BACKGROUND: Incidence data on pediatric chronic kidney disease (CKD) is incomplete. We developed electronic health record (EHR)-based algorithms (e-phenotypes) to identify cases and provide incidence estimates of 5 leading causes of pediatric CKD. METHODS: E-Phenotypes using common standardized clinical terminology were built and contained utilization, diagnostic, procedural, age, and time-period inclusion and exclusion criteria for autosomal dominant polycystic kidney disease (ADPKD), Alport Syndrome (AS), congenital anomalies of the kidney and urinary tract (CAKUT), lupus nephritis (LN), and primary childhood nephrotic syndrome (NS). Cases diagnosed between 2014 and 2023 were identified from a pediatric healthcare system that is the sole pediatric nephrology provider serving the Atlanta Metropolitan Statistical Area (MSA). The performance of the e-phenotypes was tested using a cohort of 1,000 pediatric patients. Cases identified were used to estimate incidences using population information from the Georgia Department of Health. RESULTS: The e-phenotypes demonstrated sensitivity ranging from 0.83 to 0.95, specificity 0.96 to 1.00, PPV 0.81 to 1.00, and NPV 0.98 to 1.00. All positive likelihood ratios (LR) were >20 and negative LR < 0.20. The 6,814 combined cases of ADPKD (n=107), AS (n=31), CAKUT (n=6,120), LN (n=161), and NS (n=395) had an annual incidence of 47.07 (95% CI 45.96-48.20) per 100,000 children. Annual incidence per 100,000 children (95% CI) for each condition was: ADPKD 0.74 (0.61- 0.89), AS 0.21 (0.15-0.30), CAKUT 42.28 (41.22-43.35), LN 1.11 (0.95-1.30), and NS 2.73 (2.47-3.01). CONCLUSIONS: Our incidence estimates suggest CKD conditions are common among children. The e-phenotypes require validation for use at other institutions but offer opportunities to examine determinants of CKD detection, management, and outcomes.

A significant portion of the work of developing and validating methods for volatile organic compound (VOC) sampling in workplace atmospheres involves the use of laboratory-generated atmospheres. The sample variability was evaluated from the dynamic atmosphere generation system used for VOC atmosphere generation and sampling. Characterization of the bias and variability of samples was done for a variety of atmospheres containing neat n-heptane and mixtures of VOCs sampled on activated coconut shell charcoal. Estimates of sampling variability ranged from 2% for neat n-heptane to 12% for a component in the 10 VOC mix. Sample variability increased for lower concentration samples and for mixtures of VOCs compared to single component atmospheres. This study can serve as a baseline for future atmosphere sampling experiments evaluating performance at lower concentrations and mixed VOC environments.

Importance: There are limited data describing SARS-CoV-2-specific immune responses and their durability following infection and vaccination in nursing home residents. Objective(s): To evaluate the quantitative titers and durability of binding antibodies detected after SARSCoV-2 infection and subsequent COVID-19 vaccination. Design(s): A prospective longitudinal evaluation included nine visits over 150 days; visits included questionnaire administration, blood collection for serology, and paired anterior nasal specimen collection for testing by BinaxNOWTM COVID-19 Ag Card (BinaxNOW), reverse transcription polymerase chain reaction (RT-PCR), and viral culture. Setting(s): A nursing home during and after a SARS-CoV-2 outbreak. Participant(s): 11 consenting SARS-CoV-2-positive nursing home residents. Main Outcomes and Measures: SARS-CoV-2 testing (BinaxNOWTM, RT-PCR, viral culture); quantitative titers of binding SARS-CoV-2 antibodies post-infection and post-vaccination (beginning after the first dose of the primary series). Result(s): Of 10 participants with post-infection serology results, 9 (90%) had detectable Pan-Ig, IgG, and IgA antibodies and 8 (80%) had detectable IgM antibodies. At first antibody detection post-infection, two-thirds (6/9, 67%) of participants were RT-PCR-positive but none were culture positive. Ten participants received vaccination; all had detectable Pan-Ig, IgG, and IgA antibodies through their final observation <=90 days post-first dose. Post-vaccination geometric means of IgG titers were 10-200-fold higher than post-infection. Conclusions and Relevance: Nursing home residents in this cohort mounted robust immune responses to SARS-CoV-2 post-infection and post-vaccination. The augmented antibody responses post-vaccination are potential indicators of enhanced protection that vaccination may confer on previously infected nursing home residents. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. This article is a US Government work. It is not subject to copyright under 17 USC 105 and is also made available for use under a CC0 license.

