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Background The evidence base for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is nascent. We sought to characterize SARS-CoV-2 transmission within US households and estimate the household secondary infection rate (SIR) to inform strategies to reduce transmission. Methods We recruited patients with laboratory-confirmed SARS-CoV-2 infection and their household contacts in Utah and Wisconsin during 22 March 2020–25 April 2020. We interviewed patients and all household contacts to obtain demographics and medical histories. At the initial household visit, 14 days later, and when a household contact became newly symptomatic, we collected respiratory swabs from patients and household contacts for testing by SARS-CoV-2 real-time reverse-transcription polymerase chain reaction (rRT-PCR) and sera for SARS-CoV-2 antibodies testing by enzyme-linked immunosorbent assay (ELISA). We estimated SIR and odds ratios (ORs) to assess risk factors for secondary infection, defined by a positive rRT-PCR or ELISA test. Results Thirty-two (55%) of 58 households secondary infection among household contacts. The SIR was 29% (n = 55/188; 95% confidence interval [CI], 23%–36%) overall, 42% among children (aged Conclusions We found substantial evidence of secondary infections among household contacts. People with COVID-19, particularly those with immunocompromising conditions or those with household contacts with diabetes, should take care to promptly self-isolate to prevent household transmission.

BACKGROUND AND OBJECTIVES: Limited data exist on severe acute respiratory syndrome coronavirus 2 in children. We described infection rates and symptom profiles among pediatric household contacts of individuals with coronavirus disease 2019. METHODS: We enrolled individuals with coronavirus disease 2019 and their household contacts, assessed daily symptoms prospectively for 14 days, and obtained specimens for severe acute respiratory syndrome coronavirus 2 real-time reverse transcription polymerase chain reaction and serology testing. Among pediatric contacts ( RESULTS: Among 58 households, 188 contacts were enrolled (120 adults; 68 children). Secondary infection rates for adults (30%) and children (28%) were similar. Among households with potential for transmission from children, child-to-adult transmission may have occurred in 2 of 10 (20%), and child-to-child transmission may have occurred in 1 of 6 (17%). Pediatric case patients most commonly reported headache (79%), sore throat (68%), and rhinorrhea (68%); symptoms had low positive predictive values, except measured fever (100%; 95% confidence interval [CI]: 44% to 100%). Compared with symptomatic adults, children were less likely to report cough (odds ratio [OR]: 0.15; 95% CI: 0.04 to 0.57), loss of taste (OR: 0.21; 95% CI: 0.06 to 0.74), and loss of smell (OR: 0.29; 95% CI: 0.09 to 0.96) and more likely to report sore throat (OR: 3.4; 95% CI: 1.04 to 11.18). CONCLUSIONS: Children and adults had similar secondary infection rates, but children generally had less frequent and severe symptoms. In two states early in the pandemic, we observed possible transmission from children in approximately one-fifth of households with potential to observe such transmission patterns.

Background Improved understanding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spectrum of disease is essential for clinical and public health interventions. There are limited data on mild or asymptomatic infections, but recognition of these individuals is key as they contribute to viral transmission. We describe the symptom profiles from individuals with mild or asymptomatic SARS-CoV-2 infection. Methods From 22 March to 22 April 2020 in Wisconsin and Utah, we enrolled and prospectively observed 198 household contacts exposed to SARS-CoV-2. We collected and tested nasopharyngeal specimens by real-time reverse-transcription polymerase chain reaction (rRT-PCR) 2 or more times during a 14-day period. Contacts completed daily symptom diaries. We characterized symptom profiles on the date of first positive rRT-PCR test and described progression of symptoms over time. Results We identified 47 contacts, median age 24 (3–75) years, with detectable SARS-CoV-2 by rRT-PCR. The most commonly reported symptoms on the day of first positive rRT-PCR test were upper respiratory (n = 32 [68%]) and neurologic (n = 30 [64%]); fever was not commonly reported (n = 9 [19%]). Eight (17%) individuals were asymptomatic at the date of first positive rRT-PCR collection; 2 (4%) had preceding symptoms that resolved and 6 (13%) subsequently developed symptoms. Children less frequently reported lower respiratory symptoms (21%, 60%, and 69% for Conclusions Household contacts with laboratory-confirmed SARS-CoV-2 infection reported mild symptoms. When assessed at a single timepoint, several contacts appeared to have asymptomatic infection; however, over time all developed symptoms. These findings are important to inform infection control, contact tracing, and community mitigation strategies.

