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Background Implementing public health interventions can be challenging in carceral settings. Jails are institutions with the shortest lengths of stay, resulting in frequent turnover and constantly shifting populations. Jails had particularly acute challenges during the early stages of the COVID-19 pandemic when incarcerated persons were highly susceptible to infection and severe disease. The purpose of this study was to identify barriers and facilitators to wastewater-based surveillance (WBS) and nasal self-testing (NST) as a combined strategy of COVID-19 surveillance in Fulton County Jail (FCJ), Atlanta, Georgia. Implications for efficient and effective infectious disease testing among this susceptible population are relevant for ongoing surveillance of current endemic pathogens and future epidemics. Methods We utilized a multilevel, theory-informed qualitative approach to conduct semi-structured one-on-one and small group interviews with nine distinct jail stakeholder groups: jail custody leadership, administrators, officers, maintenance workers, Georgia Department of Health’s COVID-19 testing contractor, jail health care leaders, nursing staff, laboratory leadership, and staff. Interview guides and analyses were informed by the Consolidated Framework for Implementation Research (CFIR). We used Applied Thematic Analysis to identify domains within CFIR reflecting barriers and facilitators to WBS combined with NST in large urban jail settings. Results Twelve interviews were conducted with administrative, healthcare, maintenance, custody, and laboratory personnel from July 2022 to November 2022. Seven CFIR constructs were identified as barriers, sixteen as facilitators, and one as a neutral factor for the implementation of WBS combined with NST. Jail stakeholders underscored the relative advantage of self-testing, highlighted limited resources, and expressed concerns for the sustainability of WBS due to competing priorities. Many of the stakeholders within the jail setting that were interviewed had hierarchical organizational structures, which made decision-making processes regarding WBS and NST complex and challenging to implement. Conclusions Given the political, structural, and organizational factors in a jail setting, innovations such as NST and WBS require a rigorous implementation strategy supported by ongoing engagement and collaboration with a multitude of stakeholders.

Implementing public health interventions can be challenging in carceral settings. Jails are institutions with the shortest lengths of stay, resulting in frequent turnover and constantly shifting populations. Jails had particularly acute challenges during the early stages of the COVID-19 pandemic when incarcerated persons were highly susceptible to infection and severe disease. The purpose of this study was to identify barriers and facilitators to wastewater-based surveillance (WBS) and nasal self-testing (NST) as a combined strategy of COVID-19 surveillance in Fulton County Jail (FCJ), Atlanta, Georgia. Implications for efficient and effective infectious disease testing among this susceptible population are relevant for ongoing surveillance of current endemic pathogens and future epidemics. We utilized a multilevel, theory-informed qualitative approach to conduct semi-structured one-on-one and small group interviews with nine distinct jail stakeholder groups: jail custody leadership, administrators, officers, maintenance workers, Georgia Department of Health's COVID-19 testing contractor, jail health care leaders, nursing staff, laboratory leadership, and staff. Interview guides and analyses were informed by the Consolidated Framework for Implementation Research (CFIR). We used Applied Thematic Analysis to identify domains within CFIR reflecting barriers and facilitators to WBS combined with NST in large urban jail settings. Twelve interviews were conducted with administrative, healthcare, maintenance, custody, and laboratory personnel from July 2022 to November 2022. Seven CFIR constructs were identified as barriers, sixteen as facilitators, and one as a neutral factor for the implementation of WBS combined with NST. Jail stakeholders underscored the relative advantage of self-testing, highlighted limited resources, and expressed concerns for the sustainability of WBS due to competing priorities. Many of the stakeholders within the jail setting that were interviewed had hierarchical organizational structures, which made decision-making processes regarding WBS and NST complex and challenging to implement. Given the political, structural, and organizational factors in a jail setting, innovations such as NST and WBS require a rigorous implementation strategy supported by ongoing engagement and collaboration with a multitude of stakeholders.

