Lessons Learned from CDC's Global COVID-19 Early Warning and Response Surveillance System.

Early warning and response surveillance (EWARS) systems were widely used during the early COVID-19 response. Evaluating the effectiveness of EWARS systems is critical to ensuring global health security. We describe the Centers for Disease Control and Prevention (CDC) global COVID-19 EWARS (CDC EWARS) system and the resources CDC used to gather, manage, and analyze publicly available data during the prepandemic period. We evaluated data quality and validity by measuring reporting completeness and compared these with data from Johns Hopkins University, the European Centre for Disease Prevention and Control, and indicator-based data from the World Health Organization. CDC EWARS was integral in guiding CDC's early COVID-19 response but was labor-intensive and became less informative as case-level data decreased and the pandemic evolved. However, CDC EWARS data were similar to those reported by other organizations, confirming the validity of each system and suggesting collaboration could improve EWARS systems during future pandemics.

Do seedlings of larger geophytic species outperform smaller ones when challenged by drought?

PREMISE: In semiarid regions, decreasing rainfall presents a challenge to perennial seedlings that must reach sufficient size to survive the first year's seasonal drought. Attaining a large storage organ size has been hypothesized to enhance drought resilience in geophytes, but building larger storage organs requires faster growth, but paradoxically, some traits that confer faster growth are highly sensitive to drought. We examined whether tuber size confers greater drought resilience in seedlings of four closely related geophytic species of Pelargonium. METHODS: We imposed two drought treatments when seedlings were 2 months old: chronic low water and acute water restriction for 10 days. Plants in the acute dry-down treatment were then rewatered at control levels. We compared morphological and ecophysiological traits at 2, 3, and 6 months of age and used mixed-effects models to identify traits determining tuber biomass at dormancy. RESULTS: Despite a 10-fold variation in size, species had similar physiological trait values under well-watered conditions. Chronic and acute droughts negatively affected tuber size at the end of the season, but only in the two species with large tubers. Chronic drought did not affect physiological traits of any species, but in response to acute drought, larger species showed reduced photosynthetic performance. Canopy area was the best predictor of final tuber biomass. CONCLUSIONS: Contradictory to the hypothesis that large tubers provide greater drought resiliency, small Pelargonium seedlings actually had higher drought tolerance, although at the expense of more vigorous growth compared to species with larger tubers under well-watered conditions.

Countries with delayed COVID-19 introduction - characteristics, drivers, gaps, and opportunities.

BACKGROUND: Three months after the first reported cases, COVID-19 had spread to nearly 90% of World Health Organization (WHO) member states and only 24 countries had not reported cases as of 30 March 2020. This analysis aimed to 1) assess characteristics, capability to detect and monitor COVID-19, and disease control measures in these 24 countries, 2) understand potential factors for the reported delayed COVID-19 introduction, and 3) identify gaps and opportunities for outbreak preparedness, particularly in low and middle-income countries (LMICs). We collected and analyzed publicly available information on country characteristics, COVID-19 testing, influenza surveillance, border measures, and preparedness activities in these countries. We also assessed the association between the temporal spread of COVID-19 in all countries with reported cases with globalization indicator and geographic location. RESULTS: Temporal spreading of COVID-19 was strongly associated with countries' globalization indicator and geographic location. Most of the 24 countries with delayed COVID-19 introduction were LMICs; 88% were small island or landlocked developing countries. As of 30 March 2020, only 38% of these countries reported in-country COVID-19 testing capability, and 71% reported conducting influenza surveillance during the past year. All had implemented two or more border measures, (e.g., travel restrictions and border closures) and multiple preparedness activities (e.g., national preparedness plans and school closing). CONCLUSIONS: Limited testing capacity suggests that most of the 24 delayed countries may have lacked the capability to detect and identify cases early through sentinel and case-based surveillance. Low global connectedness, geographic isolation, and border measures were common among these countries and may have contributed to the delayed introduction of COVID-19 into these countries. This paper contributes to identifying opportunities for pandemic preparedness, such as increasing disease detection, surveillance, and international collaborations. As the global situation continues to evolve, it is essential for countries to improve and prioritize their capacities to rapidly prevent, detect, and respond, not only for COVID-19, but also for future outbreaks.

Leaf margins in a deciduous lineage from the Greater Cape Floristic Region track climate in unexpected directions.

