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Introduction: Regular whole blood donors often suffer from iron deficiency (ID) or iron deficiency anemia due to the loss of 200-300 mg of iron with each donation. Hemoglobin (Hb) as donor eligibility criterion reflects iron stores only poorly. ID in blood donors is typically prevented or treated with orally administered ferrous salts, which frequently cause gastrointestinal side effects. A high daily oral iron dose is counterproductive due to hepcidin upregulation. Oral sucrosomial iron (sucriron) is encapsulated ferric pyrophosphate that may be an option for blood donors due to its supposed high bioavailability and good tolerability. Methods: This monocentric single-cohort pilot study included fifty whole blood donors (divided into premenopausal women, postmenopausal women, and men) who did not meet Hb donation criteria. Participants aged 18-65 years with ferritin <30 ng/mL and venous Hb <12.5 g/dL in women and Hb <13.5 g/dL in men received oral sucriron (30 mg iron) for 90-120 days. Primary endpoints were the increase of Hb and ferritin. Results: Forty-seven participants completed the study. With the limitation that no control group was included, there was a substantial overall median increase of 0.94 g/dL Hb and 4.97 ng/mL ferritin (standardized on 90 days of iron intake). These value improvements were likewise observed in each of the subgroups. sucriron was very well tolerated, with almost no gastrointestinal side effects identified. Conclusion: A clear increase of Hb and ferritin was observed after the intake of sucriron, so it may be a reasonable and useful alternative to traditional oral iron therapy. The ease of administration, pleasant taste, dietary supplement status, and, most importantly, good tolerability highlight the value of sucriron supplementation.

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Less than seven years remain for Europe to meet the targets of the United Nations Sustainable Development Goals (SDGs). However robust and accurate methods for assessing SDG progress are currently lacking. Through the development of several SDG indices, this study addresses this critical knowledge gap by providing the means to accurately identify national 'problem areas' and thereby accelerate SDG achievement. Specifically, an indicator-based approach has been used to create a composite index containing 166 unique SDG indicators that assess a nation's SDG performance compared to the best and worst performers in the European Union (EU). Our results indicate that each EU nation is on average, 58% of the way towards the best performer in the overall SDG indicator framework. A nuanced taxonomy has been developed that allows for the assessment of SDG performance in several critical dimensions of the SDGs, including in 'Means-of-Implementation (MoI)', 'Linkage', and 'Outcome' indicators. The index's comprehensive framework allows for EU's performance in individual SDG indicators to be investigated while providing the most accurate assessment of national SDG performance, to date. Overall, the indices presented in this paper can significantly enhance the understanding of SDG performance while concurrently guiding national and EU SDG policy development.

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Temperature is critical in regulating virtually all biological functions in fish. Low temperature stress (cold shock/stress) is an often-overlooked challenge that many fish face as a result of both natural events and anthropogenic activities. In this study, we present an updated review of the cold shock literature based on a comprehensive literature search, following an initial review on the subject by M.R. Donaldson and colleagues, published in a 2008 volume of this journal. We focus on how knowledge on cold shock and fish has evolved over the past decade, describing advances in the understanding of the generalized stress response in fish under cold stress, what metrics may be used to quantify cold stress and what knowledge gaps remain to be addressed in future research. We also describe the relevance of cold shock as it pertains to environmental managers, policymakers and industry professionals, including practical applications of cold shock. Although substantial progress has been made in addressing some of the knowledge gaps identified a decade ago, other topics (e.g., population-level effects and interactions between primary, secondary and tertiary stress responses) have received little or no attention despite their significance to fish biology and thermal stress. Approaches using combinations of primary, secondary and tertiary stress responses are crucial as a research priority to better understand the mechanisms underlying cold shock responses, from short-term physiological changes to individual- and population-level effects, thereby providing researchers with better means of quantifying cold shock in laboratory and field settings.

