We present the main findings of the 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia (AAGA). Incidences were estimated using reports of accidental awareness as the numerator, and a parallel national anaesthetic activity survey to provide denominator data. The incidence of certain/probable and possible accidental awareness cases was ~1:19,600 anaesthetics (95% confidence interval 1:16,700-23,450). However, there was considerable variation across subtypes of techniques or subspecialities. The incidence with neuromuscular block (NMB) was ~1:8200 (1:7030-9700), and without, it was ~1:135,900 (1:78,600-299,000). The cases of AAGA reported to NAP5 were overwhelmingly cases of unintended awareness during NMB. The incidence of accidental awareness during Caesarean section was ~1:670 (1:380-1300). Two-thirds (82, 66%) of cases of accidental awareness experiences arose in the dynamic phases of anaesthesia, namely induction of and emergence from anaesthesia. During induction of anaesthesia, contributory factors included: use of thiopental, rapid sequence induction, obesity, difficult airway management, NMB, and interruptions of anaesthetic delivery during movement from anaesthetic room to theatre. During emergence from anaesthesia, residual paralysis was perceived by patients as accidental awareness, and commonly related to a failure to ensure full return of motor capacity. One-third (43, 33%) of accidental awareness events arose during the maintenance phase of anaesthesia, mostly due to problems at induction or towards the end of anaesthesia. Factors increasing the risk of accidental awareness included: female sex, age (younger adults, but not children), obesity, anaesthetist seniority (junior trainees), previous awareness, out-of-hours operating, emergencies, type of surgery (obstetric, cardiac, thoracic), and use of NMB. The following factors were not risk factors for accidental awareness: ASA physical status, race, and use or omission of nitrous oxide. We recommend that an anaesthetic checklist, to be an integral part of the World Health Organization Safer Surgery checklist, is introduced as an aid to preventing accidental awareness. This paper is a shortened version describing the main findings from NAP5--the full report can be found at http://www.nationalauditprojects.org.uk/NAP5_home.

Despite numerous barriers to transmission, zoonoses are the major cause of emerging infectious diseases in humans. Among these, severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and ebolaviruses have killed thousands; the human immunodeficiency virus (HIV) has killed millions. Zoonoses and human-to-animal cross-species transmission are driven by human actions and have important management, conservation, and public health implications. The current SARS-CoV-2 pandemic, which presumably originated from an animal reservoir, has killed more than half a million people around the world and cases continue to rise. In March 2020, New York City was a global epicenter for SARS-CoV-2 infections. During this time, four tigers and three lions at the Bronx Zoo, NY, developed mild, abnormal respiratory signs. We detected SARS-CoV-2 RNA in respiratory secretions and/or feces from all seven animals, live virus in three, and colocalized viral RNA with cellular damage in one. We produced nine whole SARS-CoV-2 genomes from the animals and keepers and identified different SARS-CoV-2 genotypes in the tigers and lions. Epidemiologic and genomic data indicated human-to-tiger transmission. These were the first confirmed cases of natural SARS-CoV-2 animal infections in the United States and the first in nondomestic species in the world. We highlight disease transmission at a nontraditional interface and provide information that contributes to understanding SARS-CoV-2 transmission across species. IMPORTANCE The human-animal-environment interface of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an important aspect of the coronavirus disease 2019 (COVID-19) pandemic that requires robust One Health-based investigations. Despite this, few reports describe natural infections in animals or directly link them to human infections using genomic data. In the present study, we describe the first cases of natural SARS-CoV-2 infection in tigers and lions in the United States and provide epidemiological and genetic evidence for human-to-animal transmission of the virus. Our data show that tigers and lions were infected with different genotypes of SARS-CoV-2, indicating two independent transmission events to the animals. Importantly, infected animals shed infectious virus in respiratory secretions and feces. A better understanding of the susceptibility of animal species to SARS-CoV-2 may help to elucidate transmission mechanisms and identify potential reservoirs and sources of infection that are important in both animal and human health.

