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Colloid transport through complex and dynamic (i.e. non-steady-state) hydrologic systems is rarely studied, owing to the difficulty of constraining initial and boundary conditions and quantifying colloid-porous media and colloid-colloid interactions in transient flow systems. Here we present a particle tracer experiment conducted on a sloped lysimeter receiving periodic rainfall events for 10 days. Four unique, DNA-labelled particle tracers were injected both in sequence and in parallel, together with a conservative tracer (deuterium), over the course of the first day and allowed to move through the system. Discharge-particle tracer concentration curves and the spatial distribution of particle tracer mass retained in the soil at the end of the experiment were found to be highly dependent on the timing of the tracer injection and the precipitation input and subsequent dynamic response of the water table. Overall, neglecting the total DLT recovery rate, the DLT particle tracer breakthrough trend (DNA-labelled particle tracer 4) was similar to deuterium and decreased over time with the exception of a few peaks later in the experiment. The individual particle tracer breakthrough curves suggest a complex system with different fast transport mechanisms (e.g. capillary barrier and size exclusion effect) and slow retention-release mechanisms (e.g. straining, physical-chemical adsorption), which resulted in particle tracers transferring faster than deuterium in the first 10 h of the experiment but being exceeded by deuterium soon after deuterium started to break through. The experiment not only highlights the interaction of repeated colloidal pollution events in hydrologic systems with different pre-event saturation conditions, but also the benefits of using multiple synchronous or sequential tracer applications to dissect explicit formulations of water flow and colloid transport processes in complex and dynamic hydrological systems. Such explicit process formulations could help improve understanding hydrologically-controlled transport through catchments and the quantitative prediction of these processes with water quality models.

The proper use of species names depends entirely on verifying whether newly analysed specimens are conspecific with the type material. True lemmings (Lemmus) are the most common rodents of the Arctic tundra in the Old and New World and play an important role in the Arctic ecosystem; however, their taxonomy is far from resolved. The Amur lemming (L. amurensis) is the least studied and most enigmatic species of the genus. Its taxonomic position, distribution and nomenclature are uncertain due to a lack of cytogenetic, molecular phylogenetic and hybridization studies. Assignment of all true lemmings from the vast territory of western Beringia to this species has never properly been confirmed. Moreover, the type locality for this species was flooded by a newly created reservoir in 1974, making additional topotypes unavailable. In this context, genetic analysis of museum specimens, especially type material, has great potential. Here we report partial cytochrome b sequences extracted from all specimens identified as L. amurensis stored in the two largest mammal collections in Russian museums, including the holotype of L. amurensis and the type material of all forms currently considered as synonyms of L. amurensis. Phylogenetic analyses suggest that the range of the Amur lemming is dramatically smaller than previously assumed and is limited to the territories of Transbaikalia, South Yakutia and Amur in the eastern Palaearctic. Lemmus taxa from other territories, including L. amurensis ognevi and L. amurensis flavescens, refer to other lemming species. Our results impinge on nomenclature issues, taxonomy, divergence times and the evolutionary history of lemmings in the eastern part of the Palearctic and on the species concept as applied to the genus Lemmus. [ABSTRACT FROM AUTHOR]

Background The Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) clinical trial documented that metformin plus rosiglitazone, but not metformin plus lifestyle intervention, provided superior durability of glycemic control relative to metformin monotherapy. Objectives We examined weight changes among TODAY participants that completed at least 6 months of treatment, evaluated predictors of lifestyle outcome, and examined whether weight changes were related to cardiometabolic outcomes across treatment arms. Methods The 595 youth with type 2 diabetes, (85.1% of randomized participants aged 11-17 years) completed assessments of weight-related and cardiometabolic measures at months 0, 6, 12 and 24. Repeated measures models were used to investigate associations over time. Results Lifestyle intervention did not enhance outcome relative to metformin alone and no predictors of response to lifestyle treatment were identified. However, changes in percent overweight across treatment arms were associated with changes in multiple cardiometabolic risk factors, and decreases of ≥ 7% in overweight were associated with significant benefits over 24 months. Conclusions Although adjunctive intensive lifestyle intervention did not improve weight-related outcomes, weight changes in the full TODAY sample were associated with small, but significant improvements in cardiometabolic status, highlighting the importance of optimizing weight management in youth with T2DM. [ABSTRACT FROM AUTHOR]

