Jefferson Village Downtown District Plan

Jefferson Village is an incorporated municipality in Northeastern Ohio, with a population in 2000 of about 4000 residents. Originally founded in 1803 and incorporated in 1836, the Village has been the county seat for Ashtabula County since 1807. The Village is centrally located in Ashtabula County, 10 miles south of Lake Erie, and 10 miles west of the Pennsylvania border. Interstate highway 90 runs parallel to the lake shore, about 6 miles north of the village; and State Route 11 is a major north-south connector located about 2 miles east of the village. The primary employment locations in the Village are the downtown County administration and the independent professional offices that serve county-related needs, and a light industrial park to the southeast of downtown. The County fairground is also located within the village limits. While residential, commercial and retail growth have occurred over the years, the village still retains much of its original Western Reserve town character. Over 25% of the buildings in the downtown district have historic merit, and both Chestnut and Jefferson Streets are lined with older brick commercial buildings, as well as large, well-kept residences of Western Reserve, Georgian and Victorian architectural styles. Village administration is still based in the original Town Hall, and residents take much pride in the small town charm of the community. In 2006, new commercial development was proposed for Chestnut Street that would have required removal of a residence of historic character, replacing it with a new, generic commercial structure and a typical street-frontage parking lot. Residents were concerned, and public discourse in the local newspaper and at Town Hall led to withdrawal of the proposal. Village leadership felt that it was time to explore the historic character and economic future of the downtown district, and establish policy that could guide future decision making for the downtown

Jefferson Village Downtown District Plan

Jefferson Village is an incorporated municipality in Northeastern Ohio, with a population in 2000 of about 4000 residents. Originally founded in 1803 and incorporated in 1836, the Village has been the county seat for Ashtabula County since 1807. The Village is centrally located in Ashtabula County, 10 miles south of Lake Erie, and 10 miles west of the Pennsylvania border. Interstate highway 90 runs parallel to the lake shore, about 6 miles north of the village; and State Route 11 is a major north-south connector located about 2 miles east of the village. The primary employment locations in the Village are the downtown County administration and the independent professional offices that serve county-related needs, and a light industrial park to the southeast of downtown. The County fairground is also located within the village limits. While residential, commercial and retail growth have occurred over the years, the village still retains much of its original Western Reserve town character. Over 25% of the buildings in the downtown district have historic merit, and both Chestnut and Jefferson Streets are lined with older brick commercial buildings, as well as large, well-kept residences of Western Reserve, Georgian and Victorian architectural styles. Village administration is still based in the original Town Hall, and residents take much pride in the small town charm of the community. In 2006, new commercial development was proposed for Chestnut Street that would have required removal of a residence of historic character, replacing it with a new, generic commercial structure and a typical street-frontage parking lot. Residents were concerned, and public discourse in the local newspaper and at Town Hall led to withdrawal of the proposal. Village leadership felt that it was time to explore the historic character and economic future of the downtown district, and establish policy that could guide future decision making for the downtown

Health, education, and social care provision after diagnosis of childhood visual disability

Aim: To investigate the health, education, and social care provision for children newly diagnosed with visual disability.Method: This was a national prospective study, the British Childhood Visual Impairment and Blindness Study 2 (BCVIS2), ascertaining new diagnoses of visual impairment or severe visual impairment and blindness (SVIBL), or equivalent vi-sion. Data collection was performed by managing clinicians up to 1-year follow-up, and included health and developmental needs, and health, education, and social care provision.Results: BCVIS2 identified 784 children newly diagnosed with visual impairment/SVIBL (313 with visual impairment, 471 with SVIBL). Most children had associated systemic disorders (559 [71%], 167 [54%] with visual impairment, and 392 [84%] with SVIBL). Care from multidisciplinary teams was provided for 549 children (70%). Two-thirds (515) had not received an Education, Health, and Care Plan (EHCP). Fewer children with visual impairment had seen a specialist teacher (SVIBL 35%, visual impairment 28%, χ2p < 0.001), or had an EHCP (11% vs 7%, χ2p < 0 . 01).Interpretation: Families need additional support from managing clinicians to access recommended complex interventions such as the use of multidisciplinary teams and educational support. This need is pressing, as the population of children with visual impairment/SVIBL is expected to grow in size and complexity.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited

Evaluating the Effects of SARS-CoV-2 Spike Mutation D614G on Transmissibility and Pathogenicity.

