Issue 26, August 2020
CDC Science Clips: Volume 12, Issue 26, August 4, 2020
Science Clips is produced weekly to enhance awareness of emerging scientific knowledge for the public health community. Each article features an Altmetric Attention scoreexternal icon to track social and mainstream media mentions!
This week, Science Clips is pleased to collaborate with CDC Vital Signs by featuring scientific articles from the latest issue on Clinical Characteristics of Patients with Confirmed Acute Flaccid Myelitis, United States, 2018. The articles marked with an asterisk are general review articles which may be of particular interest to clinicians and public health professionals seeking background information in this area.
The report consists of these components:
- Key scientific articles in featured topic areas (this week featuring articles in conjunction with August CDC Vital Signs, Clinical Characteristics of Patients with Confirmed Acute Flaccid Myelitis, United States, 2018)
- CDC-authored publications
- CDC Vital Signs
- Acute Flaccid Myelitis
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*Update on acute flaccid myelitis: recognition, reporting, aetiology and outcomesexternal icon
Hardy D, Hopkins S.
Arch Dis Child. 2020 Feb 10. -
*Understanding enterovirus d68-induced neurologic disease: A basic science reviewexternal icon
Hixon AM, Frost J, Rudy MJ, Messacar K, Clarke P, Tyler KL.
Viruses. 2019 Sep 4;11(9). -
Acute flaccid myelitis in the United States: 2015-2017external icon
Ayers T, Lopez A, Lee A, Kambhampati A, Nix WA, Henderson E, Rogers S, Weldon WC, Oberste MS, Sejvar J, Hopkins SE, Pallansch MA, Routh JA, Patel M.
Pediatrics. 2019 Nov;144(5). -
Vital Signs: Surveillance for acute flaccid myelitis - United States, 2018external icon
Lopez A, Lee A, Guo A, Konopka-Anstadt JL, Nisler A, Rogers SL, Emery B, Nix WA, Oberste S, Routh J, Patel M.
MMWR Morb Mortal Wkly Rep. 2019 Jul 12;68(27):608-614. -
Characteristics of patients with acute flaccid myelitis, United States, 2015-2018external icon
McLaren N, Lopez A, Kidd S, Zhang JX, Nix WA, Link-Gelles R, Lee A, Routh JA.
Emerg Infect Dis. 2020 Feb;26(2):212-9. -
Enterovirus D68 and acute flaccid myelitis-evaluating the evidence for causalityexternal icon
Messacar K, Asturias EJ, Hixon AM, Van Leer-Buter C, Niesters HG, Tyler KL, Abzug MJ, Dominguez SR.
Lancet Infect Dis. 2018 Aug;18(8):e239-e247. -
Clinical characteristics of enterovirus A71 neurological disease during an outbreak in children in Colorado, USA, in 2018: an observational cohort studyexternal icon
Messacar K, Spence-Davizon E, Osborne C, Press C, Schreiner TL, Martin J, Messer R, Maloney J, Burakoff A, Barnes M, Rogers S, Lopez AS, Routh J, Gerber SI, Oberste MS, Nix WA, Abzug MJ, Tyler KL, Herlihy R, Dominguez SR.
Lancet Infect Dis. 2020 Feb;20(2):230-239. -
Antibodies to enteroviruses in cerebrospinal fluid of patients with acute flaccid myelitisexternal icon
Mishra N, Ng TF, Marine RL, Jain K, Ng J, Thakkar R, Caciula A, Price A, Garcia JA, Burns JC, Thakur KT, Hetzler KL, Routh JA, Konopka-Anstadt JL, Nix WA, Tokarz R, Briese T, Oberste MS, Lipkin WI.
mBio. 2019 Aug 13;10(4). -
Pan-viral serology implicates enteroviruses in acute flaccid myelitisexternal icon
Schubert RD, Hawes IA, Ramachandran PS, Ramesh A, Crawford ED, Pak JE, Wu W, Cheung CK, O'Donovan BD, Tato CM, Lyden A, Tan M, Sit R, Sowa GA, Sample HA, Zorn KC, Banerji D, Khan LM, Bove R, Hauser SL, Gelfand AA, Johnson-Kerner BL, Nash K, Krishnamoorthy KS, Chitnis T, Ding JZ, McMillan HJ, Chiu CY, Briggs B, Glaser CA, Yen C, Chu V, Wadford DA, Dominguez SR, Ng TF, Marine RL, Lopez AS, Nix WA, Soldatos A, Gorman MP, Benson L, Messacar K, Konopka-Anstadt JL, Oberste MS, DeRisi JL, Wilson MR.
