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Summary: The maturation of genomic surveillance in the past decade has enabled tracking of the emergence and spread of epidemics at an unprecedented level. During the COVID-19 pandemic, for example, genomic data revealed that local epidemics varied considerably in the frequency of SARS-CoV-2 lineage importation and persistence, likely due to a combination of COVID-19 restrictions and changing connectivity. Here, we show that local COVID-19 epidemics are driven by regional transmission, including across international boundaries, but can become increasingly connected to distant locations following the relaxation of public health interventions. By integrating genomic, mobility, and epidemiological data, we find abundant transmission occurring between both adjacent and distant locations, supported by dynamic mobility patterns. We find that changing connectivity significantly influences local COVID-19 incidence. Our findings demonstrate a complex meaning of ‘local’ when investigating connected epidemics and emphasize the importance of collaborative interventions for pandemic prevention and mitigation.

Background and aimsNon-alcoholic fatty liver disease (NAFLD) is associated with a high risk of cardiovascular disease. Whether risk scores developed in the general population accurately assess cardiovascular risk in the NAFLD population is unknown. This study aimed to evaluate the performance of the Pooled Cohort Equations (PCE) in NAFLD.MethodsIndividuals in the Multi-Ethnic Study of Atherosclerosis with baseline non-contrast cardiac computed tomography scans with sufficient data to determine the presence of hepatic steatosis were identified and assessed for the development of incident 10-year atherosclerotic cardiovascular disease. The discrimination and calibration of the PCE were evaluated, and the observed and expected events by risk category (

Natural and artificial cells are two common chassis in synthetic biology. Natural cells can perform complex tasks through synthetic genetic constructs, but their autonomous replication often causes safety concerns for biomedical applications. In contrast, artificial cells based on nonreplicating materials, albeit possessing reduced biochemical complexity, provide more defined and controllable functions. Here, for the first time, the authors create hybrid material-cell entities termed Cyborg Cells. To create Cyborg Cells, a synthetic polymer network is assembled inside each bacterium, rendering them incapable of dividing. Cyborg Cells preserve essential functions, including cellular metabolism, motility, protein synthesis, and compatibility with genetic circuits. Cyborg Cells also acquire new abilities to resist stressors that otherwise kill natural cells. Finally, the authors demonstrate the therapeutic potential by showing invasion into cancer cells. This work establishes a new paradigm in cellular bioengineering by exploiting a combination of intracellular man-made polymers and their interaction with the protein networks of living cells.

BackgroundSchools are high-risk settings for SARS-CoV-2 transmission, but necessary for children's educational and social-emotional wellbeing. Previous research suggests that wastewater monitoring can detect SARS-CoV-2 infections in controlled residential settings with high levels of accuracy. However, its effective accuracy, cost, and feasibility in non-residential community settings is unknown.MethodsThe objective of this study was to determine the effectiveness and accuracy of community-based passive wastewater and surface (environmental) surveillance to detect SARS-CoV-2 infection in neighborhood schools compared to weekly diagnostic (PCR) testing. We implemented an environmental surveillance system in nine elementary schools with 1700 regularly present staff and students in southern California. The system was validated from November 2020 to March 2021.FindingsIn 447 data collection days across the nine sites 89 individuals tested positive for COVID-19, and SARS-CoV-2 was detected in 374 surface samples and 133 wastewater samples. Ninety-three percent of identified cases were associated with an environmental sample (95% CI: 88%-98%); 67% were associated with a positive wastewater sample (95% CI: 57%-77%), and 40% were associated with a positive surface sample (95% CI: 29%-52%). The techniques we utilized allowed for near-complete genomic sequencing of wastewater and surface samples.InterpretationPassive environmental surveillance can detect the presence of COVID-19 cases in non-residential community school settings with a high degree of accuracy.FundingCounty of San Diego, Health and Human Services Agency, National Institutes of Health, National Science Foundation, Centers for Disease Control.

BACKGROUND: Schools are high-risk settings for SARS-CoV-2 transmission, but necessary for children's educational and social-emotional wellbeing. Previous research suggests that wastewater monitoring can detect SARS-CoV-2 infections in controlled residential settings with high levels of accuracy. However, its effective accuracy, cost, and feasibility in non-residential community settings is unknown. METHODS: The objective of this study was to determine the effectiveness and accuracy of community-based passive wastewater and surface (environmental) surveillance to detect SARS-CoV-2 infection in neighborhood schools compared to weekly diagnostic (PCR) testing. We implemented an environmental surveillance system in nine elementary schools with 1700 regularly present staff and students in southern California. The system was validated from November 2020 - March 2021. FINDINGS: In 447 data collection days across the nine sites 89 individuals tested positive for COVID-19, and SARS-CoV-2 was detected in 374 surface samples and 133 wastewater samples. Ninety-three percent of identified cases were associated with an environmental sample (95% CI: 88% - 98%); 67% were associated with a positive wastewater sample (95% CI: 57% - 77%), and 40% were associated with a positive surface sample (95% CI: 29% - 52%). The techniques we utilized allowed for near-complete genomic sequencing of wastewater and surface samples. INTERPRETATION: Passive environmental surveillance can detect the presence of COVID-19 cases in non-residential community school settings with a high degree of accuracy. FUNDING: County of San Diego, Health and Human Services Agency, National Institutes of Health, National Science Foundation, Centers for Disease Control.