Global dispersal and increasing frequency of the SARS-CoV-2 spike protein variant D614G are suggestive of a selective advantage but may also be due to a random founder effect. We investigate the hypothesis for positive selection of spike D614G in the United Kingdom using more than 25,000 whole genome SARS-CoV-2 sequences. Despite the availability of a large dataset, well represented by both spike 614 variants, not all approaches showed a conclusive signal of positive selection. Population genetic analysis indicates that 614G increases in frequency relative to 614D in a manner consistent with a selective advantage. We do not find any indication that patients infected with the spike 614G variant have higher COVID-19 mortality or clinical severity, but 614G is associated with higher viral load and younger age of patients. Significant differences in growth and size of 614G phylogenetic clusters indicate a need for continued study of this variant

Hospital admission and emergency care attendance risk for SARS-CoV-2 delta (B.1.617.2) compared with alpha (B.1.1.7) variants of concern: a cohort study

Background: The SARS-CoV-2 delta (B.1.617.2) variant was first detected in England in March, 2021. It has since rapidly become the predominant lineage, owing to high transmissibility. It is suspected that the delta variant is associated with more severe disease than the previously dominant alpha (B.1.1.7) variant. We aimed to characterise the severity of the delta variant compared with the alpha variant by determining the relative risk of hospital attendance outcomes. Methods: This cohort study was done among all patients with COVID-19 in England between March 29 and May 23, 2021, who were identified as being infected with either the alpha or delta SARS-CoV-2 variant through whole-genome sequencing. Individual-level data on these patients were linked to routine health-care datasets on vaccination, emergency care attendance, hospital admission, and mortality (data from Public Health England's Second Generation Surveillance System and COVID-19-associated deaths dataset; the National Immunisation Management System; and NHS Digital Secondary Uses Services and Emergency Care Data Set). The risk for hospital admission and emergency care attendance were compared between patients with sequencing-confirmed delta and alpha variants for the whole cohort and by vaccination status subgroups. Stratified Cox regression was used to adjust for age, sex, ethnicity, deprivation, recent international travel, area of residence, calendar week, and vaccination status. Findings: Individual-level data on 43 338 COVID-19-positive patients (8682 with the delta variant, 34 656 with the alpha variant; median age 31 years [IQR 17–43]) were included in our analysis. 196 (2·3%) patients with the delta variant versus 764 (2·2%) patients with the alpha variant were admitted to hospital within 14 days after the specimen was taken (adjusted hazard ratio [HR] 2·26 [95% CI 1·32–3·89]). 498 (5·7%) patients with the delta variant versus 1448 (4·2%) patients with the alpha variant were admitted to hospital or attended emergency care within 14 days (adjusted HR 1·45 [1·08–1·95]). Most patients were unvaccinated (32 078 [74·0%] across both groups). The HRs for vaccinated patients with the delta variant versus the alpha variant (adjusted HR for hospital admission 1·94 [95% CI 0·47–8·05] and for hospital admission or emergency care attendance 1·58 [0·69–3·61]) were similar to the HRs for unvaccinated patients (2·32 [1·29–4·16] and 1·43 [1·04–1·97]; p=0·82 for both) but the precision for the vaccinated subgroup was low. Interpretation: This large national study found a higher hospital admission or emergency care attendance risk for patients with COVID-19 infected with the delta variant compared with the alpha variant. Results suggest that outbreaks of the delta variant in unvaccinated populations might lead to a greater burden on health-care services than the alpha variant. Funding: Medical Research Council; UK Research and Innovation; Department of Health and Social Care; and National Institute for Health Research

Evaluating the Effects of SARS-CoV-2 Spike Mutation D614G on Transmissibility and Pathogenicity

