HIGHLIGHTS: Comprehensive view of occupational safety research: Prioritizing topics in robotics and autonomous machines. Barriers to safety research: Logistical, intellectual property, timeline, and funding challenges. Importance of surveillance or tracking system: Documenting fatalities, injuries, and near misses/good catches. Priority safety research needs: human-machine interaction, adoption of automation in the work setting, and surveillance/tracking. Collaboration with technology developers: Overcoming barriers and exploring emerging technologies and potential safety implications. ABSTRACT: In 2022, the SAfety for Emerging Robotics and Autonomous AGriculture (SAFER AG) Workshop was held to discuss and understand emerging challenges related to safety, occupational safety research needs, workforce implications, and other issues associated with robotics and autonomous machines in agriculture. This paper presents the major findings from the occupational safety research track of the workshop. This track identified existing hurdles to conducting occupational safety research including logistical barriers, intellectual property concerns, long timelines, and lack of funding. Considerations for developing a tracking or surveillance system for adverse events as well as exposure related to these technologies were also discussed, emphasizing the need for a comprehensive system. Finally, the priority occupational safety research needs identified during the session were related to human and non-human machine interaction, adoption of automation in the work setting, and event tracking/surveillance. To overcome barriers to research, collaboration between occupational safety researchers and technology developers is crucial. Enhancements to existing surveillance systems can facilitate better understanding of captured events. Additionally, prioritizing research on worker risk from robotics and autonomous machines in agriculture is essential. The integration of robotics and autonomous machines in agriculture has revolutionized the industry but requires evidence-based safety research, outreach, and education to ensure worker safety and health.

Despite significant progress in reducing malaria effects in recent decades, malaria remains a major challenge in Madagascar. Geographic and financial barriers often prevent individuals from seeking prompt care. Community health workers (CHWs) in many countries, including Madagascar, provide malaria case management services to children younger than 5 years old, although they typically do not treat older children and adults, leaving a gap for those living far from health facilities. To determine the efficacy of expanding malaria community case management (mCCM) to community members of all ages, a cluster randomized trial was conducted in one district of Madagascar from November 2020 to December 2021. Qualitative surveys were conducted to describe the acceptability and feasibility of this intervention among beneficiaries and CHWs. For this purpose, 87 semistructured interviews and 12 focus groups were conducted in intervention and control arms of the study to assess understanding of malaria, behaviors related to care seeking for fever, perceptions of CHW roles, and acceptability and feasibility of the age-expanded mCCM. Two major findings emerged. First, stakeholders found age-expanded mCCM to be consistent with existing CHW roles and practices. Age-expanded mCCM induced a recognition of adults' susceptibility to malaria and led to a more accurate understanding of malaria. Second, structural and community-based challenges were not fully resolved by age-expanded mCCM, and some, such as the question of the cost of care, emerged after its implementation. Despite the fact that age-expanded mCCM was acceptable to beneficiaries and CHWs, successful scale-up will require addressing structural challenges and sociodemographic inequalities.

BACKGROUND: Human metapneumovirus (HMPV) and respiratory syncytial virus (RSV) are genetically related viruses and major causes of medically attended acute respiratory illness in children. Research comparing the severity of illnesses resulting from these infections lacks consensus. METHODS: Children younger than 18 years with acute respiratory illness were enrolled through active, prospective surveillance from 2016 to 2020 at 7 US pediatric hospitals and emergency departments (EDs). Clinical information was obtained from parent interviews and medical records. Midturbinate nasal swabs were collected and tested for RSV and HMPV using molecular diagnostic assays at each site. We compared descriptive and clinical features of children with RSV or HMPV and calculated adjusted odds ratios (aOR) for severe outcomes comparing RSV with HMPV. Risk factors for severe outcomes were assessed in children with RSV or HMPV using logistic regression models. RESULTS: A total of 5329 children hospitalized with RSV (n = 4398) or HMPV (n = 931) and 3276 children with RSV-associated (n = 2371) or HMPV-associated (n = 905) ED visits were enrolled. The median age of children hospitalized with RSV was lower than that of children with HMPV (7 months vs 16 months, P < .0001). Children presenting to the ED with RSV-associated acute respiratory illness had higher odds of being hospitalized than children with HMPV (aOR, 1.68; 95% CI, 1.50-1.87), with the highest odds in infants younger than 6 months (aOR, 3.27; 95% CI, 2.53-4.23). Underlying conditions were more than twice as common among infants hospitalized with HMPV (26%) than those with RSV (11%). CONCLUSIONS: Children with HMPV-associated hospitalization tend to be older and more likely to have underlying medical conditions compared with children with RSV-associated hospitalization.

BACKGROUND: Pneumonia causes high rates of hospitalization among adults living in long-term care (LTC) facilities and is a major cause of mortality in this population. Since 2014, pneumococcal conjugate vaccines (PCVs) have been recommended for U.S. adults aged ≥65 years; however, effectiveness of PCVs against all-cause pneumonia hospitalization among adults living in LTC remains unclear. METHODS: We used Medicare Fee-for-Service claims data to construct an open cohort of beneficiaries aged ≥65 years between September 2014 and December 2019. We estimated 13-valent PCV (PCV13) vaccine effectiveness (VE) by comparing rates of pneumonia hospitalization among PCV13-exposed and PCV13-unexposed time during LTC stays. Discrete-time logistic regression models with generalized estimating equations were used to estimate VE, incorporating time-varying exposures and covariates. RESULTS: Among 3,485,071 beneficiaries meeting the eligibility criteria, the proportion vaccinated with PCV13 increased from 1.1% to 52.7% during the study period. The characteristics of beneficiaries with shorter LTC stays differed from those with longer LTC stays: a lower proportion of beneficiaries aged ≥85 years (LTC stay ≤100 days vs >100 days: 38.5% vs. 48.2%), but a higher proportion with chronic medical conditions (71.4% vs 66.4%), immunocompromising conditions (36.6% vs. 25.2%), and recent hospitalizations (84.1% vs. 74.7%). VE of PCV13-only against all-cause pneumonia hospitalization was 3.8% (95% confidence interval 2.4%-5.2%) overall; 5.6% (3.9%-7.2%) for LTC stays ≤100 days and 0.3% (-2.1%- 2.77%) for LTC stays >100 days. CONCLUSIONS: PCV13 reduced the risk of pneumonia hospitalization among this population. Differences in beneficiary characteristics could explain differences in VE by length of LTC stay.

