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The majority of emerging infectious diseases originate in animals. Current routine surveillance is focused on known diseases and clinical syndromes, but the increasing likelihood of emerging disease outbreaks shows the critical importance of early detection of unusual illness or circulation of pathogens - prior to human disease manifestation. In this Viewpoint, we focus on one key pillar of preparedness-the need for early warning surveillance at the human, animal, environmental interface. The COVID-19 pandemic has revolutionized the scale of sequencing of pathogen genomes, and the current investments in global genomic surveillance offer great potential for a novel, truly integrated Disease X (with epidemic or pandemic potential) surveillance arm provided we do not make the mistake of developing them solely for the case at hand. Generic tools include metagenomic sequencing as a catch-all technique, rather than detection and sequencing protocols focusing on what we know. Developing agnostic or more targeted metagenomic sequencing to assess unusual disease in humans and animals, combined with random sampling of environmental samples capturing pathogen circulation is technically challenging, but could provide a true early warning system. Rather than rebuilding and reinforcing the pre-existing silo's, a real step forward would be to take the lessons learned and bring in novel essential partnerships in a One Health approach to preparedness.The COVID-19 pandemic has induced large-scale behavioral changes, presenting a unique opportunity to study how air pollution is affected by societal shifts. At 455 PM 2.5 monitoring sites across the United States, we conduct a causal inference analysis to determine the impacts of COVID-19 lockdowns on PM 2.5 . Our approach allows for rigorous confounding adjustment with highly spatio-temporally resolved effect estimates. We find that, with the exception of the Southwest, most of the US experienced increases in PM 2.5 compared to concentrations expected under business-as-usual. To investigate possible drivers of this phenomenon, we use a regression model to characterize the relationship of various factors with the observed impacts. Our findings have immense environmental policy relevance, suggesting that mobility reductions alone may be insufficient to substantially and uniformly reduce PM 2.5 .Nucleocapsid proteins are essential for SARS-CoV-2 life cycle. Here, we describe protocols to gather domain-specific insights about essential properties of nucleocapsids. These assays include dynamic light scattering to characterize oligomerization, fluorescence polarization to quantify RNA binding, hydrogen-deuterium exchange mass spectrometry to map RNA binding regions, negative-stain electron microscopy to visualize oligomeric species, interferon reporter assay to evaluate interferon signaling modulation, and a serology assay to reveal insights for improved sensitivity and specificity. These assays are broadly applicable to RNA-encapsidated nucleocapsids. For complete details on the use and execution of this protocol, please refer to Wu et al. (2021).Multisystem inflammatory syndrome in children (MIS-C) can cause a myriad of cardiac manifestations, including coronary dilation and aneurysms; giant aneurysms are infrequent. check details We describe 3patients with giant coronary aneurysms associated with MIS-C, including the youngest case reported to date, treated with intravenous immunoglobulin, corticosteroids, and biologic agents. (Level of Difficulty Intermediate.).Prolonged pharmacological interventions have detrimental health consequences by developing drug tolerance or drug resistance, in addition to adverse drug events. The ongoing COVID-19 pandemic-related stress has adversely affected the emotional and mental health aspects around the globe. Consequently, depression is growing during the COVID-19 pandemic. Besides specific pharmacological interventions, which if prolonged have detrimental health consequences, non-pharmacological interventions are needed to minimize the emotional burden related to the COVID-19 pandemic. Laughter therapy is a universal non-pharmacologic approach to reduce stress and anxiety. Therapeutic laughter is a non-invasive, cost-effective, and easily implementable intervention that can be used during this pandemic as a useful supplementary therapy to reduce the mental health burden. Laughter therapy can physiologically lessen the pro-stress factors and increase the mood-elevating anti-stress factors to reduce anxiety and depression. In this ongoing stressful period of the COVID-19 pandemic, keeping necessary social distancing, it is important to create a cheerful environment that will facilitate laughter among the family, neighbor, and community to cope with the stresses of the COVID-19 pandemic.Acquisition of oncogenic mutations with age is believed to be rate limiting for carcinogenesis. However, the incidence of leukemia in children is higher than in young adults. Here we compare somatic mutations across pediatric acute myeloid leukemia (pAML) patient-matched leukemic blasts and hematopoietic stem and progenitor cells (HSPCs), as well as HSPCs from age-matched healthy donors. HSPCs in the leukemic bone marrow have limited genetic relatedness and share few somatic mutations with the cell-of-origin of the malignant blasts, suggesting polyclonal hematopoiesis in pAML patients. Compared to normal HSPCs, a subset of pAML cases harbored more somatic mutations and a distinct composition of mutational process signatures. We hypothesize these cases might have arisen from a more committed progenitor. This subset had better outcomes