Advances in AI-driven analytics, human-in-the loop techniques, and wastewater monitoring provide the foundation needed to shift from reactive to anticipatory actions for mass gatherings. Traditional surveillance systems focus on clinical and laboratory-based notification pathways, which often result in tardy actions being implemented. Thus, traditional surveillance is becoming outdated. Mass gatherings pose heightened public health risks and hazards, including trauma; injury and substance misuse; deliberate poisoning; and infectious diseases such as food and waterborne illnesses, sexually transmitted infections, and respiratory diseases. There is also a heightened concern due to reduced vaccination coverage. As a result, future international events such as the Olympic Games likely will have an influx of people from regions with active outbreaks, amplifying public health threats. This reality, combined with an increased frequency of terrorism and other mass casualty incidents, highlights the need for anticipatory action. We propose a novel framework that we call the Environmental Health Surveillance and AI for Event Protection (E-SAFE) model. This model leverages and integrates environmental health measures with recent advances in AI, data availability, predictive analytics, and a multilayer defense to anticipate disease outbreaks and other risks earlier and faster. Applying these tools for the 2028 Los Angeles Olympic Games and other mass gatherings could maximize health system readiness and create a scalable and transferable legacy for environmental health surveillance.

While emergency preparedness preparations are typically focused on the most commonly occurring events such as natural disasters, disease outbreaks, and small-scale human-made disasters, concern for disasters involving mass gatherings is growing, particularly with previously less common nuclear, radiological, and explosive incidents. An example is provided of potentially useful preparedness for these events with the upcoming FIFA World Cup 2026TM, expected to be one of the largest sporting events in USA history. Trainings and protocols are reviewed, with a specific suggestion of a scorecard for prioritizing preparedness. Particular focus is also given to integrated surge pathways in this response. By combining evidence-based risk communication, burn surge planning, and the scorecard approach to prioritize and coordinate actions across host cities, organizers can reduce preventable morbidity and mortality.

OBJECTIVE:To provide an up-to-date review of existing and current literature in the field of radiological and nuclear disasters to support the needs of research applications for health care and public health preparedness and response. METHODS:A systematic literature search using 4 databases to identify articles which included a multitude of topics relevant to preparedness for nuclear and radiological disasters. One hundred articles that met inclusion criteria were summarized into 7 themes addressing medical and health care preparedness for nuclear and radiological events. RESULTS:The review generated evidence supporting and defining various measures health care and government entities can take to improve nuclear and radiological disaster readiness and responsiveness in health systems. Strengthening preventive measures and policies, prehospital and hospital mechanisms, training and education, regional collaboration, communication, and infrastructure support were the main gaps identified. CONCLUSIONS:An overarching concern regarding the inadequacies of the modern health care system's radiological disaster preparedness was a clear-cut conclusion from the literature. The major challenges and proposed solutions for public safety to the growing threat of radiologic disasters were identified.

Decentralized wastewater treatment and reuse represent critical infrastructure across the rural-periurban-urban continuum around the world. Effective, efficient, resilient, and equitable implementation of on-premise technologies and management systems is part of a One Water approach and necessary to protect public health and the environment, yet inconsistent delivery of essential public health services persists in many regions, including across states, tribes, and territories of the United States. We initiated a groundbreaking effort to understand challenges and to identify research opportunities related to the science and practice of decentralized wastewater. A horizon scanning exercise using a bottom up and transparent key questions approach was performed in which research needs were submitted by over 450 professionals working in academia, government, industry, and nonprofit organizations. We then further considered these research needs through facilitated focus group discussions and identified priority research questions through a consensus process during an in-person synthesis workshop. These key questions included technical and management topics, which were partitioned among six research categories: treatment, performance, and resource recovery; resiliency, efficacy, and sustainability; environmental quality and public health; assessment, monitoring, and operation and maintenance; implementation; and regulations, enforcement, and environmental justice. We offer recommendations to answer the priority research questions presented here; doing so promises to advance the science and improve the practice across rural-periurban-urban gradients.