Long COVID, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and other poorly understood post-acute infection syndromes (PAIS) can present with unexplained symptoms or conditions that may be misunderstood by healthcare providers, causing delays in diagnosis and care. To address these issues, the Centers for Disease Control and Prevention (CDC) funded the Long COVID and Fatiguing Illness Recovery Program (LC&FIRP), initiated as a pilot project to assess whether providing tele-mentoring and other online education for primary care providers could help them improve the quality of life and support the recovery of their patients with these conditions. The LC&FIRP multi-disciplinary team-based care approach is built on the Extension for Community Healthcare Outcomes (ECHO) learning model, which is an evidence-based virtual learning framework developed by the University of New Mexico and designed to disseminate and implement best practices, especially in under-resourced areas. A distinctive feature of LC&FIRP was the inclusion of lived-experience experts. To explore the influence of lived-experience experts on the care patients received, we collected the educational recommendations provided by the lived-experience experts during webinar sessions (January 2022-March 2024) and grouped these by themes. The major themes that emerged included validation of patients' illness experience; attitudes and beliefs about Long COVID, ME/CFS, and PAIS; understanding patients' challenges and communicating with empathy; navigating referrals; recognizing and supporting disability; and supporting self-care. Investigators also interviewed patients of the Family Health Centers of San Diego (FHCSD) about their experiences receiving care from participating primary care providers and employed content analysis methods to code interview transcripts to identify themes among patients' perspectives. Positive comments from the patients about topics emphasized by the lived-experience experts provided evidence of providers' uptake and application of the experts' recommendations and support the value of involving lived-experience experts in medical education to improve health services.

OBJECTIVES: We investigated associations between occupational noise and gestational diabetes mellitus, pregnancy-related hypertension (including pre-eclampsia/eclampsia), preterm birth and small for gestational age (SGA) infants. METHODS: Data were analysed for 7889 singleton, live-born infants without major birth defects or chromosomal disorders and their mothers from the National Birth Defects Prevention Study from 1997 to 2011. Typical maternal occupational noise exposure in all jobs held from 1 month prior to conception through the end of pregnancy was estimated by expert rater and categorised as quiet (<60 A-weighted decibels (dBA)), low (60-75 dBA), moderate (76-84 dBA) or loud (>85 dBA). Multiple logistic regression was used to estimate associations (adjusted ORs and 95% CIs) between noise exposure levels and outcomes. RESULTS: Approximately 77.4% of pregnant workers had quiet levels of occupational noise exposure, 11.0%, 10.1% and 1.5% had low, moderate and loud exposure levels, respectively. Compared with quiet levels of noise, pregnant workers exposed to low levels of noise had decreased odds of delivering an SGA infant (adjusted OR (aOR)=0.72; 95% CI 0.53 to 0.99) and those exposed to moderate levels had increased odds of delivering an SGA infant (aOR=1.37; 95% CI 1.05 to 1.77). No other significant associations were observed. CONCLUSION: Maternal occupational noise exposure below the 85 dBA threshold recognised as hazardous may be associated with SGA among infants. Elevated point estimates (>1) were observed for the highest noise exposure category and all outcomes, though CIs were wide and statistical significance was not attained. Further research is warranted to address existing knowledge gaps.

INTRODUCTION: Gulf War Illness is a chronic multisymptomatic disorder that affects as many as 25-35% of the military personnel who were sent to the Persian Gulf war in 1991. The illness has many debilitating symptoms, including cognitive problems, gastrointestinal symptoms, and musculoskeletal pain. Those so afflicted have been sick for more than 30 years and, therefore, it has become imperative to understand the etiology of Gulf War Illness and then produce treatments to ease the symptoms. We hypothesized that the length of the disease was reflected in epigenetic modification of possibly several genes related to the symptoms. METHODS: We subjected male and female mice from 11 BXD strains to combined corticosterone and the sarin surrogate, diisopropylfluorophosphate, to emulate the physiological stress of war and the potential exposures to organophosphate pesticides and nerve agent in theater. Three hundred days after treatment, we used Methyl-CpG-binding domain sequencing (MBD-seq) to assay genome-wide methylation. RESULTS: The analysis revealed 20 methylated genes, notably Eif2b5, that regulates myelin production. DISCUSSION: Loss of myelin with accompanying musculoskeletal pain is a major symptom of Gulf War Illness. Our work demonstrates multiple genes were methylated by exposure to organophosphates and glucocorticoids. These genes point to biochemical mechanisms that may be targets for therapeutic intervention.

This study assessed resource allocation among registry activities, which may provide insight for efficient collection of high-quality cancer incidence data. We used a multimodal approach and purposively sampled 21 participating population-based cancer registries in the United States to ensure variation across several registries. The registries reported prospective staffing data and retrospective costing data, completing data collection from October 2021 to September 2022, reporting retrospective costing data for July 1, 2020, through June 30, 2021. From lessons learned from prior studies, we engaged participating registries early and throughout the study, ensuring the collection of meaningful, accurate quantitative data, as well as insights not captured quantitatively. Case volume is a major driver of registry costs. (On average, high-volume registries outspend low-volume registries by nearly 3x, annually). Upon examination of registry activities by case volume, we found that the two most resource-intensive registry activities are data acquisition and data processing, which may be addressed by innovations, such as electronic reporting and automation. Innovative data transfer and processing approaches could increase timeliness of data collection and reduce the labor resources required to process manually collected data. Registries adopting these innovations might achieve cost savings, which could make resources available to support other registry activities.