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Moore, G. F., Taira, A., Klaus, A., Becker, L., Boeckel, B., Cragg, B. A., Dean, A., Fergusson, C. L., Henry, P., Hirano, S., Hisamitsu, T. et al. (2001). New insights into deformation and fluid flow processes in the Nankai Trough accretionary prism: Results of Ocean Drilling Program Leg 190. Geochemistry, Geophysics, Geosystems, 2, Article No: 2001GC000166.The Nankai Trough accretionary prism is considered an ?end-member? prism accreting a coarse terrigenous sediment section in a setting with structural simplicity, unparalleled resolution by seismic and other geophysical techniques, and large historic earthquakes. It therefore has been the focus of Ocean Drilling Program (ODP) drilling to address several unresolved questions concerning accretionary processes and prism evolution. At six sites cored along two transects across the Nankai Trough accretionary prism during ODP Leg 190, lithostratigraphy and sediment diagenesis vary markedly. For the first time, reference sites at the seaward ends of the two transects defined the stratigraphic framework of the accreting/subducting Shikoku Basin sedimentary section. A thick section of Miocene turbidites and smectite-rich mudstone is present within the subducting section at the Ashizuri site. The turbidites and mudstones are absent in the correlative section at the Muroto site; variations in lithology, mineralogy, and hydrologic properties of the incoming sediments probably contribute to the difference in prism wedge taper between the two transects, while possibly controlling the seismic character of the active plate boundary. The d?collement in both transects is localized within a common stratigraphic unit (?5.9?7 Ma) within the lower Shikoku Basin facies. The d?collement is also a major boundary for both physical and mechanical properties. A broad low-chloride pore water anomaly in the lower Shikoku Basin unit, first identified at Site 808, progressively decreases in magnitude from prism to basin along the Muroto Transect. Physical properties relationships, evidence for mineralogic changes in the sediments, and pore fluid chemistry suggest that the chloride anomaly results primarily from in situ diagenetic reactions in the sediments, possibly augmented by flow of freshened fluid from depth. New constraints on stratigraphy and age of units along more landward parts of the Muroto Transect have dramatically changed our ideas about the tectonic evolution of the prism in this area. Growth of the seaward-most part of the prism took place very rapidly, with 40 km of accretion within the past 2 Myr. This rate is at least 3 times greater than growth rates in a comparable prism.Peer reviewe

On April 22, CDC and the U.S. Department of Agriculture (USDA) reported cases of two domestic cats with confirmed infection with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). These are the first reported companion animals (including pets and service animals) with SARS-CoV-2 infection in the United States, and among the first findings of SARS-CoV-2 symptomatic companion animals reported worldwide. These feline cases originated from separate households and were epidemiologically linked to suspected or confirmed human COVID-19 cases in their respective households. Notification of presumptive positive animal test results triggered a One Health* investigation by state and federal partners, who determined that no further transmission events to other animals or persons had occurred. Both cats fully recovered. Although there is currently no evidence that animals play a substantial role in spreading COVID-19, CDC advises persons with suspected or confirmed COVID-19 to restrict contact with animals during their illness and to monitor any animals with confirmed SARS-CoV-2 infection and separate them from other persons and animals at home (1). SARS-CoV-2 is a zoonotic coronavirus that likely originated in bats (2). A small number of animals worldwide, including dogs, cats, zoo tigers and lions, and farmed mink, have been infected naturally with SARS-CoV-2, mostly through suspected human-to-animal transmission † (3). In addition, experimental studies in ferrets, golden Syrian hamsters, Egyptian fruit bats, and cats show that these species can transmit infection to cohoused animals of the same species (4-7). SARS-CoV-2 Clinical Presentation in Domestic Cats On March 24, in Nassau County, New York, a 4-year-old male domestic shorthair (cat A), developed respiratory illness characterized by sneezing, clear ocular discharge, and mild lethargy (Figure). On April 1, the cat was taken to a veterinary clinic; on physical examination the cat was found to be * One Health is a collaborative, multisectoral, and transdisciplinary approach, working at the local, regional, national, and global levels, with the goal of achieving optimal health outcomes recognizing the interconnection between humans, animals, plants, and their shared environment. † https://www.oie.int/scientific-expertise/specific-information-andrecommendations/questions-and-answers-on-2019novel-coronavirus/.

