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Persons with HIV (PWH) are at increased risk for bacterial infections, and previous publications document an increased risk for invasive meningococcal disease (IMD) in particular. This analysis provides evidence that PWH face a 6-fold increase in risk for IMD based on Active Bacterial Core surveillance data collected during 2009-2019.

Measuring river response to dam removal affords a rare, important opportunity to study fluvial response to sediment pulses on a large field scale. We present a before–after/control–impact study of the Carmel River, California, measuring fluvial geomorphic and grain-size evolution over 8 years, six of which postdated removal of a 32 m-high dam (one of the largest dams removed worldwide) and included 11 flow events exceeding the 2-year flood magnitude. We find that the reservoir-sediment pulse following dam removal was relatively small (97 000 ± 24 000 t over 4 years), owing to deliberate reservoir-sediment stabilization. Scaled to the size of the Carmel River watershed and compared against long-term bedrock denudation rates, the post-dam-removal sediment release was slightly less than the annualized long-term sediment export from this basin. New sediment transited >30 km to the river mouth in less than 2 years, assisted by floods 2 and 4 years after dam removal. The sediment pulse fined the downstream riverbed while causing mostly low-magnitude bed-elevation changes: commonly 0.5 to 1 m or smaller, occurring as discontinuous sediment patches or interstitial deposits, aside from the filling and subsequent partial scour of deep pools. There was no major geomorphic reset downstream from the dam site. Geomorphic changes were driven almost entirely by flow rather than by the modest increase in sediment supply, in contrast to recent examples from other large dam removals. The relatively minor disturbance caused by dam removal on the Carmel River is likely analogous to many future dam removals: a relatively small sediment pulse after deliberate limitation of reservoir-sediment erosion, and with an upstream dam remaining in place. Thus, a large dam removal need not lead to major downstream impacts.

BACKGROUND: Nontypeable Haemophilus influenzae (NTHi) is the most common cause of invasive H. influenzae disease in the United States (US). We evaluated the epidemiology of invasive NTHi disease in the US, including among pregnant women, infants, and people with human immunodeficiency virus (PWH). METHODS: We used data from population- and laboratory-based surveillance for invasive H. influenzae disease conducted in 10 sites to estimate national incidence of NTHi, and to describe epidemiology in women of childbearing age, infants aged ≤30 days (neonates), and PWH living in the surveillance catchment areas. H. influenzae isolates were sent to the Centers for Disease Control and Prevention for species confirmation, serotyping, and whole genome sequencing of select isolates. RESULTS: During 2008-⁠2019, average annual NTHi incidence in the US was 1.3/100 000 population overall, 5.8/100 000 among children aged

BACKGROUND: Descriptions of changes in invasive bacterial disease (IBD) epidemiology during the coronavirus disease 2019 (COVID-19) pandemic in the United States are limited. METHODS: We investigated changes in the incidence of IBD due to Streptococcus pneumoniae, Haemophilus influenzae, group A Streptococcus (GAS), and group B Streptococcus (GBS). We defined the COVID-19 pandemic period as 1 March to 31 December 2020. We compared observed IBD incidences during the pandemic to expected incidences, consistent with January 2014 to February 2020 trends. We conducted secondary analysis of a health care database to assess changes in testing by blood and cerebrospinal fluid (CSF) culture during the pandemic. RESULTS: Compared with expected incidences, the observed incidences of IBD due to S. pneumoniae, H. influenzae, GAS, and GBS were 58%, 60%, 28%, and 12% lower during the pandemic period of 2020, respectively. Declines from expected incidences corresponded closely with implementation of COVID-19-associated nonpharmaceutical interventions (NPIs). Significant declines were observed across all age and race groups, and surveillance sites for S. pneumoniae and H. influenzae. Blood and CSF culture testing rates during the pandemic were comparable to previous years. CONCLUSIONS: NPIs likely contributed to the decline in IBD incidence in the United States in 2020; observed declines were unlikely to be driven by reductions in testing.

