Cryptic transmission of SARS-CoV-2 in Washington state

After its emergence in Wuhan, China, in late November or early December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus rapidly spread globally. Genome sequencing of SARS-CoV-2 allows the reconstruction of its transmission history, although this is contingent on sampling. We analyzed 453 SARS-CoV-2 genomes collected between 20 February and 15 March 2020 from infected patients in Washington state in the United States. We find that most SARS-CoV-2 infections sampled during this time derive from a single introduction in late January or early February 2020, which subsequently spread locally before active community surveillance was implemented.

Cryptic transmission of SARS-CoV-2 in Washington State

Following its emergence in Wuhan, China, in late November or early December 2019, the SARS-CoV-2 virus has rapidly spread throughout the world. On March 11, 2020, the World Health Organization declared Coronavirus Disease 2019 (COVID-19) a pandemic. Genome sequencing of SARS-CoV-2 strains allows for the reconstruction of transmission history connecting these infections. Here, we analyze 346 SARS-CoV-2 genomes from samples collected between 20 February and 15 March 2020 from infected patients in Washington State, USA. We found that the large majority of SARS-CoV-2 infections sampled during this time frame appeared to have derived from a single introduction event into the state in late January or early February 2020 and subsequent local spread, strongly suggesting cryptic spread of COVID-19 during the months of January and February 2020, before active community surveillance was implemented. We estimate a common ancestor of this outbreak clade as occurring between 18 January and 9 February 2020. From genomic data, we estimate an exponential doubling between 2.4 and 5.1 days. These results highlight the need for large-scale community surveillance for SARS-CoV-2 introductions and spread and the power of pathogen genomics to inform epidemiological understanding.

Examining perceptions of a smartphone-based intervention system for alcohol use disorders

BACKGROUND

This study presents results from qualitative interviews conducted with participants in a study on the effectiveness of the Location-Based Monitoring and Intervention System for Alcohol Use Disorders (LBMI-A), a smartphone-based, stand-alone intervention application (app) for adults with alcohol use disorders.

MATERIALS AND METHODS

Participants were provided an LBMI-A-enabled smartphone to use during a 6-week pilot study. The LBMI-A was composed of psychoeducational modules, assessment and feedback of alcohol use patterns, geographic high-risk location monitoring and alerts, and in vivo assessment and intervention for alcohol cravings and help with managing psychological distress. Semistructured interviews were conducted with all participants following 6 weeks of interacting with the LBMI-A app (n=26). Interviews explored user perceptions of the ease and utility of LBMI-A features, module helpfulness, barriers to use, and recommendations for improvements to the program. Researchers applied a systematic qualitative coding process to transcripts that included both a priori themes identified as important by the research team and new themes that emerged during the coding process.

RESULTS AND CONCLUSIONS

Narrative analysis found the emergence of five main themes identified by LBMI-A users as the most helpful functions of the phone: (1) Awareness, (2) Accountability, (3) Skill Transference, (4) Tracking Progress, and (5) Prompts. These themes are explored, and implications of these findings for future smartphone-based interventions are discussed.

The Social Contexts of Drug Offers and Their Relationship to Drug Use of Rural Hawaiian Youth

This paper examines the differences in drug offers and recent drug use between Hawaiian and non-Hawaiian youth residing in rural communities, and the relationship between drug offers and drug use of Hawaiian youth in these communities. Two hundred forty nine youth (194 Hawaiian youth) from 7 different middle or intermediate schools completed a survey focused on the social context of drug offers. Hawaiian youth in the study received significantly more offers from peers and family, and had significantly higher rates of recent alcohol and marijuana use, compared with non-Hawaiian youth. Logistic regression analysis indicated that the social context differentially influenced drug use of Hawaiian youth, with family drug offers and context influencing overall drug use and the use of the widest variety of substances. Implications for prevention practices are discussed.

Drug offers as a context for violence perpetration and victimization

Drug use has been linked empirically with and aggression and violence among youth in national and State of Hawai'i samples. However, the nature of this link and its implications for prevention are unclear. Therefore, this article explores the intersection of drugs with aggression and violence by using the drug offer context as the unit of analysis. Native Hawaiian youth are sampled because substance use rates tend to be higher and onset tends to be earlier for them than for their non-Hawaiian peers. Fourteen sex-specific focus group discussions were held with rural Native Hawaiian middle school students (N = 64). Students discussed what they think they would do in terms of drug refusal strategies in a variety of drug offer contexts. Although aggression and violence were perceived to be socially inappropriate, students nonetheless felt drug use would be less socially competent. Narrative analyses indicated that aggression and violence were thought to function as potential drug refusal strategies. As proximal drug resistance, aggression and violence perpetration served as an immediate deterrent to the drug offerer and thus drug use. As distal drug resistance, victimization served as a rationale for avoiding drug using contexts. Implications are discussed in terms of prevention policy and practice, specifically in terms of a school-based prevention curriculum. Future research in Hawaiian epistemology and gendered approaches are warranted.

