Iowa’s Bridge and Highway Climate Change and Extreme Weather Vulnerability Assessment Pilot

The Iowa Department of Transportation (DOT) is responsible for approximately 4,100 bridges and structures that are a part of the state’s primary highway system, which includes the Interstate, US, and Iowa highway routes. A pilot study was conducted for six bridges in two Iowa river basins—the Cedar River Basin and the South Skunk River Basin—to develop a methodology to evaluate their vulnerability to climate change and extreme weather. The six bridges had been either closed or severely stressed by record streamflow within the past seven years. An innovative methodology was developed to generate streamflow scenarios given climate change projections. The methodology selected appropriate rainfall projection data to feed into a streamflow model that generated continuous peak annual streamflow series for 1960 through 2100, which were used as input to PeakFQ to estimate return intervals for floods. The methodology evaluated the plausibility of rainfall projections and credibility of streamflow simulation while remaining consistent with U.S. Geological Survey (USGS) protocol for estimating the return interval for floods. The results were conveyed in an innovative graph that combined historical and scenario-based design metrics for use in bridge vulnerability analysis and engineering design. The pilot results determined the annual peak streamflow response to climate change likely will be basin-size dependent, four of the six pilot study bridges would be exposed to increased frequency of extreme streamflow and would have higher frequency of overtopping, the proposed design for replacing the Interstate 35 bridges over the South Skunk River south of Ames, Iowa is resilient to climate change, and some Iowa DOT bridge design policies could be reviewed to consider incorporating climate change information

Clinical Guidelines for the Use of Unattended Portable Monitors in the Diagnosis of Obstructive Sleep Apnea in Adult Patients

Based on a review of literature and consensus, the Portable Monitoring Task Force of the American Academy of Sleep Medicine (AASM) makes the following recommendations: unattended portable monitoring (PM) for the diagnosis of obstructive sleep apnea (OSA) should be performed only in conjunction with a comprehensive sleep evaluation. Clinical sleep evaluations using PM must be supervised by a practitioner with board certification in sleep medicine or an individual who fulfills the eligibility criteria for the sleep medicine certification examination. PM may be used as an alternative to polysomnography (PSG) for the diagnosis of OSA in patients with a high pretest probability of moderate to severe OSA. PM is not appropriate for the diagnosis of OSA in patients with significant comorbid medical conditions that may degrade the accuracy of PM. PM is not appropriate for the diagnostic evaluation of patients suspected of having comorbid sleep disorders. PM is not appropriate for general screening of asymptomatic populations. PM may be indicated for the diagnosis of OSA in patients for whom in-laboratory PSG is not possible by virtue of immobility, safety, or critical illness. PM may also be indicated to monitor the response to non-CPAP treatments for sleep apnea. At a minimum, PM must record airflow, respiratory effort, and blood oxygenation. The airflow, effort, and oximetric biosensors conventionally used for in-laboratory PSG should be used in PM. The Task Force recommends that PM testing be performed under the auspices of an AASM-accredited comprehensive sleep medicine pro- gram with written policies and procedures. An experienced sleep technologist/technician must apply the sensors or directly educate patients in sensor application. The PM device must allow for display of raw data with the capability of manual scoring or editing of automated scoring by a qualified sleep technician/technologist. A board certified sleep specialist, or an individual who fulfills the eligibility criteria for the sleep medicine certification examination, must review the raw data from PM using scoring criteria consistent with current published AASM standards. Under the conditions specified above, PM may be used for unattended studies in the patient’s home. A follow-up visit to review test results should be performed for all patients undergoing PM. Negative or technically in- adequate PM tests in patients with a high pretest probability of moderate to severe OSA should prompt in-laboratory polysomnography

The Role of I Region Gene Products in Macrophage - T Lymphocyte Interaction

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73965/1/j.1600-065X.1978.tb00400.x.pd

Physical characterixation and in vitro biological impact of highly aggregated antibodies separated into size-enriched populations by fluorescence-activated cell sorting

An IgG2 monoclonal antibody (mAb) solution was subjected to stirring, generating high concentrations of nanometer and subvisible particles, which were then successfully size enriched into different size bins by low speed centrifugation or a combination of gravitational sedimentation and Fluorescence-Activated Cell Sorting (FACS). The size-fractionated mAb particles were assessed for their ability to elicit the release of cytokines from a population of donor-derived human peripheral blood mononuclear cells (PBMC) at two phases of the immune response. Fractions enriched in nanometer-sized particles showed a lower response than those enriched in micron-sized particles in this assay. Particles of 5–10 μm in size displayed elevated cytokine release profiles compared to other size ranges. Stir-stressed mAb particles had amorphous morphology, contained protein with partially altered secondary structure, elevated surface hydrophobicity (compared to controls), and trace levels of elemental fluorine. FACS size-enriched the mAb particle samples, yet did not notably alter the overall morphology or composition of particles as measured by Microflow imaging, Transmission Electron Microscopy, and Scanning Electron Microscopy-Energy Dispersive X-ray Spectroscopy. The utility and limitations of FACS for size separation of mAb particles and potential of in-vitro PBMC studies to rank order the immunogenic potential of various types of mAb particles is discussed