Translesion synthesis polymerases efficiently incorporate nucleotides opposite DNA lesions. Pol ι, for example, bypasses minor-groove and exocyclic purine adducts. Conventional X-ray crystallography showed that this enzyme incorporates nucleotides by forming Hoogsteen base pairs with the incoming nucleotide rather than Watson-Crick base pairs. While this revealed the structural basis of nucleotide selection during nucleotide binding, it did not allow the visualization of the process of phosphodiester bond formation or the detection of reaction intermediates that form during nucleotide incorporation. Here, we use a combination of time-lapse crystallography and molecular dynamics simulations to examine the mechanism of pol ι-catalyzed nucleotide incorporation. We show that this enzyme maintains Hoogsteen base pairing with the incoming dNTP during the entire reaction. We also show that pol ι possesses a pyrophosphatase activity that generates two monophosphates within its active site. Our findings provide insights into the features of pol ι's active site that allow it to translocate along DNA and catalyze processive DNA synthesis.

Single-strand breaks (SSBs) are one of the most prevalent forms of DNA damage found in the chromatinized genome and are repaired by single-strand break repair (SSBR) or base excision repair (BER). DNA polymerase beta (Pol β) is the primary enzyme responsible for processing the 1-nt gap intermediate in chromatin during SSBR and BER. To date, the mechanism used by Pol β to process a 1-nt gap in the context of chromatin remains poorly understood. Here, we use biochemical assays and cryogenic electron microscopy (cryo-EM) to determine the kinetic and structural basis of gap-filling DNA synthesis in the nucleosome by Pol β. This work establishes that Pol β uses a global DNA sculpting mechanism for processing 1-nt gaps in the nucleosome during SSBR and BER, providing fundamental insight into DNA repair in chromatin.

Disasters can have dramatic implications for gateway communities of National Parks, especially local economies that rely on park tourist visitation as their primary source of income. In June 2022, a 500-year flood event impacted Yellowstone National Park (YNP) and gateway businesses, both directly through infrastructure damages (property loss) and indirectly through park closures and post-disaster marketing. We used a combination of approaches to document and explore the relative importance of these diverse sources of economic impacts. First, structured surveys were used to evaluate economic impacts, from the perspective of individual business owners and community leaders in six gateway communities surrounding YNP. Average revenue loss was 48% during peak tourist season across all communities but averaged 75% for communities inaccessible to the park. Direct infrastructure damages to businesses were localized; however, even businesses sustaining property losses suggested more severe economic impacts were the result of loss of visitors from park closures and damaging media coverage. Using annual visitation and economic input-output model data, we developed a statistical model to estimate regional economic impacts from the flood. The model corroborated the results of our survey and suggested the flood led to a total loss of $156 million in visitor spending in gateway areas in 2022, exceeding economic losses from the COVID-19 pandemic in 2020. We present some guidelines for building economic resilience in gateway communities, including diversifying sources of income, building social capital, embracing tourist adaptations, and developing coordinated park-gateway-regional messaging and marketing to the media post-disasters.

Objective: This study aims to assess the public healthcare system by implementing a scorecard in Hatay and Kahramanmaras provinces in T & uuml;rkiye after the Kahmaranmaras earthquake. Method: The methodology employing in this study, action research, informs the active interaction between participants who have been involved in disaster risk reduction in the variety of capacities, such as affected local government, emergency medicine department, nursing and care association. Results: The scorecard application was carried out with 18 participants in Mara & scedil; and 22 in Hatay. The scorecard application shows that the items with the lowest scores in Hatay were related to the resilience of public health infrastructure and key health facilities, and the fulfilment of society's role in disasters. In Mara & scedil;, on the other hand, coping with patient surge in disaster, fulfilment of society's role in disasters, and mental health services in the context of disasters. Conclusions: With the participation in scorecard workshop, communications between these stakeholders for community public healthcare system can discuss the best way to prepare and collaborate to promote further community disaster risk reduction planning during post-disaster recovery phase.