Smartphone-Based, Self-Administered Intervention System for Alcohol Use Disorders: Theory and Empirical Evidence Basis

Advances in mobile technology provide an opportunity to deliver in-the-moment interventions to individuals with alcohol use disorders, yet availability of effective "apps" that deliver evidence-based interventions is scarce. We developed an immediately available, portable, smartphone-based intervention system whose purpose is to provide stand-alone, self-administered assessment and intervention. In this paper, we describe how theory and empirical evidence, combined with smartphone functionality contributed to the construction of a user-friendly, engaging alcohol intervention. With translation in mind, we discuss how we selected appropriate intervention components including assessments, feedback and tools, that work together to produce the hypothesized outcomes.

A typology and analysis of drug resistance strategies of rural Native Hawaiian youth

This study examines the drug resistance strategies described by Native Hawaiian youth residing in rural communities. Sixty-four youth from 7 middle and intermediate schools on the Island of Hawai'i participated in a series of gender-specific focus groups. Youth responded to 15 drug-related problem situations developed and validated from prior research. A total of 509 responses reflecting primary or secondary drug resistance strategies were identified by the youth, which were qualitatively collapsed into 16 different categories. Primary drug resistance strategies were those that participants listed as a single response, or the first part of a two-part response, while secondary drug resistance strategies were those that were used in tandem with primary drug resistance strategies. Over half of the responses reflecting primary drug resistance strategies fell into three different categories ("refuse," "explain," or "angry refusal"), whereas over half of the responses reflecting secondary drug resistance strategies represented one category ("explain"). Significant gender differences were found in the frequency of using different strategies as well as variations in the frequency of using different strategies based on the type of drug offerer (family versus friends/peers). Implications for prevention practice are discussed.

Gender Differences in Drug Offers of Rural Hawaiian Youths: A Mixed-Methods Analysis

This study examined the gender differences in drug-offer situations of Native Hawaiian youths in rural communities. Youths from seven middle or intermediate schools (N 194) on the Big Island of Hawai'i completed a survey that focused on the drug offers they had received. Multivariate and bivariate analyses indicated that the girls received significantly more drug offers than did the boys in the sample and found it more difficult to refuse drugs in such situations. Qualitative data gathered from communities in the survey's sampling frame elucidated the quantitative findings. Limitations of the study and implications for prevention practice are discussed.

The development and initial validation of the Hawaiian Youth Drug Offers Survey (HYDOS)

OBJECTIVE

This study describes the development and preliminary validation of a survey focused on the most salient situations where drugs and/or alcohol are offered to Native Hawaiian youth in rural communities.

DESIGN

The study used a five-phase approach to test development and validation. In Phase 1 (item generation), survey items were created from a series of focus groups with middle school aged youth (n = 47). In Phase 2 (item refinement and selection), items were edited and reduced to 62 drug-offer situations that were selected for inclusion in the survey. In Phase 3 (item reduction), items were administered to 249 youth from seven middle or intermediate schools in Hawai'i.

RESULTS

Exploratory factor analysis of the Native Hawaiian subsample (n = 194) indicated the presence of three factors accounting for 63% of the variance: peer pressure (23%); family offers and context (21%); and unanticipated drug offers (19%). The survey items differentiated between Hawaiian and non-Hawaiian youth respondents, supporting the validity of the questionnaire. The hypothesized relationship between cultural connectedness and drug offer exposure was not confirmed. Internal consistency of the measure was high.

CONCLUSIONS

The survey helps to fill the gap in information related to drug use of Native Hawaiian youth and has implications for the development and assessment of culturally-specific drug prevention programs for these youth.

A review of the literature on Native Hawaiian youth and drug use: implications for research and practice

This article provides a comprehensive review of the recent literature on Native Hawaiian youth and substance use. Eight-hundred and twelve potential articles pertaining to Native Hawaiian youth and substance use published between 1995 to May 2009 were identified through an exhaustive literature search. The total number of articles was reduced to 32 articles, which were systematically coded and content analyzed. The findings indicated that the majority of studies focused on epidemiology, with relatively few of them focused on causal factors/etiology and systematic program development or evaluation. Gender differences in drug use were highlighted in several studies. Implications for culturally tailored interventions and future research are discussed.

