eneath top-down national and state directives and recommendations, communities must respond to the many phases of coronavirus disease 2019 . The pandemic has unfolded differently across those communities with outcomes dependent on context, infrastructure, capacity, and how assets are organized, linked, and deployed. Achieving control requires real-time multisector data sharing, learning, and adaptation. Leaders from health care, public health, congregate care, elected offices, neighborhoods, schools, and businesses must work together to create systems that can respond to a pathogen that does not respect geographic, jurisdictional, or disciplinary boundaries. 1 Response capabilities have been compromised by limited cross-sector coordination and decades-long disinvestment in public health. [2][3][4] The Pandemic All-Hazards Preparedness Act of 2006 was passed to overcome these limitations by establishing an "electronic nationwide public health situational awareness capability through an interoperable network of systems to share data and information." 5 This goal has not been achieved, 6 and communities continue to rely on insights pieced together, often manually, from multiple isolated sources. 7 Data are often at too large a scale (ie, national or state) or too incomplete (ie, single sector or jurisdiction) to be useful for decision-making.As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) found its way

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SUMMARYSpicules morphologically similar to those present on the spores oE Pithomyces chartarurn invest the spores of several other Pithoinyces species. Depsipeptides are quantitatively removed from dried mycelial felts by brief chloroform washing, and their amount is proportional to the number of spores present. Three pure spore-coat depsipeptides have no demonstrable antibiotic activity.

Summary.Red cell exchange is important in the care of acutely ill sickle-cell patients, and may be life-saving. An automated red cell exchange technique has been developed using a Baxter blood cell separator, enabling an isovolaemic exchange to be performed within 2·5 h. A total of 20 procedures have been performed in 15 patients, including one woman in the third trimester of pregnancy, with a mean decrease of 72% in the circulating sickle haemoglobin (HbS) level. This method enables almost all adult patients with sickle cell anaemia to have their HbS reduced to safe levels by only one procedure. The procedure was well tolerated by all patients, including those who were acutely ill. This technique provides an effective procedure for reducing the percentage of circulating HbS rapidly in acutely ill patients with complications of sickle cell anaemia.

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