Echinocandins are the recommended antifungal therapy for Candida auris infections in many countries. While echinocandin resistance remains uncommon, recent reports demonstrate an increase in such cases, with the potential for echinocandin-resistant C. auris transmission between persons. The expansion of C. auris whole-genome sequencing capacity in public health laboratories provides a great opportunity to leverage genomic data to detect echinocandin resistance-conferring mutations. However, curated datasets for validating genomic tools for these purposes are lacking. Therefore, we developed a benchmark dataset comprising 100 whole-genome sequenced C. auris isolates categorized as echinocandin-susceptible (n = 53) and resistant (n = 47) by antifungal susceptibility testing. We implemented the fungal bioinformatics pipeline, MycoSNP-nf, to perform whole-genome sequencing analysis, including C. auris clade typing and the detection of FKS1 mutations in hotspot (HS) regions. Phylogenetic analysis classified isolates into four major clades (Clades I-IV). Of the 47 isolates considered resistant by AFST, 44 showed HS mutations identified by MycoSNP-nf-with 41 positioned in two well-described HS regions and 3 within a potential third hotspot that was recently reported. This benchmark dataset is designed to be a resource to build sequencing capacity to detect echinocandin resistance-conferring mutations in FKS1 and to help standardize comparisons across other bioinformatics tools. IMPORTANCE: Echinocandins are the recommended first-line treatment for invasive infections caused by Candida auris, a multi-drug-resistant yeast that has emerged in healthcare facilities globally. Increasing instances of echinocandin-resistant cases highlight the need for rapid detection and response. We developed a benchmark dataset comprising 100 C. auris echinocandin-resistant and -susceptible isolates to demonstrate the utility of the bioinformatics tool, MycoSNP-nf, for detecting echinocandin resistance-related FKS1 mutations and to assess their concordance with antifungal susceptibility testing results. This benchmark may help validate MycoSNP-nf and other bioinformatics tools aimed at detecting these mechanisms using whole-genome sequencing data.

BACKGROUND: Traumatic brain injury is a major cause of death and disability worldwide, with almost half of new cases occurring in children, adolescents, and young adults. However, data on injury characteristics stratified by social determinants of health are scarce. This study explores severity, intent, and mechanism of traumatic brain injury sustained during childhood, adolescence, and young adulthood by social determinants of health. METHODS: This study utilizes a population-based birth cohort of births in publicly funded hospitals in Ontario, Canada, between April 1, 1992 and March 31, 2020 (n = 3,648,760). Individuals experiencing a traumatic brain injury requiring medical attention to the emergency department or acute care between April 1, 2002 and November 20, 2020 (n = 94,514) were identified using International Classification of Diseases Version 10 diagnosis codes. Social determinants of health variables included age, sex, rurality of residence, neighbourhood income quintile, and the following Ontario Marginalization Index variables: households and dwellings, material resources, and racialized and newcomer populations. The primary outcome was percentage of injuries falling under each mechanism, intent, and severity of injury category, stratified by social determinants of health variables. RESULTS: Approximately 50% of injuries were mild and 96.2% of injuries were unintentional. Injury severity and intent of injury significantly varied by social determinants of health; for example, the proportion of traumatic brain injury-related healthcare visits for moderate/severe and intentional injuries was highest in areas with the lowest income quintile (13.3% and 6.1%, respectively), lowest households and dwellings stability (12.2% and 5.7%, respectively), lowest material resources (12.8% and 6.0% respectively), and highest racialized and newcomer populations (13.5% and 4.5% respectively). The percentage of traumatic brain injury-related healthcare visits for a sports-related injury significantly varied by social determinants of health; for example, the proportion of traumatic brain injury-related healthcare visits for sports-related injuries was highest among males (45.5%), those living rural areas (44.0%), and those living in areas with the highest income (47.2%), highest households and dwellings stability (44.0%), highest material resources (45.8%), and lowest racialized and newcomer populations (43.4%). CONCLUSIONS: Characteristics of traumatic brain injury-related healthcare visits vary based on social determinants of health. Targeted prevention of traumatic brain injury beyond the sports settings, including fall prevention among young children, are encouraged, and guidelines to identify and address traumatic brain injury outside of the sports setting must be developed to support early intervention of traumatic brain injury across social determinants of health.

This survey was conducted with the aim of determining the public health risk of Rocky Mountain spotted fever and murine typhus in the urban and peri-urban areas of El Paso, as well as other areas in Texas, southern New Mexico, and Ciudad Juarez, Mexico. The approach was to assess the diversity of tick and flea species, determine if the ticks and fleas were infected with Rickettsia rickettsii and Rickettsia typhi (R. typhi), respectively, and assess previous human infection with Rickettsia species. Ticks and fleas were collected from domestic and wild animals and tested using a nested polymerase chain reaction assay. Human plasma samples were also tested for antibodies using an indirect fluorescence assay. Among 203 fleas, including Pulex irritans, Echidnophaga gallinacea, and Ctenocephalides felis (C. felis), collected from wild and domestic small mammals, only one pool of four C. felis collected from a dog in the El Paso community was positive for Rickettsia felis. All 194 Rhipicephalus sanguineus ticks collected from stray and domestic dogs in the El Paso community, southern Doña Ana County, and Ciudad Juarez were negative for Rickettsia spp. In Travis County, Texas, a total of 207 ticks collected from white-tailed deer, including 196 Ixodes scapularis and 11 Dermacentor albipictus, were negative for Rickettsia spp. pathogens. Among 375 archived human plasma samples collected in the El Paso community, only two were positive for R. typhi antibodies. These preliminary findings suggested that tick- and flea-borne diseases were not a major health risk in the El Paso community or the other areas included in this survey.

