BLOOM: A 176B-Parameter Open-Access Multilingual Language Model

Large language models (LLMs) have been shown to be able to perform new tasks based on a few demonstrations or natural language instructions. While these capabilities have led to widespread adoption, most LLMs are developed by resource-rich organizations and are frequently kept from the public. As a step towards democratizing this powerful technology, we present BLOOM, a 176B-parameter open-access language model designed and built thanks to a collaboration of hundreds of researchers. BLOOM is a decoder-only Transformer language model that was trained on the ROOTS corpus, a dataset comprising hundreds of sources in 46 natural and 13 programming languages (59 in total). We find that BLOOM achieves competitive performance on a wide variety of benchmarks, with stronger results after undergoing multitask prompted finetuning. To facilitate future research and applications using LLMs, we publicly release our models and code under the Responsible AI License

Public Health Workforce Knowledge and Perceptions of Vaccinations and Employee Vaccination Policies in Georgia Health Districts

Objective: The purpose of this study is: (1) to systematically review the current state of employee vaccination policies in existence across the 18 public health districts in Georgia; (2) to examine the perceptions of the significance (or necessity) of vaccination laws and knowledge of employee vaccination policies and; and (3) to identify the barriers to implementation of vaccination policies in public health districts without them. Methods: For this cross-sectional quantitative study, a survey was administered to the census of public health employees who are employed in a full and part-time capacity at the 18 public health districts in Georgia. This research involved descriptive, bivariate and multivariable logistic regression analysis using SAS 9.4 ©. Results: A total of 1,527 employees completed the survey. Eighty-six percent of employees correctly identified the presence or absence of an employee vaccination policy. Employees who indicated that they have direct patient contact have significantly higher odds (AOR:1.62, CI: 1.25-2.09; p=0.0002) of correctly identifying if their public health district had an employee immunization policy. Employees perception of risk of vaccine-preventable diseases was not significant for any of the independent variables for those districts that have a policy. However, for those districts that do not have a policy, or they were not sure if there was a policy 8.3% indicated a perceived high risk of contracting a vaccine-preventable disease, 15% indicated moderate risk, 23.7% indicate 50/5 risk, 32% indicated slight risk and 17.4% indicated no risk. Blacks were significantly less likely to believe vaccinations were effective and significantly more likely to believe vaccinations had side effects. A significant association between vaccine effectiveness for all five vaccinations and the following independent variables: population size, public health district, and patient contact was identified. Conclusion: Employees working in public health districts in Georgia perceive vaccines to be of high importance and efficacy. Future initiatives should be focused on continued education regarding side effects of vaccination and the importance of vaccination policies. Through identification of public health employees’ perceptions of vaccination importance and effectiveness and their knowledge of their current state and content of employee vaccination policies, barriers to implementing vaccination policies can be reduced

Detection of a Salmonellosis Outbreak using Syndromic Surveillance in Georgia

ObjectiveDescribe how the Georgia Department of Public Health (DPH) used data from its State Electronic Notifiable Disease Surveillance System (SendSS) Syndromic Surveillance (SS) module for early detection of an outbreak of salmonellosis in Camden County, Georgia.IntroductionEvidence about the value of syndromic surveillance data for outbreak detection is limited (1). In July 2018, a salmonellosis outbreak occurred following a family reunion of 300 persons held in Camden County, Georgia, where one meal was served on 7/27/2018 and on 7/28/2018.MethodsSendSS-SS and SAS were used for cluster detection of Emergency Department (ED) patients with similar Chief Complaint (CC), Triage Notes (TN), or Discharge Diagnoses (DDx) by facility, time of ED visit, and zip code / county of residence. A SAS-based free-text query related to food poisoning in the CC and DDx fields was also performed on a daily basis. County- and hospital-specific charting of the Diarrhea syndrome was also conducted in SendSS-SS, whereas county- and zip code-specific charting of the same syndrome were done in both SendSS-SS and SAS (2).ResultsOn Sunday July 29th, 2018, three children and three adults were seen within 18 hours at the ED of Hospital A in Camden County, Georgia. All patients complained of diarrhea, vomiting, and food poisoning, after a large family reunion that had been held the day before. This early cluster was detected by the SAS-based free-text query of ‘food poisoning’ and the SAS-based cluster detection tool for patients with Diarrhea syndrome. The District Epidemiologists (DE) in the Coastal Health District were notified on Monday, July 30th, 2018. One-year high daily spikes of the Diarrhea syndrome occurred from July 29th to July 31st, 2018 in a local hospital ED (Fig 1), Camden County, and zip code 31548. Two HIPAA-compliant line lists with a total of 27 patients seen at EDs were emailed to the DEs to support active case finding. No further spikes of the Diarrhea syndrome were detected in Camden County during the 2-week period after the 3-day spike.ConclusionsSyndromic surveillance was a useful surveillance tool for early detection of a salmonellosis outbreak, helping with the active search for outbreak cases, tracking the peak of the outbreak, and assuring that no further spikes were occurring.References1.R Hopkins, C Tong, H Burkom, et al. A Practitioner-Driven Research Agenda for Syndromic Surveillance. Public Health Reports 2017; 132(Supplement1): 116S-126S.2. G Zhang, A Llau, J Suarez, E O'Connell, E Rico, R Borroto, F Leguen. Using ESSENCE to Track a Gastrointestinal Outbreak in a Homeless Shelter in Miami-Dade County, 2008. Advances in Disease Surveillance. 2008; 5:139.