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CONTEXT.­: Serologic tests on automated immunology analyzers are increasingly used to monitor acquired immunity against SARS-CoV-2. The heterogeneity of assays raises concerns about their diagnostic performance and comparability. OBJECTIVE.­: To test sera from formerly infected individuals for SARS-CoV-2 antibodies by using 6 automated serology assays and a pseudoneutralization test (PNT). DESIGN.­: Six SARS-CoV-2 serology assays were used to assess 954 samples collected during a 12-month period from 315 COVID-19 convalescents. The tests determined either antibodies against the viral nucleocapsid (anti-NC) or spike protein (anti-S). Two assays did not distinguish between antibody classes, whereas the others selectively measured immunoglobulin G (IgG) antibodies. PNT was used to detect the presence of neutralizing antibodies. RESULTS.­: Comparison of qualitative results showed only slight to moderate concordance between the assays (Cohen κ < 0.57). Significant correlations (P < .001) were observed between the antibody titers from all quantitative assays. However, titer changes were not detected equally. A total anti-S assay measured an increase in 128 of 172 cases (74%) of a suitable subset, whereas all IgG anti-S tests reported decreases in at least 118 (69%). Regarding the PNT results, diagnostic sensitivities of 89% or greater were achieved with positive predictive values of at least 93%. In contrast, specificity changed substantially over time, varying from 20% to 100%. CONCLUSIONS.­: Comparability of serologic SARS-CoV-2 antibody tests is rather poor. Owing to different diagnostic specificities, the tested assays were not equally capable of capturing changes in antibody titers. However, with thoroughly validated cutoffs, IgG-selective anti-S assays are a reliable surrogate test for SARS-CoV-2 neutralizing antibodies in former COVID-19 patients.

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BACKGROUND: Pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk for severe illness compared with nonpregnant women. Data to assess risk factors for illness severity among pregnant women with COVID-19 are limited. This study aimed to determine risk factors associated with COVID-19 illness severity among pregnant women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS: Pregnant women with SARS-CoV-2 infection confirmed by molecular testing were reported during 29 March 2020-5 March 2021 through the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET). Criteria for illness severity (asymptomatic, mild, moderate-to-severe, or critical) were adapted from National Institutes of Health and World Health Organization criteria. Crude and adjusted risk ratios for moderate-to-severe or critical COVID-19 illness were calculated for selected demographic and clinical characteristics. RESULTS: Among 7950 pregnant women with SARS-CoV-2 infection, moderate-to-severe or critical COVID-19 illness was associated with age 25 years and older, healthcare occupation, prepregnancy obesity, chronic lung disease, chronic hypertension, and pregestational diabetes mellitus. Risk of moderate-to-severe or critical illness increased with the number of underlying medical or pregnancy-related conditions. CONCLUSIONS: Older age and having underlying medical conditions were associated with increased risk of moderate-to-severe or critical COVID-19 illness among pregnant women. This information might help pregnant women understand their risk for moderate-to-severe or critical COVID-19 illness and can inform targeted public health messaging.

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Pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk for severe illness and might be at risk for preterm birth (1-3). The full impact of infection with SARS-CoV-2, the virus that causes COVID-19, in pregnancy is unknown. Public health jurisdictions report information, including pregnancy status, on confirmed and probable COVID-19 cases to CDC through the National Notifiable Diseases Surveillance System.* Through the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET), 16 jurisdictions collected supplementary information on pregnancy and infant outcomes among 5,252 women with laboratory-confirmed SARS-CoV-2 infection reported during March 29-October 14, 2020. Among 3,912 live births with known gestational age, 12.9% were preterm (<37 weeks), higher than the reported 10.2% among the general U.S. population in 2019 (4). Among 610 infants (21.3%) with reported SARS-CoV-2 test results, perinatal infection was infrequent (2.6%) and occurred primarily among infants whose mother had SARS-CoV-2 infection identified within 1 week of delivery. Because the majority of pregnant women with COVID-19 reported thus far experienced infection in the third trimester, ongoing surveillance is needed to assess effects of infections in early pregnancy, as well the longer-term outcomes of exposed infants. These findings can inform neonatal testing recommendations, clinical practice, and public health action and can be used by health care providers to counsel pregnant women on the risks of SARS-CoV-2 infection, including preterm births. Pregnant women and their household members should follow recommended infection prevention measures, including wearing a mask, social distancing, and frequent handwashing when going out or interacting with others or if there is a person within the household who has had exposure to COVID-19.†.

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A 76-year-old woman presented following two episodes of unexplained falls at home. Blood cultures were positive for Bacteroides fragilis and following investigations she was diagnosed with L4/L5 spondylodiscitis confirmed on spine MRI. She was initially treated with intravenous metronidazole and flucloxacillin prior to switching to ceftriaxone with good results. No primary cause of B. fragilis bacteraemia was found in this case. B. fragilis is a rare cause of spondylodiscitis.