Nat Med. 2019 Nov;25(11):1748-1752. -
Acute flaccid myelitis in the United States, August-December 2014: Results of nationwide surveillanceexternal icon
Sejvar JJ, Lopez AS, Cortese MM, Leshem E, Pastula DM, Miller L, Glaser C, Kambhampati A, Shioda K, Aliabadi N, Fischer M, Gregoricus N, Lanciotti R, Nix WA, Sakthivel SK, Schmid DS, Seward JF, Tong S, Oberste MS, Pallansch M, Feikin D.
Clin Infect Dis. 2016 Sep 15;63(6):737-745.
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- Acute Flaccid Myelitis
- CDC Authored Publications
The names of CDC authors are indicated in bold text.
Articles published in the past 6-8 weeks authored by CDC or ATSDR staff.- Chronic Diseases and Conditions
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Effectiveness of interventions to increase colorectal cancer screening among American Indians and Alaska Nativesexternal icon
Haverkamp D, English K, Jacobs-Wingo J, Tjemsland A, Espey D.
Prev Chronic Dis. 2020 Jul 16;17:E62. -
Depressive symptoms and the arthritis-employment interface. A population-level studyexternal icon
Jetha A, Theis KA, Boring MA, Murphy LB, Guglielmo D.
Arthritis Care Res (Hoboken). 2020 Jul 23. -
Hospital length of stay, charges, and costs associated with a diagnosis of obesity in US children and youth, 2006-2016external icon
Kompaniyets L, Lundeen EA, Belay B, Goodman AB, Tangka F, Blanck HM.
Med Care. 2020 Aug;58(8):722-726. -
Weekend effect on in-hospital mortality for ischemic and hemorrhagic stroke in US rural and urban hospitalsexternal icon
Mekonnen B, Wang G, Rajbhandari-Thapa J, Shi L, Thapa K, Zhang Z, Zhang D.
J Stroke Cerebrovasc Dis. 2020 ;29(10). -
Identifying optimal survey-based algorithms to distinguish diabetes type among adults with diabetesexternal icon
Nooney JG, Kirkman MS, Bullard KM, White Z, Meadows K, Campione JR, Mardon R, Rivero G, Benoit SR, Pfaff E, Rolka D, Saydah S.
J Clin Transl Endocrinol. 2020 Sep;21:100231. -
Comparison of three devices for 24-hour ambulatory blood pressure monitoring in a nonclinical environment through a randomized trialexternal icon
Nwankwo T, Coleman King SM, Ostchega Y, Zhang G, Loustalot F, Gillespie C, Chang TE, Begley EB, George MG, Shimbo D, Schwartz JE, Muntner P, Kronish IM, Hong Y, Merritt R.
Am J Hypertens. 2020 Jul 23. -
Examination of laws allowing sunscreen use in schools in the context of UV levels by stateexternal icon
Patterson B, Holman DM, Qin J, Smith K, Zhou Y.
J Adolesc Health. 2020 Jul 18. -
Prevalence and predictors of high blood pressure among women of reproductive age and children aged 10 to 14 years in Guatemalaexternal icon
Pickens CM, Flores-Ayala R, Addo OY, Whitehead RD, Palmieri M, Ramirez-Zea M, Hong Y, Jefferds ME.
Prev Chronic Dis. 2020 Jul 23;17:E66. -
Hemophilia without prophylaxis: Assessment of joint range of motion and factor activityexternal icon
Wang M, Recht M, Iyer NN, Cooper DL, Soucie JM.
Res Pract Thromb Haemost. 2020 . -
Trends and outcomes of hip fracture hospitalization among Medicare beneficiaries with inflammatory bowel disease, 2000-2017external icon
Xu F, Wheaton AG, Barbour KE, Liu Y, Greenlund KJ.
Dig Dis Sci. 2020 Jul 22.
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- Communicable Diseases
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Associations among water, sanitation, and hygiene; and food exposures and typhoid fever in case-control studies: A systematic review and meta-analysisexternal icon
Brockett S, Wolfe M, Hamot A, Appiah GD, Mintz ED, Lantagne D.