than pAML cases with mutation burden comparable to age-matched healthy HSPCs. Our study provides insights into the etiology and patient stratification of pAML.Epidemics caused by microbial organisms are part of the natural phenomena of increasing biological complexity. The heterogeneity and constant variability of hosts, in terms of age, immunological status, family structure, lifestyle, work activities, social and leisure habits, daily division of time and other demographic characteristics make it extremely difficult to predict the evolution of epidemics. Such prediction is, however, critical for implementing intervention measures in due time and with appropriate intensity. General conclusions should be precluded, given that local parameters dominate the flow of local epidemics. Membrane computing models allows us to reproduce the objects (viruses and hosts) and their interactions (stochastic but also with defined probabilities) with an unprecedented level of detail. Our LOIMOS model helps reproduce the demographics and social aspects of a hypothetical town of 10 320 inhabitants in an average European country where COVID-19 is imported from the outside. The above-mentioned characteristics of hosts and their lifestyle are minutely considered. For the data in the Hospital and the ICU we took advantage of the observations at the Nursery Intensive Care Unit of the Consortium University General Hospital, Valencia, Spain (included as author). The dynamics of the epidemics are reproduced and include the effects on viral transmission of innate and acquired immunity at various ages. The model predicts the consequences of delaying the adoption of non-pharmaceutical interventions (between 15 and 45 days after the first reported cases) and the effect of those interventions on infection and mortality rates (reducing transmission by 20, 50 and 80%) in immunological response groups. The lockdown for the elderly population as a single intervention appears to be effective. This modeling exercise exemplifies the application of membrane computing for designing appropriate multilateral interventions in epidemic situations.Response to the COVID-19 (coronavirus disease 2019) pandemic saw an unprecedented uptake in bottom-up efforts to incorporate community wastewater testing to inform public health. While not a new strategy, various specialized scientific advancements were achieved to establish links between wastewater concentrations of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) and public health outcomes. Maximizing public health benefit requires collaboration among a broad range of disciplinary experts, each bringing their own historical context to the central goal of protecting human health. One challenge has been a lack of shared terminology. Standardized terminology would provide common ground for this rapidly growing field. Based on the review herein, we recommend categorical usage of the term 'wastewater-based epidemiology' to describe the science of relating microbes, chemicals or other analytes in wastewater to public health. We further recommend the term 'wastewater surveillance' to describe continuous monitoring of health outcomes (either microbes or chemicals) via wastewater. We suggest that 'wastewater tracking' and 'wastewater tracing' be used in more narrow ways, specifically when trying to find the source of a health risk. Finally, we suggest that the phrase 'wastewater monitoring' be abandoned, except in rare circumstances when ensuring wastewater discharge is safe from a public health perspective.Digital contact tracing has been deployed as a public health intervention to help suppress the spread of Covid-19 in many jurisdictions. However, most governments have struggled with low uptake and participation rates, limiting the effectiveness of the tool. This paper characterises a number of systems developed around the world, comparing the uptake rates for systems with different technology, data architectures, and mandates. The paper then introduces the MAST framework (motivation, access, skills, and trust), adapted from the digital inclusion literature, to explore the drivers and barriers that influence people's decisions to participate or not in digital contact tracing systems. Finally, the paper discusses some suggestions for policymakers on how to influence those drivers and barriers in order to improve uptake rates. Examples from existing digital contact tracing systems are presented throughout, although more empirical experimentation is required to support more concrete conclusions on effective interventions.

Isolation precautions are essential prevent spread of COVID-19 infection but may have a negative impact on inpatient care. The impact of these measures on non-COVID-19 patients remains largely unexplored.

This study aimed to investigate diagnostic and treatment delays related to isolation precautions, the associated patient outcome, and the predisposing risk factors for delays.

This observational study was conducted in seven Helsinki region hospitals during the first wave of the COVID-19 pandemic in Finland. The study used data on all non-COVID-19 inpatients, who were initially isolated due to suspected COVID-19, to estimate whether isolation precautions resulted in diagnostic or treatment delays.

Out of 683 non-COVID-19 patients, 33 (4.8%) had delays related to isolation precautions. Clinical condition deteriorated non-fatally in seven (1.0%) patients. The following events were associated with an increased risk of treatment or a diagnostic delay more than three ward transfers (

= 0.025); referral to an incorrect speciality in the emergency department (

= 0.

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