History of coronavirus

The history of coronaviruses is a reflection of the discovery of the diseases caused by coronaviruses and identification of the viruses. It starts with the first report of a new type of upper-respiratory tract disease among chickens in North Dakota, US, in 1931. The causative agent was identified as a virus in 1933. By 1936, the disease and the virus were recognised as unique from other viral disease. They became known as infectious bronchitis virus (IBV), but later officially renamed as "Avian coronavirus".
A new brain disease of mice (murine encephalomyelitis) was discovered in 1947 at Harvard Medical School in Boston. The virus causing the disease was called JHM (after Harvard pathologist John Howard Mueller). Three years later a new mouse hepatitis was reported from the National Institute for Medical Research in London. The causative virus was identified as mouse hepatitis virus (MHV).
In 1961, a virus was obtained from a school boy in Epsom, England, who was suffering from common cold. The sample designated B814 was confirmed as novel virus in 1965. New common cold viruses (assigned 229E) collected from medical students at the University of Chicago were also reported in 1966. Structural analyses of IBV, MHV, B18 and 229E using transmission electron microscopy revealed that they all belong to the same group of viruses. Making a crucial comparison in 1967, June Almeida and David Tyrrell invented the collective name coronavirus, as all those viruses were characterised by solar corona-like projections (called spikes) on their surfaces.
Other coronaviruses have been discovered from pigs, dogs, cats, rodents, cows, horses, camels, Beluga whales, birds and bats. As of 2020, 39 species are described. Bats are found to be the richest source of different species of coronaviruses. All coronaviruses originated from a common ancestor about 293 million years ago. Zoonotic species such as "Severe acute respiratory syndrome-related coronavirus" (SARS-CoV), "Middle East respiratory syndrome-related coronavirus" (MERS-CoV) and "Severe acute respiratory syndrome-related coronavirus 2" (SARS-CoV-2), the aetiological agent of the COVID-19 pandemic.
Discovery of chicken coronavirus.
Arthur Frederick Schalk and Merle C. Fawn at the North Dakota Agricultural College were the first to report what was later identified as coronavirus disease in chickens. Their publication in the "Journal of the American Veterinary Medical Association" in 1931 indicates that there was a new respiratory disease that mostly affected 2-day-old to 3-week-old chickens. They referred to the disease as "an apparently new respiratory disease of baby chicks." The symptoms included severe shortness of breath and physical weakness. The infection was contagious and virulent. It was easily transmitted through direct contact between chickens or experimental transfer of the bronchial exudates from infected to healthy chickens. Maximum mortality recorded was 90%.
The causative pathogen was not known. Charles D. Hudson and Fred Robert Beaudette at the New Jersey Agricultural Experiment Station in New Brunswick, New Jersey, put forth a hypothesis in 1932 that virus could be the cause and introduced the name as "virus of the infectious bronchitis." But this was a misattribution because at the time another related disease, known as infectious laryngotracheitis, was reported that exhibited almost similar symptoms but mostly affected adult chickens. As Beaudette later recalled in 1937, the disease he described was infectious layngotracheitis, saying: "Infectious laryngotracheitis is said to be the correct name for this disease rather than infectious bronchitis… Moreover, the gasping symptom ordinarily accepted as typical of the disease is also a prominent symptom in infectious bronchitis (gasping disease, chick bronchitis)." The names infectious bronchitis and infectious laryngotracheitis were till then used synonymously and interchangeably.
Unaware of the developments, Leland David Bushnell and Carl Alfred Brandly at the Kansas Agricultural Experiment Station studied a similar case which they called "gasping disease" due to the apparent symptom. They had known the disease since 1928. Their report in 1933 titled "Laryngotracheitis in chicks" published in the "Poultry Science" indicated a clear distinction of infectious bronchitis from infectious laryngotracheitis as the main organ affected was the bronchi. The bronchi infection resulted in severe gasping and swift death due to inability to eat food. It was also found that the pathogens could not be bacteria or protozoans as they passed through membranes (Berkefield filter) that would block those pathogens. The isolation and identification of the pathogen as a virus was reported as:
In several experiments we have reproduced the disease in chicks by the intratracheal, subcutaneous and intraperitoneal injection of Berkefeld filtered material. The chicks developed typical gasping symptoms after various periods of incubation, different groups of chicks first showing symptoms in six, seventeen, nineteen, etc., days after receiving the filtrate... The disease may also be transferred by means of filtrates of spleen, liver, and kidney tissues and by the transfer of bacteriologically sterile blood.
This was the discovery of infectious bronchitis virus (IBV). But Bushnell and Brandy made an erroneous remark by saying, "The symptoms and lesions in the chicks [caused by IBV] are similar to those seen in so-called laryngotracheitis of adult birds and are probably due to the same agent."
In 1936, Jerry Raymond Beach and Oscar William Schalm at the University of California, Berkeley, reexamined Bushnell and Brady's experiment with a conclusion that infectious laryngotracheitis and infectious bronchitis with their causative viruses were different. (Beach had discovered infectious laryngotracheitis virus in 1931.) They concluded that:
Discovery of mouse coronaviruses.
Francis Sargent Cheevers, Joan B. Daniels, Alwin M. Pappenheimer and Orville T. Bailey investigated the case of brain disease (murine encephalitis) at the Department of Bacteriology and Immunology of Harvard Medical School in Boston in 1949. Two laboratory mice (Schwenktker strains) of 17 and 18 days old had flaccid paralysis and died. By then it was known that murine encephalitis was caused by a picornavirus, called Theiler's virus, which was discovered by Max Theiler at the Rockefeller Foundation in New York in 1937. But the Harvard scientists found that the two mice had unusual symptoms other than brain damage (demyelination). The mice had no visible illness or diarrhoea, which usually are associated with murine encephalitis. In addition, the causative virus was isolated from different organs including liver, spleen, lungs, and kidneys. This indicated that brain was not the primary target organ. Liver was particularly affected with severe necrosis, indicating hepatitis. The new virus was named JHM, after the initials of John Howard Mueller.
In the autumn of 1950 there was a sudden outbreak of fatal hepatitis among laboratory mice (Parkes or P strains) at the National Institute for Medical Research, Mill Hill, London. Alan Watson Gledhill and Christopher Howard Andrewes isolated the causative virus, which experimentally was highly infectious to healthy mice. They named the virus as "mouse hepatitis virus (MHV)." Gledhill called the experiments on the highly infectious nature of the virus as a "bizarre discovery".
John A. Morris at the National Institutes of Health, Bethesda, discovered a new mouse virus, named H747, in 1959 from samples in Japan. When he compared the virus with JHM and MHV using serological tests he found that they were both antigenically related, upon which he created a common name as "hepatoencephalitis group of murine viruses."
Discovery of human coronaviruses.
Human coronaviruses were discovered as one of the many causative viruses of common cold. Research on the study of common cold originated when the British Medical Research Council and the Ministry of Health established the Common Cold Research Unit (CCRU) at Salisbury in 1946. Directed by Andrewes, the research laboratory discovered several viruses such as influenza viruses, parainfluenza viruses and rhinoviruses that cause common cold.
David Arthur John Tyrrell joined CCRU in 1957 and succeeded Andrewes in 1962. He developed a technique for growing rhinoviruses using nasal epithelial cells for the first time in 1960. His team soon after developed a concept of broad categorisation of common cold viruses into two groups: one group, called H strain, could be maintained only in human-embryo-kidney cell culture, and another group, designated M strain, could be maintained both in human-embryo-kidney cell culture and monkey-embryo-kidney cell culture. By then many common cold viruses could be grown in either of these cell cultures and were accordingly classified as M or H strain.
During 1960-1961, Tyrrell's team collected throat swabs from 170 school boys having common cold at a boarding school in Epsom, Surrey. England. Among few samples that could not be cultured in any of the culture media, a specimen designated B814, collected on 17 February 1961, was particularly infectious among healthy volunteers. There was no evidence whether the pathogen in B814 was a bacterium or a virus as all bacterial and viral culture methods available showed negative results. It could only be maintained in human tracheal culture and experimentally passed on to healthy volunteers by nasal inoculation. In 1965, they were able to confirm that the pathogen was a filter-passing virus, susceptible to ether treatment (indicating a lipid envelope of the virus), able to induce cold in antibiotic-treated volunteers (indicating it was not a bacterium), and cultured in human-embryo-trachea epithelial cell culture. Serological tests (antigen-antibody reactions) further indicated that the virus was not related (not reactive) to antibodies (serotypes) of any known viruses at the time. Reporting in the "British Medical Journal", Tyrrell and Malcolm L. Bynoe wrote their conclusion as:After considerable initial doubts we now believe that the B814 strain is a virus virtually unrelated to any other known virus of the human respiratory tract, although, since it is ether-labile, it may be a myxovirus.But they contradicted themselves regarding the identity of the virus as they mentioned in the experimental results, saying:It was concluded that B814 did not belong to any of the serotypes of myxovirus used, but might be distantly related to influenza C or Sendai viruses.In an independent research in US, Dorothy Hamre and John J. Procknow studied respiratory tract infection among medical students at the University of Chicago. In 1962, they obtained five samples that were associated with very different symptoms, causing mild cold only, and could be cultured only in secondary human kidney tissue in contrast to other cold viruses which could be maintained in monkey-embryo-kidney cell culture. Serological test indicated they were not myxoviruses ("Orthomyxoviridae"). They presented their discovery as "A new virus isolated from the human respiratory tract" in the "Proceedings of the Society for Experimental Biology and Medicine" in 1966. They further studied one sample, designated 229E, grown in human diploid cell culture (Wi-38) and described its developmental stages using transmission electron microscopy to show that it was new type of virus.
Discovery of the structure.
Viruses cannot be seen normally with light microscopes. It was only with the development of electron microscopy that viruses could be visualised and structurally elucidated. Reginald L. Reagan, Jean E. Hauser, Mary G. Lillie, and Arthur H. Craige Jr. of the University of Maryland were the first to describe the structure of coronavirus using the transmission electron microscopy. In 1948, they reported in "The Cornell Veterinarian" that IBV was spherical in shape and some of them had filamentous projections. But the images were difficult to interpret due to poor resolution and low magnification (at × 28,000). Their subsequent studies did not show any striking properties from other viruses. An important advancement was made by Charles Henry Domermuth and O.F. Edwards at the University of Kentucky in 1957 when they observed IBVs as "ring or doughnut-shaped structures."
D.M. Berry at the Glaxo Laboratories, Middlesex, UK, with J.G. Cruickshank, H.P. Chu and R.J.H. Wells at the University of Cambridge published a more comprehensive and better electron microscopic images in 1964. Four strains of IBV, including Beaudette strain, were compared with influenza virus, with which they share most resemblance. In contrast to influenza virus in which the projections were small and straight, all IBV strains had "pear-shaped projections", which were names the "spikes" and described as:These “spikes” were often seen over part of the surface only and were less densely packed than those seen in influenza viruses. They varied considerably in shape. Commonly they appeared to be attached to the virus by a very narrow neck and to thicken towards their distal ends, sometimes forming a bulbous mass 90-110 Å in diameter.J. F. David-Ferreira and R. A. Manaker from the National Cancer Institute, Bethesda, were the first to study the structure of MHV in 1965. They also observed the surface projections as on IBV, stating, "The outer surface of the particle is covered by 'spicules'."
In 1966, Tyrrell sought the help of Anthony Peter Waterson at the St Thomas's Hospital Medical School in London who had recruited June Dalziel Almeida as an electron microscopist. Almeida had studied IBV and MHV finding them as structurally distinct viruses, but her manuscript was rejected upon a referee's decision that the microscopic images were of influenza virus and lacked novelty. Tyrrell supplied the human virus samples from which it was possible to ascertain the viral structure. Almeida and Tyrrell published their findings in the April 1967 issue of the "Journal of General Virology", in which they concluded:Probably the most interesting finding from these experiments was that two human respiratory viruses, 229 E and B814 are morphologically identical with avian infectious bronchitis. Their biological properties, as far as they are known, are consistent with this. Both the human viruses are ether sensitive as is avian infectious bronchitis 229 E, have a similar size by filtration and multiply in the presence of an inhibitor of DNA synthesis.