Haemophilus influenzae (Hi) can cause meningitis and other serious invasive disease. Encapsulated Hi is classified into six serotypes (a-f) based on chemical composition of the polysaccharide capsule; unencapsulated strains are termed nontypeable Hi (NTHi). Hi serotype b (Hib) was the most common cause of bacterial meningitis in children in the pre-Hib vaccine era, and secondary transmission of Hi among children (e.g., to household contacts and in child care facilities) (1,2) led to the Advisory Committee on Immunization Practices (ACIP) recommendation for antibiotic chemoprophylaxis to prevent Hib disease in certain circumstances.* High Hib vaccination coverage since the 1990s has substantially reduced Hib disease, and other serotypes now account for most Hi-associated invasive disease in the United States (3). Nevertheless, CDC does not currently recommend chemoprophylaxis for contacts of persons with invasive disease caused by serotypes other than Hib and by NTHi (non-b Hi). Given this changing epidemiology, U.S. surveillance data were reviewed to investigate secondary cases of invasive disease caused by Hi. The estimated prevalence of secondary transmission was 0.32% among persons with encapsulated Hi disease (≤60 days of one another) and 0.12% among persons with NTHi disease (≤14 days of one another). Isolates from all Hi case pairs were genetically closely related, and all patients with potential secondary infection had underlying medical conditions. These results strongly suggest that secondary transmission of non-b Hi occurs. Expansion of Hi chemoprophylaxis recommendations might be warranted to control invasive Hi disease in certain populations in the United States, but further analysis is needed to evaluate the potential benefits against the risks, such as increased antibiotic use.

BackgroundPeople with HIV (PWH) are at increased risk for invasive pneumococcal disease (IPD). Thirteen-valent pneumococcal conjugate vaccine (PCV13) was recommended for use in US children in 2010 and for PWH aged 19 years or older in 2012. We evaluated the population-level impact of PCV13 on IPD among PWH and non-PWH aged 19 years or older.MethodsWe identified IPD cases from 2008 to 2018 through the Active Bacterial Core surveillance platform. We estimated IPD incidence using the National HIV Surveillance System and US Census Bureau data. We measured percent changes in IPD incidence from 2008 to 2009 to 2017-2018 by HIV status, age group, and vaccine serotype group, including serotypes in recently licensed 15-valent (PCV15) and 20-valent (PCV20) PCVs.ResultsIn 2008-2009 and 2017-2018, 8.4% (552/6548) and 8.0% (416/5169) of adult IPD cases were among PWH, respectively. Compared with non-PWH, a larger proportion of IPD cases among PWH were in adults aged 19-64 years (94.7%-97.4% vs. 56.0%-60.1%) and non-Hispanic Black people (62.5%-73.0% vs. 16.7%-19.2%). Overall and PCV13-type IPD incidence in PWH declined by 40.3% (95% confidence interval: -47.7 to -32.3) and 72.5% (95% confidence interval: -78.8 to -65.6), respectively. In 2017-2018, IPD incidence was 16.8 (overall) and 12.6 (PCV13 type) times higher in PWH compared with non-PWH; PCV13, PCV15/non-PCV13, and PCV20/non-PCV15 serotypes comprised 21.5%, 11.2%, and 16.5% of IPD in PWH, respectively.ConclusionsDespite reductions post-PCV13 introduction, IPD incidence among PWH remained substantially higher than among non-PWH. Higher-valent PCVs provide opportunities to reduce remaining IPD burden in PWH.