9554Background: Anti-PD1 alone and combined with anti-CTLA4 therapy has improved survival in pts with advanced melanoma. Optimal treatment duration has not been defined and it is unclear if surviva...

Telephone interviews were conducted with more than 900 adolescents aged 12 to 18 as part of a multimillion dollar, statewide, antitobacco advertising campaign. The interviews addressed two primary questions: (1) Do counter-advertising campaign attitudes directly affect antismoking beliefs and intent in a manner similar to those of conventional advertisements? and (2) Can advertising campaign attitudes have a stronger effect on beliefs and intent for adolescents with prior smoking behavior and for adolescents exposed to social influence (i.e., friends, siblings, or adult smoker in the home)? The authors’ findings show that advertising campaign attitudes, prior trial behavior, and social influence all directly affect antismoking beliefs and that advertising campaign attitudes interact with prior trial behavior to strengthen antismoking beliefs. The results indicate that attitudes related to the campaign, prior trial behavior, and social influence directly influence intent, and advertising campaign attitudes interact with social influence and prior trial behavior to attenuate adolescent intent to smoke. In addition, the effect of advertising campaign attitudes in attenuating social influence and prior trial behavior effects on adolescent intent to smoke persists even when the authors account for strongly held beliefs about smoking. The authors discuss implications for countermarketing communications and the design and understanding of future antismoking campaigns.

To account for cross-linguistic differences in agrammatism, Bates and her colleagues have employed the Competition Model, proposing that the cue validity and cue costs of a grammatical morpheme in a particular language will directly affect how agrammatism is manifested. Using Goodglass et al.'s (1993) Morphosyntax Battery in English and a translated version in Spanish, we analyzed the use of equivalent grammatical structures in production and comprehension by agrammatic speakers of the two languages. Wilcoxon signed-rank tests revealed that the relative order of difficulty in both production and comprehension of various grammatical morphemes was the same for both Spanish- and English-speaking agrammatic patients, with two exceptions: (1) the Spanish-speaking agrammatics were relatively better at producing subject-verb agreement, and (2) the Spanish speakers were significantly worse at comprehending both active and passive voice sentences. The Competition Model can explain the performance differences regarding subject-verb agreement and comprehension of active voice sentences, but it cannot account for the differences seen in comprehending passive voice sentences.

Aphasic patients have been generally assumed to produce coherent narratives, despite their numerous surface structure deficits. The current study is designed to analyze three types of coherence violations (i.e., information gaps, repetitions of propositions, and irrelevant propositions) in the narratives of mildly impaired conduction, anemic, and Wernicke′s aphasics. Results reveal that the three aphasic groups produce qualitatively different patterns of coherence violations. It is hypothesized that these coherence violations reflect adaptive strategies used by the aphasic patients to compensate for their underlying impairments. While the anemic and conduction aphasics appear to compensate for surface structure deficits, the Wernicke′s aphasics seem to have an underlying coherence deficit.

Background: While uncommon, non-Hodgkin's Lymphoma (NHL) can relapse in extranodal sites in the lower extremities. It is well established that venous thomboembolism occurs in higher incidence in patients with underlying malignancy. We describe 3 cases of NHL in which relapsed disease was discovered after lower extremity swelling prompted evaluation for deep vein thrombosis (DVT), and revealed recurrent NHL. CASE 1: A 61 YO F with history of Stage IEA Marginal Zone Lymphoma (MZL) of the dura diagnosed in 2012 received treatment with whole-brain and local brain radiation. In 2016 she developed recurrence in cervical lymph nodes. Six months after receiving 4 cycles of bendamustine and rituximab she developed left leg pain and calf swelling. PET/CT showed a hypermetabolic lesion in left tibia. MRI confirmed large lesion in mid-shaft of tibia extending down the length of the bone. CT-guided bone biopsy confirmed MZL. CASE 2: A 67 YO F with history of triple-negative inflammatory breast cancer treated in 2000 with neoadjuvant chemotherapy and mastectomy. PET/CT in 2008 showed 2 left femoral lesions. She underwent CT-guided bone biopsy of femoral lesion which confirmed follicular lymphoma (FL). Interim PET/CT in 2010 showed decreased FDG uptake in left femur. She was followed with watchful waiting. Then in 2014 patient developed leg swelling and pain, thought to be a DVT. Duplex ultrasound of the lower extremity was negative. PET/CT showed a left inguinal mass and left calf mass. MRI confirmed large mass within the left lower leg centered on the left fibular diaphysis with a very large associated soft tissue component with extensive muscular and neurovascular involvement. Biopsy of left inguinal lymph node confirmed diffuse large B-Cell lymphoma (DLBCL). CASE 3: A 61 YO M with history Stage IV FL in 1988 and initially treated with 4 cycles of PROMACE-CytaBOM. He relapsed nodally in 1995 and was treated on the IDEC investigational protocol with rituximab which led to a complete remission. In 2001 he developed a subcutaneous nodule on his back, biopsy showed FL, grade 1. A staging CT scan of neck, chest, abdomen, and pelvis was unremarkable, but a PET scan showed left axillary disease. He was re-treated with rituximab and local radiation which led to a complete response. Patient presented in 2008 with right calf swelling. Ultrasound at that time showed no DVT but confirmed swelling and suggested right inguinal adenopathy. PET/CT showed FDG uptake in multiple areas in groin and pelvis plus extensive uptake in thickened calf muscles extending from the right knee to the toe. Biopsy of right inguinal lymph node confirmed FL. Conclusion: Among NHLs, relapse patterns can vary significantly. Timing and frequency of relapse is largely dependent on whether NHL is classified as indolent or aggressive. However, location of relapsed disease in NHL is less well established. NHL relapse can occur in a fashion mimicking DVT with lower extremity swelling. When patients with history of NHL present with lower extremity swelling, relapsed disease should be included in the differential diagnosis. Table Patient characteristics Table. Patient characteristics Disclosures Cohen: Takeda Oncology: Honoraria; Pharmacyclics: Honoraria; Seattle Genetics: Honoraria; Amgen: Honoraria. Broome:True North Therapeutics: Honoraria; Alexion Pharmaceuricals: Honoraria.