In 1967, Kenneth McIntosh and co-workers at the National Institute of Health, Bethesda, reported the structure of common cold viruses they collected from fellow workers during 1965-1966. They found six of their samples had common characters with B814. Two samples (designated OC38 and OC43, as the number of specimen in organ culture) were particularly virulent and caused encephalitis in experimental mice. They compared the structure of one of their samples numbered 501 (OC43 ) with those of 229E, IBV and influenza virus. It was so identical to IBV that they called the human viruses as "IBV-like viruses". They made a definitive description as:All "IBV-like" viruses, 229E, and IBV itself show the following characteristics: (1) an over-all diameter of 160 mμ with a variation of ± 440 mμ; (2) a moderate pleomorphism with resultant elliptical, round, or tear-drop shapes but no filamentous or "tailed" forms; (3) characteristic spikes 20 mμ long, usually club- or pear-shaped narrow at the base and 10 mμ wide at the outer edge, spaced widely apart and distributed fairly uniformly about the circumference of the particle.
Invention of the name and history of the taxonomy.
By mid-1967 it was recognised that IBV, MHV, B814 and 229E were structurally and biologically similar so that they form a distinct group. Tyrrell met Waterson and Almeida in London to decide on the name of the viruses. Almeida had earlier suggested the term "influenza-like" because of their resemblance, but Tyrrell thought it inappropriate. Almeida came up with a novel name "coronavirus". Tyrrell wrote of his recollection in "Cold Wars: The Fight Against the Common Cold" in 2002:Even though we could only base our judgement on the electron microscope images we were quite certain that we had identified a previously unrecognised group of viruses. So what should we call them? 'Influenza-like' seem a bit feeble, somewhat vague, and probably misleading. We looked more closely at the appearance of the new viruses and noticed that they had a kind of halo surrounding them. Recourse to a dictionary produced the Latin equivalent, corona, and so the name coronavirus was born.Proposal of the new name was submitted to and accepted by the International Committee for the Nomenclature of Viruses (ICNV, established in 1966). 16 November 1968 issue of "Nature" reported the justification by Almeida, Berry, C.H. Cunningham, Hamre, M.S. Hofstad, L. Mallucci, McIntosh and Tyrrell as:Particles [of IBV] are more or less rounded in profile; although there is a certain amount of polymorphism, there is also a characteristic "fringe" of projections 200 Å long, which are rounded or petal shaped, rather than sharp or pointed, as in the myxoviruses. This appearance, recalling the solar corona, is shared by mouse hepatitis virus and several viruses recently recovered from man, namely strain B814, 229E and several others... In the opinion of the eight virologists these viruses are members of a previously unrecognized group which they suggest should be called the coronaviruses, to recall the characteristic appearance by which these viruses are identified in the electron microscope."Coronavirus" was accepted as a genus name by ICNV in its first report in 1971. IBV was then officially designated the type species as "Avian infectious bronchitis virus" (but renamed to "Avian coronavirus" in 2009). "Mouse hepatitis virus" approved in 1971 was merged with "Rat coronavirus" (discovered in 1970) as "Murine coronavirus" in 2009. 229E and OC43 were collectively named "Human respiratory virus" but merged as "Human coronavirus 229E" (HCoV-229E) in 2009"." The first discovered human coronavirus B814 was antigenically different from 229E and OC43, but it could not be propagated in culture and was exhausted during experiments in 1968, thus, was excluded in taxonomy. "Coroniviridae" was adopted as the family name in the ICNV (soon after renamed International Committee on Taxonomy of Viruses, ICTV) second report in 1975.
229E and OC43 were together named "Human respiratory virus" in the ICNV first report. The species was split into "Human coronavirus 229E" (HCoV-OC229E) and "Human coronavirus OC43" (HCoV-OC43) in 1995. While HCoV-OC229E is retained as a valid species, HCoV-OC43 was merged with "Porcine hemagglutinating encephalomyelitis virus" (discovered in 1962), "Bovine coronavirus" (discovered in 1973), "Human enteric coronavirus" (discovered in 1975), "Equine coronavirus" (discovered in 2000) and "Canine respiratory coronavirus" (discovered in 2003) into a single species "Betacoronavirus 1" in 2009.
Owing to increasing number and diversity of new species discovered, CTV split the genus "Coronavirus" in 2009 into four genera, "Alphacoronavirus", "Betacoronavirus", "Deltacoronavirus", and "Gammacoronavirus". As of 2020, there are 39 species of coronaviruses under the family "Coronaviridae". There are 7 human coronaviruses while 32 species are those of pigs, dogs, cats, rodents, cows, horses, camels, Beluga whales, birds and bats.
Other human coronaviruses.
"Human coronavirus NL63" (HCoV-NL63).
HCoV-NL63 was discovered in January 2003 from a seven-month-old baby in Amsterdam, the Netherlands. The baby was suffering from bronchiolitis, coryza, conjunctivitis and fever. A year later, a comprehensive analysis of nasal swab samples was done from where it was found that a sample from an eight-month-old boy diagnosed in 1988 with pneumonia had a similar virus (HCoV-NL). The virus was independently described in 2005 as HCoV-NH following a discovery among a group of children having respiratory infection in New Haven, Connecticut, US. The origin of the virus remains a mystery, but it is closely related to tricolored bat ("Perimyotis subflavus") coronavirus and can survive in bat cell lines, suggesting that it is derived from animals (zoonotic).
"Human coronavirus HKU1" (HCoV-HKU1).
HCoV-HKU1 was discovered from a 71-year-old man in Hong Kong, China, who was suffering from pneumonia in January 2004. When samples (nasopharyngeal aspirates from pneumonia patients) collected between April 2004 to March 2005 were analysed in 2006, it was found that 13 individuals had HCoV-HKU1. The same year, the virus was subsequently reported from Australia, Europe, and US.
Zoonotic coronaviruses.
Coronaviruses that are transmitted from animals (zoonoses) are clinically the most important human coronaviruses as they are responsible for a series of global epidemics. There are two species of such coronaviruses:
1. "Severe acute respiratory syndrome-related coronavirus".
Two distinct viruses are known under this species, namely SARS-CoV and SARS-CoV-2. SARS-CoV emerged as an acute respiratory syndrome in Guangdong Province, southern China, during 16 November 2002 to 28 February 2003. The syndrome was accompanied by pneumonia that was fatal in many cases. The infection was believed to have been contained in China, but an infected individual carried it to Hong Kong on 21 February and spread it in the hospital. The first clinical case outside China was reported on 26 February 2003 in Hanoi, Viet Nam. It rapidly spread to Southeast Asia, North America and Europe. The World Health Organization (WHO) notified an epidemic alert on 6 March 2003, referring to the disease as severe acute respiratory syndrome. The virus was identified as a novel coronavirus from Hong Kong in April, from Toronto in May, and at the Centers for Disease Control and Prevention (CDC) in US in May. In October, the samples from Guangdong were established as the prototype specimens, and the name SARS coronavirus (SARS CoV) was introduced. ICTV approved it as "Severe acute respiratory syndrome coronavirus" in 2004, and renamed it "Severe acute respiratory syndrome-related coronavirus" in 2009. By mid-July 2003, the infection subsided, and by then it had spread to 28 countries infecting 8096 people and causing 774 deaths. In October, it was found that the infection was acquired from the masked palm civets ("Paguma larvata") from a live-animal market in Guangdong. Further studies in 2005 showed that civets were the intermediate reservoirs of the virus, and horseshoe bats ("Rhinilophus" species) were the natural hosts.
Infection with SARS-CoV-2 was known from cases of atypical pneumonia in Wuhan, China. The Wuhan Municipal Health Commission reported 27 individuals having "viral pneumonia" on 31 December 2019. The first known case was recorded on 12 December. The first case outside China was in Thailand on 13 January. WHO adopted the name of the disease as "coronavirus disease 2019" (COVID-19) on 11 February 2020, and used "2019 novel coronavirus" or "2019-nCoV" for the virus. On 2 March 2020, ICTV published the formal description and gave the official name as "Severe acute respiratory syndrome-related coronavirus 2" (SARS-CoV-2). WHO declared the infection as pandemic on 11 March, and since then has spread around the world, affecting over people and resulting in more than deaths. The origin of the virus is not known. Malayan pangolins ("Manis javanica") which are available in the live-animal market in Wuhan city has been studied as a probable source as the virus is closely related to the pangolin coronavirus. Genetic evidence that it bears 93% nucleotide similarity with a novel coronavirus of Malayan horseshoe bat ("Rhinolophus malayanus"), and 96% identity with Bat SARS-like coronavirus RaTG13 of intermediate horseshoe bat ("R. affinis") indicates that it probably originated in bats.
2. "Middle East respiratory syndrome-related coronavirus".
In April 2012, the Ministry of Health, Jordan, reported an outbreak of acute respiratory illness affecting 11 people at a hospital in Zarqa. On 13 June 2012, a 60-year-old man having the symptoms was admitted to Dr. Soliman Fakeeh Hospital in Jeddah, Saudi Arabia. He was diagnosed with acute pneumonia and died on 24 June due to progressive respiratory and renal failure. His sputum sample showed the presence of coronavirus very similar to bat coronaviruses HKU4 and HKU5. The virus was named HCoV-EMC (after Erasmus Medical Center in Rotterdam, the Netherlands, where it was identified). Retrospective study of samples from the Jordan hospital revealed that the diseases and the virus were similar. WHO referred to the virus as the Middle East respiratory syndrome coronavirus (MERS-CoV) on 23 May 2013. ICTV announced the name as "Middle East respiratory syndrome-related coronavirus" on 15 May 2013. In 2013, a study revealed that the virus was 100% genetically identical to the coronavirus of the Egyptian tomb bat ("Taphozous perforatus coronavirus HKU4") from Bisha, Saudi Arabia, indicating its origin. In 2014, it was established that the virus was transmitted to humans by dromedary camels, which act as the intermediate hosts. By December 2019, the infection was confirmed in 2,499 individuals with 858 deaths (34·3% mortality) from 27 countries covering all continents.
Other animal coronaviruses.
"Feline infectious peritonitis virus".
A viral infection in pigs, called transmissible gastroenteritis, which was characterised mainly by diarrhoea and vomiting, and associated with high mortality was first recognised by Leo P. Doyle and L. M. Hutchings in 1946. A. W. McClurkin isolated and identified the virus in 1965. The virus was named "Transmissible gastro-enteritis virus of swine" in the ICNV first report, and changed to "Porcine transmissible gastroenteritis virus" (PTGV) in the second report in 1976. A new disease that caused inflammation of the abdomen (peritonitis) in cats was reported in 1966, the virus was identified in 1968, and was named by ICTV in 1991 as "Feline infectious peritonitis virus". In 1974 a new coronavirus was discovered from US military dogs, and was named by ICTV in 1991 as "Canine coronavirus." As the molecular and antigenic relationship of the three viruses were later established, ICTV merged the three viruses into "Alphacoronavirus 1" in 2009"."
"Porcine epidemic diarrhea virus".
An acute infectious diarrhoea was first known in England in 1971. The infection was specifically among fattening pigs and sows. It was referred to as TOO (for "the other one") or TGE2 (for "transmissible gastroenteritis type 2") as the symptoms were similar to transmissible gastroenteritis. Other than causing rapid and acute diarrhoea, it was not a fatal disease. The case was first reported by J. Oldham in "Pig Farming" in 1972 using the term "epidemic diarrhea". A second outbreak occurred in 1976, and was called "porcine epidemic diarrhoea." It eventually spread throughout Europe. M. B. Pensaert and P. de Bouck at the Ghent University, Begium isolated and identified the new coronavirus in 1978, and designated it CV777. It eventually spread throughout Europe. ICTV named the virus "Porcine epidemic diarrhea virus" in 1995. An epidemic broke out from China in 2010 that spread throughout the world. A virulent strain emerged in US between 2013 and 2015. It affected pigs of all ages, and mortality was as high as 95% among the suckling piglets. Another severe outbreak occurred in Germany in 2014 that spread to other European countries.
Bat coronaviruses.
Reagan and his colleagues at the University of Maryland were the first to investigate bats as a potential sources of coronavirus in 1956. They experimentally inoculated 44 cave bats or little brown bats ("Myotis lucifugus") with IBV and found that all of them developed the symptoms of infectious bronchitis. Their report reads:50 percent of the bats exposed to the infectious bronchitis virus showed symptoms or death in the intracerebral, intraperitoneal, intradermal, intracardiac and intraocular groups; 75 percent in the intranasal and intrarectal groups; 100 percent in the intraoral group; and 25 percent intralingual and intramuscular group, whereas the controls appeared normal.But nothing was known of the real nature of bats as reservoirs of coronaviruses until the epidemic of severe acute respiratory syndrome of humans in 2002/2003. Since the identification of SARS-CoV was identified in the early 2003, and horseshoe bats as their natural hosts in 2005, bats have been extensively studied. Among all coronavirus hosts, bats are known to harbour the most variety, with more than 30 species identified. According to diversity estimate, there may be 3,200 species of coronaviruses in bats.
Evolutionary history.
According to phylogenetic estimate all coronaviruses evolved from the most recent common ancestor that lived around 190 to 489 (with a mean of 293) million years ago. The four genera split up around 2,400 to 3,300 years ago into bat and avian coronavirus ancestors. Bat coronavirus gave rise to species of "Alphacoronavirus" and "Betacoronavirus" that infect mammals"," while avian coronavirus produced those of "Gammacoronavirus" and "Deltacoronavirus" that infect birds. Zoonotic coronaviruses emerged recently. For instance, SARS-CoV was transmitted from bats in 1998 (4.08 years prior to the outbreak), and diverged from bat coronavirus in around 1962. SARS-CoV-2 evolved from bat coronavirus in around 1948.