BACKGROUND: Stigma is a major barrier to ending HIV as a public health threat. We present an analytical framework for quantifying the effects of HIV-related stigma on the treatment cascade using biomarker data from a Population-based HIV Impact Assessment (PHIA) in Tanzania. METHODS: We first reviewed HIV-related stigma items from 15 PHIA surveys in sub-Saharan Africa. Using nationally representative data of 1,831 diagnosed and undiagnosed PLHIV aged 15 and older in Tanzania, we applied modified Poisson regression models to examine associations of stigma with the treatment cascade, adjusting for HIV knowledge and demographics. RESULTS: We identified 41 unique stigma-related items in 13 of the 15 PHIA surveys. In Tanzania, PLHIV who expressed any stigma driver (stigmatizing attitude, discriminatory attitude, or shame) were 27% less likely to know their HIV status (adjusted prevalence ratio [aPR] 0.73; 95%CI [0.65-0.83], p < 0.001), while those expressing all three were almost never aware of their status (aPR < 0.01; 95%CI [0-0.01], p < 0.001). Stigma drivers were not significantly associated with ART use among diagnosed PLHIV or viral load suppression (VLS) among those on ART. Diagnosed PLHIV who felt the need to hide their status when seeking non-HIV healthcare were 9% less likely to be on ART (aPR 0.91; 95%CI [0.85-0.98], p = 0.013), and those on ART were 10% less likely to achieve VLS (aPR 0.90; 95%CI [0.81-0.99], p = 0.047). CONCLUSIONS: Stigma likely prevented many undiagnosed PLHIV in Tanzania from knowing their status. Fear of healthcare discrimination due to anticipated stigma undermines ART uptake among diagnosed PLHIV and viral suppression among those on ART. PHIA surveys have untapped potential to quantify the effects of HIV-related stigma and inform interventions to end HIV as a public health threat.

BACKGROUND: The Nigeria Hypertension Control Initiative (NHCI) program, launched in 2020, integrates hypertension care into primary healthcare using the HEARTS technical package, which includes screening, health counselling, and standardized hypertension treatment protocols. This package has been piloted through NHCI in Kano and Ogun States and in the Federal Capital Territory (FCT) Abuja, as part of the Hypertension Treatment in Nigeria (HTN) project. OBJECTIVE: To assess the costs of scaling up the HEARTS hypertension control package and compare these costs with those of usual care. METHODS: Data on the costs of implementing the HEARTS program were collected from 15 purposively sampled primary health facilities in Kano, Ogun, and FCT Abuja between February and April 2024. Costs included training, medicines, provider time, and administrative expenses. We used the HEARTS costing tool, an Excel-based instrument, to collect and analyze the annual costs from a health system perspective, using an activity-based approach. RESULTS: The estimated annual cost of implementing HEARTS was USD 16 per adult primary care user (PCU), with variations across the three locations: USD 21 in Abuja, USD 11 in Kano, and USD 16 in Ogun. Average annual medication costs per patient treated under HEARTS also varied by location, amounting to USD 28 in Abuja, USD 27 in Ogun, and USD 16 in Kano. Under usual care, annual medication costs per patient were estimated at USD 32 in Kano and USD 16 in Ogun (data for Abuja were unavailable). Major cost drivers for the HEARTS package included provider time (49%) and medication (47%), compared to usual care, where medication alone accounted for 80% of costs. Implementing HEARTS requires a full-time equivalent of 0.45 doctors, 1.59 nurses, and 5.21 community health workers per 10,000 primary care users. CONCLUSIONS: In the Nigerian primary care setting, provider time costs and medication costs emerge as major considerations in scaling up hypertension services. Policy options could consider reducing follow-up visit frequency for well-controlled patients to decrease provider time costs. Additionally, medication costs may be reduced by prioritizing first-line treatments and volume-driven purchasing as program scale-up continues.

Few type-specific antibodies that recognize drifted epitopes are made during post-vaccination exposures to SARS-CoV-2 variants(1-12), perhaps due to suppression by previous immunity. We compared type-specific B cell responses in unvaccinated and vaccinated individuals with Delta and Omicron BA.1 SARS-CoV-2 variant infections. For both Delta, which is antigenically similar to the vaccine strain, and the more distant BA.1 variant, neutralizing antibodies were greater in post-vaccination variant infections than in primary variant infections. Delta type-specific memory B cells were reduced in post-vaccination Delta infections relative to primary variant infections. Yet some drifted epitopes in the Delta variant elicited minimal responses even in primary infections. For BA.1 infections, type-specific antibodies and memory B cells were mostly undetectable, irrespective of previous immunity. Thus, poor intrinsic antigenicity of drifted epitopes in Delta and BA.1 infections superseded the impact of previous immunity. Enhancing the immunogenicity of vaccine antigens may promote type-specific responses.

PURPOSE: Studies of influenza vaccination during pregnancy and major birth defects generally provide reassuring findings. To maintain public confidence, it is important to continue evaluating the safety of maternal vaccination using well characterized, population-based data. This study extended previous research to examine associations between maternal influenza vaccination and selected birth defects using data from the Birth Defects Study To Evaluate Pregnancy exposureS, a US, multisite case-control study. METHODS: Mothers of case children (diagnosed with a birth defect) and control children (without a birth defect diagnosis) were identified from population-based birth defect surveillance programs and recruited to complete a telephone interview. Data from 2675 case and 1575 control mothers (participants) with deliveries during 2014-2019 were analyzed. Influenza vaccination exposure during the critical exposure period (one month before pregnancy through the first pregnancy month [B1P1] for spina bifida or through the third pregnancy month [B1P3] for other selected birth defects) was assessed controlling for several participant covariates. Logistic regression with propensity score adjustment was used to estimate adjusted odds ratios (aORs) and 95 % confidence intervals (CIs). Several secondary analyses were conducted. A probabilistic bias analysis examined the effect of exposure misclassification. RESULTS: The aOR observed between B1P1 influenza vaccination exposure and spina bifida was 0.9 (95 % CI: 0.4-2.0). The aORs for B1P3 exposure and other selected birth defects examined ranged from 0.4 to 1.3, with 95 % CIs including the null except those for cleft lip ± cleft palate (aOR: 0.6; 95 % CI: 0.4-0.9) and gastroschisis (aOR: 0.4; 95 % CI: 0.2-0.7). Results from secondary analyses were similar to the primary analyses, and those from probabilistic bias analysis were similar to respective primary and secondary analyses. CONCLUSION: Findings showed no statistically significant positive associations between influenza vaccination and the selected birth defects, supporting public health efforts to promote optimal vaccination coverage among pregnant women.