Global dispersal and increasing frequency of the SARS-CoV-2 spike protein variant D614G are suggestive of a selective advantage but may also be due to a random founder effect. We investigate the hypothesis for positive selection of spike D614G in the United Kingdom using more than 25,000 whole genome SARS-CoV-2 sequences. Despite the availability of a large dataset, well represented by both spike 614 variants, not all approaches showed a conclusive signal of positive selection. Population genetic analysis indicates that 614G increases in frequency relative to 614D in a manner consistent with a selective advantage. We do not find any indication that patients infected with the spike 614G variant have higher COVID-19 mortality or clinical severity, but 614G is associated with higher viral load and younger age of patients. Significant differences in growth and size of 614G phylogenetic clusters indicate a need for continued study of this variant

Genomic epidemiology of SARS-CoV-2 in a UK university identifies dynamics of transmission

AbstractUnderstanding SARS-CoV-2 transmission in higher education settings is important to limit spread between students, and into at-risk populations. In this study, we sequenced 482 SARS-CoV-2 isolates from the University of Cambridge from 5 October to 6 December 2020. We perform a detailed phylogenetic comparison with 972 isolates from the surrounding community, complemented with epidemiological and contact tracing data, to determine transmission dynamics. We observe limited viral introductions into the university; the majority of student cases were linked to a single genetic cluster, likely following social gatherings at a venue outside the university. We identify considerable onward transmission associated with student accommodation and courses; this was effectively contained using local infection control measures and following a national lockdown. Transmission clusters were largely segregated within the university or the community. Our study highlights key determinants of SARS-CoV-2 transmission and effective interventions in a higher education setting that will inform public health policy during pandemics.</jats:p

Changes in symptomatology, reinfection, and transmissibility associated with the SARS-CoV-2 variant B.1.1.7: an ecological study

Background The SARS-CoV-2 variant B.1.1.7 was first identified in December, 2020, in England. We aimed to investigate whether increases in the proportion of infections with this variant are associated with differences in symptoms or disease course, reinfection rates, or transmissibility. Methods We did an ecological study to examine the association between the regional proportion of infections with the SARS-CoV-2 B.1.1.7 variant and reported symptoms, disease course, rates of reinfection, and transmissibility. Data on types and duration of symptoms were obtained from longitudinal reports from users of the COVID Symptom Study app who reported a positive test for COVID-19 between Sept 28 and Dec 27, 2020 (during which the prevalence of B.1.1.7 increased most notably in parts of the UK). From this dataset, we also estimated the frequency of possible reinfection, defined as the presence of two reported positive tests separated by more than 90 days with a period of reporting no symptoms for more than 7 days before the second positive test. The proportion of SARS-CoV-2 infections with the B.1.1.7 variant across the UK was estimated with use of genomic data from the COVID-19 Genomics UK Consortium and data from Public Health England on spike-gene target failure (a non-specific indicator of the B.1.1.7 variant) in community cases in England. We used linear regression to examine the association between reported symptoms and proportion of B.1.1.7. We assessed the Spearman correlation between the proportion of B.1.1.7 cases and number of reinfections over time, and between the number of positive tests and reinfections. We estimated incidence for B.1.1.7 and previous variants, and compared the effective reproduction number, Rt, for the two incidence estimates. Findings From Sept 28 to Dec 27, 2020, positive COVID-19 tests were reported by 36 920 COVID Symptom Study app users whose region was known and who reported as healthy on app sign-up. We found no changes in reported symptoms or disease duration associated with B.1.1.7. For the same period, possible reinfections were identified in 249 (0·7% [95% CI 0·6–0·8]) of 36 509 app users who reported a positive swab test before Oct 1, 2020, but there was no evidence that the frequency of reinfections was higher for the B.1.1.7 variant than for pre-existing variants. Reinfection occurrences were more positively correlated with the overall regional rise in cases (Spearman correlation 0·56–0·69 for South East, London, and East of England) than with the regional increase in the proportion of infections with the B.1.1.7 variant (Spearman correlation 0·38–0·56 in the same regions), suggesting B.1.1.7 does not substantially alter the risk of reinfection. We found a multiplicative increase in the Rt of B.1.1.7 by a factor of 1·35 (95% CI 1·02–1·69) relative to pre-existing variants. However, Rt fell below 1 during regional and national lockdowns, even in regions with high proportions of infections with the B.1.1.7 variant. Interpretation The lack of change in symptoms identified in this study indicates that existing testing and surveillance infrastructure do not need to change specifically for the B.1.1.7 variant. In addition, given that there was no apparent increase in the reinfection rate, vaccines are likely to remain effective against the B.1.1.7 variant. Funding Zoe Global, Department of Health (UK), Wellcome Trust, Engineering and Physical Sciences Research Council (UK), National Institute for Health Research (UK), Medical Research Council (UK), Alzheimer's Society