Concussions are the most common type of traumatic brain injury. They result from external force to the head that causes a neuro-metabolic cascade to unfold. This can then lead to a variety of symptoms in the domains of physical, cognition, mood, and sleep. Concussions are a clinical diagnosis but it is important to rule out acute intracranial pathology through a detailed history and physical examination in addition to possible head imaging. Treatment should include an individualized approach that focuses on what domains are affected after concussion., Competing Interests: Disclosure No commercial or financial conflicts of interest and no external funding sources., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Measles is a highly contagious viral disease, and hence, sufficient herd immunity is obligatory to prevent infection transmission. Measles is still a cause of considerable disease burden globally, mainly in children. During a national measles outbreak in Israel in 2018-2019, the peak incidence rates occurred in the Jerusalem district. Most measles cases in the Jerusalem district (75.5%, 1702) were observed in children younger than 15 years of age, 49.2% (1109) were in children under 5 years of age, and 18.9% (425) were in infants under 1 year of age. The routine measles vaccination schedule includes two doses at 1 and 6 years of age. Most cases (1828, 81.1%) were unvaccinated (zero measles vaccine doses). These cases comprised the 425 affected infants under 1 year of age, who were ineligible for vaccination, along with the 1403 children over 1 year of age, who were otherwise unvaccinated. This study aimed to describe the epidemiologic and laboratory features of this measles outbreak, and to investigate case ascertainment (laboratory confirmed compared to epidemiologically confirmed cases). The study population included 2254 measles cases notified during the period spanning June 2018 to May 2019 in the Jerusalem district (incidence rate 176 per 10,000 population). Of the 2254 cases, 716 (31.8%) were laboratory confirmed, and 1538 (68.2%) were confirmed as epidemiologically linked. Most laboratory confirmed cases (420, 58.7%) underwent real-time PCR tests. Serological tests (measles IgM and IgG) were used in 189 (26.4%) cases, and a combination of RT-PCR and serology was used in 107 (14.9%) cases. In a multivariate model analysis, the variables significantly associated (after adjustment) with higher odds for laboratory confirmation included month of disease onset (late), additional measles cases in the household (single case), place of medical treatment (hospital; either emergency department, or hospitalization) and vaccination status (at least one prior vaccine dose). The measles outbreak described demonstrates the urgency of addressing vaccination gaps with appropriate outbreak prevention programs. The road to measles elimination needs to be paved with robust public health infrastructure, excellent field epidemiology for outbreak surveillance, investigation, and control, and laboratory proficiency.

Exposed and un-remediated metal(loid)-bearing mine tailings are susceptible to wind and water erosion that disperses toxic elements into the surrounding environment. Compost-assisted phytostabilization has been successfully applied to legacy tailings as an inexpensive, eco-friendly, and sustainable landscape rehabilitation that provides vegetative cover and subsurface scaffolding to inhibit offsite transport of contaminant laden particles. The possibility of augmented metal(loid) mobility from subsurface redox reactions driven by irrigation and organic amendments is known and arsenic (As) is of particular concern because of its high affinity for adsorption to reducible ferric (oxyhydr)oxide surface sites. However, the biogeochemical transformation of As in mine tailings during multiple redox oscillations has not yet been addressed. In the present study, a redox-stat reactor was used to control oscillations between 7 d oxic and 7 d anoxic half-cycles over a three-month period in mine tailings with and without amendment of compost-derived organic matter (OM) solution. Aqueous and solid phase analyses during and after redox oscillations by mass spectrometry and synchrotron X-ray absorption spectroscopy revealed that soluble OM addition stimulated pyrite oxidation, which resulted in accelerated acidification and increased aqueous sulfate activity. Soluble OM in the reactor solution significantly increased mobilization of As under anoxic half-cycles primarily through reductive dissolution of ferrihydrite. Microbially-mediated As reduction was also observed in compost treatments, which increased partitioning to the aqueous phase due to the lower affinity of As(III) for complexation on ferric surface sites, e.g. ferrihydrite. Oxic half-cycles showed As repartitioned to the solid phase concurrent with precipitation of ferrihydrite and jarosite. Multiple redox oscillations increased the crystallinity of Fe minerals in the Treatment reactors with compost solution due to the reductive dissolution of ferrihydrite and precipitation of jarosite. The release of As from tailings gradually decreased after repeated redox oscillations. The high sulfate, ferrous iron, and hydronium activity promoted the precipitation of jarosite, which sequestered arsenic. Our results indicated that redox oscillations under compost-assisted phytostabilization can promote As release that diminishes over time, which should inform remediation assessment and environmental risk assessment of mine site compost-assisted phytostabilization., Competing Interests: Declaration of interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Despite being a vaccine-preventable disease for decades, pertussis control is still a public health challenge. A pertussis outbreak emerged in Jerusalem ( n  = 257 cases, January to June 2023). Most cases were young children (median age 1.5 years), and 100 were infants under 1 year. The hospitalisation rate of infants was 24%, which was considerably higher than that of cases aged 1 year and above (3.8%). There was one fatality in an unvaccinated, 10-week-old infant whose mother had not received pertussis vaccination during pregnancy. Most children were unvaccinated and resided in Jewish ultra-orthodox neighbourhoods in Jerusalem district. An intervention programme and vaccination campaign are ongoing.