Endotoxin-driven systemic immune activation is a common hallmark across various clinical conditions. During acute critical illness, elevated plasma lipopolysaccharide triggers non-specific systemic immune activation. In addition, a compositional shift in the gut microbiota, including an increase in gut-luminal opportunistic pathogens, is observed. Whether a causal link exists between acute endotoxemia and abundance of gut-luminal opportunistic pathogens is incompletely understood. Here, we model acute, pathophysiological lipopolysaccharide concentrations in mice and show that systemic exposure promotes a 100–10’000-fold expansion of Klebsiella pneumoniae , Escherichia coli , Enterococcus faecium  and Salmonella Typhimurium in the gut within one day, without overt enteropathy. Mechanistically, this is driven by a Toll-like receptor 4-dependent increase in gut-luminal oxygen species levels, which transiently halts microbiota fermentation and fuels growth of gut-luminal facultative anaerobic pathogens through oxidative respiration. Thus, systemic immune activation transiently perturbs microbiota homeostasis and favours opportunistic pathogens, potentially increasing the risk of infection in critically ill patients. Acute systemic immune activation may affect gut-luminal colonisation dynamics. Here, the authors show that LPS exposure in mice elevates gut-luminal oxygen species levels, inhibiting the microbiota and enabling pathogen growth through aerobic respiration.

The Soil Moisture Active Passive (SMAP) mission Level-4 Surface and Root-Zone Soil Moisture (L4_SM) data product is generated by assimilating SMAP L-band brightness temperature observations into the NASA Catchment land surface model. The L4_SM product is available from 31 March 2015 to present (within 3 days from real time) and provides 3-hourly, global, 9-km resolution estimates of surface (0–5 cm) and root-zone (0–100 cm) soil moisture and land surface conditions. This study presents an overview of the L4_SM algorithm, validation approach, and product assessment versus in situ measurements. Core validation sites provide spatially averaged surface (root zone) soil moisture measurements for 43 (17) “reference pixels” at 9- and 36-km gridcell scales located in 17 (7) distinct watersheds. Sparse networks provide point-scale measurements of surface (root zone) soil moisture at 406 (311) locations. Core validation site results indicate that the L4_SM product meets its soil moisture accuracy requirement, specified as an unbiased RMSE (ubRMSE, or standard deviation of the error) of 0.04 m³ m−3 or better. The ubRMSE for L4_SM surface (root zone) soil moisture is 0.038 m³ m−3 (0.030 m³ m−3) at the 9-km scale and 0.035 m³ m−3 (0.026 m³ m−3) at the 36-km scale. The L4_SM estimates improve (significantly at the 5% level for surface soil moisture) over model-only estimates, which do not benefit from the assimilation of SMAP brightness temperature observations and have a 9-km surface (root zone) ubRMSE of 0.042 m³ m−3 (0.032 m³ m−3). Time series correlations exhibit similar relative performance. The sparse network results corroborate these findings over a greater variety of climate and land cover conditions.

The Soil Moisture Active Passive (SMAP) mission Level-4 Surface and Root-Zone Soil Moisture (L4_SM) data product is generated by assimilating SMAP L-band brightness temperature observations into the NASA Catchment land surface model. The L4_SM product is available from 31 March 2015 to present (within 3 days from real time) and provides 3-hourly, global, 9-km resolution estimates of surface (0-5 cm) and root-zone (0-100 cm) soil moisture and land surface conditions. This study presents an overview of the L4_SM algorithm, validation approach, and product assessment versus in situ measurements. Core validation sites provide spatially averaged surface (root zone) soil moisture measurements for 43 (17) “reference pixels” at 9- and 36-km gridcell scales located in 17 (7) distinct watersheds. Sparse networks provide point-scale measurements of surface (root zone) soil moisture at 406 (311) locations. Core validation site results indicate that the L4_SM product meets its soil moisture accuracy requirement, specified as an unbiased RMSE (ubRMSE, or standard deviation of the error) of 0.04 m3 m−3 or better. The ubRMSE for L4_SM surface (root zone) soil moisture is 0.038 m3 m−3 (0.030 m3 m−3) at the 9-km scale and 0.035 m3 m−3 (0.026 m3 m−3) at the 36-km scale. The L4_SM estimates improve (significantly at the 5% level for surface soil moisture) over model-only estimates, which do not benefit from the assimilation of SMAP brightness temperature observations and have a 9-km surface (root zone) ubRMSE of 0.042 m3 m−3 (0.032 m3 m−3). Time series correlations exhibit similar relative performance. The sparse network results corroborate these findings over a greater variety of climate and land cover conditions.

The fourth edition of this well-known and highly regarded book by Marvin Tile et al. is now a two-volume set of books based on the AO principles of operative management of fractures, as applied to the pelvis and acetabulum. With the collaboration of over 80 international expert surgeons and through hundreds of images and illustrations, each volume emphasizes decision making based on the assessment of the personality of the injury through the patient's history, physical examination, and interpretation of radiographic investigations. Access to video presentations demonstrating surgical approaches and reduction techniques performed by world-renowned experts is included. Hear the authors discuss Fractures of the Pelvis and Acetabulum.