Abstract: Historically, anadromous steelhead Oncorhynchus mykiss and spring‐run Chinook Salmon O. tshawytscha used high‐elevation rivers in the Sierra Nevada of California but were extirpated in the 20th century by construction of impassable dams. Plans to reintroduce the fish by opening migratory passage across the dams and reservoirs can only succeed if upstream habitats have the capacity to support viable populations of each species. To estimate capacity in the Tuolumne and Merced rivers of the central Sierra Nevada, we used a high‐resolution approach based on remote sensing and dynamic habitat modeling. Our results suggested that for both species in both systems, sediment grain sizes would support widespread spawning and the water temperatures, depths, and velocities would generate ample capacity for fry and juveniles. However, the unregulated Merced River was consistently too warm for adult Chinook Salmon to hold in the dry season prior to spawning, while the regulated Tuolumne River maintained a cooler, more stable thermal regime with a capacity for thousands of holding adults. In our high‐resolution approach, we also discovered several specific physical controls on life history expression, including thermal constraints on the timing of spawning, hydraulic prompts for downstream migration of fry, divergence of the hydraulic niches of steelhead and Chinook Salmon, and a key but uncertain role for thermal tolerance in adult Chinook Salmon. Our results suggested that steelhead reintroduction could succeed in either system and Chinook Salmon could succeed in the Tuolumne River if passage strategies account for large numbers of migrant fry and juveniles driven downstream by winter storms and snowmelt. The Merced River appeared too warm for adult Chinook Salmon, which raises questions about the current limited understanding of thermal tolerance in holding adults. Our study shows how a high‐resolution approach can provide valuable insights on specific limiting factors that must be addressed for reintroduction to succeed.

Recovery of anadromous salmonid populations is complicated by their complex life histories. We examined the spatiotemporal interplay of stream temperature, geomorphic features, and a species' thermal sensitivity mediated by biological interactions in a case study of steelhead trout (Oncorhynchus mykiss) and Chinook salmon (Oncorhynchus tshawytscha) in California's Eel River watershed. We estimated habitat suitability and fish capacity for each salmonid run and freshwater life stage during average, cool, and warm years in each of the watershed's subbasins, including a historically occupied highelevation subbasin upstream of an impassable dam. Our estimates varied depending on whether we accounted for exposure to the Sacramento pikeminnow (Ptychocheilus grandis), an introduced predator and competitor. Our results indicate that the dammed subbasin has substantial salmonid capacity relative to the rest of the watershed and could provide an important cool-water refuge during warm years and from pikeminnow, potentially improving the productivity and resilience of multiple anadromous salmonid populations. Our approach can be applied in any setting where spatially explicit habitat metrics can be estimated and population-specific and life-stage-specific habitat criteria can be specified. La complexite des cycles biologiques des salmonides anadromes complique le retablissement de leurs populations. Nous examinons l'interaction spatiotemporelle de la temperature du cours d'eau, d'elements geomorphologiques et de la sensibilite thermique des especes modulee par les interactions biologiques dans une etude de cas de la truite arc-en-ciel anadrome (Oncorhynchus mykiss) et du saumon chinook (Oncorhynchus tshawytscha) dans le bassin versant de la riviere Eel, en Californie. Nous estimons la qualite des habitats et la capacite de charge de poissons pour les differentes etapes de migration et de vie en eau douce de ces salmonides durant des annees moyennes, froides et chaudes dans chacun des sous-bassins du bassin versant, dont un sous-bassin de haute altitude occupe par le passe situe en amont d'un barrage infranchissable. Nos estimations varient selon que nous tenons compte ou non de l'exposition a la sauvagesse du Sacramento (Ptychocheilus grandis), un predateur et concurrent introduit. Nos resultats indiquent que le sous-bassin endigue presente une capacite de charge de salmonides considerable comparativement au reste du bassin versant et pourrait offrir un important refuge d'eau froide durant des annees chaudes et contre la sauvagesse, ameliorant potentiellement la productivite et la resilience de plusieurs populations de salmonides anadromes. Notre approche peut s'appliquer a tout contexte oU des parametres spatialement explicites de l'habitat peuvent etre estimes et des criteres relatifs a l'habitat peuvent etre specifies pour des populations et etapes du cycle biologique precises. [Traduit par la Redaction], Introduction Recovery of anadromous salmonid populations is complicated by the fact that these fish have complex life histories, exposing them to a variety of climatic, physical, and biological impacts throughout [...]

