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In February 2020, during the early days of the COVID-19 pandemic, 232 evacuees from Wuhan, China, were placed under federal 14-day quarantine upon arrival at a US military base in San Diego, California. We describe the monitoring of evacuees and responders for symptoms of COVID-19, case and contact investigations, infection control procedures, and lessons learned to inform future quarantine protocols for evacuated people from a hot spot resulting from a novel pathogen. Thirteen (5.6%) evacuees had COVID-19-compatible symptoms and 2 (0.9%) had laboratory-confirmed SARS-CoV-2. Two case investigations identified 43 contacts; 3 (7.0%) contacts had symptoms but tested negative for SARS-CoV-2 infection. Daily symptom and temperature screening of evacuees and enacted infection control procedures resulted in rapid case identification and isolation and no detected secondary transmission among evacuees or responders. Lessons learned highlight the challenges associated with public health response to a novel pathogen and the evolution of mitigation strategies as knowledge of the pathogen evolves.

Background Early in the pandemic, cruise travel exacerbated the global spread of SARS-CoV-2. We report epidemiologic and molecular findings from an investigation of a cluster of travellers with confirmed COVID-19 returning to the USA from Nile River cruises in Egypt. Methods State health departments reported data on real-time reverse transcription-polymerase chain reaction-confirmed COVID-19 cases with a history of Nile River cruise travel during February–March 2020 to the Centers for Disease Control and Prevention (CDC). Demographic and epidemiologic data were collected through routine surveillance channels. Sequences were obtained either from state health departments or from the Global Initiative on Sharing Avian Flu Data (GISAID). We conducted descriptive analyses of epidemiologic data and explored phylogenetic relationships between sequences. Results We identified 149 Nile River cruise travellers with confirmed COVID-19 who returned to 67 different US counties in 27 states: among those with complete data, 4.7% (6/128) died and 28.1% (38/135) were hospitalized. These individuals travelled on 20 different Nile River cruise voyages (12 unique vessels). Fifteen community transmission events were identified in four states, with 73.3% (11/15) of these occurring in Wisconsin (as the result of a more detailed contact investigation in that state). Phylogenetic analyses supported the hypothesis that travellers were most likely infected in Egypt, with most sequences in Nextstrain clade 20A 93% (87/94). We observed genetic clustering by Nile River cruise voyage and vessel. Conclusions Nile River cruise travellers with COVID-19 introduced SARS-CoV-2 over a very large geographic range, facilitating transmission across the USA early in the pandemic. Travellers who participate in cruises, even on small river vessels as investigated in this study, are at increased risk of SARS-CoV-2 exposure. Therefore, history of river cruise travel should be considered in contact tracing and outbreak investigations. [ABSTRACT FROM AUTHOR]

Titles of clinical trials may directly influence whether patients, caretakers, or healthcare professionals will want to obtain more information about the trial. Major clinical trial registries require lay titles (referred to as "brief " or "public" titles) that are understandable to the public. However, devising adequate lay titles is challenging. In this study, we assessed the quality of lay titles from Phase II/III and III clinical trials registered in ClinicalTrials.gov in 2021. Assessments includ ed the presence of recommended elements, use of technical terms, an expert assessment of adequacy and informativeness, title length, and the use of acronyms. A large proportion (72%) of lay titles did not include all recommended elements, contained technical terms (73%), and were not adequate according to experts (51%). Often, brevity was given precedence over content and understandability. Generally, lay titles with acronyms had better ratings in all assessed categories. These results suggest that industry sponsors can do more to create lay titles that better inform patients and healthcare providers. [ABSTRACT FROM AUTHOR]

Advancements in transportation coupled with the growth and movement of human populations enable efficient transport of infectious diseases almost anywhere in the world within 24 hours (1). This recognition has [...]

Overconsumption of fructose, particularly in the form of soft drinks, is increasingly recognized as a public health concern. The acute cardiovascular responses to ingesting fructose have not, however, been well-studied in humans. In this randomized crossover study, we compared cardiovascular autonomic regulation after ingesting water and drinks containing either glucose or fructose in 15 healthy volunteers (aged 21-33 yr). The total volume of each drink was 500 ml, and the sugar content 60 g. For 30 min before and 2 h after each drink, we recorded beat-to-beat heart rate, arterial blood pressure, and cardiac output. Energy expenditure was determined on a minute-by-minute basis. Ingesting the fructose drink significantly increased blood pressure, heart rate, and cardiac output but not total peripheral resistance. Glucose ingestion resulted in a significantly greater increase in cardiac output than fructose but no change in blood pressure and a concomitant decrease in total peripheral resistance. Ingesting glucose and fructose, but not water, significantly increased blood pressure variability and decreased cardiovagal baroreflex sensitivity. Energy expenditure increased by a similar amount after glucose and fructose ingestion, but fructose elicited a significantly greater increase in respiratory quotient. These results show that ingestion of glucose and fructose drinks is characterized by specific hemodynamic responses. In particular, fructose ingestion elicits an increase in blood pressure that is probably mediated by an increase in cardiac output without compensatory peripheral vasodilatation. cardiac output; autonomic nervous system; thermogenesis; heart rate variability