F lipoprotein


Cadet Nurse Corps

The United States (U.S.) Cadet Nurse Corps (CNC) was authorized by the U.S. Congress on 15 June 1943 and signed into law by president Franklin D. Roosevelt on 1 July. The legislative act contained a specific provision that prohibited discrimination based upon race, color, or creed.
The pimary purpose of the law was to help alleviate the nursing shortage that existed during World War II. The United States Public Health Service (USPHS) was named the supervisory agency; it was answerable to Thomas Parran, Jr. the surgeon general of the United States. The USPHS established a division to administer the CNC program and Parran appointed Lucile Petry, a registered nurse (RN), as its director.
The program was open to all women between the ages of 17 and 35 who were in good health and had graduated from an accredited high school. The recruiting target was the high-school graduate but college women were also recruited. Nearly every type of media source advertised for the CNC. All state nursing schools in the U.S. were eligible to participate in the program; they were, however, required to be accredited by the accrediting agency in their state and be connected with a hospital that had been approved by the American College of Surgeons. The participating schools of nursing were required to compress the traditional 36-month nursing program into 30 months, and were obligated to provide the students with the clinical experiences of medicine, surgery, pediatrics, and obstetrics.
The cadets came from locations across the nation and from all backgrounds. The CNC was the largest of the federal nurse-training programs; it allowed young women to serve their country in uniform while being protected by law against discrimination. Of the 1,300 schools of nursing in the country, 1,125 participated in the program. The CNC operated from 1943 until 1948; during this period 179,294 student nurses enrolled in the program and 124,065 of them graduated from participating nursing schools. The American Hospital Association credited the cadet student nurses with helping to prevent the collapse of civilian nursing in the U.S. during the war.
Background.
The U.S. experienced a shortage of nurses long before its entry into World War II; this shortage worsened with the prewar buildup of the military and industrial upturn that this caused. Professional nursing groups were unprepared to deal with the problem. On 10 July 1940, however, the situation changed when Isabel M. Stewart, professor of nursing at Columbia University and a member of the National League for Nursing, wrote to its president: "I believe we should have a committee or board that is representative of the nursing profession as a whole and it should be at work now ...". Within three weeks, on 29 July 1940, representatives of the national nursing community gathered in New York City under the umbrella of the American Nurses Association, where they formed the Nursing Council on National Defense. In its first order of business, the council concentrated on surveying nursing resources and securing federal funding to expand nursing educational opportunities.
The survey results indicated 100,000 nurses were eligible for military service, and that most nursing schools were ill-equipped to enlarge their instructional or housing facilities. The council submitted its federal aid request for fiscal year 1 July 1941 to 30 June 1942 to the U.S. commissioner of education, who approved it and moved it on to the Bureau of the Budget. The Congress enacted and funded the Nurse Training Program, which assisted in the education of 12,000 students at 309 nursing schools. Through the program, 3,800 inactive nurses received refresher courses and 4,800 graduate nurses received postgraduate training. By the end of the fiscal year, 47,500 students were enrolled in nursing schools but this did not meet the country's demands. Nurses could not be trained quickly enough to keep pace with the country's civilian and military needs.
During 1942 the Office of War Information tried to mobilize interest in the nursing profession, using prime-time radio advertisements to focus their broadcasts on interviews, dramatic sketches, and spot announcements urging young women to join the nursing profession. While these efforts were helpful, they did not meet expectations. The supporters of the nurse training programs recommended doubling federal aid for basic nursing education in the fiscal year ending 30 June 1943. Representative Frances P. Bolton of Ohio, a longtime advocate of nursing, supported the proposed increase in federal aid, and informed the Congress that further aid requests for nurse training programs were likely.
Creation of the program.
On 29 March 1943 Bolton took the initiative and introduced H.R. 2326, a bill to create and fund a training program for nurses. The Senate added an amendment that prohibited discrimination based upon race, color, or creed. At the bill's legislative hearings, hospital groups explained how distressed nursing care in civilian hospitals had become. Support for the bill also came in the form of letters and telegrams. The bill passed both houses of the Congress by unanimous vote on 15 June 1943 and became Public Law 74 on 1 July 1943; with the title of Nurse Training Act of 1943 but commonly referred to as the Bolton act. It provided for the training of nurses for the armed forces, government and civilian hospitals, health agencies, and war industries through grants to the institutions providing the training. It also contained a provision requiring that those trained under the act would comprise a uniformed body but without military status.
The Division of Nurse Education was established in the USPHS to supervise the program; it was answerable to the surgeon general of the United States, Thomas Parran Jr. He appointed Lucile Petry, a registered nurse (RN), as the director. The federal security administrator was required to appoint an advisory committee to assist in guiding the nurse-training programs. The committee consisted of people in the nursing and related fields, who were drawn from various parts of the country. On 25 June 1943, the committee met for the first time with government officials to establish the rules and regulations to carry out the act. As required, they were approved by the surgeon general and published in the "Federal Register".
The surgeon general then sent telegrams that outlined the program to 1,300 nursing schools in the United States and Puerto Rico. This was followed up with applications and instructions sent by mail. Territory of Hawaii's two nursing schools were not eligible for the program because they were in a war zone and Territory of Alaska had no nursing schools at the time.
The regulations required interested nursing schools to:
The standards of the National League for Nursing were adopted to evaluate the participating schools. After issuing these regulations, the surgeon general said: The CNC was open to all women between the ages of 17 and 35 who were in good health and had graduated from an accredited high-school. Marriage was permissible subject to individual nursing school guidelines. Successful applicants were eligible for a government subsidy that paid for tuition, books, uniforms, and a stipend. In exchange, student cadets were required to pledge to actively serve in essential civilian or federal government services for the duration of World War II. All state-accredited schools of nursing were eligible to participate in the program; each school, however, was required to apply individually. Of the 1,300 nursing schools in the country, 1,125 participated. For this program, the traditional 36-month nurse training was accelerated to 30 months. Senior nursing students were required to work for a six-month period in a hospital or in another health agency. In return, the federal government would pay the schools for the related tuition and fees of the students.
The advisory committee was also responsible for naming the new program. The Victory Nurse Corps and the Student War Nursing Reserve were considered, but both were rejected in favor of the United States Cadet Nurse Corps (CNC).
Housing.
In its 1940 survey, the Nursing Council on National Defense reported that most of the nursing schools in the U.S. were ill-equipped to enlarge their housing and classroom facilities. In the following two fiscal years, federal aid was provided to nursing schools for nurse training but it did not provide any aid for housing facilities. Even with the passage of the Nurse Training Act of 1943, the problem remained. Some schools were able to rent or purchase additional buildings; those that could not requested assistance from the federal government. Without funds for physical facilities, the USPHS arranged with the Federal Works Agency to allow nursing schools to share in some of the construction funds provided under the National Defense Act of 1940. The two federal agencies agreed the need for housing and other facilities in nursing schools would be based on school participation in the CNC program. The Federal Works Agency would decide where, how, and to whom the aid would be granted.
Under the agreement, the schools of nursing that could not otherwise accommodate classes would receive a share of the federal aid for housing. It would include aid for living quarters, library space, classrooms, and demonstration rooms. The amount allocated for construction projects was $25,657.785. The Federal Works Agency projects started in September 1943 and ended in November 1944; during this period, about 400 applications consisting of 160 for training facilities, 172 for construction, and 68 for the purchase, lease, or renovation of existing buildings, were cleared. Nursing schools in all but nine states were helped by the federal aid; the arrangement called for the nursing schools to share in the cost of the projects. Of the $25,657.785 spent on the nursing school projects, federal aid paid $17,397.002 (about 67.8 percent) and the nursing schools paid $8,260.783 (about 32.2 percent).
Recruitment.
General.
The USPHS recruiting campaign was aimed at reaching the maximum number of potential applicants in the shortest period of time. The primary target was the high-school graduate but college women were also recruited. The selling point was free education in a proud profession while providing an essential service to the country. Appeals to join the CNC reached more than 7,000,000 newspaper and magazine readers, and millions of radio listeners and movie patrons around the country. Pleas were made in speeches, through billboards, and in leaflets. U.S. corporations donated $13,000,000 worth of advertising space and technical services to the program in one year. Nearly every type of media source advertised for the CNC.
The Eastman Kodak Company sponsored a full-page advertisement in "Life" magazine (24 January 1944) touting the CNC as a way to serve the country in "a war job with a future". The advertisement said young women who could qualify as cadet nurses were "lucky girls" who were eligible for free training with pay, room and board, and gray uniforms with gray berets. The uniforms were described as one for summer and one for winter, which "you'll wear with pride". Applicants were assured they could wear something "frilly and feminine" instead of uniforms for dances, that they would have time for dating, and that many schools allowed students to marry.