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Based on existing laboratory research on the visual physiology of walleye Sander vitreus, we tested colours of known spectral sensitivity (i.e., green and orange) using constant and strobing (5 Hz) illumination with an LED-based light guidance device (LGD). Hatchery-reared age 0 and 2 years S. vitreus were exposed to these four light combinations as well as an unilluminated control treatment during day and night trials. Age 2 years S. vitreus generally avoided the LGD when light was produced (negative phototaxis) compared with the control, with continuous illumination having a greater effect than strobing. The proportions of both age 0 and 2 year fish exiting illuminating zones of the trial arena did not differ with light colour or strobe rate, suggesting that phototactic behaviours in S. vitreus do not change with ontogeny in these age classes. Our findings confirm that typical behavioural responses of S. vitreus to light stimuli are characterised by avoidance and provide evidence that the use of light for behavioural guidance (deterrence) may be effective at reducing entrainment and impingement of this species on hydraulic barriers during migrations, independent of ontogenetic stage.

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Exploiting species-specific behavioural responses of fish to light is an increasingly promising technique to reduce the entrainment or impingement of fish that results from the diversion of water for human activities, such as hydropower or irrigation. Whilst there is some evidence that white light can be an effective deterrent for Chinook salmon smolts, the results have been mixed. There is a need to test the response of fish to different spectra and strobing frequencies to improve deterrent performance. We tested the movement and spatial response of groups of four fish to combinations of light-emitting diode (LED) spectra (red, green, blue and white light) during the day and night, and strobing frequencies (constant and 2Hz) during the day, using innovative LED technology intended as a behavioural guidance device for use in the field. Whilst strobing did not alter fish behaviour when compared to constant light, the red light had a repulsive effect during the day, with fish under this treatment spending significantly less time in the half of the arena closest to the behavioural guidance device compared to both the control and blue light. Importantly, this effect disappeared at night, where there were no differences in movement and space use found between spectra. There was some evidence of a potential attractive response of fish to the blue and green light during the day. Under these light treatments, fish spent the highest amount of time closest to the behavioural guidance device. Further tests manipulating the light intensity in the different spectra are needed to verify the mechanistic determinants of the observed behaviours. Results are discussed in reference to the known spectral sensitivities of the cone and rod photopigments in these fish, and further experiments are suggested to better relate the work to mitigating the effects on fish of infrastructure used for hydropower and irrigation.

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IMPORTANCE: Oklahoma's infant mortality remains among the highest in the nation.1 Infant mortality rates are highest within the African American community.2 Physician and community partner efforts to decrease infant mortality are discussed to encourage more involvement in addressing infant mortality. The purpose of this article is to describe both provider and community-based efforts to combat infant mortality, particularly those focused on infant mortality disparities. OBSERVATIONS: The leading causes of infant deaths are prematurity, congenital malformations and/or chromosomal anomalies, and unclassified deaths such as Sudden Infant Death Syndrome or accidents. Prematurity accounts for the highest number of infant deaths. Efforts in Oklahoma focus on prematurity and SIDS prevention. Fetal Infant Mortality Review programs in Oklahoma and Tulsa Counties focus on local issues contributing to infant mortality and promote community engagement. In central Oklahoma, an Infant Mortality Alliance (IMA) was formed including over 180 stakeholders focusing on healthcare access, community and faith engagement, and health disparities. In the year following the IMA's initial work, the non-Hispanic African American infant mortality rate in Oklahoma County decreased by 18.8%.12. CONCLUSIONS AND RELEVANCE: Infant mortality is multifactorial and requires multiple strategies to combat. To address infant mortality and disparities, all aspects of the community must be involved. No individual alone can improve infant mortality. Physicians providing prenatal care make an impact by implementing recommended guidelines for progesterone therapy. Physicians seeing infants can encourage safe sleep practices among their families and local hospitals. While progress has been made addressing Oklahoma's infant mortality, much work remains.

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Pneumococcal peritonitis is prevalent in children and adults with comorbidities but extremely rare in healthy adults. Here we describe a case of pneumococcal peritonitis in a previously healthy woman with no known risk factors who presented with constipation, abdominal pain, and distention. Her only past medical history was an uncomplicated C-section two months prior to presentation. A laparotomy revealed a pneumococcal peritonitis without visible source of infection. The patient remained hospitalized until completion of antibiotic regimen with Ceftriaxone and resolution of symptoms. This report adds to the small body of evidence showing possible pneumococcal peritonitis in healthy young adults.