INTRODUCTION: People who inject drugs (PWID) in Zambia are an understudied population at high risk for HIV acquisition and transmission. We report here on the progress within the PWID communities of Livingstone, Lusaka, and Ndola, Zambia towards the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets. METHODS: A biobehavioral survey used respondent-driven sampling to survey 235 PWID in Livingstone, 349 in Lusaka, and 259 in Ndola in 2021-22. Questions on HIV and injection drug use were administered, and blood was collected for HIV, syphilis, Hepatitis B, and Hepatitis C testing. Weighted prevalence and 95% confidence intervals (CIs) were calculated using Gile's sequential sampling estimator. RESULTS: In Livingstone, Lusaka, and Ndola, HIV prevalence among PWID was 11.9% (95% CI: 7.3, 16.5), 7.3% (95% CI: 4.5, 10.2), and 21.9% (95% CI: 14.5, 29.3), respectively. Among HIV-positive PWID in Livingstone, 70.7% (95% CI: 55.4, 85.0) were aware of their HIV status (95% is 1st UNAIDS target), 100% of those were on antiretroviral therapy (ART) (95% is 2nd UNAIDS target), and 100% of those achieved viral load suppression (VLS) (95% is 3rd UNAIDS target). In Lusaka, 66.0% (95% CI: 49.3, 82.2) were aware, 75.7% (95% CI: 51.1, 99.9) were on ART, and 66.3% (95% CI: 42.1, 90.9) achieved VLS. In Ndola, 60.2% (95% CI: 44.1, 76.0), 100%, and 90.2% (95% CI: 82.2, 98.3) were aware, on ART, and achieved VLS, respectively. CONCLUSIONS: Awareness of HIV status was low among PWID living in Livingstone, Lusaka, and Ndola, Zambia. Treatment and VLS progress were lacking in Lusaka and Ndola as well with Lusaka showing the least progress toward all three UNAIDS targets. Our site-level findings highlight critical gaps in PWID-specific HIV awareness, treatment, and VLS status in three major urban areas in Zambia that limit progress toward HIV epidemic control in this hard-to-reach population.

INTRODUCTION: Retention in care and antiretroviral therapy (ART) adherence are major clinical and public health challenges in the treatment of HIV in the United States. Traditional data to care (D2C) approaches use health department surveillance data to promote retention in HIV care, with challenges in the timeliness of data and inconclusive findings. Earlier identification of people with HIV who are at risk of loss from care-such as when an ART prescription is not filled-represents a new direction for D2C (D2C-Rx or prescription-based D2C). METHODS: We designed the Antiretroviral Improvement among Medicaid EnrolleeS (AIMS) study, a D2C-Rx initiative in Virginia, which leveraged real-time administrative claims from Virginia Medicaid and HIV surveillance data from Virginia Department of Health (April 2023-June 2024). AIMS was a statewide cluster-randomized, controlled trial comparing a phased, multi-level program of support (intervention) to usual care, among Virginia Medicaid enrollees without current ART prescriptions. Support included a provider-level component for those with no prior ART prescription and patient-level component for those with a > 30-90-day late ART prescription refill(s). We hypothesized that AIMS would increase HIV viral suppression and improve ART adherence at 12 months compared to usual care. We describe the original study protocol and discuss changes implemented to the study design and program implementation. We also consider key methodologic contributions, as well as limitations and challenges to patient- and provider-level enrollment, such as ART prescription data accuracy. ETHICS AND DISSEMINATION: This study was reviewed and approved by the Institutional Review Board of Virginia Commonwealth University (HM20018229). REGISTRATION: The trial is registered at clinicaltrials.gov (NCT05477485).

Introduction: Drowning is a major public health problem. There are about 4,500 fatal unintentional drownings in the United States each year, and more children ages 1–4 die from drowning than from any other cause. Some sociodemographic characteristics are associated with increased risk of unintentional fatal drowning. The purpose of this study was to better understand the association between county-level social vulnerability and unintentional fatal drowning. Methods: This study used the 2014 Centers for Disease Control and Prevention and Agency for Toxic Substances and Disease Registry's (CDC/ATSDR) Social Vulnerability Index (SVI) and mortality data from the National Vital Statistics System from 1999 to 2023. Counties were ranked and categorized into tertiles across social vulnerability scores for all indicators of the SVI. Negative binomial regression was used to estimate crude rate ratios (RR) and 95% confidence intervals comparing county-level fatal drowning rates and the SVI indicators. Results: County-level social vulnerability is associated with unintentional fatal drowning. Counties with high overall social vulnerability had fatal drowning rates 1.59 times as high as counties with low social vulnerability. These associations were most pronounced for the SVI indicators of socioeconomic status (RR = 1.56), disability status (RR = 1.49), and proportion of mobile homes (RR = 1.62). Conclusions: While the reasons for the associations between indicators of the SVI and higher rates of drowning are not fully understood, counties with high social vulnerability may be associated with reduced access to swimming pools, affordable swimming lessons, and other evidence-based drowning prevention strategies. Practical Applications: Communities can use the SVI and other indicators of risk to support drowning prevention program implementation, ensuring strategies reach and are tailored to populations most at risk of drowning. © 2025 National Safety Council and Elsevier Ltd