In the same year, a motion-picture company produced a recruiting film about the CNC called "Reward Unlimited" for the USPHS. Mary C. McCall Jr. wrote the story and Dorothy McGuire played the lead role of Peggy Adams, a cadet nurse. The ten-minute film shows the way that Peggy Adams decided to become a cadet nurse, along with her training and everyday nursing experiences. "Reward Unlimited" received awards for the best recruitment film for 1944; it was shown in 16,000 theaters and seen by an audience of 90 million. It was also likely that many young women saw a newsreel clip of the CNC program at movie theaters; one such clip showed President Franklin D. Roosevelt signing the CNC bill into law and another featured the cadet uniforms.
The American Hospital Association established recruitment centers in all 1,125 participating nursing schools. Using recruiting booths, volunteers disseminated information about the opportunities offered by the CNC to potential candidates. State and local nursing councils, and many other organizations, associations, and volunteers aided the recruitment effort. In the fiscal year 1943—the first year of enrollment—65,521 nursing students registered. In the 1944 enrollment period, 61,471 registered. In the 1945 enrollment period, 3,000 students were admitted to what would be the final class of the program.
Minority women.
The Nurse Training Act of 1943 prohibited discrimination against race, creed, or color. However:
To record the enrollment of each student, a membership card was used by the CNC; however, it did not require the student to list her race or ethnicity. Thus, increasing the difficulty to ascertain the diversity across participating nursing schools.
African American.
Long before the World War II era, African Americans were confronted with more hostility than any other minority group. African American organizations had actively advocated for discriminatory changes in the American society and in military policies. The non-discrimination provision in the CNC legislation of 1943 had a positive effect on encouraging young African American women to enter the nursing profession. In particular, those women who could not afford to pay for a nursing education. Some 2,000 students attended 20 black institutions, while around 400 students were enrolled in 42 white schools.
The African American press helped the CNC in its efforts to recruit black women, as did community leaders. Some of these cadets took part in public ceremonies, and were the subject of special feature stories released to their local newspapers. In 1940, there were 230 black-owned newspapers in the United States. They were publishing regularly in Baltimore; Washington, DC; Chicago; New York; Philadelphia; and Atlanta.
Japanese American.
The Japanese experience in the United States was rife with discrimination. But the bombing attack on Pearl Harbor on 7 December 1941 by the Empire of Japan caused hysteria among residents along the Pacific coast, where many Japanese Americans lived - including the Nisei generation. The U.S. intelligence found that the majority of Japanese Americans were not security threats and posed no danger to the country. The press, patriotic organizations, and others continued to fuel the fire for their removal from the Pacific coast. On 16 February 1942, President Franklin D. Roosevelt (bowing to political pressure) signed Executive Order 9066; the order caused the evacuation of people of Japanese ancestry from the Pacific coast states. The order uprooted in excess of 100,000 men, women, and children from their homes and farms, jobs, and schools. Forcibley removed, they were interned at ten relocation camps in seven states.
Among those interned included Nisei women students who were attending nursing schools in the coastal states of California, Oregon, and Washington. Many of these students volunteered to staff relocation hospitals, as did other Nisei women after completing nurse's aid training.
The non-discrimination provision in the CNC legislation of 1943 opened the portal for more than 400 Japanese (Nisei) American women to become cadet nurses. Of the 1,125 schools of nursing that participated in the CNC program, only about 70 schools of nursing opened their enrollment to Japanese American women. Too few nursing schools were open to Japanese American women; it was perceived that hospital staff and patients would not trust them.
Native American.
There is no ready record of the number of Native American women who participated in the CNC program across the country. The only accredited school of nursing for Native Americans in the entire United States then was the Sage Memorial Hospital School of Nursing, located in Ganado, Arizona, the heart of the Navajo Nation.
The hospital opened in 1930 and closed in 1953. Over its operating life, the Sage School of Nursing graduated about 150 Native American women from more than 50 tribes. Among them were about 39 women who were enrolled in the Cadet Nurse program. Sage excluded white students, reportedly because they had many other options, while Native Americans did not. Later, they accepted Hispanic and Asian American nursing students.
Uniforms.
The outdoor uniforms of the CNC were designed to be distinctive and to identify each cadet as a member of the corps. There was one uniform for winter and another for summer. The winter uniform was a gray, woolen, single-breasted jacket suit, a gored skirt, and a gray, velour overcoat. A gray Montgomery beret, similar to the one worn by the British officer, General Bernard Montgomery, was worn with both of the uniforms. The summer uniform consisted of a two-piece, gray-and-white-striped, cotton suit and a gray twill raincoat. The winter uniform was one of three designs created by professional designers and introduced at a fashion show in New York City on 16 August 1943. Thirty-two fashion editors judged this uniform and the Montgomery beret as the winners. The selected uniform style was said to be attractive enough to have provided an incentive for young women to join the CNC.
The official outdoor uniforms—with the exception of blouse, gloves, shoes, and stockings—were supplied to the cadets by the institution in which they were enrolled. The students paid for the excluded items. The indoor or work uniforms varied from school to school; these were purchased by the school from federal grants. Work uniforms were worn by the cadets while on duty in hospitals; the CNC patch on the sleeve of the uniform identified the wearer as a cadet.
The insignia of the CNC was a Maltese Cross. A patch with the insignia was worn on the left shoulder of the uniforms and on the student nurse uniform of the official school of nursing. The USPHS official insignia was worn on the jacket lapels and was also present on the silver buttons. On the Montgomery beret, the USPHS insignia was worn beneath the spread eagle and the American Shield. Wearing the CNC outdoor uniforms was optional for all cadets, except when instructed to do otherwise.
Training.
The participating schools of nursing were required to compress the traditional nursing program to 30 instead of 36 months, and to provide students with the four clinical experiences of medicine, surgery, pediatrics, and obstetrics. The students became senior cadets in their last six months before graduation, requiring them to serve in a federal or civilian hospital, where they provided the equivalent services to those of a graduate nurse. During their first nine months of training, cadets were protected by regulation from working on the hospital wards for more than 24 hours each week. Junior cadets typically worked between 40 and 48 hours each week, including classes; senior cadets were free of classes. All state boards of nursing modified their regulations to agree with the accelerated program.
The quality and standards of the educational systems in which cadets would be trained varied considerably. In 1943, nursing schools, hospital administrators, and government officials assured the U.S. Congress the federally subsidized training of nurses would conform to the minimum standards. With his rule-making powers, the surgeon general issued these regulations:
Congressional hearings on appropriations stressed all schools should be allowed to take part in the program. When the standards were applied against the existing conditions, they did not seem practical for some schools to achieve. Some accommodations were made for smaller schools by lowering the standards for them. They would be judged by criteria that included the qualifications and number of instructional personnel, their clinical facilities, the curricula, the weekly schedule of hours, and the health and guidance programs. Such schools produced a small percentage of the cadet force. While monitoring the standards of the 1,125 approved schools of nursing, the consultants of the Division of Nurse Education traveled thousands of miles, wrote countless letters, and provided direct and specific support services. The consultants were assigned to an area and each school was well known to them.
The CNC program began on 1 July 1943 and ended with the last group of graduating students on 31 December 1948and included three enrollment periods; the first term was in 1943, the second in 1944, and the third and final term was in 1945. During this time, 179,294 students enrolled in the program and 124,065 of them graduated from the participating nursing schools and became registered nurses. The main cause of student withdrawals was homesickness; some married students withdrew to be with their husbands when they were released from the military; others when the hostilities ceased; some failed in their studies; others left for health reasons; and some left because of the stress of a nursing career.
The CNC was the largest of the federal nurse training programs. The federal government spent $160,326,237 on the Nurse Training Act of 1943 for administration, uniforms, maintenance, tuition, fees, and stipends. By the end of the program, the records of all participating schools of nursing had been audited. The work of the field auditors resulted in the recovery of $2,200,000 of prepaid funds.
Cadet nurses.
Cadet nurses came from every state in the U.S.; they were the daughters of farmers and mechanics, of teachers, lawyers, clerks and businessmen. Some joined because they wished to become nurses and others for the free education. In the course of their training, cadet nurses served in Army and Navy hospitals, with the Indian Health Service, with the Veterans' Administration, and in Public Health hospitals. During and after World War II, student nurses restored the diminished capacity of civilian nurses; making a major contribution to the nation's civilian and military healthcare systems.
The American Hospital Association credited cadet student nurses with helping to prevent the collapse of civilian nursing care and commended them for replacing graduate nurses who enlisted in the armed forces during World War II. In "Cadet Nurse Stories", the authors noted the CNC program influenced the way in which future nurses would be educated and trained in the United States.
By the time October 1945 rolled around, 10,000 CNC graduates had applied for service with the U.S. Army. It is, however, unknown how many of these applicants were accepted.
Cadet stories.
Florence Blake Ford:
Dorothie Melvin Crowley:
Pauline M. Perry:
Thelma M. Robinson:
Cadet hymn.
The cadet hymn was composed by the director of music at Mt. Vernon Methodist Church in Washington, D.C. and the words were written by a member of the Division of Nursing Education of the USPHS. It was released in 1945 on the second anniversary of the CNC.
<poem>
Now I dedicate my service, pledge myself and all I am,
Thus to make of life a triumph, over sorrow over death,
Give me pride in my endeavor
In the service of my Corps, o grant that I may heal the suffering ones.</poem>