Am J Trop Med Hyg. 2020 Jul 20. -
Essential components of a public health tuberculosis prevention, control, and elimination program: Recommendations of the Advisory Council for the Elimination of Tuberculosis and the National Tuberculosis Controllers Associationexternal icon
Cole B, Nilsen DM, Will L, Etkind SC, Burgos M, Chorba T.
MMWR Recomm Rep. 2020 Jul 31;69(7):1-27. -
Characteristics of sexual partnerships among men with diagnosed HIV who have sex with men, United States and Puerto Rico-2015-2019external icon
Dasgupta S, Tie Y, Bradley H, Beer L, Rosenberg ES, Holtgrave D, Fagan J, Green S, Shouse RL.
J Acquir Immune Defic Syndr. 2020 Aug 15;84(5):443-452. -
Awareness and willingness to use biomedical prevention strategies for HIV among sexual and gender minority youth: Results from a national surveyexternal icon
Dunville R, Harper C, Johns MM, Heim Viox M, Avripas S, Fordyce E, Stern M, Schlissel A, Carpenter R, Michaels S.
J Adolesc Health. 2020 Jul 18. -
Ventilator-associated pneumonia involving Aspergillus flavus in a patient with coronavirus disease 2019 (COVID-19) from Argentinaexternal icon
Fernandez NB, Caceres DH, Beer KD, Irrazabal C, Delgado G, Farias L, Chiller TM, Verweij PE, Stecher D.
Medical Mycology Case Reports. 2020 . -
Systematic testing for influenza and COVID-19 among patients with respiratory illnessexternal icon
Flannery B, Meece JK, Williams JV, Martin ET, Gaglani M, Jackson ML, Talbot HK.
Clin Infect Dis. 2020 Jul 20. -
Seroprevalence of antibodies to SARS-CoV-2 in 10 sites in the United States, March 23-May 12, 2020external icon
Havers FP, Reed C, Lim T, Montgomery JM, Klena JD, Hall AJ, Fry AM, Cannon DL, Chiang CF, Gibbons A, Krapiunaya I, Morales-Betoulle M, Roguski K, Rasheed MA, Freeman B, Lester S, Mills L, Carroll DS, Owen SM, Johnson JA, Semenova V, Blackmore C, Blog D, Chai SJ, Dunn A, Hand J, Jain S, Lindquist S, Lynfield R, Pritchard S, Sokol T, Sosa L, Turabelidze G, Watkins SM, Wiesman J, Williams RW, Yendell S, Schiffer J, Thornburg NJ.
JAMA Intern Med. 2020 Jul 21. -
Parainfluenza virus types 1-3 infections among children and adults hospitalized with community-acquired pneumoniaexternal icon
Howard LM, Edwards KM, Zhu Y, Williams DJ, Self WH, Jain S, Ampofo K, Pavia AT, Arnold SR, McCullers JA, Anderson EJ, Wunderink RG, Grijalva CG.
Clin Infect Dis. 2020 Jul 18. -
Infectious disease hospitalizations, New York City, 2001-2014external icon
Huang CC, Lucero DE, Lim S, Zhao Y, Arciuolo RJ, Burzynski J, Daskalakis D, Fine AD, Kennedy J, Haberling D, Vora NM.
Public Health Rep. 2020 Jul 20. -
Bringing women's voices to PMTCT CARE: adapting CARE's Community Score Card to engage women living with HIV to build quality health systems in Malawiexternal icon
Laterra A, Callahan T, Msiska T, Woelk G, Chowdhary P, Gullo S, Mwale PM, Modi S, Chauwa F, Kayira D, Kalua T, Wako E.
BMC Health Serv Res. 2020 Jul 22;20(1):679. -
Advanced HIV disease in the Botswana Combination Prevention Project: prevalence, risk factors, and outcomesexternal icon
Lebelonyane R, Mills LA, Mogorosi C, Ussery F, Marukutira T, Theu J, Kapanda M, Matambo S, Block L, Raizes E, Makhema J, Lockman S, Bachanas P, Moore J, Jarvis JN.
Aids. 2020 Jul 17. -
They are likely to be there: using a family-centered index testing approach to identify children living with HIV in Kenyaexternal icon
Okoko N, Kulzer JL, Ohe K, Mburu M, Muttai H, Abuogi LL, Bukusi EA, Cohen CR, Penner J.