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The primary etiological agents associated with dental caries include the mutans streptococci (MS) comprised of Streptococcus mutans and Streptococcus sobrinus. The effective cultivation and isolation of MS are necessary for the study of MS, including their proper clinical assessment in the epidemiological study of dental caries. Several selective media have been developed for the isolation, enumeration, and characterization of MS. However, inhibition of MS may occur, reducing counts and perhaps limiting selection of some strains. The purpose of this study was to compare five culture media containing bacitracin recommended for the isolation of MS. Five commonly used bacitracin-containing media (MSB, MSKB, GTSB, TYS20B, and TYCSB) used for MS isolation were quantitatively evaluated. Standard plate counts were performed in duplicate for 2 prototype MS strains (S. mutans UA159 and S. sobrinus 6715) and for MS isolates from clinical saliva samples obtained from 16 children (approximate age 5years) to determine total plate counts, and total S. mutans counts. Selected isolates (n=249) from all five media for 5 saliva samples were further confirmed as S. mutans with real-time PCR then subsequently evaluated qualitatively with rep-PCR for genotype determination. All media resulted in variable enumeration with no significant difference in MS counts. MS prototype strains grew well on all five media; clinical isolates demonstrated more variability in counts but no overall significant differences were found. MSB demonstrated comparable ability to grow S. mutans but allowed for more non-S. mutans growth. All 5 media identified a consistent predominant genotype by rep-PCR. Recovery of minor genotypes was not inhibited by media type.

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The Preparing for a Lifetime, It's Everyone's Responsibility initiative was developed to improve the health and well- being of Oklahoma's mothers and infants. The development phase included systematic data collection, extensive data analysis, and multi-disciplinary partnership development. In total, seven issues (preconception/interconception health, tobacco use, postpartum depression, breastfeeding, infant safe sleep, preterm birth, and infant injury prevention) were identified as crucial to addressing infant mortality in Oklahoma. Workgroups were created to focus on each issue. Data and media communications workgroups were added to further partner commitment and support for policy and programmatic changes across multiple agencies and programs. Leadership support, partnership, evaluation, and celebrating small successes were important factors that lead to large scale adoption and support for the state-wide initiative to reduce infant mortality.

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BACKGROUND: The supine (back) sleep position has been found to be an important factor in the reduction of sudden infant death syndrome (SIDS). This paper will examine infant sleep position in Oklahoma and offer recommendations to increase safe sleep practices for Oklahoma infants. METHODS: Oklahoma Pregnancy Risk Assessment Monitoring System (PRAMS) data were used to estimate prevalence of sleep position among demographic maternal groups and related health behaviors. Chi-square tests were used to determine significance at p< 0.05. Logistic regression modeling was used to produce adjusted odds ratios to measure the association of selected independent variables and sleep position. RESULTS: Fifty-six percent of Oklahoma newborns were placed on their backs to sleep most of the time, far short of the Healthy People 2010 goal of 70%. Almost 1 in 5 infants were placed on their stomachs to sleep, a known risk factor for SIDS. Women between 100-184% of the federal poverty level, African American women and mothers with more than one child were those least likely to place their infants on their backs to sleep. CONCLUSION: Overall, the issue of not utilizing the recommended safe sleep position, the supine position, is pervasive among all maternal groups in Oklahoma. Significant differences were present for only a few variables (race, income, parity) indicating a strong need for a consistent message on sleep position for all Oklahoma parents and grandparents.

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BACKGROUND & OBJECTIVES: Group A streptococcal C5a peptidase (SCPA) is a major virulence surface factor. Its highly conserved nature among all tested serotypes of group A streptococci (GAS) as well as animal protection studies make SCPA a prime vaccine candidate. The present study was undertaken to explore the human immunogenicity to SCPA using an indirect enzyme-linked immunosorbent assay. METHODS: Children (n=72) who had signs and symptoms of acute pharyngitis and had GAS isolated from the throat at initial visit were included. Acute and convalescent sera were collected 4 weeks apart. ELISA was performed using recombinant SCPA peptide as antigen. RESULTS: The mean convalescent anti-SCPA level was twice the level of mean acute anti-SCPA and the difference was statistically significant (P < 0.0001). There was a rise in convalescent anti-SCPA in all children aged 2-12 yr. INTERPRETATION & CONCLUSION: Our observations confirmed that SCPA was highly immunogenic in children infected with group A streptococcal pharyngitis. Further studies need to be done to characterize the immune response including antibody subclass.

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