Francis Butler

Francis Butler (1810–1874) was an American author, veterinarian, and dog trainer, who lived in New York City until his death. His success with the training and control of dogs is said to have been remarkable. He was the first recorded owner of a Great Dane in the United States.
Butler was originally from England and moved to the USA around age 32. Among other occupations, he held the post of Professor of the French Language at the Brooklyn Female Academy, and a similar post at another school in Flushing. As such, he was quite the linguist.
Butler, his wife, and family owned several acres of land around their home in Brooklyn, where Mr. Butler ran his dog-veterinary business.
He died at age 64 from hydrophobia, rabies, given to him from a bite on the thumb by a dog he had treated six weeks earlier. He was survived by his wife and nine children.


George Critchett (surgeon)

George Critchett (1817 in Highgate – 1 November 1882, in London) was an ophthalmic surgeon.
Critchett studied at the London Hospital. He became an M.R.C.S. in 1839 and a F.R.C.S. in 1844. He was a demonstrator of anatomy at and, from 1861–3, a surgeon to the London Hospital. Critchett became a member of the council of the College of Surgeons in 1870 and served as an ophthalmic surgeon and lecturer at Middlesex Hospital from 1876–82.


NHS Alliance

The Health Creation Alliance is an independent leadership body representing progressive providers of care outside hospital. Neither professional body nor trade union, it is a fresh, open-minded and patient-centred organisation, bringing together a community of more than 10,000 passionate individuals and organisations across primary care who believe innovation, connections and integration are key to the sustainability of a health service that remains free to all at the point of need.
Known as the New NHS Alliance before 2021, the Health Creation Alliance focuses on health creation, championing the '3Cs' of control, contact, and communication.
It represents all providers of primary care including general practice; community eye, hearing and foot care; community pharmacy; dentistry and physiotherapy; and out-of-hours and emergency services. The Health Creation Alliance also represents determinants of health outcomes like housing organisations or those with an interest in maintaining good health such as local authorities and health and wellbeing boards.
An early exponent of clinical commissioning groups, the Health Creation Alliance now works closely with providers and communities to identify and share the solutions needed to sustain the NHS. It also focuses on providing practical support to help drive the innovation it endorses.
The Health Creation Alliance works with a number of strategic partners with whom it co-produces and delivers important think and action papers, reports, programmes and summits.
Two recent publications, Breaking Boundaries and Beyond: A Manifesto for Primary Care (March 2013) and Think Big, Act Now: Creating a Community of Care (October 2014) were early articulations of NHS England's Five Year Forward View, describing the requirement to dissolve silos and tensions within the system and work towards more lateral organisations, what it calls 'Communities of Care', equivalent to NHS England's Multispecialty Community Providers.
Other networks include people-powered improvement, general practice, new providers, urgent care and housing.


Marie-Claude Bomsel

Marie-Claude Dominique Bomsel (born 1946) is a French veterinary doctor and professor at the National Museum of Natural History. Outside of her work as a researcher and teacher, she is a wildlife commentator in the programme "" on France 2. She regularly appears in programmes where various journalists ask her questions about subjects on which she is considered to be an expert. Marie-Claude Dominique Bomsel is the president of the Jane Goodall Institute, France.
Biography.
Born into a bourgeois environment of the city of Versailles, Marie-Claude Bomsel has been passionate about animals since childhood. In 1969, she began studying to be a veterinarian at the École nationale vétérinaire d'Alfort. After graduating, she worked for a few months in rural areas of France, before flying to the Central African Republic with her husband. When the government of Bokassa decided to deport resident aliens, she returned to France, where she obtained an internship at the zoological park in Vincennes. She then worked at the Jardin des Plantes in Paris, where she ran the Ménagerie, from 1981 to 1989 and from 2001 to 2004. Since then, she works as a professor at the Natural History Museum at the heart of the Department of Botanical and Zoological Gardens.
Marie-Claude Bomsel, a professor at the National Museum of Natural History, wrote 79 articles on Mammals for the supplement to the Encyclopædia Universalis published in 1999.


Frank Galey

Francis D. "Frank" Galey is the Provost of Utah State University. A notable scholar and author in the veterinary sciences, he has written or edited over 17 books. Previously the Dean of The University of Wyoming College of Agriculture and Natural Resources, and has previously been employed at the UC Davis School of Veterinary Medicine.
Personal life.
Galey is married to Donna Brown and the couple has four adult children.


Joshua Aronson

Joshua Michael Aronson is an American social psychologist and Associate Professor of Applied Psychology at New York University's Steinhardt School of Culture, Education, and Human Development. He is known for his pioneering work on stereotype threat, which he conducted in the 1990s along with Claude Steele and Steven Spencer. This work has shown that female, minority, and low-income children are stereotyped as performing worse on standardized tests, and that when they are taught to overcome these stereotypes, their standardized test scores improve. He also co-authored a study in 2009 in which he reported no evidence that African Americans' test scores had improved as a result of the election of Barack Obama as President of the United States the previous year.


Mariana Castells

Mariana Castells is a Spanish-American allergist who focuses on mast cell disease, including mastocytosis, a rare disease with limited treatment options. Castells works at Brigham and Women's Hospital in Massachusetts in the Department of Allergy, Rheumatology, and Immunology and at the Dana Farber Cancer Institute. She is also a professor of medicine at Harvard Medical School.
Education.
Castells attended medical school at Autonomous University of Barcelona, Spain and was a resident at University of Kansas Medical Center. She also has a PhD.
Career.
Castells is a leader in the mastocytosis treatment and research field, and directs both the Mastocytosis Center of Excellence and the Drug Hypersensitivity and Desensitization Center at Brigham and Women's Hospital. She is also part of the medical advisory board for The Mastocytosis Society. Castells leads clinical trials related to both mast cell disease and drug desensitization. In her desensitization research, she works to reduce allergic reactions to chemotherapy and other kinds of drugs.
Castells is often quoted as an expert in media articles about seasonal environmental allergies.