Invasive meningococcal disease (IMD) is a devastating disease with significant mortality and long-term morbidity. The COVID-19 pandemic and containment measures have affected the epidemiology of infectious pathogens. This study's aim was to assess IMD trends in Israel prior to and during the COVID-19 pandemic. The Neisseria meningitidis invasive infection is a notifiable disease in Israel. Laboratory analysis includes serogrouping and molecular characterization. The overall national IMD incidence rate (1998-2022) was 0.8/100,000 population. The IMD incidence rates declined during the pandemic years (0.3/100,000 in 2020-2022 vs. 0.9/100,000 in 1998-2019). The number of notified IMD cases declined by 65% in 2020-2022. The case fatality rate among laboratory-confirmed IMD cases was 9% (47/521, 2007-2022). Mortality risk markers included cases' age (older) and socio-economic status (lower). Overall, most Neisseria meningitidis isolates were of serogroup B (62.6%), and the most prevalent clonal complex (CC) was CC32 (24.2%). Serogroup B prevailed in cases aged 0-9 years (74.5%) and less in cases aged 10 years and above (39%). Neisseria meningitidis serogroups and CC distribution altered recently with a decline in serogroup B fraction, an increase in serogroup Y, and a decline in CC32. Ongoing IMD surveillance is necessary to assess trends in circulating strains and support decision-making on meningococcal vaccination programs.

Background: SARS-CoV-2 clinical presentation is associated with the patients' age group. Overall, young individuals present higher proportions of asymptomatic or mild COVID-19 infection, compared to adults. Data on secondary COVID-19 transmission in households, according to the cases' age group, are accumulating., Methods: We performed a follow-up cohort study including all COVID-19 real-time polymerase chain reaction (RT-PCR)-confirmed cases (adolescent students and school staff) diagnosed in an epidemiological investigation of a large high school outbreak. We compared the adolescent and adult groups regarding clinical symptoms, time to negative COVID-19 RT-PCR tests, and infection transmission in households., Results: The study population included 817 persons. The confirmed COVID-19 RT-PCR outbreak cases ( n  = 178) were followed (students aged 12-19 years, median age 14 years, n  = 153, school staff aged 24-67 years, median age 39 years, n  = 25) and the cases' household close contacts ( n  = 639) were tested. The adolescents had lower symptomatic infection rates, shorter time to negative COVID-19 RT-PCR tests, and lower transmission rates to household members, compared to the adults. The general transmission rate among household contacts was 13.5%, (86/639) ranging from 8.6% in asymptomatic students' contacts to 27.3% in symptomatic staff contacts. COVID-19 transmission rates were significantly higher in contacts of symptomatic cases compared to asymptomatic cases (odds ratio: 2.06, 95% CI 1.26-3.4) and higher in adults compared to adolescents (odds ratio: 2.69, 95% CI 1.43-4.89)., Conclusions: Adolescents and adults diagnosed in an outbreak investigation differ as to COVID-19 clinical presentation and transmission. As adolescents may show mild or no symptoms, COVID-19 prevention in school settings is challenging. Implementing nonpharmaceutical measures and promoting vaccination programs in eligible staff and students should be considered., (© 2023 The Author(s).)

