) of reviews where this was judged relevant. When data on harms were included, they were generally not treated with the same methodological rigor as the benefits, with no assessment of the risk of bias or certainty of the evidence. About half of the Abstracts, Plain Language Summaries, and Summary of Findings tables did not include any harms. CONCLUSION: The underreporting of harms of screening in Cochrane reviews likely reflects primary research and is problematic. We call for broad collaboration to develop reporting guidelines and core outcome sets for studies of screening interventions.

Community Women and Reproductive Autonomy: Building an Infrastructure for Long-Acting Reversible Contraception (LARC) Services in a Mobile Health Clinic.

This article describes implementation of a long-acting reversible contraception (LARC) program in a free primary care clinic in central Florida. A background of LARC is presented, along with a description of the infrastructure built by the University of Florida Mobile Outreach Clinic, in an effort to share a framework for the provision of LARC services with other resource-limited settings.

Design and Early Experience With a Real-World Surgical Registry.

OBJECTIVES: We describe the rationale, design, and methods and 6-year experience with a real-world surgical registry for female pelvic reconstructive and incontinence procedures and postoperative outcomes. METHODS: The primary goal of creating this registry was to establish the feasibility of prospective data capture for all urogynecologic procedures. Data captured included baseline demographics, surgical procedures, perioperative complications, and subjective and objective findings up to 36 months after surgery. RESULTS: The Pelvic Reconstruction and Incontinence Surgery ± Mesh Registry was developed over 3 years to include 194 unique variables for prospective data capture. The registry was implemented in December 2010, and data from 924 separate case events from a single surgeon were recorded, comprising 100% surgical case capture. Cases included a variety of procedures representing a comprehensive urogynecology practice on 804 unique patients. Patients who were asked to participate in long-term follow-up (n = 299) returned with attendance of 96% at 6 weeks, 64% at 6 months, 51% at 12 months, 39% at 24 months, and 22% at 36 months. CONCLUSIONS: The Pelvic Reconstruction and Incontinence Surgery ± Mesh Registry effectively captured all urogynecologic procedures for the purpose of quality improvement. This real-world tool demonstrates that 100% case capture is feasible and provides valuable information for the highly motivated surgeon, although adequate long-term follow-up is limited. Additional research is needed to better understand the role of surgical registries for quality improvement and development of patient-centered strategies to increase long-term follow-up.

Isolation and partial characterization of Streptococcus suis from clinical cases in cattle.

Sixteen isolates of gram-positive, coccoid bacteria were obtained from clinical cases of diverse conditions in cattle and identified as Streptococcus suis using 16S ribosomal DNA gene sequencing and other bacterial identification methods. None of the isolates could be assigned to any of the known S. suis capsular types. Virulence-associated gene profiling that targeted muramidase-released protein, extracellular protein factor, suilysin, 89-kb pathogenicity island, and arginine deiminase ( arcA) genes were negative except for 1 isolate that was arcA positive. The arcA-positive isolate caused severe widespread lesions, including multiorgan suppurative and hemorrhagic inflammation in the meninges, lung, liver, spleen, lymph nodes, and serosae of heart and intestines. The other isolates were primarily associated with meningitis, bronchopneumonia, and multifocal acute necrotizing hepatitis. The isolates differed from each other by 4-6 fragments when examined by pulsed-field gel electrophoresis, indicating they are possibly related. The isolates were susceptible to ampicillin, penicillin, and tiamulin. Resistance was noted to sulfadimethoxine (93%), oxytetracycline (86%), chlortetracycline (86%), neomycin (67%), tilmicosin (47%), clindamycin (47%), enrofloxacin (33%), gentamicin (13%), florfenicol (7%), trimethoprim-sulfamethoxazole (7%), and spectinomycin (53%). Multi-drug resistance (defined as resistance to at least 1 agent in 3 or more antimicrobial classes) was detected in 67% of the isolates. The pathology observations provide evidence that S. suis may be an important pathogen of bovine calves. S. suis is an agent that clinical bacteriology laboratories should consider when dealing with cases involving cattle.

Do Educational Seminars for the Human Papillomavirus Vaccine Improve Attitudes Toward the Value of Vaccination?

STUDY OBJECTIVE: This study aimed to determine the effectiveness and effect of educational seminars given at 2 sites in north central Florida on the knowledge of human papillomavirus (HPV), perceived barriers to HPV vaccination, and willingness to vaccinate against HPV in eligible patients. DESIGN, SETTING, AND PARTICIPANTS: This study was performed in conjunction with the Committee for the Healthcare of Underserved Women, District XII, American College of Obstetrics and Gynecology. One hundred participants, ages 18-65 years, were included in the study. INTERVENTIONS: Community outreach educational seminars, approximately 30 minutes in length, were given at 2 sites in Gainesville, Florida. MAIN OUTCOMES MEASURES: Before and after seminar surveys were given to evaluate the effect of the seminars on knowledge of HPV, willingness to vaccinate against HPV, and barriers to vaccination. RESULTS: There was a statistically significant improvement in the willingness to accept the HPV vaccine and an improvement in knowledge of several HPV-related facts. There was a statistically significant decrease in several perceived barriers to HPV vaccination. CONCLUSION: This study illustrates the utility of educational seminars in patients' acceptance of health care options. Improving the educational opportunities of patients and families in relation to the HPV vaccine has the opportunity to make a significant outcome on vaccination rates.