The COVID-19 pandemic highlighted the urgent need to strengthen public health systems. In response, the United Nations Disaster Risk Reduction (UNDRR) Public Health System Resilience Scorecard (Scorecard) was applied in workshops across multiple countries. The aim of our research was to explore the workshop findings to develop priority strategies for strengthening public health system resilience. We conducted a workshop from 14 to 16 March 2023, at the UNDRR Global Education and Training Institute in Incheon, Republic of Korea. A sequential modified Delphi method was utilized to develop a set of prioritized resilience strategies. These were drawn from 70 strategies identified from 13 distinct workshops in eight countries. After two surveys, 23 strategies were finalized. Ten received ratings of “High” or “Very High” from 89% of participants. These related to the inclusion of public health risks in emergency plans, integrating multidisciplinary teams into public health, enabling local transport mechanisms, and improving the ability to manage an influx of patients. The Scorecard provides an adaptable framework to identify and prioritize strategies for strengthening public health system resilience. By leveraging this methodology, our study demonstrated how resilience strategies could inform disaster risk reduction funding, policies, and actions.

INTRODUCTION:Interest in nuclear power as a cleaner and alternative energy source is increasing in many countries. Despite the relative safety of nuclear power, large-scale disasters such as the Fukushima Daiichi (Japan) and Chernobyl (Ukraine) meltdowns are a reminder that emergency preparedness and safety should be a priority. In an emergency situation, there is a need to balance the tension between a rapid response, preventing harm, protecting communities, and safeguarding workers and responders. The first line of defense for workers and responders is personal protective equipment (PPE), but the needs vary by situation and location. Better understanding this is vital to inform PPE needs for workers and responders during nuclear and radiological power plant accidents and emergencies. STUDY OBJECTIVE:The aim of this study was to identify and describe the PPE used by different categories of workers and responders during nuclear and radiological power plant accidents and emergencies. METHODS:A systematic literature review format following the PRISMA 2020 guidelines was utilized. Databases SCOPUS, PubMed, EMBASE, INSPEC, and Web of Science were used to retrieve articles that examined the PPE recommended or utilized by responders to nuclear radiological disasters at nuclear power plants (NPPs). RESULTS:The search terms yielded 6,682 publications. After removal of duplicates, 5,587 sources continued through the systematic review process. This yielded 23 total articles for review, and five articles were added manually for a total of 28 articles reviewed in this study. Plant workers, decontamination or decommissioning workers, paramedics, Emergency Medical Services (EMS), emergency medical technicians, military, and support staff were the categories of responders identified for this type of disaster. Literature revealed that protective suits were the most common item of PPE required or recommended, followed by respirators and gloves (among others). However, adherence issues, human errors, and physiological factors frequently emerged as hinderances to the efficacy of these equipment in preventing contamination or efficiency of these responders. CONCLUSION:If worn correctly and consistently, PPE will reduce exposure to ionizing radiation during a nuclear and radiological accident or disaster. For the best results, standardization of equipment recommendations, clear guidelines, and adequate training in its use is paramount. As fields related to nuclear power and nuclear medicine expand, responder safety should be at the forefront of emergency preparedness and response planning.