In this paper, we report the complete mitochondrial genome of the northern smooth-tailed treeshrew Dendrogale murina , which was sequenced for the first time using the Illumina next-generation sequencing (NGS) technology. The total length of the mitochondrial genome is 16,844-16,850 bp and encodes 37 genes, including two ribosomal RNAs (rRNAs) 12S and 16S , 22 transfer RNAs (tRNAs), 13 protein-coding genes (PCGs), and a D-loop in the characteristic arrangement of family Tupaiidae (Mammalia: Scandentia). The overall base composition of the complete mitochondrial DNA is A (33.5%), C (25.5%), G (13.9%), and T (27.1%). Phylogenetic analysis of Scandentia mitochondrial genomes showed a classic pattern, which was revealed previously while using individual phylogenetic markers. The result of the current study is consistent with one based on the latest morphological studies, with the basal position of Ptilocercus and Dendrogale sister to the rest of the Tupaiidae genera. The divergence time of the Dendrogale genus is estimated as Eocene-Oligocene, with the mean value of 35.8 MYA, and the Ptilocercus genus probably separated at about 46.3 MYA. We observe an increase in the age of all nodes within the Scandentia, except for a decrease in the age of separation of Ptilocercus. This result can be explained both by the addition of new mitochondrial genome data in the analysis and the usage of new calibration points from recently published data.

This study evaluates signatures of selection in the evolution of the mitochondrial DNA of voles, subfamily Arvicolinae, during the colonization of subterranean environments. The comparative sequence analysis of mitochondrial protein-coding genes of eight subterranean vole species ( Prometheomys schaposchnikowi , three species of the genus Ellobius : Ellobius talpinus , Ellobius fuscocapillus and Ellobius lutescens , two species of the genus Terricola : Terricola subterraneus and Terricola daghestanicus , Lasiopodomys mandarinus, and Hyperacrius fertilis ) and their closest aboveground relatives was applied using codon-substitution models. The highest number of selection signatures was detected in genes ATP8 and CYTB. The relaxation of selection was observed in most mitochondrial DNA protein-coding genes for subterranean species. The largest amount of relaxed genes is discovered in mole voles (genus Ellobius ). The number of selection signatures was found to be independent of the evolutionary age of the lineage but fits the degree of specialization to the subterranean niche. The common trends of selective pressures were observed among the evolutionary ancient and highly specialized subterranean rodent families and phylogenetically young lineages of voles. It suggests that the signatures of adaptation in individual mitochondrial protein-coding genes associated with the colonization of the subterranean niche may appear within a rather short evolutionary timespan.

Microbial communities in incipient soil systems serve as the only biotic force shaping landscape evolution. However, the underlying ecological forces shaping microbial community structure and function are inadequately understood. We used amplicon sequencing to determine microbial taxonomic assembly and metagenome sequencing to evaluate microbial functional assembly in incipient basaltic soil subjected to precipitation. Community composition was stratified with soil depth in the pre-precipitation samples, with surficial communities maintaining their distinct structure and diversity after precipitation, while the deeper soil samples appeared to become more uniform. The structural community assembly remained deterministic in pre- and post-precipitation periods, with homogenous selection being dominant. Metagenome analysis revealed that carbon and nitrogen functional potential was assembled stochastically. Sub-populations putatively involved in the nitrogen cycle and carbon fixation experienced counteracting assembly pressures at the deepest depths, suggesting the communities may functionally assemble to respond to short-term environmental fluctuations and impact the landscape-scale response to perturbations. We propose that contrasting assembly forces impact microbial structure and potential function in an incipient landscape; in situ landscape characteristics (here homogenous parent material) drive community structure assembly, while short-term environmental fluctuations (here precipitation) shape environmental variations that are random in the soil depth profile and drive stochastic sub-population functional dynamics., Competing Interests: TV is currently employed by Accenture GmbH. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Sengupta, Volkmann, Danczak, Stegen, Dontsova, Abramson, Bugaj, Volk, Matos, Meira-Neto, Barberán, Neilson, Maier, Chorover, Troch and Meredith.)

