Genomic epidemiological analysis of SARS-CoV-2 household transmission

Family clusters have contributed significantly to the onward spread of SARS-CoV-2. However, the dynamics of viral transmission in this setting remain incompletely understood. We describe the clinical and viral-phylogenetic characteristics of a family cluster of SARS-CoV-2 infections with a high attack rate, and explore how whole-genome sequencing (WGS) can inform outbreak investigations in this context. In this cluster, the first symptomatic case was a 22-month-old infant who developed rhinorrhoea and sneezing 2 days prior to attending a family gathering. Subsequently, seven family members in attendance at this event were diagnosed with SARS-CoV-2 infections, including the infant described. WGS revealed indistinguishable SARS-CoV-2 genomes recovered from the adults at the gathering, which were closely related genetically to B.1 lineage viruses circulating in the local community. However, a divergent viral sub-lineage was recovered from the infant and another child, each harbouring a distinguishing spike substitution (N30S). This suggested that the infant was unlikely to be the primary case, despite displaying symptoms first, and additional analysis of her nasopharyngeal swab revealed a picornavirus co-infection to account for her early symptoms. Our findings demonstrate how WGS can elucidate the transmission dynamics of SARS-CoV-2 infections within household clusters and provide useful information to support outbreak investigations. Additionally, our description of SARS-CoV-2 viral lineages and notable variants circulating in Ireland to date provides an important genomic-epidemiological baseline in the context of vaccine introduction.

Predicting COVID-19 cases with unknown homogeneous or heterogeneous resistance to infectivity

We present a restricted infection rate inverse binomial-based approach to better predict COVID-19 cases after a family gathering. The traditional inverse binomial (IB) model is inappropriate to match the reality of COVID-19, because the collected data contradicts the model’s requirement that variance should be larger than the expected value. Our version of an IB model is more appropriate, as it can accommodate all potential data scenarios in which the variance is smaller, equal, or larger than the mean. This is unlike the usual IB, which accommodates only the scenario in which the variance is more than the mean. Therefore, we propose a refined version of an IB model to be able to accommodate all potential data scenarios. The application of the approach is based on a restricted infectivity rate and methodology on COVID-19 data, which exhibit two clusters of infectivity. Cluster 1 has a smaller number of primary cases and exhibits larger variance than the expected cases with a negative correlation of 28%, implying that the number of secondary cases is lesser when the number of primary cases increases and vice versa. The traditional IB model is appropriate for Cluster 1. The probability of contracting COVID-19 is estimated to be 0.13 among the primary, but is 0.75 among the secondary in Cluster 1, with a wider gap. Cluster 2, with a larger number of primary cases, exhibits smaller variance than the expected cases with a correlation of 79%, implying that the number of primary and secondary cases do increase or decrease together. Cluster 2 disqualifies the traditional IB model and requires its refined version. The probability of contracting COVID-19 is estimated to be 0.74 among the primary, but is 0.72 among the secondary in Cluster 2, with a narrower gap. The advantages of the proposed approach include the model’s ability to estimate the community’s health system memory, as future policies might reduce COVID’s spread. In our approach, the current hazard level to be infected with COVID-19 and the odds of not contracting COVID-19 among the primary in comparison to the secondary groups are estimable and interpretable.

Prinsip Arsitektur Berkelanjutan sebagai Basis Membangun Kemandirian Obyek Cagar Budaya Pesanggrahan Langenharjo Kabupaten Sukoharjo