Abstract: Large‐scale river restoration programs have emerged recently as a tool for improving spawning habitat for native salmonids in highly altered river ecosystems. Few studies have quantified the extent to which restored habitat is utilized by salmonids, which habitat features influence redd site selection, or the persistence of restored habitat over time. We investigated fall‐run Chinook salmon spawning site utilization and measured and modeled corresponding habitat characteristics in two restored reaches: a reach of channel and floodplain enhancement completed in 2013 and a reconfigured channel and floodplain constructed in 2002. Redd surveys demonstrated that both restoration projects supported a high density of salmon redds, 3 and 14 years following restoration. Salmon redds were constructed in coarse gravel substrates located in areas of high sediment mobility, as determined by measurements of gravel friction angles and a grain entrainment model. Salmon redds were located near transitions between pool‐riffle bedforms in regions of high predicted hyporheic flows. Habitat quality (quantified as a function of stream hydraulics) and hyporheic flow were both strong predictors of redd occurrence, though the relative roles of these variables differed between sites. Our findings indicate that physical controls on redd site selection in restored channels were similar to those reported for natural channels elsewhere. Our results further highlight that in addition to traditional habitat criteria (e.g., water depth, velocity, and substrate size), quantifying sediment texture and mobility, as well as intragravel flow, provides a more complete understanding of the ecological benefits provided by river restoration projects.

Abstract: Dam removal provides a valuable opportunity to measure the fluvial response to changes in both sediment supply and the processes that shape channel morphology. We present the first study of river response to the removal of a large (32‐m‐high) dam in a Mediterranean hydroclimatic setting, on the Carmel River, coastal California, USA. This before‐after/control‐impact study measured changes in channel topography, grain size, and salmonid spawning habitat throughout dam removal and subsequent major floods. During dam removal, the river course was re‐routed in order to leave most of the impounded sediment sequestered in the former reservoir and thus prevent major channel and floodplain aggradation downstream. However, a substantial sediment pulse occurred in response to base‐level fall, knickpoint migration, and channel avulsion through sediment in the former reservoir above the newly re‐routed channel. The sediment pulse advanced ~3.5 km in the first wet season after dam removal, resulting in decreased riverbed grain size downstream of the dam site. In the second wet season after dam removal, high flows (including a 30‐year flood and two 10‐year floods) transported sediment > 30 km downstream, filling pools and reducing cross‐channel relief. Deposition of gravel in the second wet season after dam removal enhanced salmonid spawning habitat downstream of the dam site. We infer that in dam removals where most reservoir sediment remains impounded and where high flows follow soon after dam removal, flow sequencing becomes a more important driver of geomorphic and fish‐habitat change than the dam removal alone. © 2018 John Wiley & Sons, Ltd.