Eric Barlow

Eric Barlow (born May 8, 1966) is an American politician current serving as the Speaker of the Wyoming House of Representatives since January 12, 2021 and a Republican member of the chamber representing District 3 since January 8, 2013. Barlow has a wife, Kelly Barlow, and 2 children.
Education.
Barlow earned his DVM from Colorado State University.


Virulence

Virulence is a pathogen's or microorganism's ability to cause damage to a host.
In most contexts, especially in animal systems, virulence refers to the degree of damage caused by a microbe to its host. The pathogenicity of an organism—its ability to cause disease—is determined by its virulence factors. In the specific context of gene for gene systems, often in plants, virulence refers to a pathogen's ability to infect a resistant host.
The noun "virulence" derives from the adjective "virulent", meaning disease severity. The word "virulent" derives from the Latin word "virulentus", meaning "a poisoned wound" or "full of poison."
From an ecological standpoint, virulence is the loss of fitness induced by a parasite upon its host. Virulence can be understood in terms of proximate causes—those specific traits of the pathogen that help make the host ill—and ultimate causes—the evolutionary pressures that lead to virulent traits occurring in a pathogen strain.
Virulent bacteria.
The ability of bacteria to cause disease is described in terms of the number of infecting bacteria, the route of entry into the body, the effects of host defense mechanisms, and intrinsic characteristics of the bacteria called virulence factors. Many virulence factors are so-called effector proteins that are injected into the host cells by specialized secretion apparati, such as the type three secretion system. Host-mediated pathogenesis is often important because the host can respond aggressively to infection with the result that host defense mechanisms do damage to host tissues while the infection is being countered (e.g., cytokine storm).
The virulence factors of bacteria are typically proteins or other molecules that are synthesized by enzymes. These proteins are coded for by genes in chromosomal DNA, bacteriophage DNA or plasmids. Certain bacteria employ mobile genetic elements and horizontal gene transfer. Therefore, strategies to combat certain bacterial infections by targeting these specific virulence factors and mobile genetic elements have been proposed. Bacteria use quorum sensing to synchronise release of the molecules. These are all proximate causes of morbidity in the host.
Virulent viruses.
Virus virulence factors allow it to replicate, modify host defenses, and spread within the host, and they are toxic to the host.
They determine whether infection occurs and how severe the resulting viral disease symptoms are. Viruses often require receptor proteins on host cells to which they specifically bind. Typically, these host cell proteins are endocytosed and the bound virus then enters the host cell. Virulent viruses such as HIV, which causes AIDS, have mechanisms for evading host defenses. HIV infects T-helper cells, which leads to a reduction of the adaptive immune response of the host and eventually leads to an immunocompromised state. Death results from opportunistic infections secondary to disruption of the immune system caused by AIDS. Some viral virulence factors confer ability to replicate during the defensive inflammation responses of the host such as during virus-induced fever. Many viruses can exist inside a host for long periods during which little damage is done. Extremely virulent strains can eventually evolve by mutation and natural selection within the virus population inside a host. The term "neurovirulent" is used for viruses such as rabies and herpes simplex which can invade the nervous system and cause disease there.
Extensively studied model organisms of virulent viruses include virus T4 and other T-even bacteriophages which infect Escherichia coli and a number of related bacteria.
The lytic life cycle of virulent bacteriophages is contrasted by the temperate lifecycle of temperate bacteriophages.
Evolution.
According to evolutionary medicine, optimal virulence increases with horizontal transmission (between non-relatives) and decreases with vertical transmission (from parent to child). This is because the fitness of the host is bound to the fitness in vertical transmission but is not so bound in horizontal transmission.


Washington Healthplanfinder

Washington Healthplanfinder is one of the fourteen health insurance marketplaces in the United States and was created in accordance with the Patient Protection and Affordable Care Act, commonly referred to as Obamacare.
Washington Healthplanfinder is a state-operated website that allows residents of the state of Washington to shop for and to sign up for medical insurance with a private insurance company.
Individuals who sign up may also obtain subsidies from the state that cover a portion of the insurance premiums in accordance with Obamacare.
The subsidies may be paid directly to the insurance company.
The premium payments (minus subsidy) are paid directly to the insurance company by the insured individual.
Individuals who obtained subsidies during the year must include this information when filing their income tax return the following April (U.S. tax returns are due on April 15 every year).
In order to maintain coverage individuals must sign up every year during the open enrollment period. The open enrollment period for 2017 was November 1, 2016 until January 31, 2017.
History.
The Washington Health Benefit Exchange (Exchange) was created in statute to meet a key provision of the Affordable Care Act that called for each state to establish a new marketplace that would offer health benefits to individuals, families, and small businesses. Under national health care reform, states were required to have an Exchange in place by Jan. 1, 2014.
These new marketplaces were to be developed and implemented either by the state or by the United States Department of Health and Human Services. Washington State's governor and legislators chose to implement a state-based exchange model and, in 2011, passed legislation to establish the state's new marketplace as a "public-private partnership," separate and distinct from the state. This legislation's strong governance model and public-private structure provided an innovative approach that other states would adopt in creating their own exchanges. The Exchange has a close working relationship with the Washington State Health Care Authority, Office of the Insurance Commissioner, and the Department of Social and Health Services.
In 2012, legislation was passed that established market rules, requirements for qualified health plans (QHPs), essential health benefits, and other key elements of the state's Exchange. This legislation also enabled the Exchange to focus on developing its operations and information technology (IT) platform, which was critical to meeting the tight timeline of beginning operations on Oct. 1, 2013, the beginning of the first open enrollment period.
Until the middle of 2015 insured individuals paid their premiums to the Washington Health Benefit Exchange, since then payments are made directly to the insurance company.
The Exchange is responsible for the creation of "Washington Healthplanfinder", the online portal to facilitate the shopping and enrolling in health and dental insurance.
Exchange funding & sustainability.
The Exchange received initial operational and implementation funding through federal grant dollars totaling $302,333,310. A substantial amount of the grant funding was used to develop the IT system critical to determining eligibility for and enrolling residents in health plans. To determine eligibility appropriately, the IT system has essential integration points with state and federal agencies and carriers. The grant funding was also used to support activities, such as the development of the navigator program and a marketing campaign. Beginning in 2015, the Exchange was required to be self-sustaining and has been appropriated funds by the state legislature. The Exchange sustainability is tied to three funding sources established in statute: (1) the existing 2 percent tax on health insurance premiums sold through "Washington Healthplanfinder"; (2) reimbursement for activities performed on behalf of Washington Apple Health (the state's Medicaid program), and; (3) an agreed upon carrier assessment. The Exchange was provided with $110 million for operation in the recently passed 2015-17 biennial budget.
Exchange governance.
The Exchange is run by an 11-member bipartisan board composed of a chair and eight voting members appointed by the Governor. Board members are nominated by the Republican and Democratic caucuses in both the State House and State Senate. The Exchange board must have expertise in a variety of health care areas including employee benefits, health economics, consumer advocacy, individual insurance, small group insurance, and health plan administration. The Director of the Health Care Authority and Insurance Commissioner are ex-officio, non-voting board members. There are currently 10 stakeholder committees, technical advisory committees, or workgroups, including a technical advisory committee for key program areas including the navigator program, agents and brokers, health equity, and outreach. There are also three workgroups that address plan management, consumers, and tribal issues.
Customer support network.
"Washington Healthplanfinder" has a network of customer support across Washington State to help customers enroll in health and dental insurance.