School closures during the COVID-19 pandemic compromised access to essential meals for many children. In response, a public/private partnership known as the Emergency Meals-to-You program was established to deliver meals in affected rural areas of the United States. This study builds on this using a scorecard approach adapted from the United Nations Ten Essentials for Making Cities Resilient to identify and prioritize actions for strengthening food system resilience. A pilot food system resilience scorecard facilitated data collection from five workshops with professionals familiar with the program, emergency management, public health, or food systems. Data analysis and interpretation identified nine priority actions. These included integrating the food sector and schools within emergency management, mapping local food sector capacities, working with schools to receive de-identified data about nutritional, allergy and other health needs, developing disaster plans for sustaining food access at the school district level, and protecting ecosystem services and agricultural areas. There is an urgent need to embed the food sector and schools within emergency management. These systems are local, designed to coordinate complicated tasks in crises, multidisciplinary, and are used in many countries. Providing a ready-made framework for locally driven initiatives to strengthen food systems now and into the future.

Objective: Nuclear radiological emergencies are classified as low frequency, but high impact events. Radiophobia and fear of deleterious outcomes often evokes hesitancy among responders. This review explored PPE use as a protective mechanism for responders' safety and identified tools that promote PPE efficacy among first responders during nuclear radiological events. Methods: A systematic literature review was conducted using five scientific databases. More than 5,500 articles were screened to identify literature relating to " PPE use" by first responders during " nuclear radiological events". Results: Regulatory agencies such as the IAEA and the NRC assert that PPE, (when worn correctly and consistently) minimizes radiation exposure. Adequate training of first responders emerged as a critical determinant to support appropriate PPE selection and usage during radiological emergencies. This included new employee trainings and refresher courses for existing employees. Pedagogical tools highlighted in the literature included tabletop exercises, safety huddles, trial runs for donning and doffing of new gear (with emphasis on air-fed suits), just-in-time training and virtual reality simulations. Conclusions: Education on the effective use of PPE is essential to promote self-efficacy among medical staff and other first responders during nuclear radiological events. Comprehensive training will reduce unintended exposures, decrease hesitancy, and maximize employee safety.

N6-(2-deoxy-α,β-d-erythro-pentofuranosyl)-2,6-diamino-4-hydroxy-5-formamido-pyrimidine (Fapy•dG) is formed from a common intermediate and in comparable amounts to the well-studied mutagenic DNA lesion 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-OxodGuo). Fapy•dG preferentially gives rise to G → T transversions and G → A transitions. However, the molecular basis by which Fapy•dG is processed by DNA polymerases during this mutagenic process remains poorly understood. To address this we investigated how DNA polymerase β (Pol β), a model mammalian polymerase, bypasses a templating Fapy•dG, inserts Fapy•dGTP, and extends from Fapy•dG at the primer terminus. When Fapy•dG is present in the template, Pol β incorporates TMP less efficiently than either dCMP or dAMP. Kinetic analysis revealed that Fapy•dGTP is a poor substrate but is incorporated ∼3-times more efficiently opposite dA than dC. Extension from Fapy•dG at the 3'-terminus of a nascent primer is inefficient due to the primer terminus being poorly positioned for catalysis. Together these data indicate that mutagenic bypass of Fapy•dG is likely to be the source of the mutagenic effects of the lesion and not Fapy•dGTP. These experiments increase our understanding of the promutagenic effects of Fapy•dG.

Abstract Rapid deforestation, urbanization, and biodiversity loss over the last century has changed landscapes and disorientated the climate. This has magnified temperature, wind speed, air quality, and other meteorological variables. For example, the urban heat island effect has resulted in city areas being hotter than nearby rural areas and expanding physical landscapes combined with shifting precipitation patterns has increased flood risks in new locations. The result has been unexpected disruption to healthcare, supply chains, and changes in vector, water, and foodborne disease patterns. To find solutions to this challenge, a transdisciplinary approach is needed to assess and anticipate the impact of floods and other emerging risks on public health systems. The United Nations Public Health System Resilience Scorecard (Scorecard) could provide the process needed for this to occur. This is a reliable, scalable, and versatile tool that has been applied and tested in multiple communities and countries. Attendees to this session will learn about the Scorecard methodology and how it can be applied in different settings, used to build consensus, and employed to inform future resilience actions. Ultimately, providing a framework for maximizing the resilience of public health systems during a time of rapidly shifting environmental, social, and fiscal climates. Learning Objectives Identify the impact floods and other disasters can have on public health systems in non-traditional at-risk areas. Explore the United Nations Public Health System Resilience Scorecard (Scorecard) and its alignment with the 2030 United Nations agenda. Understand why a transdisciplinary approach is needed to assess the impact of floods and other emerging risks on public health systems. Demonstrate how the Scorecard can be applied in multiple communities and countries to identify, rank, and prioritize resilience actions for public health systems.