3598Background: Little is known about the molecular characteristics of BRAF mutant (mt) CRC. It is unknown whether BRAF mt CRC have molecular and biological profiles similar to BRAF mutant melanoma...

Medical student education has begun to embrace integration across specialties in order to improve understanding of diseases. The Medical College of Wisconsin's Trauma and Injury Control course was developed to expose students to the science, principles, and practice of injury prevention and control, with emphasis on collaboration among disciplines. This paper describes the development, implementation, and evaluation of that course.This retrospective study evaluated learner satisfaction and knowledge gained during a fourth-year selective from March 2007 to 2009. The educational experience provided unique activities developed through an interprofessional approach. Student assessment included oral presentations, small-group discussions, and participation in activities. Students evaluated the quality of the experience using written narrative evaluations. Two independent, blinded raters analyzed student narratives using the constant comparative method associated with grounded theory.Thirty-seven students completed the course and provided comments. Evaluations demonstrated high satisfaction. Five themes emerged as strengths and outcomes: (1) recognition of injury as preventable, (2) variety of interactive educational experiences, (3) understanding physician's role in injury policy, (4) opportunity to see the system of injury care, (5) recognition of injury as a disease. Criticisms of the course related to problems with coordination.Horizontal integration of the teaching of injury is feasible and should be promoted as a valued instructional technique.

Seven agrammatic Broca's and seven paragrammatic conduction aphasics were evaluated on a free narrative story elicitation test and on a structured, cross-modal morphology and syntax battery (MSB). The latter permitted comparison of the same set of morphosyntactic forms in both production and comprehension. Results suggests distinctive oral production profiles, with agrammatics inferior to paragrammatics in use of auxiliaries, verb inflection and passive word order. Only agrammatics commonly omitted articles or main verbs. The use of noun plurals and possessivesdid not discriminate between the groups. The two groups did not differ in level of performance on MSB comprehension subtests, and the order of difficulty among the comprehension subtests was unrelated to their difficulty for production. This suggests that the source of agrammatic production errors is independent of comprehension errors. The production of targeted constructions on the MSB, an easily scored instrument, closely paralleled production in free narrative.

To describe the nature and extent of workplace environmental tobacco smoke exposures in Wisconsin.Descriptive data and confidence intervals from the Current Population Survey tobacco supplements of 1995-1996 and 1998-1999 are presented.The percent of indoor workers working under a smoke-free policy increased slightly, from 62% in 1995-1996 to 65% in 1998-1999. Respondents with a college degree were more likely to work under a smoke-free policy than those with a high school education or less. Among respondents with a work policy in 1998-1999, a complete ban on smoking reduced any workplace exposure in the past 2 weeks (4%) compared to a partial ban (26%) or an unrestricted policy (30%).Wisconsin has seen a small increase in workplace policies that ban smoking in the workplace. These policies are more likely to protect workers of higher socioeconomic status and may increase health disparities in tobacco-related diseases in the future.