PREMISE: The functional significance of leaf margins has long been debated. In this study, we explore influences of climate, leaf lobing, woodiness, and shared evolutionary history on two leaf margin traits within the genus Pelargonium. METHODS: Leaves from 454 populations of Pelargonium (161 species) were collected in the Greater Cape Floristic Region and scored for tooth presence/absence and degree of lobing. Tooth density (number of teeth per interior perimeter distance) was calculated for a subset of these. We compared five hypotheses to explain tooth presence and density using mixed effect models. RESULTS: Tooth presence/absence was best predicted by the interaction of leaf lobing and mean annual temperature (MAT), but often in patterns opposite those previously reported: species were more likely to be toothed with warmer temperatures, particularly for unlobed and highly lobed leaves. In contrast, tooth density was best predicted by the interaction of MAT and the season of most rain; density declines with temperature as consistent with expectations, but only in winter-rain dominated areas. Woody and nonwoody species within Pelargonium have similar associations between tooth presence/absence and MAT, contrary to the expectation that patterns within nonwoody species would be insignificant. CONCLUSIONS: We conclude Pelargonium leaf margins show predictable responses to climate, but these responses are complex and can contradict those found for global patterns across plant communities.

The implementation of a dedicated education unit in a public health setting.

INTRODUCTION: The dedicated education unit (DEU) is an innovative clinical model that prepares preceptors for success in clinical settings with nursing students. Though the DEU is mostly used in acute-care settings, this project explores the implementation of a DEU in a public health setting. OBJECTIVES: Better preparation of public health nurses and social workers as clinical preceptors for nursing students with the implementation of a DEU in a public health setting. DESIGN: IRB approved, pre/post survey with participant comments. MEASUREMENTS: Clinical Nurse Teacher Survey was assessed pre/post intervention with registered nurses and social work staff (n = 13). Paired t-tests analysis was used to determine significance. The Clinical Learning Environment and Nurse Teacher (CLES+T) scale completed postimplementation by nursing students (n = 8) after the clinical rotation. RESULTS: Clinical Nurse Teacher Survey mean scores preintervention was 4.56 and increased postintervention to 4.89, though not statistically significant (p-value .11). CLES+T showing 100% fully agree or agree that the Public Health DEU is an effective learning environment. CONCLUSIONS: The DEU model in a public health setting is an opportunity to improve lived clinical experiences of preceptors and nursing students, which may increase nursing students' positive perceptions of, and increase interest in serving as a public health nurse after graduation.

Plastome based phylogenetics and younger crown node age in Pelargonium.

The predominantly South-African plant genus Pelargonium L'Hér. (Geraniaceae) displays remarkable morphological diversity, several basic chromosome numbers as well as high levels of organelle genomic rearrangements, and represents the 7th largest Cape Floristic Region clade. In this study, we reconstructed a phylogenetic tree based on 74 plastome exons and nuclear rDNA ITS regions for 120 species, which represents 43% taxon coverage for Pelargonium. We also performed a dating analysis to examine the timing of the major radiations in the genus. Phylogenetic analyses of nucleotide, amino acid, and ITS alignments confirmed the previously-documented subgeneric split into five main clades ((C1,C2),(B(A1,A2))) although clade only A1 received low bootstrap support. Using calibration evidence from a range of sources the Pelargonium crown age was estimated to be 9.7 My old, much younger than previous estimates for the genus but similar to recent studies of other Cape Floristic lineages that are part of both Fynbos and Succulent Karoo biomes.

A review of the antimicrobial potential of precious metal derived nanoparticle constructs.

The field of nanotechnology is rapidly growing. The promise of pharmacotherapeutics emerging from this vast field has drawn the attention of many researchers. However, with the increase in the prevalence of antibiotic resistant microorganisms, the manifestations of these promises are needed now more than ever. Many have postulated the antimicrobial potential of nanoparticle constructs derived from precious metals/noble metals nanoparticles (NMNPs), such as silver nanoparticles that show activity against multidrug resistant bacteria. In this review we will evaluate the current studies and explore the data to obtain a clear picture of the potential of these particles and the validity of the claims of drug resistant treatments with NMNPs.

Missed Nursing Care as a Quality Indicator During Transition to a Dedicated Education Unit Model.