BackgroundImportant insights into the early pathogenesis of Alzheimer's disease can be provided by studies of autosomal dominant Alzheimer's disease and Down syndrome. However, it is unclear whether the timing and spatial distribution of amyloid accumulation differs between people with autosomal dominant Alzheimer's disease and those with Down syndrome. We aimed to directly compare amyloid changes between these two groups of people.MethodsIn this cross-sectional study, we included participants (aged ≥25 years) with Down syndrome and sibling controls who had MRI and amyloid PET scans in the first data release (January, 2020) of the Alzheimer's Biomarker Consortium-Down Syndrome (ABC-DS) study. We also included carriers of autosomal dominant Alzheimer's disease genetic mutations and non-carrier familial controls who were within a similar age range to ABC-DS participants (25-73 years) and had MRI and amyloid PET scans at the time of a data freeze (December, 2020) of the Dominantly Inherited Alzheimer Network (DIAN) study. Controls from the two studies were combined into a single group. All DIAN study participants had genetic testing to determine PSEN1, PSEN2, or APP mutation status. APOE genotype was determined from blood samples. CSF samples were collected in a subset of ABC-DS and DIAN participants and the ratio of amyloid β42 (Aβ42) to Aβ40 (Aβ42/40) was measured to evaluate its Spearman's correlation with amyloid PET. Global PET amyloid burden was compared with regards to cognitive status, APOE ɛ4 status, sex, age, and estimated years to symptom onset. We further analysed amyloid PET deposition by autosomal dominant mutation type. We also assessed regional patterns of amyloid accumulation by estimated number of years to symptom onset. Within a subset of participants the relationship between amyloid PET and CSF Aβ42/40 was evaluated.Findings192 individuals with Down syndrome and 33 sibling controls from the ABC-DS study and 265 carriers of autosomal dominant Alzheimer's disease mutations and 169 non-carrier familial controls from the DIAN study were included in our analyses. PET amyloid centiloid and CSF Aβ42/40 were negatively correlated in carriers of autosomal dominant Alzheimer's disease mutations (n=216; r=-0·565; p

Procalcitonin (PCT) is commonly used to evaluate the etiology and severity of pneumonia. PCT has been shown to be elevated at baseline in patients with obesity. The aim of this study is to determine if body mass index (BMI) has an influence on admission PCT level in patients admitted to the hospital with a diagnosis of pneumonia. We conducted a retrospective cohort study that encompassed patient visits to a tertiary care center from 2014 until September 2023. A total of 18,652 patients presented to the emergency department with a diagnosis of pneumonia. A total of 3659 were admitted to the floor, and 2246 were admitted to the MICU. Patients were grouped based on admission BMI into five categories. The Kruskal–Wallis test performed on patients admitted to the floor revealed a statistically significant difference in PCT levels among groups of different BMIs (H = 34.97, df = 4, p < 0.001). In patients admitted to the MICU, the Kruskal–Wallis test revealed a significant difference in PCT levels among groups of different BMIs (H = 32.92, df = 4, p < 0.001). BMI has a statistically significant effect on PCT in patients admitted to the hospital with pneumonia. Patients with higher BMI may exhibit less robust PCT levels, which may impact management decisions.

Injury by firearm is now the leading cause of death in children in the U.S.. Effective injury prevention requires first defining the problem and identifying risk and protective factors before implementing prevention strategies. There is no comprehensive source available to define firearm injuries, especially at the local level. We propose a local firearm injury surveillance model based on the socio-ecological injury prevention framework that combines injury data from health care, law enforcement, county services, and census data that can help to guide targeted firearm injury prevention interventions.

While firearm-related injuries are the leading cause of death among US children between 1-18, and account for nearly half of suicides among young people, public health experts continue to struggle in identifying efficacious mechanisms to reduce and prevent firearm access for children. Currently 4.8 million children live in a home with a loaded and unlocked firearm and more than a third of adolescents nationwide say that they can access a loaded firearm within five minutes. However, the risk of unintentional or self-inflicted firearm injury is lower if all household firearms are stored locked. It is imperative for parents to be counseled on safe firearm storage practices, and this has been studied within various healthcare settings. Yet, little is known about the impact on the education of safe firearm storage counseling within the community. Also, temporary emergency storage can be a vital option for families in crisis. We identified 130 firearm retailers and 31 firearm ranges in the Greater Houston Area and were able to successfully contact 66 retailers (51%) and 19 ranges (61%). Only 9% (n=8) of retailers and ranges contacted reported offering temporary emergency firearm storage. At point-of-sale, there was wide variation in the communication mechanisms employed in educating individuals on safe firearm storage practices including informational handouts, videos, posters, training classes, and verbal counseling. Collaborating with firearm retailers and ranges to introduce more consistent messaging on firearm safe storage at point-of-sale represents a novel approach to community-based interventions to firearm counseling and potentially suicide prevention.

There is no doubt that 2020 has put a number of professions through their paces--college admission and recruitment included. The longer it takes to secure widespread COVID relief, the worse the economic situation becomes. These challenges are broad, sweeping, and beyond the scope of one institution's individual strategies. One framework has shown up time and time again to offer clarity. Intersectionality: An intellectual framework championed by Black, queer, and Latinx feminist scholars in the 1970s, and popularized by Kimberlé Crenshaw in a 1991 law article, claims that identities like race, gender, and class can not be examined in isolation. They must be considered as reinforcing stressors that compound the level of oppressing forces an individual might navigate. This article presents how to apply intersectionality to the college admission process.