Int J STD AIDS. 2020 Jul 21. -
Notes from the field: Public health efforts to mitigate COVID-19 transmission during the April 7, 2020, election - city of Milwaukee, Wisconsin, March 13-May 5, 2020external icon
Paradis H, Katrichis J, Stevenson M, Tomaro N, Mukai R, Torres G, Bhattacharyya S, Kowalik J, Schlanger K, Leidman E.
MMWR Morb Mortal Wkly Rep. 2020 Jul 31;69(30):1002-1003. -
Progress toward hepatitis B control - South-East Asia Region, 2016-2019external icon
Sandhu HS, Roesel S, Sharifuzzaman M, Chunsuttiwat S, Tohme RA.
MMWR Morb Mortal Wkly Rep. 2020 Jul 31;69(30):988-992. -
Use of drug-level testing and single-genome sequencing to unravel a case of HIV seroconversion on PrEPexternal icon
Spinelli MA, Lowery B, Shuford JA, Spindler J, Kearney MF, McFarlane JR, McDonald C, Okochi H, Phung N, Kuncze K, Jee K, Johannessen D, Anderson PL, Smith DK, Defechereux P, Grant RM, Gandhi M.
Clin Infect Dis. 2020 Jul 20. -
Symptom duration and risk factors for delayed return to usual health among outpatients with COVID-19 in a multistate health care systems network - United States, March-June 2020external icon
Tenforde MW, Kim SS, Lindsell CJ, Billig Rose E, Shapiro NI, Files DC, Gibbs KW, Erickson HL, Steingrub JS, Smithline HA, Gong MN, Aboodi MS, Exline MC, Henning DJ, Wilson JG, Khan A, Qadir N, Brown SM, Peltan ID, Rice TW, Hager DN, Ginde AA, Stubblefield WB, Patel MM, Self WH, Feldstein LR, IVY Network Investigators , CDC COVID-19 Response Team .
MMWR Morb Mortal Wkly Rep. 2020 Jul 31;69(30):993-998.
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- Environmental Health
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Prenatal and early childhood exposure to phthalates and childhood behavior at age 7 yearsexternal icon
Daniel S, Balalian AA, Insel BJ, Liu X, Whyatt RM, Calafat AM, Rauh VA, Perera FP, Hoepner LA, Herbstman J, Factor-Litvak P.
Environ Int. 2020 Jul 14;143:105894. -
Heat-associated mortality in a hot climate: Maricopa County, Arizona, 2006-2016external icon
Iverson SA, Gettel A, Bezold CP, Goodin K, McKinney B, Sunenshine R, Berisha V.
Public Health Rep. 2020 Jul 20.
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- Epidemiology and Surveillance
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Amplifying improvements in the Centers for Disease Control and Prevention Youth Risk Behavior Surveillance Systemexternal icon
Underwood JM, Brener N, Ford CA.
J Adolesc Health. 2020 Jul 18.
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- Health Behavior and Risk
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Exchange sex among high school students - Washington, DC, 2017external icon
Head SK, Eaton D, Lloyd PC, McLaughlin A, Davies-Cole J.
J Adolesc Health. 2020 Jul 14.
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- Healthcare Associated Infections
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Antibiotic multi-drug-resistance of Escherichia coli causing device- and procedure-related infections in the United States reported to the National Healthcare Safety Network (NHSN), 2013-2017external icon
Kourtis AP, Sheriff EA, Weiner-Lastinger LM, Elmore K, Preston LE, Dudeck M, McDonald LC.
Clin Infect Dis. 2020 Jul 23.
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- Immunity and Immunization
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The origins and genomic diversity of American Civil War Era smallpox vaccine strainsexternal icon
Duggan AT, Klunk J, Porter AF, Dhody AN, Hicks R, Smith GL, Humphreys M, McCollum AM, Davidson WB, Wilkins K, Li Y, Burke A, Polasky H, Flanders L, Poinar D, Raphenya AR, Lau TT, Alcock B, McArthur AG, Golding GB, Holmes EC, Poinar HN.
Genome Biol. 2020 Jul 20;21(1):175. -
Notes from the field: Rebound in routine childhood vaccine administration following decline during the COVID-19 pandemic - New York City, March 1-June 27, 2020external icon
Langdon-Embry M, Papadouka V, Cheng I, Almashhadani M, Ternier A, Zucker JR.