This pilot study compared the implementation of the innovative dedicated education unit (DEU) clinical model on quality of care with the traditional clinical model using missed nursing care as a quality indicator. A university and academic medical center partnered to conduct this quasiexperimental study, which is the first to use missed nursing care as a quality indicator when assessing transition to the DEU model. Evidence suggests that quality of care was maintained during DEU implementation.

The US Nuclear Regulatory Commission radiation protection policy and opportunities for the future.

For nearly 50 years, the US Nuclear Regulatory Commission (NRC) has been responsible for the development of radiation protection regulations and guidance for protecting workers, the public and the environment. In 1971, although ALARA was not a regulatory requirement, NRC's predecessor, the Atomic Energy Commission, incorporated the concept of 'as low as is practically achievable' into its general provisions for standards against radiation, Title 10, Code of Federal Regulations (10 CFR) Part 20. In 1975, the NRC codified the phrase 'as low as is reasonably achievable' (ALARA) and the definition of ALARA was broadly consistent with today's definition. Implicit in the ALARA concept is the linear no-threshold (LNT) dose-response relationship. The NRC acknowledges that a bifurcation between the public's concern with radiation exposure and the perspectives of many in the scientific community to eliminate LNT-based regulations exists. NRC understands that the LNT basis for ALARA (i.e. that the stochastic effects of radiation do not have a low dose threshold) is not accepted by all individuals, but the LNT theory continues to serve as the basis of its regulatory approach, which is derived directly from the recommendations of national and international expert bodies. Over the years, NRC and other Federal agencies have been petitioned to revise the basis for their radiation protection policy. This article presents an overview of what NRC has done and explores opportunities for maintaining the right balance between the potential risks and benefits of radiation in establishing radiation protection policy.

Divergent trait and environment relationships among parallel radiations in Pelargonium (Geraniaceae): a role for evolutionary legacy?

Functional traits in closely related lineages are expected to vary similarly along common environmental gradients as a result of shared evolutionary and biogeographic history, or legacy effects, and as a result of biophysical tradeoffs in construction. We test these predictions in Pelargonium, a relatively recent evolutionary radiation. Bayesian phylogenetic mixed effects models assessed, at the subclade level, associations between plant height, leaf area, leaf nitrogen content and leaf mass per area (LMA), and five environmental variables capturing temperature and rainfall gradients across the Greater Cape Floristic Region of South Africa. Trait-trait integration was assessed via pairwise correlations within subclades. Of 20 trait-environment associations, 17 differed among subclades. Signs of regression coefficients diverged for height, leaf area and leaf nitrogen content, but not for LMA. Subclades also differed in trait-trait relationships and these differences were modulated by rainfall seasonality. Leave-one-out cross-validation revealed that whether trait variation was better predicted by environmental predictors or trait-trait integration depended on the clade and trait in question. Legacy signals in trait-environment and trait-trait relationships were apparently lost during the earliest diversification of Pelargonium, but then retained during subsequent subclade evolution. Overall, we demonstrate that global-scale patterns are poor predictors of patterns of trait variation at finer geographic and taxonomic scales.

Contrasting lengths of Pelargonium floral nectar tubes result from late differences in rate and duration of growth.

Background and Aims: Much of morphological evolution in flowers has arisen from pollinator-mediated selection, often manifest as a match between the length of the pollinator's proboscis and the depth of tubular corollas or spurs. We investigate development, growth and homology of the unique nectar tube of Pelargonium, frequently described as 'a spur adnate to the pedicel'. Methods: We focused on two species. The nectar tube of P. ionidiflorum is three times longer than that of P. odoratissimum. Light and scanning electron microscopy were carried out, and daily growth measurements were used to compare nectar tube development and vascular patterns. Key Results: Nectar tubes in both species are initiated centripetally to the dorsal sepal in a space created by lateral displacement of two antepetalous stamens. The cavity deepens through subsequent intercalary growth of the receptacle that proceeds at the same rate in both species until tubes reach approx. 10 mm in length. Differences in final nectar tube lengths arise via an increase in the rate and duration of growth of the receptacle that begins just before anthesis (floral opening) and continues for several days past anthesis in P. ionidiflorum but does not occur in P. odoratissimum. Epidermal cells of the dorsal surface of the nectar tube in P. ionidiflorum are approx. 1.6 times longer than those in P. odoratissimum. Histological sections show no evidence that the nectar tube is a spur that became evolutionarily fused to the pedicel. Conclusions: Nectar tubes in Pelargonium are localized cavities that form in the receptacle via intercalary growth. Differences in the rate and duration of growth just prior to and following anthesis underlie differences in final tube lengths. Because differences in cell lengths do not fully account for differences in nectar tube lengths, evolutionary diversification must involve changes in both cell cycle and cell expansion.