The goal of this mixed-methods study was to identify and compare the key capacity considerations regarding public health system resilience before and after the 2023 Türkiye-Syria earthquakes. Public health system resilience was assessed through online and face-to-face workshops using the United Nations Public Health System Resilience Scorecard. The pre-earthquake evaluation was conducted in Istanbul and Trabzon in 2021; the post-earthquake evaluation took place in Hatay and Kahramanmaraş in 2023, with a total of 41 participants each. The online workshops lasted approximately four days, while the face-to-face workshops lasted one day. The study found a significant decrease in the scores for most scorecard resilience indicators in the post-earthquake assessment. Qualitative analysis showed that this decline was largely due to infrastructure collapse. Additionally, defining the roles of health disciplines in disaster management and having data transmission procedures between public health system stakeholders in disasters were among the main capacity considerations in both the pre-and post-earthquake assessments. The post-earthquake evaluation revealed several capacity gaps that had not been addressed in pre-earthquake assessments in areas such as disaster preparedness of vulnerable populations and logistics. The findings highlight the critical importance of strengthening building stock and infrastructure to establish a disaster-resilient public health system.

Gram-positive bacteria utilize a Fatty Acid Kinase (FAK) complex to harvest fatty acids from the environment. This complex consists of the fatty acid kinase, FakA, and an acyl carrier protein, FakB, and is known to impact virulence and disease outcomes. Despite some recent studies, there remain many outstanding questions as to the enzymatic mechanism and structure of FAK. To better address this knowledge gap, we used a combination of modeling, biochemical, and cell-based approaches to build on prior proposed models and identify critical details of FAK activity. Using bio-layer interferometry, we demonstrated nanomolar affinity between FakA and FakB which also indicates that FakA is dimer when binding FakB. Additionally, targeted mutagenesis of the FakA Middle domain demonstrates it possesses a metal binding pocket that is critical for FakA dimer stability and FAK function in vitro and in vivo. Lastly, we solved structures of the apo and ligand-bound FakA kinase domain to capture the molecular changes in the protein following ATP binding and hydrolysis. Together, these data provide critical insight into the structure and function of the FAK complex which is essential for understanding its mechanism.

Gram-positive bacteria utilize a Fatty Acid Kinase (FAK) complex to harvest fatty acids from the environment. The complex, consisting of the fatty acid kinase, FakA, and an acyl carrier protein, FakB, is known to impact virulence and disease outcomes. However, FAK’s structure and enzymatic mechanism remain poorly understood. Here, we used a combination of modeling, biochemical, and cell-based approaches to establish critical details of FAK activity. Solved structures of the apo and ligand-bound FakA kinase domain captured the protein state through ATP hydrolysis. Additionally, targeted mutagenesis of an understudied FakA Middle domain identified critical residues within a metal-binding pocket that contribute to FakA dimer stability and protein function. Regarding the complex, we demonstrated nanomolar affinity between FakA and FakB and generated computational models of the complex’s quaternary structure. Together, these data provide critical insight into the structure and function of the FAK complex which is essential for understanding its mechanism.