Type II secretion system

The type 2 secretion system (often referred to as the type II secretion system or the T2SS) is protein secretion machinery found in various species of Gram-negative bacteria, including various human pathogens such as "Pseudomonas aeruginosa" and "Vibrio cholerae". The type II secretion system is one of six protein secretory systems that are commonly found in gram negative bacteria along with the type I secretion system, the type III secretion system, The type IV secretion system, the chaperone/usher pathway, the autotransporter pathway/type V secretion system and the type VI secretion system (some bacteria also utilize the type VII secretion system). Like these other systems, the type II secretion system enables the transport of cytoplasmic proteins across the lipid bilayers that make up the cell membranes in gram negative bacteria.
Overview.
The type II secretion system is a membrane bound protein complex found in Gram-negative bacteria that is used to secrete proteins found in the cytoplasm of the bacteria into the extracellular space outside of the cell. The type II secretion system is just one of many secretory systems found in Gram-negative bacteria and is used to secrete a variety of different proteins, including bacterial toxins and degradative enzymes such as proteases and lipases. These secreted proteins are generally associated with the breakdown of host tissues and therefore are often important in causing the symptoms associated with certain bacterial infections. Each bacterial cell will contain a number of type II secretion systems and these are found embedded in the inner and outer membranes of the cell.
Along with other secretory systems such as the chaperone/usher pathway and the type IV secretion system, secretion via the type II secretion system is a two-step process. The first step involves the Sec and Tat secretory pathways which are responsible for transporting proteins across the inner membrane into the periplasm. For instance, the Sec pathway is used to transport structural components of the type II secretion system into the periplasm where they can then assemble, while both the Sec and Tat pathways are used to transport secretory proteins into the periplasm. Once these secretory proteins are in the periplasm the second step can then take place and they are secreted out of the cell through the type II secretion system.
Structure.
Overall the type II secretion system is a large multiprotein machinery, made up of a number of distinct protein subunits known as the general secretory proteins (GSPs). The genes encoding these GSPs are usually found together in the genome in a single operon and many of these genes overlap. Each gene is named with a letter corresponding to the GSP that it encodes (for example the gspD gene encodes GspD) and studies indicate that between 12 and 15 of these genes are essential to the function of the type II secretion system. The GSPs are common among a number of different bacterial species and when they come together they form a complex that is structurally very similar to the type IV pili, an appendage that is also commonly found in gram negative bacteria. Overall the type II secretion system can be broken down into four main components. These are the outer membrane complex, the inner membrane complex, the secretion ATPase and the pseudopilus.
Outer Membrane Complex.
The outer membrane complex is made up largely by the secretin GspD. Secretins are β-barrels that are found in membrane where they form channels that allow substances to move in or out of cells. In the type II secretion system GspD creates a pore in the outer membrane of the bacterial cell through which proteins can be secreted. As a result, GspD is essential for the correct function system because without it secretory proteins cannot exit the cell. GspD is transported into the periplasm via the Sec translocon and is then inserted into the outer membrane. This insertion is not spontaneous however and is often reliant upon the β-barrel assembly machinery which ensures β-barrel proteins are folded correctly before insertion into the membrane.
GspD is often found associated with the lipoprotein GspS. GspS is also transported into the periplasm using the Sec translocation machinery, at which point it is inserted into the inner layer of the outer membrane where it remains closely associated with GspD. It is thought that GspS plays an important role in the stabilization of the secretin GspD and helps prevent it from breaking down in the presence of highly degradative periplasmic enzymes.
Inner Membrane Complex.
The inner membrane complex is made up of several different Gsp proteins which are embedded in the inner membrane. Like the outer membrane secretin GspD these proteins are transported into the periplasm via the Sec translocation pathway before being inserted into the inner membrane. Four different proteins make up the inner membrane complex; these are GspC, GspF, GspL and GspM.
Each of these individual subunits plays a slightly different role. GspC for instance has been shown to interact with GspD. This interaction helps gate the type II secretion system and only when this gate is open are secretory proteins able to enter the system and be pumped out of the cell. Importantly, when associated together, GspC, GspL and GspM help protect each other from proteolytic enzymes that would otherwise degrade them. Unlike the other proteins that make up the inner membrane complex GspF is a multipass transmembrane protein and it may play a role in binding the secretion ATPase. GspL is however known to form tight interactions with the secretion ATPase and these are needed to hold it in close association with the rest of the inner membrane complex.
Secretion ATPase.
The secretion ATPase, GspE, is an ATPase which is found closely associated with the inner membrane complex on the cytoplasmic side of the inner membrane. GspE belongs to the type II/type IV secretion ATPase family. ATPases belonging to this family have a distinct hexameric structure. Each individual subunit of the hexamer has 3 main domains. These are 2 separate N-terminal domains called N1D and N2D which are separated by a short linker region and a single C-terminal domain termed the CTD. The CTD in turn is made up of 3 subdomains, one of which is a nucleotide binding domain. It is this nucleotide binding domain, which is present in of each of the 6 subunits of the hexamer, that is responsible for binding ATP. The other 2 domains that make up the CTD, a four helical domain and a metal binding domain, then help catalyze the hydrolysis of bound ATP. This ATP hydrolysis is used to power the assembly and disassembly of the pseudopillus which is what drives secretion via the type II secretion system. As a result, the system cannot function without GspE. The N-terminal domains N1D and N2D form the interactions with the inner membrane complex which help keep the secretion ATPase in close association with the rest of the type II secretion system. The N2D domain is not fully understood but observations show that it is the N1D which is responsible for forming the tight interactions seen with the inner membrane complex subunit GspL.
Pseudopilus.
The pseudopilus is found in the periplasm but does not extend out through the secretin GspD into the extracellular milieu. Its name it derived from the fact that it is made up of a number of pilin like proteins or pseudopilins, known as GspG, GspH, GspI, GspJ and GspK. They are known as pseudopilins due to their similarity to the pilins (like PilA) that make up the type IV pili found in gram negative bacteria. Like their counterparts, the pseudopilins are initially produced in an immature form. These pre-pseudopilins consist of an N-terminal signal sequence that targets the proteins to the Sec translocon and a long C-terminal passenger domain which encodes the actual pseudopilin protein itself. Once the Sec machinery has transported the pre-pseudopilin across the inner membrane, but before the protein itself is released into the periplasm, the N-terminal signal sequence is cleaved at a conserved stretch of positively charged amino acid residues. This cleavage is catalysed by the signal peptidase GspO and the end result is the removal of the N-terminal signal sequence and the formation of a mature pseudopilin. GspO is inserted in the inner membrane and is often closely associated with the type II secretion system machinery. Mature pilins and pseudopilins have a lollipop shaped structure, made up of a long hydrophobic tail and a globular hydrophilic head domain. Once in the periplasm in their mature state, the pseudopilins will then often be inserted into the outer leaflet of the inner membrane via their hydrophobic tails.
The major pseudopilin present in the pseudopilus is GspG. The pseudopilus forms when the individual pseudopilin subunits polymerize together. In this reaction the hydrophobic tails of different pseudopilins mesh together leaving their globular hydrophilic heads exposed. These long hydrophobic tails are able to aggregate together like this due to strong hydrophobic interactions and the end result is that the pseudopilus steadily grows. The assembly and disassembly of these pseudopilus subunits is powered by the secretion ATPase GspE. It is thought that this constant extension and retraction of the pseudopilus causes it to act like a piston and push secretory proteins out through the outer membrane secretin. When the pseudopilus then retracts new secretory proteins can then enter the system and the process will repeat. This movement of the pseudopilus is similar to the movement displayed by type IV pili which is known to enable twitching motility.
Mechanism.
Secretion of proteins via the type II secretion system occurs in a very specific way and is largely uniform among different species of bacteria. This mechanism can be broken down into several steps:
It is believed that quorum sensing plays a key role in controlling the activation of the type II secretion system and the initiation of exoprotein release. Specifically quorum sensing helps regulate the transcription of the genes encoding these exoproteins and ensures that they are only produced when other like bacteria are nearby and environmental conditions are conducive to survival and infection.