Background: Opioid use experiences among people with disability (PWD) as a group has not been clearly articulated in the current literature, despite links between pain and measures of disability., Objective: To conduct a systematic search and scoping study examining the characteristics of current literature focused on opioid use among PWD., Methods: Four databases were queried (i.e., Medline, PsycINFO, Embase, and CINAHL) for peer-reviewed, empirical, English-language, journal articles focused on long-term opioid use among PWD. Collected data points included: disability details (specific condition, onset of disability), opioid details (category of opioid use, and specified substance), study details, and design., Results: A total of 196 articles were included, with 83.7% published since 2000 largely from the US. The majority of articles (70.4%) focused on the use of opioids as medical treatment, with fewer articles focusing on recreational opioid use or substance use disorders. The majority of included sources (73%) focused on opioid use in acquired conditions; neuropathic pain (21.9%) and attention deficit hyperactivity disorder (20.4%) were the most commonly studied. Differences were observed in the distribution of disability conditions across category of opioid use and study design classification; 73.5% were considered observational in design., Conclusions: The varied representation of disability conditions, and differences across opioid use category and study design classification point to a complicated relationship between opioid use and disability. The present research portfolio would benefit from research matching informational needs of a specific disability area or opioid use category to provide the evidence necessary to advance current knowledge and promote inclusion in national agendas., Competing Interests: Conflicts of interest The authors have no conflicts of interest to report., (Published by Elsevier Inc.)

Measles is a highly contagious disease. A 24 years old patient, recently exposed to measles (unvaccinated), presented in the emergency department with severe agitation, compatible with an acute psychotic episode, during the measles epidemic which spread in Israel in 2018-2019. Upon hospital admission, strict isolation was instructed, yet, without compliance, probably due to the patient's status. Measles diagnosis was promptly confirmed. As measles transmission was eminent, public health measures were employed through immediate implementation of the section 15 of the Public Health Ordinance, allowing for compulsory short-term isolation. The patient's condition improved within a few days and the measures were no longer necessary. This measles case occurred in the pre-Coronavirus disease 2019 (COVID-19) epidemic when use of a Public Health Ordinance was considered an extreme measure. This is in contrast to the current global use of Public Health laws to enforce strict quarantine and isolation on persons infected or potentially exposed to COVID-19. Nevertheless, minimizing infectious diseases transmission is a core function of public health law. Utilizing legal enforcement in circumstances of immediate public health hazard, such as nosocomial measles transmission, necessitates careful consideration. The integrative clinical and public health approach and prompt measures employed in this exceptional case, led to prevention of further infection spread.

Land-atmosphere interactions at different temporal and spatial scales are important for our understanding of the Earth system and its modeling. The Landscape Evolution Observatory (LEO) at Biosphere 2, managed by the University of Arizona, hosts three nearly identical artificial bare-soil hillslopes with dimensions of 11 × 30 m 2 (1 m depth) in a controlled and highly monitored environment within three large greenhouses. These facilities provide a unique opportunity to explore these interactions. The dataset presented here is a subset of the measurements in each LEO's hillslopes, from 1 July 2015 to 30 June 2019 every 15 minutes, consisting of temperature, water content and heat flux of the soil (at 5 cm depth) for 12 co-located points; temperature, relative humidity and wind speed above ground at 5 locations and 5 different heights ranging from 0.25 m to 9-10 m; 3D wind at 1 location; the four components of radiation at 2 locations; spatially aggregated precipitation rates, total subsurface discharge, and relative water storage; and the measurements from a weather station outside the greenhouses.