Sleeve pneumonectomy for lung cancer--survival and complications (single-center experience with 42 patients)

BACKGROUND

Sleeve pneumonectomy is challenging both from the technical and oncological standpoint. The benefit of induction treatment is still under investigation.

MATERIAL AND METHODS

The study included 42 patients with sleeve pneumonectomy for non-small cell lung cancer in an eight-year period. Right sleeve pneumonectomy was performed in 39 patients. Squamous cell and adenocarcinoma were found in 33 (78.5%) and 5 (11.9%) patients, respectively. Overall stage was IIIa for 25 (59.5%) and IIIb for 17 (40.5%) patients, respectively.

RESULTS

Perioperative mortality and morbidity were 16.6% and 35.7%. Leading cause of death was bronchopleural fistula. Five-year survival was 35%. The survival difference between patients with NO+N1 versus N2 lesions was statistically significant (p = 0.01). There were no two-year survivors among patients with N2 lesions. Survival difference between T3 and T4 patients was also significant (p = 0.04). In a multivariate analysis, only T and N components were found significant in terms of prognosis.

CONCLUSION

Sleeve pneumonectomy should be avoided in patients with N2 lesions confirmed preoperatively. A safe operation can be performed if the surgeon restricts airway resection to a maximum length of 4 cm.

Ontogeny of immunoreactive prostaglandin endoperoxide synthase isoforms in ovine fetal pituitary, hypothalamus and brainstem

Parturition is initiated in sheep by an increase in the activity of the fetal hypothalamus-pituitary-adrenal (HPA) axis. Prostaglandins, known to augment the activity of this endocrine axis, have long been proposed as involved in the initiation of paturition. We have previously demonstrated that endogenously produced prostanoids augment the activity of the HPA axis, and we have proposed that the increased production of prostanoids within the fetal brain or pituitary at the end of gestation might be involved in the initiation of parturition. An important regulatory step in the biosynthesis of prostanoids is the activity of prostaglandin endoperoxide synthase (PGHS). The present study was designed to test the hypothesis that the abundance of one or both isoforms of PGHS (PGHS-1 and PGHS-2) increase in brain and/or pituitary at the end of gestation. We used immunoblot analysis to measure the abundance of immunoreactive PGHS-1 and PGHS-2 in pituitary, hypothalamus and brainstem collected from fetuses of known gestational ages. We found that the abundance of PGHS-1 was weakly but significantly increased at the end of gestation in the pituitary and brainstem. The abundance of PGHS-2, on the other hand, increased exponentially in the pituitary and hypothalamus with highest concentrations found in term fetuses. We conclude that these enzymes are developmentally regulated in pituitary and in brain regions important for HPA axis control. We speculate that the increased enzyme's abundance results in increased prostanoid biosynthesis near term, and is a link in the chain of events which initiates parturition.

Treatment of poor-prognosis extensive disease small-cell lung cancer with an all-oral regimen of etoposide and cyclophosphamide - a Southwest Oncology Group clinical and pharmacokinetic study

PURPOSE

An all-oral regimen of etoposide and cyclophosphamide was developed for use in poor-prognosis extensive disease small-cell lung cancer. Limited pharmacokinetic sampling was used to derive a pharmacodynamic model predictive of myelosuppression early in the course of therapy.

PATIENTS AND METHODS

Eligible patients were chemotherapy-naive and had extensive disease small-cell lung cancer with either SWOG performance status 2 or serum albumin <3.5 g/dl. The first cohort (n = 18) received etoposide orally at 50 mg daily and cyclophosphamide orally at 50 mg daily days 1-14 every 28 days. Due to good hematologic tolerance, the second cohort (n = 39) received both agents orally at 50 mg twice daily days 1-14 every 28 days. Plasma etoposide levels were determined in samples drawn at baseline, and at 1 h, 2 h, and 23.5 h (trough) after the first dose. Linear regression analysis was used to determine pharmacokinetic and demographic parameters predictive of myelosuppression.

RESULTS

A total of 173 treatment cycles were delivered. Patients on the daily regimen had a 22% response rate (complete and partial), a 22% unconfirmed response rate, and a 5-month median survival, while patients on the twice-daily regimen had a 28% response rate (complete and partial), a 13% unconfirmed response rate, and a 7-month median survival. Granulocytopenia and alopecia were the most common toxicities seen. Significant granulocytopenia could be predicted for the twice-daily regimen according to the formula ln(AGC nadir)=7.80 - 1.88(trough), with an increased incidence of granulocytopenia if the etoposide trough value was >/=1.49 microg/ml.

CONCLUSION

Oral etoposide and oral cyclophosphamide given days 1-14 every 28 days is well tolerated and results in an acceptable response rate and median survival in poor-prognosis (poor performance status or low serum albumin) extensive disease small-cell lung cancer. A trough etoposide level obtained within 24 h of starting therapy can predict severe granulocytopenia.