Household transmission of SARS-CoV-2 in the United States: living density, viral load, and disproportionate impact on communities of color

Households are hotspots for SARS-CoV-2 transmission. In the US, the COVID-19 pandemic has had a disproportionate impact on communities of color. Between April-October 2020, the CO-HOST prospective cohort study enrolled 100 COVID-19 cases and 208 of their household members in North Carolina, including 44% who identified as Hispanic or non-white. Households were enrolled a median of 6 days from symptom onset in the index case. Incident secondary cases within the household were detected by quantitative PCR of weekly nasal swabs (days 7, 14, 21) or by seroconversion at day 28.Excluding 73 household contacts who were PCR-positive at baseline, the secondary attack rate among household contacts was 32% (33/103, 95% CI 22%-44%). The majority of cases occurred by day 7, with later cases confirmed as household-acquired by viral sequencing. Infected persons in the same household had similar nasopharyngeal viral loads (ICC=0.45, 95% CI 0.23-0.62). Households with secondary transmission had index cases with a median viral load that was 1.4 log10 higher than households without transmission (p=0.03) as well as higher living density (>3 persons occupying <6 rooms) (OR 3.3, 95% CI 1.02-10.9). Minority households were more likely to experience high living density and had a higher risk of incident infection than did white households (SAR 51% vs. 19%, p=0.01).Household crowding in the context of high-inoculum infections may amplify the spread of COVID-19, potentially contributing to disproportionate impact on communities of color

High household transmission of SARS-CoV-2 in the United States: living density, viral load, and disproportionate impact on communities of color.

BACKGROUND: Few prospective studies of SARS-CoV-2 transmission within households have been reported from the United States, where COVID-19 cases are the highest in the world and the pandemic has had disproportionate impact on communities of color. METHODS AND FINDINGS: This is a prospective observational study. Between April-October 2020, the UNC CO-HOST study enrolled 102 COVID-positive persons and 213 of their household members across the Piedmont region of North Carolina, including 45% who identified as Hispanic/Latinx or non-white. Households were enrolled a median of 6 days from onset of symptoms in the index case. Secondary cases within the household were detected either by PCR of a nasopharyngeal (NP) swab on study day 1 and weekly nasal swabs (days 7, 14, 21) thereafter, or based on seroconversion by day 28. After excluding household contacts exposed at the same time as the index case, the secondary attack rate (SAR) among susceptible household contacts was 60% (106/176, 95% CI 53%-67%). The majority of secondary cases were already infected at study enrollment (73/106), while 33 were observed during study follow-up. Despite the potential for continuous exposure and sequential transmission over time, 93% (84/90, 95% CI 86%-97%) of PCR-positive secondary cases were detected within 14 days of symptom onset in the index case, while 83% were detected within 10 days. Index cases with high NP viral load (>10^6 viral copies/ul) at enrollment were more likely to transmit virus to household contacts during the study (OR 4.9, 95% CI 1.3-18 p=0.02). Furthermore, NP viral load was correlated within families (ICC=0.44, 95% CI 0.26-0.60), meaning persons in the same household were more likely to have similar viral loads, suggesting an inoculum effect. High household living density was associated with a higher risk of secondary household transmission (OR 5.8, 95% CI 1.3-55) for households with >3 persons occupying <6 rooms (SAR=91%, 95% CI 71-98%). Index cases who self-identified as Hispanic/Latinx or non-white were more likely to experience a high living density and transmit virus to a household member, translating into an SAR in minority households of 70%, versus 52% in white households (p=0.05). CONCLUSIONS: SARS-CoV-2 transmits early and often among household members. Risk for spread and subsequent disease is elevated in high-inoculum households with limited living space. Very high infection rates due to household crowding likely contribute to the increased incidence of SARS-CoV-2 infection and morbidity observed among racial and ethnic minorities in the US. Quarantine for 14 days from symptom onset of the first case in the household is appropriate to prevent onward transmission from the household. Ultimately, primary prevention through equitable distribution of effective vaccines is of paramount importance. AUTHORS SUMMARY: Why was this study done?: Understanding the secondary attack rate and the timing of transmission of SARS-CoV-2 within households is important to determine the role of household transmission in the larger pandemic and to guide public health policies about quarantine.Prospective studies looking at the determinants of household transmission are sparse, particularly studies including substantial racial and ethnic minorities in the United States and studies with adequate follow-up to detect sequential transmission events.Identifying individuals at high risk of transmitting and acquiring SARS-CoV-2 will inform strategies for reducing transmission in the household, or reducing disease in those exposed.What did the researchers do and find?: Between April-November 2020, the UNC CO-HOST study enrolled 102 households across the Piedmont region of North Carolina, including 45% with an index case who identified as racial or ethnic minorities.Overall secondary attack rate was 60% with two-thirds of cases already infected at study enrollment.Despite the potential for sequential transmission in the household, the majority of secondary cases were detected within 10 days of symptom onset of the index case.Viral loads were correlated within families, suggesting an inoculum effect.High viral load in the index case was associated with a greater likelihood of household transmission.Spouses/partners of the COVID-positive index case and household members with obesity were at higher risk of becoming infected.High household living density contributed to an increased risk of household transmission.Racial/ethnic minorities had an increased risk of acquiring SARS-CoV-2 in their households in comparison to members of the majority (white) racial group.What do these findings mean?: Household transmission often occurs quickly after a household member is infected.High viral load increases the risk of transmission.High viral load cases cluster within households - suggesting high viral inoculum in the index case may put the whole household at risk for more severe disease.Increased household density may promote transmission within racial and ethnic minority households.Early at-home point-of-care testing, and ultimately vaccination, is necessary to effectively decrease household transmission