MMWR Morb Mortal Wkly Rep. 2020 Jul 31;69(30):999-1001. -
Incidence of meningococcal disease before and after implementation of quadrivalent meningococcal conjugate vaccine in the United Statesexternal icon
Mbaeyi S, Pondo T, Blain A, Yankey D, Potts C, Cohn A, Hariri S, Shang N, MacNeil JR.
JAMA Pediatr. 2020 Jul 20. -
Implementing the routine immunisation data module and dashboard of DHIS2 in Nigeria, 2014-2019external icon
Shuaib F, Garba AB, Meribole E, Obasi S, Sule A, Nnadi C, Waziri NE, Bolu O, Nguku PM, Ghiselli M, Adegoke OJ, Jacenko S, Mungure E, Gidado S, Wilson I, Wiesen E, Elmousaad H, Bloland P, Rosencrans L, Mahoney F, MacNeil A, Franka R, Vertefeuille J.
BMJ Glob Health. 2020 Jul;5(7).
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- Informatics
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Public health reporting and outbreak response: synergies with evolving clinical standards for interoperabilityexternal icon
Mishra NK, Duke J, Lenert L, Karki S.
J Am Med Inform Assoc. 2020 Jul 1;27(7):1136-1138.
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- Injury and Violence
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Fall-related emergency department visits involving alcohol among older adultsexternal icon
Shakya I, Bergen G, Haddad YK, Kakara R, Moreland BL.
J Safety Res. 2020 . -
Concussion reporting, return to learn, and return to play experiences in a sample of private preparatory high school studentsexternal icon
Waltzman D, Daugherty J, Snedekar K, Bouton J, Wang D.
Brain Inj. 2020 Jul 22:1-9.
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- Laboratory Sciences
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Potential antitumor activity of digitoxin and user-designed analog administered to human lung cancer cellsexternal icon
Eldawud R, Wagner A, Dong C, Gupta N, Rojanasakul Y, O'Doherty G, Stueckle TA, Dinu CZ.
Biochim Biophys Acta Gen Subj. 2020 Jul 14:129683. -
Lyssavirus vaccine with a chimeric glycoprotein protects across phylogroupsexternal icon
Fisher CR, Lowe DE, Smith TG, Yang Y, Hutson CL, Wirblich C, Cingolani G, Schnell MJ.
Cell Rep. 2020 Jul 21;32(3):107920. -
IMVAMUNE and ACAM2000 provide different protection against disease when administered postexposure in an intranasal monkeypox challenge prairie dog modelexternal icon
Keckler MS, Salzer JS, Patel N, Townsend MB, Nakazawa YJ, Doty JB, Gallardo-Romero NF, Satheshkumar PS, Carroll DS, Karem KL, Damon IK.
Vaccines (Basel). 2020 Jul 20;8(3). -
Optical microscopy reveals the dynamic nature of B. pseudomallei morphology during beta-lactam antimicrobial susceptibility testingexternal icon
McLaughlin HP, Bugrysheva J, Sue D.
BMC Microbiol. 2020 Jul 16;20(1):209. -
Estimation of the critical external heat leading to the failure of lithium-ion batteriesexternal icon
Tang W, Tam WC, Yuan L, Dubaniewicz T, Thomas R, Soles J.
Appl Therm Eng. 2020 ;179. -
Clindamycin protects nonhuman primates against inhalational anthrax but does not enhance reduction of circulating toxin levels when combined with ciprofloxacinexternal icon
Vietri NJ, Tobery SA, Chabot DJ, Ingavale S, Somerville BC, Miller JA, Schellhase CW, Twenhafel NA, Fetterer DP, Cote CK, Klimko CP, Boyer AE, Woolfitt AR, Barr JR, Wright ME, Friedlander AM.
J Infect Dis. 2020 Jul 22. -
Toxicity evaluation following pulmonary exposure to an as-manufactured dispersed boron nitride nanotube (BNNT) material in vivoexternal icon
Xin X, Barger M, Roach KA, Bowers L, Stefaniak AB, Kodali V, Glassford E, Dunn KL, Dunn KH, Wolfarth M, Friend S, Leonard SS, Kashon M, Porter DW, Erdely A, Roberts JR.
