Social determinants of health significantly impact morbidity and mortality; however, physicians lack ready access to this information in patient care and population management. Just as traditional vital signs give providers a biometric assessment of any patient, "community vital signs" (Community VS) can provide an aggregated overview of the social and environmental factors impacting patient health. Knowing Community VS could inform clinical recommendations for individual patients, facilitate referrals to community services, and expand understanding of factors impacting treatment adherence and health outcomes. This information could also help care teams target disease prevention initiatives and other health improvement efforts for clinic panels and populations. Given the proliferation of big data, geospatial technologies, and democratization of data, the time has come to integrate Community VS into the electronic health record (EHR). Here, the authors describe (i) historical precedent for this concept, (ii) opportunities to expand upon these historical foundations, and (iii) a novel approach to EHR integration.

Deletions at 2p16.3 involving exons of NRXN1 are associated with susceptibility for autism and schizophrenia, and similar deletions have been identified in individuals with developmental delay and dysmorphic features. We have identified 34 probands with exonic NRXN1 deletions following referral for clinical microarray-based comparative genomic hybridization. To more firmly establish the full phenotypic spectrum associated with exonic NRXN1 deletions, we report the clinical features of 27 individuals with NRXN1 deletions, who represent 23 of these 34 families. The frequency of exonic NRXN1 deletions among our postnatally diagnosed patients (0.11%) is significantly higher than the frequency among reported controls (0.02%; P = 6.08 × 10(-7) ), supporting a role for these deletions in the development of abnormal phenotypes. Generally, most individuals with NRXN1 exonic deletions have developmental delay (particularly speech), abnormal behaviors, and mild dysmorphic features. In our cohort, autism spectrum disorders were diagnosed in 43% (10/23), and 16% (4/25) had epilepsy. The presence of NRXN1 deletions in normal parents and siblings suggests reduced penetrance and/or variable expressivity, which may be influenced by genetic, environmental, and/or stochastic factors. The pathogenicity of these deletions may also be affected by the location of the deletion within the gene. Counseling should appropriately represent this spectrum of possibilities when discussing recurrence risks or expectations for a child found to have a deletion in NRXN1.

Coronavirus disease 2019 (COVID-19) has underscored longstanding societal differences in the drivers of health and demonstrated the value of applying a health equity lens to engage at-risk communities, communicate with them effectively, share data, and partner with them for program implementation, dissemination, and evaluation. Examples of engagement — across diverse communities and with community organizations; tribes; state and local health departments; hospitals; and universities — highlight the opportunity to apply lessons from COVID-19 for sustained changes in how public health and its partners work collectively to prevent disease and promote health, especially with our most vulnerable communities.

The QWASI fugacity mass balance model has been widely used since 1983 for both scientific and regulatory purposes to estimate the concentrations of organic chemicals in water and sediment, given an assumed rate of chemical emission, advective inflow in water or deposition from the atmosphere. It has become apparent that an updated version is required, especially to incorporate improved methods of obtaining input parameters such as partition coefficients. Accordingly, the model has been revised and it is now available in spreadsheet format. Changes to the model are described and the new version is applied to two chemicals, D5 (decamethylcyclopentasiloxane) and PCB-180, in two lakes, Lake Pepin (MN, USA) and Lake Ontario, showing the model's capability of illustrating both the chemical to chemical differences and lake to lake differences. Since there are now increased regulatory demands for rigorous sensitivity and uncertainty analyses, these aspects are discussed and two approaches are illustrated. It is concluded that the new QWASI water quality model can be of value for both evaluative and simulation purposes, thus providing a tool for obtaining an improved understanding of chemical mass balances in lakes, as a contribution to the assessment of fate and exposure and as a step towards the assessment of risk.