There are limited data describing SARS-CoV-2-specific immune responses and their durability following infection and vaccination in nursing home residents. We conducted a prospective longitudinal evaluation of 11 consenting SARS-CoV-2-positive nursing home residents to evaluate the quantitative titers and durability of binding antibodies detected after SARS-CoV-2 infection and subsequent COVID-19 vaccination. The evaluation included nine visits over 150 days from October 25, 2020, through April 1, 2021. Visits included questionnaire administration, blood collection for serology, and paired anterior nasal specimen collection for testing by BinaxNOW™ COVID-19 Ag Card (BinaxNOW), reverse transcription polymerase chain reaction (RT-PCR), and viral culture. We evaluated quantitative titers of binding SARS-CoV-2 antibodies post-infection and post-vaccination (beginning after the first dose of the primary series). The median age among participants was 74 years; one participant was immunocompromised. Of 10 participants with post-infection serology results, 9 (90%) had detectable Pan-Ig, IgG, and IgA antibodies, and 8 (80%) had detectable IgM antibodies. At first antibody detection post-infection, two-thirds (6/9, 67%) of participants were RT-PCR-positive, but none were culture- positive. Ten participants received vaccination; all had detectable Pan-Ig, IgG, and IgA antibodies through their final observation ≤90 days post-first dose. Post-vaccination geometric means of IgG titers were 10-200-fold higher than post-infection. Nursing home residents in this cohort mounted robust immune responses to SARS-CoV-2 post-infection and post-vaccination. The augmented antibody responses post-vaccination are potential indicators of enhanced protection that vaccination may confer on previously infected nursing home residents.

Choosing an appropriate surrogate of hazardous drugs for use in testing Closed System Drug-Transfer Devices (CSTDs) is a challenging endeavor with many factors that must be considered. It was suggested that the compound propylene glycol methyl ether (PGME) may meet many of the criteria we considered important in a suitable surrogate. Criteria included sufficient volatility to evaporate from aqueous liquid leaks efficiently, a Henry's constant which produced sufficient vapor phase concentrations to make headspace leaks detectable, and suitability for detection using a low-cost detection system. We evaluated the measurement of vapors from solutions containing PGME released inside a closed chamber. We present data used to quantify limits of detection, limits of quantification, bias, precision, and accuracy of Fourier Transform Infrared Spectroscopy (FTIR) measurements of vapors from 2.5 M PGME solutions. The effects of ethanol as a component of the PGME solution were also evaluated. Liquid drops of PGME solutions and headspace vapors above PGME solutions were released to simulate leaks from CSTDs. Using a calibration apparatus, an instrumental limit of detection (LOD) of 0.25 ppmv and a limit of quantitation (LOQ) of 0.8 ppmv were determined for PGME vapor. A LOD of 1.1 μL and a LOQ of 3.5 μL were determined for liquid aliquots of 2.5 M PGME solution released in a closed chamber. Accurate quantitation of liquid leaks required complete evaporation of droplets. With the upper end of the useable quantitation range limited by slow evaporation of relatively large droplets and the lower end defined by the method LOQ, the method evaluated in this research had a narrow quantitative range for liquid droplets. Displacement of 45 mL of vial headspace containing PGME vapor is the largest amount expected when using the draft NIOSH testing protocol. Release of an unfiltered 45 mL headspace aliquot within the NIOSH chamber was calculated to produce a concentration of 0.8 ppmv based on the Henry's constant, which is right at the instrumental LOQ. Therefore, the sensitivity of the method was not adequate to determine leaks of PGME vapor from a headspace release through an air filtering CSTD when using the draft NIOSH testing protocols with an FTIR analyzer.