Introduction Acute large vessel occlusion (LVO) can be secondary to thromboembolism or intracranial atherosclerotic disease (ICAD). Data on LVO management due to underlying ICAD are scarce. We hypothesized that patients with ICAD have worse clinical outcomes following mechanical thrombectomy (MT) than those without ICAD. Methods We performed a retrospective analysis of consecutive patients who underwent MT for LVO in a large academic comprehensive stroke center between January 14, 2018 and October 24, 2021. Presence of ICAD at LVO site was determined by the interventionalist. We compared in‐hospital mortality, 90‐day mortality, and 90‐day modified Rankin Scale (mRS) scores between those with and without ICAD, in unadjusted and adjusting logistic regression models. Results Among 215 patients (mean age 67.1±16.0 years; 60.5% female; 80.5% Black, median NIHSS score 16), ICAD was present in 38 patients (17.7%). Diabetes and dyslipidemia were more common in those with ICAD (57.9% vs. 38.4%, p = 0.027 and 29.0% vs. 14.7%, p = 0.035, respectively). Substantial reperfusion (TICI ≥ 2b) was achieved less often (84.2% vs. 94.4%, p = 0.031) but symptomatic ICH was also less common in ICAD patients (0% vs. 9.0%, p = 0.054). In‐hospital and 90‐day mortality were more common (36.8% vs. 15.8%, p = 0.003 and 52.6% vs. 26.6%, p = 0.002, respectively) and favorable functional outcome (mRS 0–2) at 90 days was less common (7.9% vs. 33.9%, p = 0.001) in ICAD patients. After adjusting for prognostic variables, ICAD was independently associated with in‐hospital mortality (OR = 4.1, 95% CI 1.7‐9.7), 90‐day mortality (OR = 3.7, 95% CI 1.6‐8.6), and poor functional outcome at 90 days (OR = 5.5, 95% CI 1.6‐19.4). Conclusions Symptomatic ICAD in a predominantly African American cohort is associated with increased odds of mortality and poor functional outcome at 90 days in patients with LVO undergoing MT. Further research is warranted to understand factors associated with worse outcomes and investigate alternative interventional approaches and medical management in this high‐risk population.

Escherichia coli multi-locus sequence type ST131 is a globally distributed pandemic lineage that causes multidrug-resistant extra-intestinal infections. ST131 E. coli frequently produce extended-spectrum β-lactamases (ESBLs), which confer resistance to many β-lactam antibiotics and make infections difficult to treat. We sequenced the genomes of 154 ESBL-producing E. coli clinical isolates belonging to the ST131 lineage from patients at the University of Pittsburgh Medical Center (UPMC) between 2004 and 2018. Isolates belonged to the well described ST131 clades A (8%), B (3%), and C (89%). Time-dated phylogenetic analysis estimated that the most recent common ancestor (MRCA) for all clade C isolates emerged around 1989, consistent with previous studies. We identified multiple genes potentially under selection in clade C, including the cell wall assembly gene ftsI, the LPS biosynthesis gene arnC, and the yersiniabactin uptake receptor fyuA. Diverse ESBL-encoding genes belonging to the blaCTX-M, blaSHV, and blaTEM families were identified; these genes were found at varying numbers of loci and in variable numbers of copies across isolates. Analysis of ESBL flanking regions revealed diverse mobile elements that varied by ESBL type. Overall, our findings show that ST131 subclade C dominated among patients and uncover possible signals of ongoing adaptation within this ST131 lineage. [ABSTRACT FROM AUTHOR]

Background: Multiple factors, such as less complex U.S. adult pneumococcal recommendations that could increase vaccination rates, childhood pneumococcal vaccination indirect effects that decrease adult vaccination impact, and increased vaccine hesitancy (particularly in underserved minorities), could diminish the cost‐effectiveness of programs to increase pneumococcal vaccination in older adults. Prior analyses supported the economic favorability of these programs. Methods: A Markov model compared no vaccination and current recommendations (either 20‐valent pneumococcal conjugate vaccine [PCV20] alone or 15‐valent pneumococcal conjugate vaccine plus the 23‐valent pneumococcal polysaccharide vaccine [PCV15/PPSV23]) without or with programs to increase vaccine uptake in Black and non‐Black 65‐year‐old cohorts. Pre‐pandemic population‐ and serotype‐specific pneumococcal disease risk and illness/vaccine costs came from U.S. databases. Program costs were $2.19 per vaccine‐eligible person and increased absolute vaccination likelihood by 7.5%. Delphi panel estimates and trial data informed vaccine effectiveness values. Analyses took a healthcare perspective, discounting at 3%/year over a lifetime time horizon. Results: Uptake programs decreased pneumococcal disease overall. In Black cohorts, PCV20 without program cost $216,805 per quality‐adjusted life year (QALY) gained compared with no vaccination; incremental cost‐effectiveness was $245,546/QALY for PCV20 with program and $425,264/QALY for PCV15/PPSV23 with program. In non‐Black cohorts, all strategies cost >$200,000/QALY gained. When considering the potential indirect effects from childhood vaccination, all strategies became less economically attractive. Increased vaccination with less complex strategies had negligible effects. In probabilistic sensitivity analyses, current recommendations with or without programs were unlikely to be favored at thresholds <$200,000/QALY gained. Conclusion: Current U.S. pneumococcal vaccination recommendations for older adults were unlikely to be economically reasonable with or without programs to increase vaccine uptake. Alternatives to current pneumococcal vaccines that include pneumococcal serotypes associated with adult disease should be considered. See related Editorial by Melissa K. Andrew in this issue. [ABSTRACT FROM AUTHOR]