<p class="AbstractTitle"><em>Pesanggrahan Langenharjo is the Heritage building that was built by Sri Susuhunan Paku Buwono X, The King of Keraton Kasunanan Surakarta Hadiningrat 1893-1939. Those building was a place where the king and his family held some activities such as a family gathering, recreation and meditation, it has a spasific location at the river side of Sungai Bengawan Solo. Most of building has suffered various serious damages because of lack of maintenance. National and local Government doesn’t have a sufficient fund for carrying out a regular reparation and recovery to those degradation processes. This research aimed to build a self capabiity for conserving Pesanggrahan Langenharjo by creating a synergic interaction with some potential factors surrounding it. Some essences of the Sustaiable Architecture were applied in formulating the concept of the Grand Design for Pesanggrahan Langenharjo for empowering the self capability in carrying out its conservation. ‘A Litle Forrest of Pesanggrahan Langenharjo’ is a grand concept which accommodate the needs of conserving a historical value of building and maintening a natural resources simultaneously. Some various activities are going to be able to be held within the area together harmoniously in order to strengthen sustainability and durability of the building and its environmrnt.</em></p>

817 A Case of Parasomnia Overlap Disorder in a Patient on Lithium

Introduction The literature contains few case reports of parasomnia overlap disorder. There are also few case reports of lithium inducing sleep walking behaviors. Here we seek to present a case of a patient with multiple parasomnias, is taking a number of psychotropic medications for bipolar I disorder, and is on PAP for OSA. Report of case(s) The patient is a 43 year old male with a history of occasional mild sleep walking since childhood that remitted approximately 10 years prior to the onset of treatment, but returned when he traveled out of area for a family gathering approximately one year prior to presentation in the sleep clinic. He reported not only the return of sleepwalking, on a nightly basis, as well as more severe symptoms (including enuresis and violence/aggression). He also reported several episodes of dream enactment, as well as a history of sleep paralysis and vivid hypnogogic hallucinations, both of which had been improved in the last year. He denied any history of cataplexy. He did complain of symptoms of significant RLS symptoms. He was partially compliant with CPAP for obstructive sleep apnea, though the sleep behaviors continued regardless of CPAP usage. His psychiatrist had started him on clonazepam (titrated to 2mg/night) prior to his intake in the sleep clinic, but with minimal benefit. His other medications included propranolol 40mg BID, lithium 900mg/1200mg, oxcarbazepine 600mg bid, lamictal 225mg bid, lurasidone 80mg qday, and benztropine 2mg bid. Attended polysomnography demonstrated five episodes of sleep behaviors, as well as loss of atonia during REM, and severe obstructive sleep apnea (AHI of 61.2). Conclusion The patients various parasomnias could be due to the side effects of his psychotropic medications, represent a genetic or structural defect that is causing the various parasomnias, or be due to or worsened by his undertreated obstructive sleep apneas. His workup and treatment is still ongoing, but he has continued on clonazepam 2mg but taken 2 hours earlier, and has started a new APAP. Because of the severity of his bipolar disorder (including severe suicidal ideation), he is not a candidate to tapering the lithium or to taking serotonergic antidepressants. Support (if any):

Clinical Characteristics of Patients Infected with Coronavirus Disease 2019 (COVID-19) in Iran: A Retrospective Cohort Study

Background: Coronavirus disease 2019 (COVID-19) was introduced by the World Health Organization as a pandemic and emergency for human health. This study aimed to investigate the clinical characteristics of patients infected with COVID-19 in Guilan Province, Iran. Methods: This retrospective study was conducted on 1,000 patients with a definitive diagnosis of COVID-19 pneumonia admitted to six hospitals in Guilan Province, Iran, from April 13 to June 14, 2020. This study evaluated the patients' clinical information, demographic characteristics, laboratory results, and chest computed tomography scans. Findings: The mean age of the patients was obtained at 55±1.3 years, and the majority (n=800; 80%) of the cases were male. Furthermore, most patients had underlying diseases, including respiratory system disease (n=173; 17.3%), cardiovascular disease (n=711; 71.1%), and malignancy (n=146; 14.6%). The most common causes of the infection with COVID-19 included the presence in crowded places (n=733; 73.3%), close contact with the infected person (n=370; 82.2%), possession of pets (n=107; 23.2%), and family gathering (n=822; 82.2%). In addition, the most common clinical symptoms in patients included fever (n=911; 91.1%), cough (n=900; 90%), and dyspnea or shortness of breath (n=889; 88.9%). Other less common symptoms were diarrhea (n=160; 16%), vomiting (n=168; 16.8%), and headache (n=217; 21.7%). Dyspnea developed in 889 (88.9%) patients, and 660 (66%) cases had increased leucocytes. Conclusion: COVID-19 causes mild to fatal pneumonia in patients. Therefore, early detection and treatment of these patients are of utmost importance. Timely treatment of the disease can reduce the severity of symptoms and prevent the further spread of the disease.