Objectives: Polycystic ovary syndrome (PCOS) is a common reproductive/metabolic condition associated with obesity, type 2 diabetes (T2D) and depression in adult women. Depression in adults is related to PCOS dermatologic manifestations. Adolescents with obesity with or without T2D have elevated depression symptoms, but data from youth with PCOS and obesity with/without T2D are limited., Methods: Our study included girls, aged 11 to 17 years, with obesity and PCOS, PCOS+T2D or T2D, who were newly seen in an obesity complications clinic after March 2016. All participants had Center for Epidemiologic Studies-Depression (CES-D, 20 items) scores obtained within 6 months of PCOS or T2D diagnosis. Data on history of psychiatric diagnosis and treatment, metabolic syndrome and severity of acne and hirsutism were collected through chart review., Results: One hundred five girls (47 with PCOS, 14 with PCOS+T2D, 44 with T2D) had similar age (15±1.8 years) and body mass index z scores (2.2±0.4). CES-D scores ≥16, indicating elevated depression symptoms, and CES-D scores ≥24, indicating severe depression symptoms, were observed in 60% and 30% of girls with PCOS, 78% and 71% of those with PCOS+T2D and 39% and 21% of those with T2D, respectively (p<0.0001 for both cutpoints). A higher CES-D score was not associated with severity of hirsutism or acne (p>0.05 for both)., Conclusions: Adolescents with PCOS and obesity have higher rates of elevated depression symptoms compared with girls with T2D, which is not related to worse dermatologic symptoms. Because depression may impact both PCOS and T2D management and adherence to therapy, greater efforts should be made to screen for and address mental health in adolescents with PCOS and obesity, especially if T2D is present., (Copyright © 2020 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)

On 13 March 2020, Israel's government declared closure of all schools. Schools fully reopened on 17 May 2020. Ten days later, a major outbreak of coronavirus disease (COVID-19) occurred in a high school. The first case was registered on 26 May, the second on 27 May. They were not epidemiologically linked. Testing of the complete school community revealed 153 students (attack rate: 13.2%) and 25 staff members (attack rate: 16.6%) who were COVID-19 positive.

Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Automated closed loop systems will greatly change type 1 diabetes management; user trust will be essential for acceptance of this new technology. This qualitative study explored trust in 32 individuals following a hybrid closed loop trial. Participants described how context-, system-, and person-level factors influenced their trust in the system. Participants attempted to override the system when they lacked trust, while trusting the system decreased self-management burdens and decreased stress. Findings highlight considerations for fostering trust in closed loop systems. Systems may be able to engage users by offering varying levels of controls to match trust preferences.

Background: Individual health behaviors (ie, eating habits and sedentary lifestyle) are associated with type 2 diabetes (T2D). Health behavior profiles specific to adolescents with T2D have not been described., Objective: To identify health behavior profiles in adolescents with T2D and examine how these profiles change over time., Methods: Diet (via food frequency questionnaire) and activity behaviors (via 3-day physical activity recall) examined at baseline, 6 months, and 24 months from participants in the the Treatment Options for T2D in Adolescents and Youth (TODAY) study were used for this analysis. Latent profile analysis identified profiles of health behaviors within three time points, and latent transition probabilities were estimated to examine the change from baseline to 6 months (n = 450) and baseline to 24 months (n = 415). Multinomial logistic regressions were used to examine if the assigned TODAY treatment group (Metformin [Met], Met + Rosiglitazone [Rosi], or Met + Lifestyle) predicted change in health behavior profiles., Results: Three profiles emerged: "most sedentary," "healthy eaters," and "active and eat most." At 6 months, 50% of males and 29% of females in the Met + Lifestyle treatment group improved in their health behavior profile. Among males only, the Met + Lifestyle treatment group were more likely to improve their profiles from baseline to 6 months (P = .01)., Conclusions: Three health behavior profiles emerged and shifted over time. A high quality, lifestyle intervention had little effect on improving health behavior profiles. Optimizing outcomes in youth with T2D might require more robust and multifaceted interventions beyond family-level lifestyle, including more extensive psychosocial intervention, novel medication regimen, or bariatric surgery., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Measles epidemics are still a public health challenge worldwide, necessitating a rapid response. The Jerusalem District Health Office applied a community-oriented intervention during the 2018-2019 epidemic (2150 notified cases). Program development targeted the socioeconomic and cultural characteristics of high-incidence Jewish ultraorthodox communities. Health care and community collaboration led to coverage rates of measles vaccination increasing from 80% to 95% within three months and a significant decline in incidence. Epidemic preparedness calls for maintaining the infrastructure of countermeasures combined with sustaining immunization coverage.