Determining worker exposure to hazardous volatile organic compounds (VOCs) in air at levels exceeding the Permissible Exposure Limits and Recommended Exposure Limits established by the U.S. federal agencies of Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH), respectively, will continue to be an important part of environmental and occupational health risk assessments. The purpose of this work was to develop a reliable analytical method for rapid and on-site assessments of occupational VOC exposures using field-capable thermal desorption-gas chromatography-mass spectrometry (TD-GC-MS) instrumentation (i.e. the HAPSITE ER). The experiments involved in this study included determining TD-GC-MS parameters suitable for efficient analyte separation and quantitation on the HAPSITE ER, determinations of analyte mass loadings that cause mass spectrometer detector saturations, generation of calibration curves, estimations of the limits of detection (LODs) and quantification (LOQs), as well as desorption efficiency and relative response factor repeatability. The LODs using Carbopack B and Tenax TA sampling media were estimated and ranged from 0.21.9 ng and 0.0450.3 ng, respectively. The LOQs using Carbopack B and Tenax TA sampling media were estimated and ranged from 1.06.3 ng and 0.21.1 ng, respectively. We have developed a reliable analytical method for chloroform, benzene, trichloroethylene, and heptane using field-portable HAPSITE ER instrumentation and Tenax TA sorbent media. Reliable and accurate methods were developed for chloroform and trichloroethylene using Carbopack B sorbent media, however, this particular sorbent hadlow desorption efficiency and insufficient repeatability in relative response factors for many analytes. Our current and ongoing work in determining the uptake rates for analytes on Tenax TA sorbent media will make the methods described herein applicable for on-site occupational VOC exposure assessments of chloroform, benzene, trichloroethylene, and heptane using either passive or active air sampling techniques. This work was authored as part of the Contributors official duties as an Employee of the United States Government and is therefore a work of the United States Government. In accordance with 17 USC 105, no copyright protection is available for such works under US Law.

BACKGROUND: On 20 March 2012, the Minnesota Department of Health (MDH) was notified of multiple Facebook postings suggestive of a foodborne outbreak of Group A Streptococcus (GAS) pharyngitis occurring among attendees of a high school dance team banquet. An investigation was initiated. METHODS: Associations between GAS pharyngitis and specific food items were assessed among banquet attendees. Pharyngeal swabs were performed on attendees, household contacts, and food workers. Patient GAS isolates from clinical laboratories were also obtained. Pharyngeal and food specimens were cultured for GAS by the MDH Public Health Laboratory. Isolates were further characterized by pulsed-field gel electrophoresis (PFGE) and emm typing. RESULTS: Among 63 persons who consumed banquet food, 18 primary illnesses occurred, yielding an attack rate of 29%. Although no food or beverage items were significantly associated with illness, pasta consumption yielded the highest relative risk (risk ratio, 3.56; 95% confidence interval, .25-50.6). GAS colonies with indistinguishable PFGE patterns corresponding to emm subtype 1.0 were isolated from 5 patients and from leftover pasta. The pasta was prepared at home by a dance team member parent; both parent and child reported GAS pharyngitis episodes 3 weeks before the banquet. CONCLUSIONS: In this foodborne outbreak of GAS pharyngitis, pasta was implicated as the vehicle. Recognition of foodborne GAS illness is challenging because transmission is typically assumed to occur by respiratory spread; foodborne transmission should be considered when clusters of GAS pharyngitis patients are encountered. DNA-based typing can reveal potentially epidemiologically related isolates during GAS disease outbreaks and facilitate understanding and control of GAS disease.

OBJECTIVE: Congenital cytomegalovirus (CMV) infection is a common cause of hearing loss and intellectual disability. We assessed CMV knowledge and the frequency of women's behaviors that may enable CMV transmission to inform strategies for communicating prevention messages to women. METHODS: We analyzed survey responses from 4184 participants (2181 women, 2003 men) in the 2010 HealthStyles survey, a national mail survey designed to be similar to the United States population. RESULTS: Only 7% of men and 13% of women had heard of congenital CMV. Women with children under age 19 (n=918) practiced the following risk behaviors at least once per week while their youngest child was still in diapers: kissing on the lips (69%), sharing utensils (42%), sharing cups (37%), and sharing food (62%). Women practiced protective, hand cleansing behaviors most of the time or always after: changing a dirty diaper (95%), changing a wet diaper (85%), or wiping the child's nose (65%), but less commonly after handling the child's toys (26%). CONCLUSIONS: Few women are aware of CMV and most regularly practice behaviors that may place them at risk when interacting with young children. Women should be informed of practices that can reduce their risk of CMV infection during pregnancy.