A superspreading event involving a cluster of 14 coronavirus disease 2019 (COVID-19) infections from a family gathering in Hong Kong SAR (China)

Objective: An outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in Wuhan, China, in December 2019, with subsequent spread around the world. Hong Kong Special Administrative Region SAR (China) recorded its first confirmed cases on 23 January 2020. In this report, we describe a family cluster of 12 confirmed cases, with two additional confirmed cases from secondary transmission. Methods: We reported the epidemiological, clinical and laboratory findings of the family cluster, as well as the public health measures instituted. Results: All 12 confirmed COVID-19 cases were among the 19 attendees of a three-hour Chinese New Year family dinner consisting of hotpot and barbecue dishes. Environmental sampling of the gathering venue was negative. Two additional confirmed cases, who were co-workers of two confirmed cases, were later identified, indicating secondary transmission. Contact tracing, quarantine and environmental disinfection were instituted to contain further spread. Discussion: Our findings were highly suggestive of a superspreading event during the family gathering. The source was likely one of the cases during the pre-symptomatic phase. The event attested to the high infectivity of SARS-CoV-2 through human-to-human transmission from social activities and argued for the necessity of social distancing in curtailing the disease spread.

Predicting COVID-19 cases with unknown homogeneous or heterogeneous resistance to infectivity

This article constructs a restricted infection rate inverse binomial-based approach to predict COVID-19 cases after a family gathering. The traditional inverse binomial (IB) model is unqualified to match the reality of COVID-19, because the data contradicts the model’s requirement that variance should be greater than expected value. A refined version of the IB model is a necessity to predict COVID-19 cases after family gatherings. Our refined version of an IB model is more appropriate and versatile, as it accommodates all potential data scenarios: equal, lesser, or greater variance than expected value.Application of the approach is based on a restricted infectivity rate and methodology on Fan et al.’s COVID-19 data, which exhibits two clusters of infectivity. Cluster 1 has a smaller number of primary cases and exhibits larger variance than the expected cases with a negative correlation of 28%, implying that the number of secondary cases is lesser when the number of primary cases increases and vice versa. The traditional inverse binomial (IB) model is appropriate for Cluster 1. The probability of contracting COVID-19 is estimated to be 0.13 among the primary, but is 0.75 among the secondary in Cluster 1, with a wider gap. Conversely, Cluster 2, exhibits smaller variance than the expected cases with a correlation of 79%, implying the number of primary and secondary cases increase or decrease together. Cluster 2 disqualifies the traditional IB model and demands its refined version. Probability of contracting COVID-19 is estimated to be 0.74 among the primary, but is 0.72 among the secondary in Cluster 2, with a narrower gap.The model’s ability to estimate the community’s health system memory for future policies to be developed is an asset of this approach. The current hazard level to be infected with COVID-19 among the primary and secondary groups are estimable and interpretable.Author SummaryCurrent statistical models are not able to accurately predict disease infection spread in the COVID-19 pandemic. We have applied a widely-used inverse binomial method to predict rates of infection after small gatherings, going from primary (original) cases to secondary (later) cases after family gatherings or social events, using the data from the Wuhan and Gansu provinces in China, where the virus first spread. The advantages of the proposed approach include that the model’s ability to estimate the community’s health system memory for future policies to be developed, as such policies might reduce COVID’s spread if not its control. In our approach, as demonstrated, the current hazard level of becoming infected with COVID-19 and the odds of contracting COVID-19 among the primary in comparison to the secondary groups are estimable and interpretable. We hope the proposed approach will be used in future epidemics.