Adults with Down syndrome (DS) represent a unique population who are in need of clinical guidelines to address their medical care. The United States Preventive Service Task Force (USPSTF) has developed criteria for prioritizing conditions of public health importance with the potential for providing screening recommendations to improve clinical care. The quality of existing evidence needed to inform clinical guidelines has not been previously reviewed. Using the National Library of Medicine (NLM) database PubMed, we first identified 18 peer reviewed articles that addressed co-occurring medical conditions in adults with DS. Those conditions discussed in over half of the articles were prioritized for further review. Second, we performed detailed literature searches on these specific conditions. To inform the search strategy and review process a series of key questions were formulated a priori. The quality of available evidence was then graded and knowledge gaps were identified. The number of participating adults and the design of clinical studies varied by condition and were often inadequate for answering all of our key questions. We provide data on thyroid disease, cervical spine disease, hearing impairment, overweight-obesity, sleep apnea, congenital heart disease, and osteopenia-osteoporosis. Minimal evidence demonstrates massive gaps in our clinical knowledge that compromises clinical decision-making and management of these medically complex individuals. The development of evidence-based clinical guidance will require an expanded clinical knowledge-base in order to move forward.

NCT01176968.

INTRODUCTIONThe Ocean Drilling Program (ODP) is committed to deep-biosphere research and has constructed a new microbiological laboratory on board the JOIDES Resolution. The use of the JOIDES Resolution as a platform for deep-biosphere research requires that the recovered cores are suitable for microbiological study. The major concern is whether microbes from the drilling fluid are introduced into the recovered core material during coring. Therefore, it is critical to verify whether recovered cores are contaminated. Here we present details of two tracer methods used to quantify the amount of contamination. These methods were modified from land-based drilling operations for use on the JOIDES Resolution (see review by Griffin et al., 1997). Tracer experiments were first conducted during ODP Leg 185 (Plank, Ludden, Escutia, et al., in press) and involve the delivery of both chemical and particulate tracers during drilling and their quantification in the ODP cores. These tracers were introduced while drilling unconsolidated sediments using the advanced hydraulic piston corer (APC), sedimentary rock using the extended core barrel and rotary core barrel (RCB), and igneous rock using the RCB and diamond core barrel. This technical note presents details on the characteristics, preparation, and delivery of the tracers and their quantification in cores. Suggestions are made regarding sample handling with the goal of minimizing sample contamination. It is strongly recommended that these contamination tests be routinely conducted when coring for microbiological studies. D.C. SMITH ET AL. TRACER TESTS FOR MICROBIOLOGICAL STUDIES 2 MATERIALS AND METHODS Chemical Tracer: Perfluorocarbon CharacteristicsPerfluorocarbon tracers (PFT) have been used extensively in landbased drilling applications (Senum and Dietz, 1991;Russell et al. 1992;McKinley and Colwell, 1996) because they are inert and can be detected with high sensitivity. Perfluoro(methylcyclohexane) is the tracer that has been tested on the JOIDES Resolution. This perfluorocarbon (Aldrich 30293-7) has a molecular weight of 350.05, a boiling point of 76°C, and a density of 1.76 g/mL. Its solubility is ~1 mg/L in water and is 10 g/L in methanol (Colwell et al., 1992). The low solubility in water facilitates gas phase partitioning and quantitative headspace analysis. Preparation and DeliveryThe stock PFT is shipped in sealed ampoules, and it is not necessary to dilute it prior to use. Because the PFT is volatile and can be detected at extremely low concentrations, it is necessary to open the ampoules and transfer the PFT to the carboy used for delivery in a ventilated area well away from the core handling and PFT detection areas. Gloves should be worn during this process and discarded afterward. It is recommended that this transfer be performed on the helicopter deck while the JOIDES Resolution is under way and that all materials that may have been in contact with the PFT be disposed of immediately. These precautions will minimize the probability of obtaining false positi...