Objective: To determine whether self-monitoring of blood glucose (SMBG) is associated with lower HbA 1c in youth with type 2 diabetes taking oral medications only or after starting insulin for persistently elevated HbA 1c ., Research Design and Methods: Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study participants ( n = 699) taking oral medications were asked to perform SMBG twice daily. After reaching primary outcome (PO) (HbA 1c ≥8% [64 mmol/mol]) over 6 months or an inability to wean from temporary insulin because of metabolic decompensation), insulin glargine was started. HbA 1c and percent of SMBG (SMBG%) (percent days when the meter was used one or more times) before and after PO were analyzed., Results: SMBG declined over time and was inversely related to HbA 1c ( P < 0.0001). Of 298 youth who reached PO and started insulin, 282 had SMBG data. At PO, mean ± SD age was 15.8 ± 2.3 years, BMI 35.5 ± 7.9 kg/m 2 , and HbA 1c 9.6 ± 2.0% (81 ± 21.9 mmol/mol); 65.3% were female. Median SMBG% was 40% at PO, which increased to 49% after 6 months and fell to 41% after 1 year on insulin. At PO, 22% of youth checked ≥80% of days, which increased to 25% and fell to 19% after 6 and 12 months using insulin, respectively. At PO, compared with those who checked <80%, youth who checked ≥80% were younger and with a lower BMI, HbA 1c , and blood pressure. SMBG ≥80% was associated with ≥1% reduction in HbA 1c at 6 and 12 months after insulin initiation., Conclusions: Low SMBG adherence was common and associated with higher HbA 1c . Optimal SMBG frequency in youth using or not using insulin, and whether less frequent SMBG is a marker for overall worse self-care, require further study., (© 2019 by the American Diabetes Association.)

Background and Aims: Neisseria meningitidis (N. meningitidis) is a Gram-negative bacterium that can cause life-threatening invasive infections referred to as invasive meningococcal disease (IMD). In the last decade the incidence of IMD in Israel is about 1/100,000 population annually. We aimed to describe the epidemiology of IMD in Israel combining epidemiological data and characterization of N. meningitidis isolates., Methods: Invasive infection caused by N. meningitidis is a notifiable disease in Israel. Data were collected by epidemiological investigations and control measures were employed. Laboratory work-up included serogrouping, N. meningitides molecular characterization and whole-genome sequencing., Results: During 1998-2017, 1349 cases of IMD were notified in Israel (mean annual incidence rate 0.94/100,000). The peak incidence rates were observed in infants under 1 year of age (10.9/100,000). Case fatality rate was 9.7%. The majority of the N. meningitidis isolates were of serogroup B (67.9%). During 2007-2017, three clonal complexes (CC) 32, 41/44 and 23 (hyper-invasive clonal complexes) were the leading CC (61%). CC32 was the leading CC causing meningococcemia and mortality. In 2017, 35 isolates were tested for 4CMenB antigens variants; of the serogroup B isolates tested 46.7% showed a match to one or more antigens (fHbp or PorA:VR1), most were ST32 (CC32)., Conclusions: Preliminary analysis based on limited number of samples suggests that the 4CMenB coverage would be about half the strains; further research is necessary. Integration of clinical, epidemiological and laboratory data is essential to support decision-making on the introduction of the novel MENB vaccines in Israel.

Background: Hybrid closed loop (HCL) systems are designed to automate insulin delivery to improve type 1 diabetes (T1D) outcomes and reduce user burden and distress. Because the systems only automate some aspects of diabetes care, psychosocial and human factors remain an important consideration in their use. Thus, we examined whether psychosocial and human factors (i.e., distress related to diabetes management, fear of hypoglycemia, and technology attitudes) would (1) change after using the system and (2) predict glycemic outcomes during the trial., Subjects and Methods: Fourteen adults and 15 adolescents with T1D participated in a multisite clinical trial of an investigational version of the MiniMed™ 670G system (Medtronic, Northridge, CA) over 4 to 5 days in a semisupervised outpatient setting. Users completed surveys assessing psychosocial and human factors before beginning the HCL system and at the conclusion of the study. t-Tests and regression analyses were conducted to examine whether these factors changed following trial exposure to the HCL system and predicted glycemic outcomes during the trial., Results: Diabetes management distress decreased and diabetes technology attitudes became more positive over the trial period. Fear of hypoglycemia did not change over the trial period. There was a trend toward greater pretrial management distress predicting less time in range during the trial, controlling for time in range before the trial., Conclusions: Results suggest that this system is promising for enhancing technology attitudes and reducing management distress. Psychosocial factors, such as management distress, may negatively impact glycemic outcomes and should be a priority area for further investigation.