Pola Perubahan Ziarah Makam sebagai Arena Sosial

The changing pattern of the grave pilgrimage as a social arena has undergone various changes. The tradition of pilgrimage to the tombs has been going on hundreds of years ago and in Islam. This study aims to determine how the pattern of changes in the grave expedition as a social arena. This article discusses habitus, arenas, social capital and practices that occur in society. Qualitative data with case studies are the approach used in the analysis. The data collection technique was carried out in three different ways, including in-depth interviews, discussions with the Nazirite tombs and document studies. Secondary sources were obtained through the old Banten museum, regional libraries, Nadziran documents, news on the pilgrimage site announcement boards, previous research reports, related papers, journal articles, visualization documents in the form of photographs others. The data analysis technique starts with data reduction, data presentation and concluding. This research resulted in several findings including grave pilgrimage as an arena for a family gathering, an arena for healing mental illnesses, an arena for work images, an arena for spiritual healing, an arena for hereditary ritual habitus, and a hall for symbolic power.

STRATEGI PENGEMBANGAN PENDIDIKAN ANAK USIA DINI (Perspektif Dakwah Nabi)

Early Childhood Education has grown in our society. But on the other hand, the problem of violence against children (KDRT), including early childhood, is still an important issue in this country. This is because parents' understanding of the meaning of education as a whole, let alone exemplified by the Prophet, is apparently still uneven. Even though the principles of early childhood education in the prophet's perspective already exist and can be role models. So, the objectives of this study are (1) to arouse awareness of parents to imitate the Prophet in early education for children, (2) to find a character education development strategy in early childhood education by involving parents This research method uses a qualitative research approach with text analysis (discourse), an objective hermeneutic approach to verses and hadiths as well as sources of information. The theory used in this study is the concept of AUD and combines the basic principles of verses from the Qur'an and Hadith and narrations. . The results of this study indicate that (1) at least 10 points of early childhood education have been exemplified by the Prophet in various aspects of children's life, in worship practices, and morals (2) strategies for developing early childhood education with the perspective of the Prophet's da'wah can be done by: strengthening communication parents with teachers, strengthening parent human resources with parenting study material, and strengthening the relationship between parents and teachers through family gathering activities.Keywords: da'wah, domestic violence, early childhood education, education, early childhood, Abstrak Pendidikan Anak Usia Dini sudah tumbuh di masyarakat kita. Tetapi pada sisi lain problem kekerasan terhadap anak-anak (KDRT), termasuk anak usia dini masih menjadi persoalan penting di negeri ini. Hal ini karena pemahaman orangtua terhadap makna pendidikan secara utuh apalagi diteladankan Nabi saw tampaknya masih belum merata. Padahal prinsip pendidikan anak usia dini dalam perspektif nabi sudah ada dan bisa jadi teladan. Maka, tujuan penelitian ini adalah (1) untuk menggugah kesadaran orangtua untuk meneladani Nabi saw dalam pendidikan sejak dini bagi anak-anak, (2) menemukan strategi pengembangan pendidikan karakter pada anak PAUD dengan melibatkan orangtua murid. Metode penelitian ini menggunakan pendekatan riset kualitatif dengan analisys text (wacana) pendekatan metode hermeneutic obyektif atasayat-ayat dan hadis serta sumber informasi.Teori yang digunakan dalam penelitian ini konsep AUD dan menggabungkan dengan prinsip dasar ayat Al-Qur’an dan Hadits serta riwayat. Hasil Penelitian ini menunjukan bahwa (1) setidaknya ada 10 poin pendidikan anak sejak dini telah dicontohkan Nabi saw dalam berbagai aspek kehidupan anak, dalam praktek ibadah, dan akhlak (2) strategi pengembangan PAUD dengan perspektif dakwah nabi saw bisa dilakukan dengan cara: penguatan komunikasi orangtua dengan guru, penguatan SDM orangtua dengan materi kajian parenting, dan penguatan silaturahmi orangtua dengan guru melalui kegiatan Family gathering.Kata kunci: dakwah, KDRT, PAUD, pendidikan, usia dini