BackgroundFollowing Haemophilus influenzae serotype b (Hib) conjugate vaccine introduction in the 1980s, Hib disease in young children dramatically decreased, and epidemiology of invasive H. influenzae changed.MethodsActive surveillance for invasive H. influenzae disease was conducted through Active Bacterial Core surveillance sites. Incidence rates were directly standardized to the age and race distribution of the US population.ResultsDuring 2009-2015, the estimated mean annual incidence of invasive H. influenzae disease was 1.70 cases per 100000 population. Incidence was highest among adults aged ≥65 years (6.30) and children aged

This study examines the dietary intake changes and factors related to dietary acculturation in international students attending an urban university in the United States. The researchers administered seven focus groups of college-age international students (n = 32) between June and August 2012. The participants were enrolled in Northeastern and Midwestern U.S. universities. A qualitative research inquiry was used for data collection, presentation, and analysis. An interview guide was developed to explore the dietary habits of international students. The results show the participants face many dietary challenges as a result of adapting to American culture. The major dietary-related influences include: the food environment, campus environment, religion, and individual preferences. Additionally, the consequences of dietary changes were associated with undesirable health outcomes including weight gain, increased blood glucose levels, increased cholesterol levels, high blood pressure, and mental problems.

ObjectiveMALT1 regulates immunity and inflammation in multiple ways, while its role in rheumatoid arthritis (RA) is obscure. This study aimed to investigate the relationship of MALT1 with disease features, treatment outcome, as well as its effect on Th1/2/17 cell differentiation and underlying molecule mechanism in RA.MethodsTotally 147 RA patients were enrolled. Then their blood Th1, Th2, and Th17 cells were detected by flow cytometry. Besides, PBMC MALT1 expression was detected before treatment (baseline), at week (W) 6, W12, and W24. PBMC MALT1 in 30 osteoarthritis patients and 30 health controls were also detected. Then, blood CD4+ T cells were isolated from RA patients, followed by MALT1 overexpression or knockdown lentivirus transfection and Th1/2/17 polarization assay. In addition, IMD 0354 (NF-κB antagonist) and SP600125 (JNK antagonist) were also added to treat CD4+ T cells.ResultsMALT1 was increased in RA patients compared to osteoarthritis patients and healthy controls. Meanwhile, MALT1 positively related to CRP, ESR, DAS28 score, Th17 cells, negatively linked with Th2 cells, but did not link with other features or Th1 cells in RA patients. Notably, MALT1 decreased longitudinally during treatment, whose decrement correlated with RA treatment outcome (treatment response, low disease activity, or disease remission). In addition, MALT1 overexpression promoted Th17 differentiation, inhibited Th2 differentiation, less affected Th1 differentiation, activated NF-κB and JNK pathways in RA CD4+ T cells; while MALT1 knockdown exhibited the opposite effect. Besides, IMD 0354 and SP600125 addition attenuated MALT1’s effect on Th2 and Th17 differentiation.ConclusionMALT1 regulates Th2 and Th17 differentiation via NF-κB and JNK pathways, as well as correlates with disease activity and treatment outcome in RA.