BACKGROUND: We calculated prevalences of birth defects among infants of participants in the Centers for Disease Control and Prevention's (CDC) COVID-19 Vaccine Pregnancy Registry (C19VPR). METHODS: C19VPR enrolled women receiving COVID-19 vaccines ≤ 30 days before the last menstrual period or during pregnancy from December 2020 through June 2021. We included 19,931 participants with singleton pregnancies ending ≥ 20 weeks' gestation who did not report COVID-19 illness during pregnancy. Clinicians identified birth defects from participant-reported infant health information up to 4 months after birth. We compared C19VPR birth defect prevalences to published pre-pandemic estimates. For seven defects originating during embryogenesis (cleft lip with/without cleft palate, atrial septal defect, coarctation of the aorta, ventricular septal defect, esophageal atresia or stenosis, hypospadias, kidney agenesis/hypoplasia/dysplasia), we estimated prevalence ratios comparing those vaccinated < 14 weeks' to those vaccinated ≥ 14 weeks' gestation. RESULTS: Participants reported receiving Pfizer-BioNTech vaccines (59.0%), Moderna (38.2%), and Janssen (2.8%) vaccines. Most (65.2%) participants received their first COVID-19 vaccine after the first trimester. The prevalence of major birth defects was 3.8%. Among defects with comparator estimates available (n = 50), 35 were below or within expected ranges. C19VPR prevalences were higher than the comparator confidence interval for 15 defects; however, C19VPR confidence intervals included comparator estimates. Prevalences did not differ by the timing of vaccination for seven defects examined. CONCLUSIONS: Birth defects prevalence estimates among infants born to women receiving COVID-19 vaccines during or just prior to pregnancy were generally similar to pre-pandemic estimates. While there was no strong evidence of associations between vaccination and specific defects, statistical power was low.

BACKGROUND: Rotavirus gastroenteritis is one of major causes of death in infants, particularly in sub-Saharan Africa. In the Central African Republic (CAR), sentinel surveillance of rotavirus gastroenteritis was established in 2011. In this study, we assessed the burden of rotavirus gastroenteritis and identified rotavirus strains circulating in CAR during 2011-2021. METHODS: Stool samples were collected from < 5-year-old children with diarrhoea according to WHO criteria, at the sentinel site in Bangui, CAR. Samples were screened for group A rotavirus antigen by EIA. RNA was extracted from all EIA-positive samples which were subjected to genotyping using a semi nested RT-PCR assay. RESULTS: From 2011 to 2021, 1855 stool samples were collected and 854 (46.0%) were positive for rotavirus by EIA. Genotypes were obtained from 77.3% (660/854) EIA positive samples. Of these 660 samples, genotypes funds were: G1 (35.4%) and G2 (26.6%) for VP7, and P[6] (42.7%) and P[8] (35.6%) for the VP4 gene. The most frequent genotype combinations were G1P[8], 19.3% and G1P[6], 15.0%. CONCLUSION: This study reports the prevalence of rotavirus genotypes that circulated for ten years, providing a pre-vaccine baseline data genotype estimate for rotavirus gastroenteritis sentinel surveillance in the Central African Republic. CLINICAL TRIAL NUMBER: Not applicable.

BACKGROUND: Hypertension is a major risk factor for cardiovascular and renal diseases, significantly contributing to morbidity and mortality. The COVID-19 pandemic has heightened concerns about the impact of hypertension on severe COVID-19 outcomes. METHODS: We analyzed 2020-2021 data from the MarketScan Commercial and Health and Productivity Management databases, focusing on adults aged 18-64 years with continuous employer-sponsored private insurance, excluding pregnancy or capitated plans. We compared medical costs, healthcare utilization (emergency department [ED] visits, inpatient admissions, outpatient visits, and outpatient prescription drugs), and productivity losses (sick absences, short-term disability [STD], and long-term disability [LTD]) between individuals with and without hypertension, stratified by COVID-19 diagnosis. We used multivariable regression models, including an interaction term for hypertension and COVID-19 diagnosis, to estimate differences in outcomes, adjusting for demographics and comorbidities. RESULTS: Among 1,296,596 adults, 21% had hypertension. Those with hypertension were older, less likely female, less likely urban residents, and had more comorbidities. Excess medical costs associated with hypertension were $8,572 per patient over the two-year period (95% CI $8,182-$8,962). Patients with versus without hypertension had 0.200 (95% CI, 0.195-0.205) more ED visits, 0.081 (95% CI, 0.077-0.085) more inpatient admissions, 5.984 (95% CI, 5.892-6.075) more outpatient visits, and 20.25 (95% CI, 20.09-20.41) more prescriptions per patient over the two-year period. They also had more sick absences (1.13 days; 95% CI 0.93-1.34) and STD occurrences (3.88 days; 95% CI 3.56-4.20) per patient. Among those with hypertension, individuals with versus without COVID-19 had $3,495 (95% CI, $2,135-$4,856) higher medical costs and 2.588 (95% CI, 1.112-4.065) more STD days per patient over the two-year period. CONCLUSIONS: Hypertension was associated with higher medical costs, healthcare utilization, and productivity losses, exacerbated by COVID-19.

BACKGROUND: The advanced disease management (ADM) package, which aims to reduce morbidity and mortality in people with Advanced HIV disease (AHD, WHO stage III/IV and/or CD4 count < 200 cells/mm(3) or age < 5 years), is not fully implemented in India. We assessed the feasibility of implementing the full WHO ADM package as part of routine HIV care under the programmatic setting in antiretroviral therapy centers of Mumbai. METHODS: We implemented the ADM package (screening, treatment, and prophylaxis for major opportunistic infections, rapid ART initiation, and ART adherence support) in 17 ART centers from October 2020 to December 2021. Treatment naïve and experienced persons with AHD, including children, were enrolled. We assessed the feasibility through coverage of ADM package components and reported the proportion of rapid ART initiation (≤ 7 days), cotrimoxazole prophylaxis, TB preventive treatment (TPT) for those eligible [(excluded active TB disease (n = 280) and those completed TPT prior to enrolment (n = 1,186)], TB-LAM screening (excluded current TB disease), and cryptococcal antigen (CrAg) assay (excluded children < 10 years of age). We used a point of care test for TB (LAM) and cryptococcus (CrAg) screening. We followed the prospective cohort for one year (through 31 July 2022) to document outcomes for survival and lost to follow- up (LTFU). RESULTS: We identified 4,334 PLHIV with AHD and provided the full ADM package to 64% (2,779/4,334); 297 did not receive ADM (146 died, 151 LTFU), and 1,258 received routine standard of care (587 had TB, 366 were at decentralized sites, and 305 LAM/CrAg kits were not available) with existing ART center staff. Nearly 78% (385/494) of treatment naïve were rapidly initiated on ART. Nearly 82% (1,129/1,383) and 99% (2,751/2,779) received TPT and cotrimoxazole prophylaxis, respectively. Of the eligible, 99% (2,508/2,524) and 98% (2,715/2,758) were screened for TB and cryptococcal infection, respectively. At the end of 12 months, 88% (2,458/2,779) were alive, 8% (210/2,779) died, and 4% (111/2,779) were LTFU. Mean survival time was significantly (p < 0.001) higher among treatment experienced people; 11.6 months (95% CI: 11.5,11.7) compared to treatment naïve people 10.8 months (95% CI: 10.5,11.0). CONCLUSION: With careful anticipatory planning, stakeholder engagement, and training, implementing the full ADM package is feasible in a routine program setting with existing human resources. Additional intensive case management may be necessary for the reduction of mortality among treatment naïve PLHIV.