Scaling relationships and vessel packing in petioles.

PREMISE OF THE STUDY: While tradeoffs among mechanical and conductive functions have been well investigated in woody stems, these tradeoffs are relatively unexplored in petioles, the structural link between stems and laminas. We investigated size-independent scaling relationships between cross-sectional areas of structural and vascular tissues, relationships between tissue areas of xylem and phloem, vessel packing within xylem, and scaling of vascular and structural tissues with lamina traits. METHODS: We examined allometric relationships among petiole tissues and as a function of lamina and petiole size variation on eleven species of Pelargonium. From transverse sections of methacrylate-embedded tissue, we measured the cross-sectional areas of all tissues within the petiole and vessel lumen, and cell wall areas of each vessel. Allometric scaling relationships were analyzed using standardized major axis regressions. KEY RESULTS: Pelargonium petiole vessels were packed as predicted by Sperry's packing rule for woody stems. In contrast to woody stems, there was no evidence of a tradeoff between vessel area and fiber area. Within cross-sections, more xylem was produced than phloem. Among bundles, xylem and phloem scaling relationships varied with bundle position. Except for lamina dry mass and petiole fiber cross-sectional area, petiole and lamina traits were independent. CONCLUSIONS: Petioles share vascular tissue traits with stems despite derivation from leaf primordia. We did not find evidence for a tradeoff between structural and vascular tissues, in part because fibers occur outside the xylem. We propose this separation of conduction and support underlies observed developmental and evolutionary plasticity in petioles.

Symbiont abundance can affect host plant population dynamics.

PREMISE OF THE STUDY: Symbioses are almost universal, but little is known about how symbiont abundance can affect host performance. Many orchids undergo vegetative dormancy and frequent and protracted dormancy have been associated with population declines. If mycorrhizal fungi affect host plant performance, those effects are likely to alter patterns of vegetative dormancy. The goal of this study was to determine whether the abundance of mycorrhizal fungi is related to the likelihood of entering dormancy and whether fungal abundance varied with dormancy duration in the federally listed threatened orchid Isotria medeoloides. METHODS: We studied three populations of the threatened North American terrestrial orchid Isotria medeoloides using long-term emergence data and evaluated the relationship between the abundance of associated mycorrhizal fungi (Russulaceae) and orchid dormancy and emergence. Mycorrhizal fungi in soil adjacent to orchids were quantified in two ways. First, ectomycorrhizal (ECM) fungi on adjacent root tips were identified using DNA sequencing to determine their phylogenetic relationship to fungi that are known to form mycorrhizae with I. medeoloides. Second, we extracted DNA from soil samples and used quantitative real-time PCR to estimate the abundance of Russulaceae hyphae adjacent to each orchid. KEY RESULTS: We found that the abundance of Russulaceae, both in the soil and on nearby ECM root tips, was significantly related to orchid prior emergence. Both abundance and prior emergence history were predictive of future emergence. CONCLUSIONS: These results suggest that the abundance of mycorrhizal fungi can influence orchid population dynamics and is an essential component of orchid conservation.

Functional Traits in Parallel Evolutionary Radiations and Trait-Environment Associations in the Cape Floristic Region of South Africa.

Evolutionary radiations with extreme levels of diversity present a unique opportunity to study the role of the environment in plant evolution. If environmental adaptation played an important role in such radiations, we expect to find associations between functional traits and key climatic variables. Similar trait-environment associations across clades may reflect common responses, while contradictory associations may suggest lineage-specific adaptations. Here, we explore trait-environment relationships in two evolutionary radiations in the fynbos biome of the highly biodiverse Cape Floristic Region (CFR) of South Africa. Protea and Pelargonium are morphologically and evolutionarily diverse genera that typify the CFR yet are substantially different in growth form and morphology. Our analytical approach employs a Bayesian multiple-response generalized linear mixed-effects model, taking into account covariation among traits and controlling for phylogenetic relationships. Of the pairwise trait-environment associations tested, 6 out of 24 were in the same direction and 2 out of 24 were in opposite directions, with the latter apparently reflecting alternative life-history strategies. These findings demonstrate that trait diversity within two plant lineages may reflect both parallel and idiosyncratic responses to the environment, rather than all taxa conforming to a global-scale pattern. Such insights are essential for understanding how trait-environment associations arise and how they influence species diversification.