Society of Radiographers

The Society of Radiographers (SoR) is a professional body and trade union that represents more than 90 percent of the diagnostic and therapeutic radiographers in the United Kingdom. The College of Radiographers (CoR) is a charitable subsidiary of the Society, they are collectively known as the Society and College of Radiographers (SCoR).
It was founded in 1920 in an effort to provide standardised training and registration for Radiographers within the British Isles. Until 1996, the SoR was also the professional body and trades union for radiographers in Ireland whereupon the Irish Institute of Radiography and Radiation Therapy was established.
History.
In the second decade of the 20th century the number of x-ray workers grew dramatically not least due to the impact of World War I and in post-war Britain the formation of an association of such workers was inevitable. This was hastened by the desire of medical practitioners (radiologists) to secure the ‘ownership’ of x-ray work and leading radiologists at the time approached the Institute of Electrical Engineers for support. As a result the Society of Radiographers was established in 1920 with its first council composed of six radiologists and six electrical engineers, to which were added six selected radiographers from the London area. Not without many controversies over the past 100 years, the Society of Radiographers has become a strong body representing the interests of radiographers and advancing the highest standards of practice in support of their patients.
In 1921, a syllabus was developed and examinations were introduced to facilitate competency checks before membership was granted to new members. Membership began to grow with 67 members in 1921 and 164 in 1923.
It was not long before the society headed straight into troubled times. The medical members with external assistance moved quickly in their attempts to prevent radiographers from reporting on their images. This was to be a crucial step along the road to medical ownership of x-ray work and in their desire to establish consultant posts in radiology. Their standing with other medical consultants was important to their esteem. It was in 1925 after a protracted dispute which involved a number of resolutions being put to council that there was agreement that non-medical members would not report and if they did they would be liable to dismissal from the society. There was opposition to this from some radiographer council members especially Mr Blake but also from the Electrical Engineers representatives. In fact they resigned en-masse including Mr A A Campbell Swinton said to be the first person in the UK to produce a radiograph. After this there followed a long period of medical dominance although this did not prevent the society from growing and working hard for the profession. It was not until the 1970s that Dr Swinburne, a radiologist, from Leeds said it was time for official recognition that radiographers assist in film interpretations. It was another 20 years before the first reporting courses for radiographers were established. By 1997 it was official policy of the College of Radiographers that "reporting by radiographers is not an option. For the future, it is a requirement." Twenty years further on, it can be said reporting by radiographers is embedded within their scope of practice.
The society formed a South African branch in 1930 and established a pattern of branch formation with a local committee management which was propagated in the UK during the 1930s. As a result, the Scottish Radiographic Society which was formed in 1927 became a branch of the society in 1936, the South West Branch in 1937, the North West in 1942, the Midland and the North East in 1943. The first Annual Conference of the Society of Radiographers was in 1947 held at Bath, England.
In June 2015, the National Institute for Health and Care Excellence (NICE) granted accreditation to the processes used by the SCoR in order to generate current clinical guidance for Radiography practice, meaning that the SCoR is NICE accredited.
Objectives.
The objectives for which The Society of Radiographers is established are as follows:<ref name="SOR Annual Report 2009/10"></ref>
The college's objectives are directed towards education, research and other activities in support of the science and practice of radiography.
Governance.
The society and college is led by a council which is made-up of representatives from a number of English regions (Eastern region, London region, Midlands region, North West region, Northern region, South East region, South West region, Yorkshire & North Trent region) and from Northern Ireland, Scotland and Wales. The Council determines the Society's policy and strategic direction in consultation with members and others that have a vested interest. It meets once a month, with the exception of August and December.
The society is a company limited by guarantee and the members of council are company directors registered at Companies House. The college, a registered charity, has its own Board of directors comprising an equal number of members drawn from council and external directors representing the legal, financial and medical fields. They have responsibilities as representatives of the membership and also as directors of the company. Neither council members nor College Board members are paid for their duties but they can claim travelling and other expenses.
The president is elected by the members of council and is inaugurated at the July council meeting each year. There is also a President-elect and a Vice-president, who also serve for one year.
Patron.
The patron of the Society and College of Radiographers is The Rt Hon Llinos "Llin" Golding, Baroness Golding of Newcastle-under-Lyme who is a Labour Party politician and former MP who sits in the House of Lords and who previously practiced as a radiographer.
Education and other activities.
Historically, the college was an awarding body for academic awards but no longer fulfils this function. The degree-equivalent radiography qualification awarded by the CoR was the Diploma of the College of Radiographers (DCR) and this was awarded following a three-year training course and successful completion of a national examination, either in Radiodiagnosis (the DCR(R)) or in Therapy Radiography (the DCR(T)). Following study equivalent to Masters level, students with a DCR could proceed by examination to the Higher Diploma of the College of Radiographers (HDCR). Holders of the HDCR undergoing specialist training in management were awarded the Management Diploma of the College of Radiographers (MDCR) and those undergoing specialist training in the teaching of radiography were awarded the Teaching Diploma of the College of Radiographers (TDCR). The first Bachelor of Science (BSc) in Radiography was validated in 1989 and with the widespread introduction of BSc courses in radiography during 1993, the DCR was phased out. The HRCR, TDCR and MDCR have been replaced by postgraduate level courses.
The college maintains an Accreditation and Approval Board which aims to protect patients of radiographers by raising the standards of education and practice. It does so by monitoring and assessing programmes of both pre-registration degree courses and ongoing professional education ranging from ad-hoc events to professional postgraduate training. The college runs courses and conferences. Various guidances and guidelines are published by the CoR often in conjunction with the Institute of Physics and Engineering in Medicine (IPEM), the Royal College of Radiologists (RCR), the British Institute of Radiology (BIR) and the Royal College of Nursing (RCN).
Research grants are awarded by the college. An academic library is maintained. Further activities to promote the public interest includes the provision of advice to the public and to government and government agencies and activities to promote public awareness of radiography, radiology and oncology. Information on the activities of the CoR is published on the website of the UK's Charity Commission.
Trade Union activities.
The society has a membership base throughout the United Kingdom. As such, the Trade Union is associated with the Trade Union Congress (TUC) in the United Kingdom and with the Scottish Trade Union Congress (STUC). The organisation was previously associated with the Irish Congress of Trade Unions(ICTU) but it left in 2013 citing financial constraints as the reason. In 2003, before leaving and whilst still in affliction with the ICTU, the society opposed a motion to restrict affiliation of small unions with the ICTU stating that the motion was "about bureaucracy."
The Society of Radiographers Benevolent Fund.
The Society of Radiographers Benevolent Fund is a registered charity (No. 326398) and it assists SoR members, former members and their families in times of hardship or distress and in particular the old, the sick and the incapacitated among members and former members. Information on the activities of the Benevolent Fund is published on the website of the UK's Charity Commission.
Publications.
The SCoR issues a number of publications:
Awards.
The SCoR maintains a number of awards and grants.
Fellowship of The College of Radiographers (FCR) Award.
The Fellowship of the College of Radiographers (FCR) is an honorary title, bestowed upon individuals who have made significant contribution to the radiographic profession. It was first awarded, in its present format, in 1978 following the establishment of The College of Radiographers as the charitable subsidiary of The Society of Radiographers. Additionally, the individual receives complimentary life membership of The Society of Radiographers.
The Gold Medal Award.
The Gold Medal is the highest award the Society may award and is only granted to individuals who have "who have made exceptional contributions to radiography, developed the profession and advanced the Society and College of Radiographers." Fewer than 20 gold medals have ever been awarded.
The Silver Medal Award.
The Silver Medal was first struck in 1985 and is awarded by The Society of Radiographers to recognise and acknowledge individuals for outstanding dedication and contribution to the profession of Radiography. Nominees must be members of the Society of Radiographers (or retired from active service and membership), or non-members who are outstanding contributors to the profession. Their work may span any aspect of the imaging and therapy modalities and/or the wider spheres of commerce, industry and management; as such overseas nominees are also eligible. Notable recipients include Stewart Whiteley who was the author for the revised editions of Clark's positioning in Radiography, a fundamental diagnostic radiography textbook.
Alan Nichols Memorial Award.
Alan Nichols was a chief technical adviser to the Department of Radiology at Oxford Hospitals and since 1996, an award in his name has been given for the best paper proffered by a radiographer at the Radiology Congress. A representative of the Mr Nichols’s family is invited to present the award. The Alan Nichols Memorial Award is currently £100.
Beth Whittaker Award.
This award, commemorating Beth Whittaker, has been awarded to the best poster presentation at the Annual Radiology Conference. The Beth Whittaker Award is currently £50.
SoR Reps' Learning Fund (Bryan Macey Scholarship).
The Bryan Macey Scholarship, named for a former Chief Executive, is open to all Society Health and Safety and Industrial Relations representatives for trade union-related academic study.
Forder Memorial Award for Students.
The Forder Memorial Award, which commemorates the memory of Mr A O Forder, founder member of the SoR in 1920 and a member of the first council of the society. From 1995, it was agreed that it would be presented to the best paper proffered by a student at the Annual Students Conference. The winning student is awarded the prize of £50.
The Arthur Kay Radiotherapy Award.
In April 2009, the organisation launched the Arthur Kay Radiotherapy Award to support an annual award to an appropriately qualified and experienced therapeutic radiographer who wishes to travel to learn new and innovative techniques in therapeutic radiography. The fund will enable successful applicants to spend time studying innovations in technology and practice at a leading world class cancer institution(s). Applications for funding to the value of £5000 will be considered although, for exceptional applications, more may be available to an absolute maximum of £10,000.
Overseas Placement Fund.
The College of Radiographers Overseas Placement Fund was established in 1998. It is managed by the College of Radiographers Board of Trustees and a number of radiography placements in developing countries have been supported by the fund. A number of individual radiographers have taken an interest in this area and this has often resulted in periods of working overseas.


Allergen of the Year

Allergen of the Year is an annual "award" of dubious distinction voted upon by the American Contact Dermatitis Society. This is "designed to draw attention to allergens that are very common, under-recognized, merit more attention because they are causing significant allergic contact dermatitis or are no longer causing significant relevant disease (as in thimerosal)".


SHAPE America

The Society of Health and Physical Educators, known as SHAPE America, is an American organization that provides support to professionals in health, physical education, recreation and dance.
SHAPE America has six previous names, most recently the American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD), and previously the Association for Health, Physical Education and recreation.
Related and/or sister organizations.
The alliance at the September 2009 Board of Governor's meeting voted to move forward on motions for the exit of the American Association for Health Education and the restructuring of the National Association for Girls and Women in Sport.
National standards.
Associations allied with SHAPE America have developed the following national standards.
Districts and states.
SHAPE America has the following districts:
Each state has a separate association.
Programs.
Let's Move in School
The goal of Let's Move in School is to ensure that every school provides a comprehensive school physical activity program with quality physical education . Let's Move in School is urging physical educators, parents, school administrators and policymakers to get involved in bringing quality physical education and physical activity to schools through a comprehensive school physical activity program.
In 2012 and again in 2016, SHAPE America published the "SHAPE OF THE NATION Report : Status of Physical Education in the USA"."


Chlamydia suis

Chlamydia suis is a member of the genus "Chlamydia". "C. suis" has only been isolated from swine, in which it may be endemic. Glycogen has been detected in "Chlamydia suis" inclusions in infected swine tissues and in cell culture. "C. suis" is associated with conjunctivitis, enteritis and pneumonia in swine.
Some strains have enhanced resistance to sulfadiazine and tetracycline. Several strains of "C. suis" are known to have an extrachromosomal plasmid, pCS. "C. suis" strains are somewhat more diverse than are other chlamydial species. The deduced ompA gene products of various "Chlamydia suis" strains contain vs4 epitopes TLNPTIAG(A.K.T)G(D.K.N.T), TWNPTIAGAGS or TLNPTISGKGQ. These epitopes are identical or nearly identical to the "Chlamydia" MOMP core epitopes NPTI, TLNPTI, LNPTIA or LNPTI, which are recognized by "Chlamydia trachomatis" vs4 mAbs. They are also identical or nearly identical to TIAGAGD and IAGAG epitopes, which are recognized by "C. trachomatis" B-serogroup mAbs.


Roy Lilley

Roy Lilley is a health policy analyst, writer, broadcaster and commentator on the National Health Service and social issues.
He was the vice-chairman of West Surrey and North East Hampshire Health Authority and formerly a Conservative member of Surrey Heath Borough Council where he was Mayor in 1988/89. Between 1991 and 1995, he was the chairman of the Homewood NHS Trust, Chertsey Surrey. He was a Visiting Fellow at the Management School, Imperial College London, and at the Centre for Health Services Management at the University of Nottingham.
He has written for the Guardian, Sunday Times, Daily Telegraph and other newspapers, journals and management periodicals including a regular column in Pharmaceutical Marketing magazine. He runs the nhsManagers.network which produces an opinionated free newsletter four times a week which is claimed to reach 300,000 NHS managers inboxes. He is the author of over twenty books on health and health service management. Because his newsletter is regarded as influential those attacked in it can be defensive. It is supported by the Institute of Healthcare Management.
He was an active opponent of the Health and Social Care Act 2012 and during the campaign produced a draft NHS Emergency Powers Act giving an alternative approach to NHS reform. At this time, he was widely credited for introducing the nickname "La La" for Andrew Lansley, the then Health Secretary and architect of the reforms. In 2013 he chaired the People’s Inquiry into London’s NHS. In March 2014 he was reported as saying, in connection with the care.data controversy that better use of data was vital to improve the quality of care but that politicians had made it more difficult for the public believe their commitments about the future use of the records, because previous ministers’ pledges - such as a promise to have no top-down reorganisation of the NHS - had been broken.
Lilley lives in Camberley, Surrey;