Macrophages are major innate immune cells for the clearance of inhaled nanoparticles but may undergo cell death upon phagocytosis of certain nanoparticles due to their resistance to lysosomal degradation and high toxicity to the cell. Here we investigated the pyroptotic effect of exposure to fibrogenic multiwalled carbon nanotubes (MWCNTs) on macrophages, an inflammatory form of cell death. We first evaluated MWCNT-induced cell death in M1 and M2 macrophages that mediate the temporal inflammatory response to MWCNTs in mammalian lungs. Macrophages were differentiated from human monocytic THP-1 cells, followed by polarization to M1 or M2 cells. MWCNTs caused concentration- and time-dependent cytotoxicity in M1 and, to a lesser extent, M2 cells. Carbon black, an amorphous carbonous material control for CNTs, did not cause apparent toxicity in the cells. MWCNTs increased the production and secretion of IL-1β, accompanied by activation of caspase-1, in M1, but not M2, cells. Moreover, MWCNTs induced the formation of apoptosis-associated speck-like protein containing a C-terminal caspase recruitment domain specks and the release of cathepsin B in M1 cells, revealing activation of the nucleotide-binding, oligomerization domain-like receptor family pyrin domain containing 3 (NLRP3) inflammasome via lysosomal damage. MWCNTs induced the cleavage of gasdermin D (GSDMD) to form the 31 kDa N-terminal fragment (GSDMD-N), the pore-forming peptide causing pyroptotic cell death. Increased IL-1β release was completely suppressed by AC-YVAD-CMK (a caspase-1 inhibitor), MCC-950 (an NLRP3 inflammasome inhibitor), or CA-074 Me (a cathepsin B inhibitor), alongside the blockage of MWCNT-induced cleavage of GSDMD. The study demonstrates that MWCNTs trigger pyroptosis in M1 macrophages and boost sterile inflammation by activating the NLRP3 inflammasome pathway. SIGNIFICANCE STATEMENT: The nucleotide-binding, oligomerization domain-like receptor family pyrin domain containing 3 inflammasome mediates the inflammatory response to fibrogenic nanoparticles in the lung via multiple means. The current study uncovers the induction of pyroptotic death of macrophages as a major means of nanotoxicity and sterile inflammation via the nucleotide-binding, oligomerization domain-like receptor family pyrin domain containing 3 pathway by nanoparticles.

BACKGROUND: This report represents a collaborative effort by the major cancer surveillance organizations to present the definitive US statistics for cancer incidence and mortality. METHODS: Cancer incidence data were obtained from population-based cancer registries funded by the Centers for Disease Control and Prevention and the National Cancer Institute and compiled by the North American Association of Central Cancer Registries. Cancer death data were obtained from the National Center for Health Statistics' National Vital Statistics System. Statistics are reported by cancer type, sex, race and ethnicity, and age. The potential impact of the coronavirus disease 2019 (COVID-19) pandemic on incidence was assessed by using state-level changes compared with previous years, the stringency of COVID-19 policy restrictions, the magnitude of COVID-19 death rates, and changes in the use of mammography. RESULTS: Overall cancer incidence rates per 100,000 were 500 among males and 437 among females. Excluding 2020, cancer incidence rates remained stable (2013-2021) among males and increased 0.3% per year on average (2003-2021) among females. The overall cancer death rate per 100,000 was 173 among males and 126 among females. Cancer death rates decreased by 1.5% per year (2018-2022), slowing from a previous 2.1% decline. Cancer incidence in 2020 declined from prepandemic levels for all demographic groups examined. However, the magnitude of decline was not strongly associated with the study's proxies for health care capacity, health care access, or COVID-19 policies. CONCLUSIONS: Overall cancer mortality declined over 20 years, even during the COVID-19 pandemic. Disruptions in health care use early in the pandemic resulted in incidence declines in 2020, but 2021 incidence returned to prepandemic levels.

INTRODUCTION: Chronic conditions are costly and major causes of death and disability. Addressing conditions earlier in adulthood can slow disease progression and improve well-being across the lifespan. We estimated, by life stage, 10-year trends among US adults in the prevalence of 1 or more chronic conditions, multiple chronic conditions (MCC; ≥2 conditions), and 12 selected chronic conditions. METHODS: We analyzed data from the 2013-2023 (odd years) Behavioral Risk Factor Surveillance System (N = 2,673,529). We estimated the prevalence of 1 or more conditions, MCC, and each of 12 conditions, by life stage: young (18-34 y), midlife (35-64 y), and older (≥65 y) adults. We used polynomial contrasts to analyze 10-year trends. RESULTS: In 2023, 76.4% (representing 194 million) of US adults reported 1 or more chronic conditions, including 59.5%, 78.4%, and 93.0% of young, midlife, and older adults, respectively. Moreover, 51.4% (representing 130 million) of US adults reported MCC, including 27.1%, 52.7%, and 78.8% of young, midlife, and older adults, respectively. Among young adults, from 2013 to 2023, prevalence increased significantly from 52.5% to 59.5% for 1 or more conditions and from 21.8% to 27.1% for MCC. CONCLUSION: Approximately 6 in 10 young, 8 in 10 midlife, and 9 in 10 older US adults report 1 or more chronic conditions. Trends in conditions worsened among young adults during 2013-2023. Recognizing the burden of chronic disease throughout life stages, especially earlier in life, practitioners and partners may consider prevention and management approaches critical for addressing costs, care, and health outcomes. Practitioners may also consider tailoring these approaches to unique roles, transitions, and challenges in different life stages.