Iowa’s Bridge and Highway Climate Change and Extreme Weather Vulnerability Assessment Pilot

The Iowa Department of Transportation (DOT) is responsible for approximately 4,100 bridges and structures that are a part of the state’s primary highway system, which includes the Interstate, US, and Iowa highway routes. A pilot study was conducted for six bridges in two Iowa river basins—the Cedar River Basin and the South Skunk River Basin—to develop a methodology to evaluate their vulnerability to climate change and extreme weather. The six bridges had been either closed or severely stressed by record streamflow within the past seven years. An innovative methodology was developed to generate streamflow scenarios given climate change projections. The methodology selected appropriate rainfall projection data to feed into a streamflow model that generated continuous peak annual streamflow series for 1960 through 2100, which were used as input to PeakFQ to estimate return intervals for floods. The methodology evaluated the plausibility of rainfall projections and credibility of streamflow simulation while remaining consistent with U.S. Geological Survey (USGS) protocol for estimating the return interval for floods. The results were conveyed in an innovative graph that combined historical and scenario-based design metrics for use in bridge vulnerability analysis and engineering design. The pilot results determined the annual peak streamflow response to climate change likely will be basin-size dependent, four of the six pilot study bridges would be exposed to increased frequency of extreme streamflow and would have higher frequency of overtopping, the proposed design for replacing the Interstate 35 bridges over the South Skunk River south of Ames, Iowa is resilient to climate change, and some Iowa DOT bridge design policies could be reviewed to consider incorporating climate change information.</p

Iowa’s Bridge and Highway Climate Change and Extreme Weather Vulnerability Assessment Pilot

The Iowa Department of Transportation (DOT) is responsible for approximately 4,100 bridges and structures that are a part of the state’s primary highway system, which includes the Interstate, US, and Iowa highway routes. A pilot study was conducted for six bridges in two Iowa river basins—the Cedar River Basin and the South Skunk River Basin—to develop a methodology to evaluate their vulnerability to climate change and extreme weather. The six bridges had been either closed or severely stressed by record streamflow within the past seven years. An innovative methodology was developed to generate streamflow scenarios given climate change projections. The methodology selected appropriate rainfall projection data to feed into a streamflow model that generated continuous peak annual streamflow series for 1960 through 2100, which were used as input to PeakFQ to estimate return intervals for floods. The methodology evaluated the plausibility of rainfall projections and credibility of streamflow simulation while remaining consistent with U.S. Geological Survey (USGS) protocol for estimating the return interval for floods. The results were conveyed in an innovative graph that combined historical and scenario-based design metrics for use in bridge vulnerability analysis and engineering design. The pilot results determined the annual peak streamflow response to climate change likely will be basin-size dependent, four of the six pilot study bridges would be exposed to increased frequency of extreme streamflow and would have higher frequency of overtopping, the proposed design for replacing the Interstate 35 bridges over the South Skunk River south of Ames, Iowa is resilient to climate change, and some Iowa DOT bridge design policies could be reviewed to consider incorporating climate change information.</p