Safety and Academic Outcomes of College Campus-Based Advocacy Services.

Intimate partner violence (IPV), sexual assault, and stalking are consequential public health and safety issues with wide reaching impacts on emerging adults, including those on college campuses in the United States. In response to high rates of violence among college student populations, universities are developing campus-based advocacy (CBA) programs, which aim to support survivors of interpersonal violence through supportive connections, resource acquisition, and safety planning. However, little data exists related to their impact on key student-survivor outcomes. Thus, this study aims to understand (a) the approach CBA programs use to address safety and academic concerns of student-survivors, and (b) the initial outcomes of CBA programs on safety and academics among students engaged in CBA services at five universities in one Southwestern state. The project used a longitudinal mixed-methods approach, with data collection activities including qualitative interviews with student survivors (n = 29) and a longitudinal, web-based, quantitative survey with matched analyses of safety and academic outcome measures from 115 student survivors who participated in an initial survey and follow-up survey after 6 months. Findings demonstrate key pathways through which CBA programs support survivors and facilitate positive safety and academic outcomes. These pathways include education, supportive connection, and resource access. Analysis of longitudinal survivor data demonstrate substantial reductions in sexual violence, IPV, stalking, and school sabotage at 6-month follow-up compared to initial survey, as well as significant reductions in academic disengagement for student survivors. The findings of the study powerfully demonstrate the positive impact of CBA programs on survivor and campus outcomes. Furthermore, programs not only enhance individual survivor safety and academic outcomes but also support the overall climate and safety of hosting universities.

Ghosts and Ghosting in Digital Communications.

Ghosting, professionally and personally, occurs when there is an abrupt end to communication between 2 individuals without any explanation or when an individual does not follow through on commitments to others associated with their communication. The increase in the available communication channels and speed at which messages can now be transmitted between individuals is resulting in a greater incidence of ghosting or perceived ghosting in our colleges/schools of pharmacy. The impact of ghosting is the disruption of effective communication and communication strategies that are essential to the development of positive and thriving cultures and subcultures in our institutions. The causes of ghosting (real or perceived) in our pharmacy academy could be attributed to increased workload and speed of communication, increased workload and productivity expectations, and increased workload and information volume. The consequences of ghosting in our colleges/schools can result in decreased psychological safety in our cultures, adversely impacting individual well-being, resiliency, grit, and satisfaction and adversely impacting student academic performance and success. There are simple steps that individuals and institutions can implement to minimize ghosting or the perception of ghosting that may occur with online communication channels used by our faculty, staff, students, and outside individuals.

Dehydration protection provided by a maternal cuticle improves offspring fitness in the moss Funaria hygrometrica.

BACKGROUND AND AIMS: In bryophytes the sporophyte offspring are in contact with, nourished from, and partially surrounded by the maternal gametophyte throughout their lifespan. During early development, the moss sporophyte is covered by the calyptra, a cap of maternal gametophyte tissue that has a multilayered cuticle. In this study the effects on sporophyte offspring fitness of removing the maternal calyptra cuticle, in combination with dehydration stress, is experimentally determined. METHODS: Using the moss Funaria hygrometrica, calyptra cuticle waxes were removed by chemical extraction and individuals were exposed to a short-term dehydration event. Sporophytes were returned to high humidity to complete development and then aspects of sporophyte survival, development, functional morphology, and reproductive output were measured. KEY RESULTS: It was found that removal of calyptra cuticle under low humidity results in significant negative impacts to moss sporophyte fitness, resulting in decreased survival, increased tissue damage, incomplete sporophyte development, more peristome malformations, and decreased reproductive output. CONCLUSIONS: This study represents the strongest evidence to date that the structure of the calyptra cuticle functions in dehydration protection of the immature moss sporophyte. The investment in a maternal calyptra with a multilayered cuticle increases offspring fitness and provides a functional explanation for calyptra retention across mosses. The moss calyptra may represent the earliest occurance of maternal protection via structural provisioning of a cuticle in green plants.