Leptospirosis (caused by pathogenic bacteria in the genus Leptospira) is prevalent worldwide but more common in tropical and subtropical regions. Transmission can occur following direct exposure to infected urine from reservoir hosts, or a urine-contaminated environment, which then can serve as an infection source for additional rats and other mammals, including humans. The brown rat, Rattus norvegicus, is an important reservoir of Leptospira spp. in urban settings. We investigated the presence of Leptospira spp. among brown rats in Boston, Massachusetts and hypothesized that rat population dynamics in this urban setting influence the transportation, persistence, and diversity of Leptospira spp. We analyzed DNA from 328 rat kidney samples collected from 17 sites in Boston over a seven-year period (2016-2022); 59 rats representing 12 of 17 sites were positive for Leptospira spp. We used 21 neutral microsatellite loci to genotype 311 rats and utilized the resulting data to investigate genetic connectivity among sampling sites. We generated whole genome sequences for 28 Leptospira spp. isolates obtained from frozen and fresh tissue from some of the 59 positive rat kidneys. When isolates were not obtained, we attempted genomic DNA capture and enrichment, which yielded 14 additional Leptospira spp. genomes from rats. We also generated an enriched Leptospira spp. genome from a 2018 human case in Boston. We found evidence of high genetic structure among rat populations that is likely influenced by major roads and/or other dispersal barriers, resulting in distinct rat population groups within the city; at certain sites these groups persisted for multiple years. We identified multiple distinct phylogenetic clades of L. interrogans among rats that were tightly linked to distinct rat populations. This pattern suggests L. interrogans persists in local rat populations and its transportation is influenced by rat population dynamics. Finally, our genomic analyses of the Leptospira spp. detected in the 2018 human leptospirosis case in Boston suggests a link to rats as the source. These findings will be useful for guiding rat control and human leptospirosis mitigation efforts in this and other similar urban settings.

OBJECTIVES: This study examines the prevalence of health conditions for which miners enrolled in a state-funded insurance program sought care. METHODS: We conducted a retrospective analysis of claims data submitted to the Wyoming Miner's Hospital during 2014-2023. Using International Classification of Diseases codes and identifiers unique to each miner, we calculated the number of unique miners with claims submitted for major disease categories and common diagnoses within each category. RESULTS: Musculoskeletal disorders (MSDs) and diseases of the endocrine and cardiovascular systems were the most prevalent conditions, affecting 72.7%, 34.2%, and 31.1% of enrolled miners, respectively. CONCLUSIONS: This population of miners has a substantial burden of health conditions that can adversely impact health and well-being. Mine safety and health professionals can use analyses of claims data to identify priorities for improving miner health and well-being.

Vaccination is an effective preventive strategy against influenza. Kyrgyzstan introduced a comprehensive influenza vaccination program in 2013 and has collaborated with the Task Force for Global Health since 2017 to expand vaccination coverage. In 2023, an influenza vaccine post-introduction evaluation was conducted to identify strengths and weaknesses in the influenza vaccination program and to identify measures for improvement. Site visits were conducted across six regions of the country and interviews were conducted with national, regional and district staff, health facility staff, and individuals from priority populations for influenza vaccination using standardized questionnaires. Two major challenges identified in this evaluation were the inadequate supply of influenza vaccine to cover the priority groups and the low acceptance and uptake of influenza vaccine among pregnant people. These findings are important as they can inform targeted strategies and policy updates to increase influenza vaccine implementation and uptake in Kyrgyzstan.

Seismic monitoring of underground longwall mines can provide valuable information for managing coal burst risks and understanding the ground response to extraction. However, the underground longwall mine environment poses major challenges for traditional in-mine microseismic sensors including the restricted use of electronics due to potentially explosive atmospheres, the need to frequently and quickly relocate sensors as rapid mining progresses, and source parameter errors associated with complex time-dependent velocity structure. Distributed acoustic sensing (DAS), a technology that uses rapid laser pulses to measure strain along fiber-optic cables, shows potential to alleviate these shortcomings and improve seismic monitoring in coal mines when used in conjunction with traditional monitoring systems. Moreover, because DAS can acquire measurements that are not possible to record with traditional seismic sensors, it also enables entirely new monitoring approaches. This work demonstrates several DAS deployment strategies such as deploying fiber on the mine floor, in boreholes drilled from the surface and from mine level, on the longwall mining equipment, and wrapped around secondary support cans. Although there are several data processing and deployment improvements needed before DAS-based monitoring can become routine in underground longwall mines, the findings presented here can aid decision makers in assessing the potential of DAS to meet their needs and help guide future deployment designs. © 2025

Work-related injuries from overexertion, particularly lifting, are a major concern in occupational safety. Traditional assessment tools, such as the Revised NIOSH Lifting Equation (RNLE), require significant training and practice for deployment. This study presents an approach that integrates tactile gloves with computer vision (CV) to enhance the assessment of lifting-related injury risks, addressing the limitations of existing single-modality methods. Thirty-one participants performed 2747 lifting tasks across three lifting risk categories (LI < 1, 1 ≤ LI ≤ 2, LI > 2). Features including hand pressure measured by tactile gloves during each lift and 3D body poses estimated using CV algorithms from video recordings were combined and used to develop prediction models. The Convolutional Neural Network (CNN) model achieved an overall accuracy of 89 % in predicting the three lifting risk categories. The results highlight the potential for a real-time, non-intrusive risk assessment tool to assist ergonomic practitioners in mitigating musculoskeletal injury risks in workplace environments.