Water drinking activates the autonomic nervous system and induces acute hemodynamic changes. The actual stimulus for these effects is undetermined but might be related to either gastric distension or to osmotic factors. In the present study, we tested whether the cardiovascular responses to water drinking are related to water's relative hypoosmolality. Therefore, we compared the cardiovascular effects of a water drink (7.5 ml/kg body wt) with an identical volume of a physiological (0.9%) saline solution in nine healthy subjects (6 male, 3 female, aged 26 [+ or -] 2 years), while continuously monitoring beat-to-beat blood pressure (finger plethysmography), cardiac intervals (electrocardiography), and cardiac output (thoracic impedance). Total peripheral resistance was calculated as mean blood pressure/cardiac output. Cardiac interval variability (high-frequency power) was assessed by spectral analysis as an index of cardiac vagal tone. Baroreceptor sensitivity was evaluated using the sequence technique. Drinking water, but not saline, decreased heart rate (P = 0.01) and increased total peripheral resistance (P < 0.01), high-frequency cardiac interval variability (P = 0.03), and baroreceptor sensitivity (P = 0.01). Neither water nor saline substantially increased blood pressure. These responses suggest that water drinking simultaneously increases sympathetic vasoconstrictor activity and cardiac vagal tone. That these effects were absent after drinking physiological saline indicate that the cardiovascular responses to water drinking are influenced by its hypoosmotic properties. baroreceptors; blood pressure; cardiac output; heart rate; autonomic nervous system

The effects of physical activity on cerebral blood flow (CBF) and cerebral autoregulation (CA) have not yet been fully evaluated. There is controversy as to whether increasing heart rate (HR), blood pressure (BP), and sympathetic and metabolic activity with altered levels of C[O.sub.2] might compromise CBF and CA. To evaluate these effects, we studied middle cerebral artery blood flow velocity (CBFV) and CA in 40 healthy young adults at rest and during increasing levels of physical exercise. We continuously monitored HR, BP, endexpiratory C[O.sub.2], and CBFV with transcranial Doppler sonography at rest and during stepwise ergometric challenge at 50, 100, and 150 W. The modulation of BP and CBFV in the low-frequency (LF) range (0.04-0.14 Hz) was calculated with an autoregression algorithm. CA was evaluated by calculating the phase shift angle and gain between BP and CBFV oscillations in the LF range. The LF BP-CBFV gain was then normalized by conductance. Cerebrovascular resistance (CVR) was calculated as mean BP adjusted to brain level divided by mean CBFV. HR, BP, C[O.sub.2], and CBFV increased significantly with exercise. Phase shift angle, absolute and normalized LF BP-CBFV gain, and CVR, however, remained stable. Stable phase shift, LF BP-CBFV gain, and CVR demonstrate that progressive physical exercise does not alter CA despite increasing HR, BP, and C[O.sub.2]. CA seems to compensate for the hemodynamic effects and increasing C[O.sub.2] levels during exercise. cross-spectral analysis; low-frequency blood pressure-cerebral blood flow velocity gain; phase shift angle; cerebrovascular resistance

After public notification of confirmed cases of bioterrorism-related anthrax, the Centers for Disease Control and Prevention's Emergency Operations Center responded to 11,063 bioterrorism-related telephone calls from October 8 to November [...]

An increasingly organized and privatized health care system, dominated by large managed care organizations, obscures the role of state public health agencies in preventing clinically important diseases. What makes a […]

Travel health alert notices (T-HANs) have been used since the 1970s by the Centers for Disease Control and Prevention (CDC; Atlanta, GA, USA) as a communication tool for international travelers [...]

Lay summaries of Phase I trials in healthy volunteers pose a challenge because their end - points are complex, the targeted indication may not be known when they are conducted, their results are often reported years after the trial ended, and the majority of substances tested in Phase I never reach the market. Nevertheless, the European Union Clinical Trials Regulation (EU CTR) mandates that lay summaries are to be provided for all clinical trials regardless of clinical phase. As lay summaries are intended to inform the public about the results of clinical studies, they need to be under standable to people without specific knowledge of the disease or the clinical research process. It is challenging to write lay summaries for Phase I trials that are both meaningful for the public and in line with the requirements of the EU CTR. We have developed a template to facilitate writing of lay summaries of Phase I trials in healthy volunteers. Using a template ensures that study designs and endpoints are described in a consistent lay-friendly manner across different types of Phase I trials. [ABSTRACT FROM AUTHOR]

With increasing transparency demands and the new legal requirements for providing clinical trial information to lay readers, clinical trials need to be given titles that patients can understand and recognise. Trial titles inform the readers what the trial is about, what substances are studied, and who the target population is. Devising a lay title is challenging as it needs to be understandable to lay readers, fully identify the trial, meet registry requirements, and also be translatable into different languages. Lay titles also need to fit different types of documents, e.g. trial protocols, trial advertisements, informed consent forms, and lay summaries. As the lay title is one of the first pieces of information that is displayed, good lay titles help patients searching clinical trial registries for trial participation. For sponsors, informative and understandable lay titles increase the chances of attracting the target patient populations for clinical trials. [ABSTRACT FROM AUTHOR]