Health Equity to Address the Health of All Georgians- Georgia Department of Public Health Epidemiology Section

Background: Health equity (HE) is achieved when everyone has a fair opportunity to attain their full potential for health and well-being. Achieving health requires focused societal efforts to address inequalities, injustices, and social determinants of health (SDoH). In Georgia, racial disparities are observed in maternal and child health. In their 2022-2025 strategic plan, DPH seeks to eliminate health disparities and promote a healthy quality of life for all Georgians. DPH Epidemiology (EPI) is developing a framework to establish HE as the foundation for all aspects of EPI work to address the underlying/root causes of HE. Methods EPI created an HE workgroup composed of a representative group of epidemiologists in October 2021. They evaluated the EPI section’s mission and vision, identified internal (DPH EPI) and external (other states/jurisdictions) HE models and projects, and held a strategic planning session. The workgroup is examining the EPI workforce makeup, SDoH indicators in EPI data collection and analysis, training and data modernization needs, identifying stakeholders, and assessing data impact on policy. Results/Anticipated Results The HE workgroup created these subgroups: Diversity, Equity, and Inclusion in the workforce; Data Collection and Quality; Data Analysis and Evaluation; and Communication and Policy. A logic model helped visualize and guide efforts. In-depth HE training emerged as a need across all subgroups. Discussions include evaluating hiring processes; creating and reinforcing multi-sectorial and community partnerships; enhancing data collection, analysis, and data dissemination methods; providing data driven program/policy recommendations Conclusion Priority areas identified included diverse and inclusive EPI workforce equipped in analyzing, interpreting and disseminating disease specific data to address health and disparities; improve program effectiveness to promote equitable opportunities to be healthy; increase community engagement to create solutions and policies based on partnerships. HE training and stakeholder engagement are the underpinning of realizing these priority areas, and to address the health of all Georgians

Let\u27s Do This Together: Expansion of Hearts and Hands Diabetes Care

In summer of 2017, our team of DrPH students taking the Public Health Funding and Grants course assisted the Hearts and Hands Clinic in securing a $50,000 grant from the Healthcare Georgia Foundation to expand the diabetes care and management program. The goal of our service-learning activity was to write a grant proposal to broaden the current abilities of the clinic to include an evidenced-based Team Care approach with a behavioral health component that has high quality and low cost to underserved individuals within Bulloch County. The grant application was funded in fall 2017. Engaging in a service-learning activity not only taught us how to write various components of a grant, but also helped us understand why certain grant applications are funded. This type of learning is not taught in the classroom, and we are grateful for the experience to have a local impact on our own community

Pharyngeal Co-Infections with Monkeypox Virus and Group A Streptococcus, United States, 2022

We report 2 cases of pharyngeal monkeypox virus and group A Streptococcus co-infection in the United States. No rash was observed when pharyngitis symptoms began. One patient required intubation before mpox was diagnosed. Healthcare providers should be aware of oropharyngeal mpox manifestations and possible co-infections; early treatment might prevent serious complications

Phase 2 study of cemiplimab in patients with metastatic cutaneous squamous cell carcinoma: primary analysis of fixed-dosing, long-term outcome of weight-based dosing