Background: Turkiye is a country that faces many disasters, especially earthquakes and floods, which have serious short- and long-term consequences for public health. The importance of disaster risk reduction activities in building resilience before a disaster strikes is increasingly recognized. Furthermore, resilience assessment is considered to be the starting point for these activities. However, there is a substantial gap in the scientific evidence on systematic assessments of the resilience of the public health system and also a serious lack of activities to strengthen the system against disasters in Turkiye. Aim: Using a Scorecard methodology, the study aimed to systematically assess the resilience of the public health system in Turkiye by examining key indicators related to disaster risk management and preparedness, and subsequently to recommend priority actions. A systematic assessment of resilience can provide the scientific evidence needed to identify weaknesses in the system. Furthermore, identifying priority actions based on this evidence allows progress to be made towards strengthening the system. Methods: This mixed-methods study was conducted in two separate regions of Turkiye with the highest earthquake (Esenler/Istanbul) and flood risk (Ortahisar/Trabzon). Based on the Scorecard methodology, two-stage workshops (online and face-to-face) were held. During the online stage, qualitative data were collected by interviewing participants about their evaluation of the situation in the counties regarding the Scorecard indicators, and quantitative data were collected through scoring. In the face-to-face stage, strategies were developed to improve the resilience of the public health system. Quantitative data were expressed with numbers and percentages, and thematic analysis was utilized for qualitative data analysis.

OBJECTIVE:The aim of this study was to identify and prioritize strategies for strengthening public health system resilience for pandemics, disasters, and other emergencies using a scorecard approach. METHODS:The United Nations Public Health System Resilience Scorecard (Scorecard) was applied across 5 workshops in Slovenia, Turkey, and the United States of America. The workshops focused on participants reviewing and discussing 23 questions/indicators. A Likert type scale was used for scoring with zero being the lowest and 5 the highest. The workshop scores were analyzed and discussed by participants to prioritize areas of need and develop resilience strategies. Data from all workshops were aggregated, analyzed, and interpreted to develop priorities representative of participating locations. RESULTS:Eight themes emerged representing the need for better integration of public health and disaster management systems. These include: assessing community disease burden; embedding long-term recovery groups in emergency systems; exploring mental health care needs; examining ecosystem risks; evaluating reserve funds; identifying what crisis communication strategies worked well; providing non-medical services; and reviewing resilience of existing facilities, alternate care sites, and institutions. CONCLUSIONS:The Scorecard is an effective tool for establishing baseline resilience and prioritizing actions. The strategies identified reflect areas in most need for investment to improve public health system resilience.

Introduction: Vulnerable populations were the most impacted by the COVID-19 pandemic. This included those with underlying health conditions, self-employed, low-income, people with limited access to health care, and the elderly. To capture these lessons and identify resilience actions, the Health Emergency and Disaster Risk Management (Health EDRM) Framework was used to guide the application of the Public Health System Resilience Scorecard (Scorecard). Method: This study was conducted in Australia, Bangladesh, Japan, Slovenia, Turkey, and the United States. Participants included emergency professionals, doctors, nurses, environmental health specialists, researchers, and government officials. The Scorecard was used to rank the level of preparedness from 0-5 (5 the highest) for the public health system resilience indicators. Following the individual workshops, recommendations were collated and interpreted to develop consolidated priority actions. Results: The priority actions related to surge capacity, mental health, ecosystems, societal needs, and high-risk populations. To address surge capacity issues, determining whether existing disaster structures have the capacity to provide support for hospitals during patient surges. This could include services that enable telehealth and primary health care to support hospitals during a crisis. Mental health services at the local government level should be evaluated and awareness of ecosystem risks in urban and rural areas needs to increase. Strategies for achieving reciprocal trust are required to enable uptake of public health information, and the extent at which pre-existing chronic health issues are likely to exacerbate needs to be understood and addressed. Conclusion: This study revealed several areas for strengthening public health system resilience. Priority actions relate to addressing needs relating to surge capacity, mental health, ecosystems, societal needs, and high-risk populations. This serves as a framework for transforming public health systems to become more adaptive, flexible, and focused on enabling societies to function at the highest possible level when responding to a disaster or pandemics.