Wastewater Sample Site Selection to Estimate Geographically Resolved Community Prevalence of COVID-19: A Sampling Protocol Perspective

Wastewater monitoring for virus infections within communities can complement conventional clinical surveillance. Currently, most SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) clinical testing is voluntary and inconsistently available, except for a few occupational and educational settings, and therefore likely underrepresents actual population prevalence. Randomized testing on a regular basis to estimate accurate population-level infection rates is prohibitively costly and is hampered by a range of limitations and barriers associated with participation in clinical research. In comparison, community-level fecal monitoring can be performed through wastewater surveillance to effectively surveil communities. However, epidemiologically defined protocols for wastewater sample site selection are lacking. Herein, we describe methods for developing a geographically resolved population-level wastewater sampling approach in Jefferson County, Kentucky, and present preliminary results. Utilizing this site selection protocol, samples (n = 237) were collected from 17 wastewater catchment areas, September 8 to October 30, 2020 from one to four times per week in each area and compared to concurrent clinical data aggregated to wastewater catchment areas and county level. SARS-CoV-2 RNA was consistently present in wastewater during the studied period, and varied by area. Data obtained using the site selection protocol showed variation in geographically resolved wastewater SARS-CoV-2 RNA concentration compared to clinical rates. These findings highlight the importance of neighborhood-equivalent spatial scales and provide a promising approach for viral epidemic surveillance, thus better guiding spatially targeted public health mitigation strategies.

A rapid assessment of wastewater for genomic surveillance of SARS-CoV-2 variants at sewershed scale in Louisville, KY

In this communication, we report on the genomic surveillance of SARS-CoV-2 using wastewater samples in Jefferson County, KY. In February 2021, we analyzed seven wastewater samples for SARS-CoV-2 genomic surveillance. Variants observed in smaller catchment areas, such as neighborhood manhole locations, were not necessarily consistent when compared to associated variant results in downstream treatment plants, suggesting catchment size or population could impact the ability to detect diversity.

A synthetic five amino acid propeptide increases dopamine neuron differentiation and neurochemical function

A major consequence of Parkinson's disease (PD) involves the loss of dopaminergic neurons in the substantia nigra (SN) and a subsequent loss of dopamine (DA) in the striatum. We have shown that glial cell line-derived neurotrophic factor (GDNF) shows robust restorative and protective effects for DA neurons in rats, non-human primates and possibly in humans. Despite GDNF's therapeutic potential, its clinical value has been questioned due to its limited diffusion to target areas from its large size and chemical structure. Several comparatively smaller peptides are thought to be generated from the prosequence. A five amino-acid peptide, dopamine neuron stimulating peptide-5 (DNSP-5), has been proposed to demonstrate biological activity relevant to neurodegenerative disease. We tested the in vitro effects of DNSP-5 in primary dopaminergic neurons dissected from the ventral mesencephalon of E14 Sprague Dawley rat fetuses. Cells were treated with several doses (0.03, 0.1, 1.0, 10.0 ng/mL) of GDNF, DNSP-5, or an equivalent volume of citrate buffer (vehicle). Morphological features of tyrosine hydroxylase positive neurons were quantified for each dose. DNSP-5 significantly increased (p < 0.001) all differentiation parameters compared to citrate vehicle (at one or more dose). For in vivo studies, a unilateral DNSP-5 treatment (30 μg) was administered directly to the SN. Microdialysis in the ipsilateral striatum was performed 28 days after treatment to determine extracellular levels of DA and its primary metabolites (3,4-dihydroxyphenylacetic acid and homovanillic acid). A single treatment significantly increased (~66%) extracellular DA levels compared to vehicle, while DA metabolites were unchanged. Finally, the protective effects of DNSP-5 against staurosporine-induced cytotoxicity were investigated in a neuronal cell line showing substantial protection by DNSP-5. Altogether, these studies strongly indicate biological activity of DNSP-5 and suggest that DNSP-5 has neurotrophic-like properties that may be relevant to the treatment of neurodegenerative diseases like PD.

Prognostic significance of adrenal gland morphology at CT in patients with three common malignancies

OBJECTIVES

To determine whether minor alterations in adrenal gland morphology at baseline CT in three common cancers indicate early metastasis.

METHODS

689 patients (237 with lung cancer, 228 with breast cancer, 224 with melanoma) underwent baseline and follow-up CTs that included the adrenals. Two readers independently scored each adrenal at baseline CT as normal, smoothly enlarged, nodular or mass-containing. Adrenals containing a mass >10 mm were excluded. The appearance of each adrenal on the latest available CT was assessed for change since baseline. Cox models were used to assess the association between adrenal morphology at initial CT and subsequent development of adrenal metastasis (defined as new mass >10 mm, corroborated by follow-up imaging). κ statistics were calculated to assess inter-reader agreement.

RESULTS

Initial and follow-up CT evaluations were recorded for 1317 adrenals (median follow-up, 18.6 months). At initial CT, Readers 1 and 2 interpreted 1242 and 1230 adrenals as normal, 40 and 57 as smoothly enlarged, 29 and 25 as nodular, and 6 and 5 as containing masses ≤ 10 mm, respectively. κ-values were 0.52 (moderate) at initial CT and 0.70 (substantial) at follow-up. The hazard ratio for developing a metastasis at follow-up CT given an abnormal adrenal assessment at baseline was 0.7 [95% confidence interval (CI) 0.2-2.1; p = 0.47] for Reader 1, and 2.0 (95% CI 0.8-4.7; p = 0.12) for Reader 2.

CONCLUSION

Minor morphological abnormalities of adrenals at initial CT did not represent early adrenal metastasis in most patients in this population.

The computer enhancement of a medical office

For several years small businesses have struggled to take advantage of the promised capabilities of the microcomputer. Limited by processor power and hindered by unyielding software these promises have gone largely unfulfilled. However, recent advances in processor speed and a new generation of user friendly software have made the microcomputer a true ally for improving the operating efficiency of an office. Now, economical computing platforms can be linked together and run with off-the-shelf software to enhance the capabilities of any medical business.