NanoImpact. 2020 ;19. -
Development of dried blood spot quality control materials for adenosine deaminase severe combined immunodeficiency and an LC-MS/MS method for their characterizationexternal icon
Young B, Hendricks J, Foreman D, Pickens CA, Hovell C, De Jesus VR, Haynes C, Petritis K.
Clinical Mass Spectrometry. 2020 ;17:4-11.
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- Maternal and Child Health
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Association between NICU admission and supine sleep positioning, breastfeeding, and postnatal smoking among mothers of late preterm infantsexternal icon
Hannan KE, Smith RA, Barfield WD, Hwang SS.
J Pediatr. 2020 Jul 19. -
A qualitative evaluation of parenting to support early development among Spanish-speaking Legacy for Children participantsexternal icon
Kotzky K, Robinson LR, Stanhope KK, Rojo AL, Beasley LO, Morris AS, Silovsky JF, Esparza I.
Journal of Child and Family Studies. 2020 .
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- Occupational Safety and Health
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Manganese fractionation using a sequential extraction method to evaluate welders’ flux core arc welding exposures in a shipyard, structural steel and custom parts manufacturersexternal icon
Hanley KW, Andrews RN, Bertke S, Carter T, Navarro K, Ashley K.
Gefahrstoffe Reinhaltung der Luft. 2020 ;80(5):185-193.
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- Parasitic Diseases
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One-step PCR: A novel protocol for determination of pfhrp2 deletion status in Plasmodium falciparumexternal icon
Jones S, Subramaniam G, Plucinski MM, Patel D, Padilla J, Aidoo M, Talundzic E.
PLoS One. 2020 ;15(7):e0236369.
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- Reproductive Health
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Ovarian hyperstimulation syndrome after assisted reproductive technologies: trends, predictors, and pregnancy outcomesexternal icon
Schirmer DA, Kulkarni AD, Zhang Y, Kawwass JF, Boulet SL, Kissin DM.
Fertil Steril. 2020 Jul 14.
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- Substance Use and Abuse
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Deaths and years of potential life lost from excessive alcohol use - United States, 2011-2015external icon
Esser MB, Sherk A, Liu Y, Naimi TS, Stockwell T, Stahre M, Kanny D, Landen M, Saitz R, Brewer RD.
MMWR Morb Mortal Wkly Rep. 2020 Jul 31;69(30):981-987. -
Current marijuana use among women of reproductive ageexternal icon
Ewing AC, Schauer GL, Grant-Lenzy AM, Njai R, Coy KC, Ko JY.
Drug Alcohol Depend. 2020 Jul 2;214:108161. -
Prevalence and correlates of ever having a substance use problem and substance use recovery status among adults in the United States, 2018external icon
Jones CM, Noonan RK, Compton WM.
Drug Alcohol Depend. 2020 Jul 12;214:108169.
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- Zoonotic and Vectorborne Diseases
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Homecare for sick family members while waiting for medical help during the 2014-2015 Ebola outbreak in Sierra Leone: a mixed methods studyexternal icon
Schmidt-Hellerau K, Winters M, Lyons P, Leigh B, Jalloh MB, Sengeh P, Sawaneh AB, Zeebari Z, Salazar M, Jalloh MF, Nordenstedt H.
BMJ Glob Health. 2020 Jul;5(7).
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- Chronic Diseases and Conditions
CDC Science Clips Production Staff
- Takudzwa Sayi, Editor
- Gail Bang, MLIS, Librarian
- Kathy Tucker, Librarian
- William (Bill) Thomas, MLIS, Librarian
- Jarvis Sims, MIT, MLIS, Librarian
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DISCLAIMER: Articles listed in the CDC Science Clips are selected by the Stephen B. Thacker CDC Library to provide current awareness of the public health literature. An article's inclusion does not necessarily represent the views of the Centers for Disease Control and Prevention nor does it imply endorsement of the article's methods or findings. CDC and DHHS assume no responsibility for the factual accuracy of the items presented. The selection, omission, or content of items does not imply any endorsement or other position taken by CDC or DHHS. Opinion, findings and conclusions expressed by the original authors of items included in the Clips, or persons quoted therein, are strictly their own and are in no way meant to represent the opinion or views of CDC or DHHS. References to publications, news sources, and non-CDC Websites are provided solely for informational purposes and do not imply endorsement by CDC or DHHS.