Genomic assessment of quarantine measures to prevent SARS-CoV-2 importation and transmission

Mitigation of SARS-CoV-2 transmission from international travel is a priority. We evaluated the effectiveness of travellers being required to quarantine for 14-days on return to England in Summer 2020. We identified 4,207 travel-related SARS-CoV-2 cases and their contacts, and identified 827 associated SARS-CoV-2 genomes. Overall, quarantine was associated with a lower rate of contacts, and the impact of quarantine was greatest in the 16–20 age-group. 186 SARS-CoV-2 genomes were sufficiently unique to identify travel-related clusters. Fewer genomically-linked cases were observed for index cases who returned from countries with quarantine requirement compared to countries with no quarantine requirement. This difference was explained by fewer importation events per identified genome for these cases, as opposed to fewer onward contacts per case. Overall, our study demonstrates that a 14-day quarantine period reduces, but does not completely eliminate, the onward transmission of imported cases, mainly by dissuading travel to countries with a quarantine requirement

Characteristics of vocally disruptive behaviour in residents with dementia in specialist dementia care hospitals and possible interventions

Background In 2002 the New Zealand Ministry of Health estimated there were 38,000 people with dementia living in New Zealand. A significant number of people with dementia show challenging behaviours; one of the most challenging is vocally disruptive behaviour (VDB). VDB may be difficult to manage in all settings but particularly in rest homes and private dementia care hospitals. Little is known about the nature and severity of this problem in the New Zealand private residential hospital setting. Study Aims The first aim of this study is to measure the prevalence and nature of vocally disruptive behaviour in two private New Zealand residential dementia care hospitals. The second aim is to trial the use of a visual cueing system to test whether it can reduce the VDB of one private hospital resident as a pilot for a potential larger study. Method Phase one has three parts; a semi-quantitative interview with care-givers about their experience of VDB including management techniques; a review of the recording of VDB in residents’ clinical notes over a 48 hour period and direct observation of VDB to analyse the incidence, content of and response to VDB. Phase Two uses an N=1 methodology in an intervention trial of a visual cueing system as an augmentative communication strategy to reduce the participant’s incidence of VDB. Baseline recordings of the participants VDB were taken followed by an intervention period. Results Phase One a. Semi-quantitative interviews with residential care workers. All the participants had experienced looking after residents with VDB and all reported finding VDB stressful. A range of techniques to manage residents with VDB was reported. b. Clinical Notes review There was a low rate of reporting VDB in the clinical notes. It is likely that the staff in dementia care hospitals accept that VDB occurs in these facilities and do not consider it worthy of being formally recorded. The two hospitals had different patterns, with Hospital One recording more VDB in the morning shifts compared to Hospital Two. Hospital Two had a peak in calling out recorded during the night shifts. c. Direct Observation of VDB. The incidence of VDB at the two hospitals had different temporal patterns and the content also differed. Hospital One had more purposive VDB and Hospital Two had more hallucination related VDB. In response to VDB a range of management strategies were observed; a high proportion of VDB was ignored. Phase Two Limited data was collected as the participants VDB largely resolved during the intervention stage. This was unrelated to the intervention; therefore no strong conclusions can be drawn. Conclusion VDB occurs frequently in some New Zealand dementia care hospitals. This challenging behaviour is highly variable and case specific. Care-givers would benefit from specific training to equip them with a range of interventions to allow for the individual needs of residents and the changing nature of the behaviour. More studies that use direct observation and participatory action research would enhance the current understanding of VDB and how to effectively manage it