Exact p-values for Simon's two-stage designs in clinical trials.

In a one-sided hypothesis testing problem in clinical trials, the monotonic condition of a tail probability function is fundamentally important to guarantee that the actual type I and II error rates occur at the boundary of their associated parameter spaces. Otherwise, one has to search for the actual rates over the complete parameter space, which could be very computationally intensive. This important property has been extensively studied in traditional one-stage study settings (e.g., non-inferiority or superiority between two binomial proportions), but there is very limited research for this property in a two-stage design setting, e.g., Simon's two-stage design. In this note, we theoretically prove that the tail probability is an increasing function of the parameter in Simon's two-stage design. This proof not only provides theoretical justification that p-value occurs at the boundary of the parameter space, but also helps to reduce the computational intensity for study design search.

Preeclampsia does not share common risk alleles in 9p21 with coronary artery disease and type 2 diabetes.

INTRODUCTION: Preeclampsia is a common and partially genetic pregnancy complication characterized by hypertension and proteinuria. Association with cardiovascular disease and type 2 diabetes has been reported in 9p21 by several genome-wide association studies. It has been hypothesized that cardiometabolic diseases may share common etiology with preeclampsia. MATERIALS AND METHODS: We tested association with the 9p21 region to preeclampsia in the Finnish population by genotyping 23 tagging single nucleotide polymorphisms (SNPs) in 15 extended preeclampsia families and in a nationwide cohort consisting of 281 cases and 349 matched controls. Replication was conducted in additional datasets. RESULTS: Four SNPs (rs7044859, rs496892, rs564398 and rs7865618) showed nominal association (p ≤ 0.024 uncorrected) with preeclampsia in the case-control cohort. To increase power, we genotyped two SNPs in additional 388 cases and 341 controls from the Finnish Genetics of Preeclampsia Consortium (FINNPEC) cohort. Partial replication was also attempted in a UK cohort (237 cases and 199 controls) and in 74 preeclamptic families from Australia/New Zealand. We were unable to replicate the initial association in the extended Finnish dataset or in the two international cohorts. CONCLUSIONS: Our study did not find evidence for the involvement of the 9p21 region in the risk of preeclampsia. Key Message Chromosome 9p21 is not associated with preeclampsia.

Genetic evidence of multiple loci in dystocia--difficult labour.

BACKGROUND: Dystocia, difficult labour, is a common but also complex problem during childbirth. It can be attributed to either weak contractions of the uterus, a large infant, reduced capacity of the pelvis or combinations of these. Previous studies have indicated that there is a genetic component in the susceptibility of experiencing dystocia. The purpose of this study was to identify susceptibility genes in dystocia. METHODS: A total of 104 women in 47 families were included where at least two sisters had undergone caesarean section at a gestational length of 286 days or more at their first delivery. Study of medical records and a telephone interview was performed to identify subjects with dystocia. Whole-genome scanning using Affymetrix genotyping-arrays and non-parametric linkage (NPL) analysis was made in 39 women exhibiting the phenotype of dystocia from 19 families. In 68 women re-sequencing was performed of candidate genes showing suggestive linkage: oxytocin (OXT) on chromosome 20 and oxytocin-receptor (OXTR) on chromosome 3. RESULTS: We found a trend towards linkage with suggestive NPL-score (3.15) on chromosome 12p12. Suggestive linkage peaks were observed on chromosomes 3, 4, 6, 10, 20. Re-sequencing of OXT and OXTR did not reveal any causal variants. CONCLUSIONS: Dystocia is likely to have a genetic component with variations in multiple genes affecting the patient outcome. We found 6 loci that could be re-evaluated in larger patient cohorts.

Evaluation of STOX1 as a preeclampsia candidate gene in a population-wide sample.

Preeclampsia is a common, pregnancy-specific vascular disorder characterised by hypertension and proteinuria. A recent report suggested association of the STOX1 gene on chromosome 10q22.1 with preeclampsia in the Dutch population. Here, we present a comprehensive assessment of STOX1 as a candidate gene for preeclampsia in the Finnish population by re-examining our previous genetic linkage analysis results for both chromosome 10 and paralogous loci, by genotyping representative markers in a nationwide data set, and by studying STOX1 expression in placentas from preeclamptic and uncomplicated pregnancies. In conclusion, we are unable to validate STOX1 as a common preeclampsia susceptibility gene.