Gentamicin pharmacokinetics in newborn and 42-day-old male piglets

The pharmacokinetics of gentamicin was investigated in six newborn male piglets, aged from 4 to 12 h at the time of administration of the drug, and six 42-day-old castrated male piglets, that had been weaned for 2 weeks following a single intravenous bolus of 5 mg/kg. Gentamicin was measured in serum and in urine by a fluorescence polarization immunoassay. The serum concentration-time data were best described by a three-compartment open model. A rapid initial distribution phase (pi phase) was observed in every animal. The serum beta half-life (t 1/2 beta) was significantly longer in the newborn piglets (mean +/- SEM) (5.19 +/- 0.30 h) than in the older group (3.50 +/- 0.23 h) (P < 0.05). Mean residence time was similarly longer in younger piglets (6.62 +/- 0.57 h) than in older animals (2.86 +/- 0.11 h) (P < 0.05). The steady-state volume of distribution (Vdss) was significantly larger for younger pigs (0.785 +/- 0.036 L/kg) than in elder pigs (0.474 +/- 0.029 L/kg) (P < 0.05). Urinary gamma half-life (t 1/2 gamma u) was 72.66 +/- 10.78 h in the newborn piglets and 69.20 +/- 14.77 h in the 42-day-old animals. A urinary delta phase was observed in three of the 42-day-old piglets and gave a mean t 1/2 delta u of 232.01 +/- 14.55 h. Percentages of urinary recovery of the administered dose after 144 h were 94.18 +/- 1.01 and 94.04 +/- 1.12 in the newborn and 42-day-old animals, respectively. Serum gentamicin clearance was significantly lower in younger animals (0.121 +/- 0.007 L/h.kg) than in the 42-day-old group (0.166 +/- 0.010 L/h.kg). It is suggested that in the newborn piglets, the increase of Vd(SS) could be explained by a higher proportion of extracellular water while the lower clearance could be attributed to a reduced glomerular filtration capacity. Gentamicin dosage requirement in the newborn piglets would therefore have to be adjusted, in order to take into consideration the observed differences in the man values of these latter pharmacokinetic parameters.

Renal artery aneurysm: treatment with percutaneous placement of a stent-graft

A stent-graft was placed percutaneously in the right renal artery of a 50-year-old woman with hypertension and a fibromuscular dysplastic lesion consisting of severe stenoses and a 1.5-cm saccular aneurysm with a wide neck. At 1-year follow-up with arteriography, arterial luminal diameter was normal and no aneurysm was depicted. The patient's blood pressure was normal without blood pressure medication.

Toxicological index and the presence in the workplace of chemical hazards for workers who breast-feed infants

The increasing number of women in the workplace has made it more important than ever to ensure a safe work environment, particularly with respect to mothers who choose to breast-feed their babies. The Quebec Commission de la santé et de la sécurité du travail (CSST) Toxicological Index is fully involved in the provincial program for the protective reassignment of workers who breast-feed infants. The Infotox database provides peer-reviewed information concerning chemicals identified in the workplace that may appear in the mother's milk, possibly to be ingested by the breast-fed infant. Data extracted from the CSST computer system that holds information on 5,500 substances are presented. A total of 153 chemicals (2.7%) are recognized as being involved in some milk transfer. The strength of evidence is assessed with reference to strong or weak association (excretion or detection) in humans or in animals. Such an effect provides a useful basis for administrative decision involving protective reassignment as well as evaluation of work environment. Database users must be well informed about the identification of chemicals in breast milk because this is an essential step for the evaluation of the hazards of transferring chemicals encountered in the workplace from mother to baby. Actually, the main problem is that there are very few data in the scientific literature concerning milk transfer.

Radioimmunoassay for albuterol using a monoclonal antibody: application for direct quantification in horse urine

A monoclonal antibody was synthesized in mouse against the O-(3-carboxypropionyl) derivative of albuterol linked to bovine serum albumin. Isotyping of this material revealed the IgG1 class characterized by an affinity constant of 1.03 nM-1 and a density of sites of 0.55 nM. This antibody was found specific as its cross-reactivity to structurally related molecules was less than 1% except for clenbuterol (75%). A radioimmunoassay was set up with culture supernatant (final dilution 1/1000) and [3H] albuterol. The calibration curve was characterized by a maximum binding of 28%, an ED50 of 1.15 pmol per tube, the detection limit was 28.8 fmol/tube and the linearity of the response was up to 39.8 pmol/tube. This RIA method has been used for direct quantitation of albuterol in horse urine without any clean-up or extraction step.