BackgroundCemiplimab, a high-affinity, potent human immunoglobulin G4 monoclonal antibody to programmed cell death-1 demonstrated antitumor activity in a Phase 1 advanced cutaneous squamous cell carcinoma (CSCC) expansion cohort (NCT02383212) and the pivotal Phase 2 study (NCT02760498). Here we report the primary analysis of fixed dose cemiplimab 350 mg intravenously every 3 weeks (Q3W) (Group 3) and provide a longer-term update after the primary analysis of weight-based cemiplimab 3 mg/kg intravenously every 2 weeks (Q2W) (Group 1) among metastatic CSCC (mCSCC) patients in the pivotal study (NCT02760498).MethodsThe primary objective for each group was objective response rate (ORR) per independent central review (ICR). Secondary endpoints included ORR by investigator review (INV), duration of response (DOR) per ICR and INV, and safety and tolerability.ResultsFor Group 3 (n=56) and Group 1 (n=59), median follow-up was 8.1 (range, 0.6 to 14.1) and 16.5 (range, 1.1 to 26.6) months, respectively. ORR per ICR was 41.1% (95% CI, 28.1% to 55.0%) in Group 3, 49.2% (95% CI, 35.9% to 62.5%) in Group 1, and 45.2% (95% CI, 35.9% to 54.8%) in both groups combined. Per ICR, Kaplan–Meier estimate for DOR at 8 months was 95.0% (95% CI, 69.5% to 99. 3%) in responding patients in Group 3, and at 12 months was 88.9% (95% CI, 69.3% to 96.3%) in responding patients in Group 1. Per INV, ORR was 51.8% (95% CI, 38.0% to 65.3%) in Group 3, 49.2% (95% CI, 35.9% to 62.5%) in Group 1, and 50.4% (95% CI, 41.0% to 59.9%) in both groups combined. Overall, the most common adverse events regardless of attribution were fatigue (27.0%) and diarrhea (23.5%).ConclusionIn patients with mCSCC, cemiplimab 350 mg intravenously Q3W produced substantial antitumor activity with durable response and an acceptable safety profile. Follow-up data of cemiplimab 3 mg/kg intravenously Q2W demonstrate ongoing durability of responses.Trial registration numberClinicaltrials.gov, NCT02760498. Registered May 3, 2016, https://clinicaltrials.gov/ct2/show/NCT0276049

Novel SOX10 indel mutations drive schwannomas through impaired transactivation of myelination gene programs

BackgroundSchwannomas are common peripheral nerve sheath tumors that can cause severe morbidity given their stereotypic intracranial and paraspinal locations. Similar to many solid tumors, schwannomas and other nerve sheath tumors are primarily thought to arise due to aberrant hyperactivation of the RAS growth factor signaling pathway. Here, we sought to further define the molecular pathogenesis of schwannomas.MethodsWe performed comprehensive genomic profiling on a cohort of 96 human schwannomas, as well as DNA methylation profiling on a subset. Functional studies including RNA sequencing, chromatin immunoprecipitation-DNA sequencing, electrophoretic mobility shift assay, and luciferase reporter assays were performed in a fetal glial cell model following transduction with wildtype and tumor-derived mutant isoforms of SOX10.ResultsWe identified that nearly one-third of sporadic schwannomas lack alterations in known nerve sheath tumor genes and instead harbor novel recurrent in-frame insertion/deletion mutations in SOX10, which encodes a transcription factor responsible for controlling Schwann cell differentiation and myelination. SOX10 indel mutations were highly enriched in schwannomas arising from nonvestibular cranial nerves (eg facial, trigeminal, vagus) and were absent from vestibular nerve schwannomas driven by NF2 mutation. Functional studies revealed these SOX10 indel mutations have retained DNA binding capacity but impaired transactivation of glial differentiation and myelination gene programs.ConclusionsWe thus speculate that SOX10 indel mutations drive a unique subtype of schwannomas by impeding proper differentiation of immature Schwann cells

Severe Monkeypox in Hospitalized Patients - United States, August 10-October 10, 2022.

As of October 21, 2022, a total of 27,884 monkeypox cases (confirmed and probable) have been reported in the United States.§ Gay, bisexual, and other men who have sex with men have constituted a majority of cases, and persons with HIV infection and those from racial and ethnic minority groups have been disproportionately affected (1,2). During previous monkeypox outbreaks, severe manifestations of disease and poor outcomes have been reported among persons with HIV infection, particularly those with AIDS (3-5). This report summarizes findings from CDC clinical consultations provided for 57 patients aged ≥18 years who were hospitalized with severe manifestations of monkeypox¶ during August 10-October 10, 2022, and highlights three clinically representative cases. Overall, 47 (82%) patients had HIV infection, four (9%) of whom were receiving antiretroviral therapy (ART) before monkeypox diagnosis. Most patients were male (95%) and 68% were non-Hispanic Black (Black). Overall, 17 (30%) patients received intensive care unit (ICU)-level care, and 12 (21%) have died. As of this report, monkeypox was a cause of death or contributing factor in five of these deaths; six deaths remain under investigation to determine whether monkeypox was a causal or contributing factor; and in one death, monkeypox was not a cause or contributing factor.** Health care providers and public health professionals should be aware that severe morbidity and mortality associated with monkeypox have been observed during the current outbreak in the United States (6,7), particularly among highly immunocompromised persons. Providers should test all sexually active patients with suspected monkeypox for HIV at the time of monkeypox testing unless a patient is already known to have HIV infection. Providers should consider early commencement and extended duration of monkeypox-directed therapy†† in highly immunocompromised patients with suspected or laboratory-diagnosed monkeypox.§§ Engaging all persons with HIV in sustained care remains a critical public health priority