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This paper examines the production of risk and blame discourses during the 2003 SARS epidemic and responses to those messages in New York City's Chinatown, a community stigmatized during the SARS epidemic despite having no SARS cases. The study consisted of 6 weeks participant observation and 37 semi-structured, open-ended interviews with community members. Stigmatizing discourses from the late 19th century resurfaced to blame Chinese culture and people for disease, and were recontextualized to fit contemporary local and global political-economic concerns. Many informants discursively distanced themselves from risk but simultaneously reaffirmed the association of Chinese culture with disease by redirecting such discourses onto recent Chinese immigrants. Legitimizing cultural blame obfuscates the structural and biological causes of epidemics and naturalizes health disparities in marginalized populations. This research demonstrates that myriad historical, political, and economic factors shape responses and risk perceptions during an unfamiliar epidemic, even in places without infection.

This study explored the links between energy and water insecurity in rural Iñupiaq Eskimo villages in Alaska's Northwest Arctic Borough. High energy costs and the need for fuel-based transportation are 2 significant factors in domestic water access for these communities. Dramatic increases in the costs of energy have led to decreased domestic water access, with adverse effects on household hygiene practices. I traced the ways in which the high costs of energy determine water consumption from production to household acquisition and use. Improving sanitation and access to domestic water requires considering the water-energy nexus: the amount and cost of energy required to treat and distribute water as well as manage waste. I use the term utility scarcity to underscore the relationship between domestic water, energy, and health.

Household water insecurity has serious implications for the health, livelihoods and wellbeing of people around the world. Existing methods to assess the state of household water insecurity focus largely on water quality, quantity or adequacy, source or reliability, and affordability. These methods have significant advantages in terms of their simplicity and comparability, but are widely recognized to oversimplify and underestimate the global burden of household water insecurity. In contrast, a broader definition of household water insecurity should include entitlements and human capabilities, sociocultural dynamics, and political institutions and processes. This paper proposes a mix of qualitative and quantitative methods that can be widely adopted across cultural, geographic, and demographic contexts to assess hard-to-measure dimensions of household water insecurity. In doing so, it critically evaluates existing methods for assessing household water insecurity and suggests ways in which methodological innovations advance a broader definition of household water insecurity.

Using a relational approach, I examine several cultural dimensions involved in household water access and use in Newtok, Alaska. I describe the patterns that emerge around domestic water access and use, as well as the subjective lived experiences of water insecurity including risk perceptions, and the daily work and hydro-social relationships involved in accessing water from various sources. I found that Newtok residents haul water in limited amounts from a multitude of sources, both treated and untreated, throughout the year. Household water access is tied to hydro-social relationships predicated on sharing and reciprocity, particularly when the primary treated water access point is unavailable. Older boys and young men are primarily responsible for hauling water, and this role appears to be important to male Yupik identity. Many interviewees described preferring to drink untreated water, a practice that appears related to cultural constructions of natural water sources as pure and self-purifying, as well as concerns about the safety of treated water. Concerns related to the health consequences of low water access appear to differ by gender and age, with women and elders expressing greater concern than men. These preliminary results point to the importance of understanding the cultural dimensions involved in household water access and use. I argue that institutional responses to water insecurity need to incorporate such cultural dimensions into solutions aimed at increasing household access to and use of water.

scheel@helmholtz-muenchen.de and 39 Martin R. Sprick, m.sprick@Dkfz-Heidelberg.de and 40 Andreas Trumpp, a.trumpp@Dkfz-Heidelberg.de 41 42 Running title: 43 Epithelial gene expression in EMT is required for breast cancer metastasis. 44 45 Abstract 48Despite important advances in the treatment of breast cancer, the 5-year survival rate 49 for patients with distant metastasis remains less than 30%. Metastasis is a complex, 50 multi-step process beginning with local invasion and ending with the outgrowth of 51 systemically disseminated cells into actively proliferating metastases that ultimately 52 cause the destruction of vital organs. It is this last step that limits patient survival and, 53 at the same time, remains the least understood mechanistically. Here, we focus on 54 understanding determinants of metastatic outgrowth using metastatic effusion biopsies 55 from stage IV breast cancer patients. By modelling metastatic outgrowth through 56 xenograft transplantation, we show that tumour initiation potential of patient-derived 57 metastatic breast cancer cells across breast cancer subtypes is strongly linked to high 58 levels of EPCAM expression. Breast cancer cells with high EPCAM levels are highly 59 plastic and, upon induction of epithelial-mesenchymal transition (EMT), readily adopt 60 mesenchymal traits while maintaining epithelial identity. In contrast, low EPCAM levels 61 are caused by the irreversible reprogramming to a mesenchymal state with 62 concomitant suppression of metastatic outgrowth. The ability of breast cancer cells to 63 retain epithelial traits is tied to a global epigenetic program that limits the actions of 64 EMT-transcription factor ZEB1, a suppressor of epithelial genes. Our results provide 65 direct evidence that maintenance of epithelial identity is required for metastatic 66 outgrowth while concomitant expression of mesenchymal markers enables plasticity. 67In contrast, loss of epithelial traits is characteristic of an irreversible mesenchymal 68 reprogramming associated to a deficiency for metastatic outgrowth. Collectively, our 69 data provide a framework for the intricate intercalation of mesenchymal and epithelial 70 traits in metastatic growth. 71Other studies emphasize that a transient, rather than permanent expression of EMT-87 transcription factors is crucial for the outgrowth of metastases 4,6,7 . This is supported by 88 the finding that most macroscopic metastases generated by carcinomas display an 89 epithelial morphology 8 . However, a strict requirement for EMT at any time during the 90 metastatic process is called into question by the finding that overexpression of micro 91RNAs that inhibit EMT does not affect metastasis 9 and loss of Twist1 and Snai1 92 expression in a pancreatic cancer mouse model does not change invasion and disease 93 progression 10 . 94More complication has recently arisen from the observation that tumour cells with an 95 intermediate, often termed hybrid epithelial-mesenchymal phenotype, are the most 96 competent in colonization and metastasis fo...

Household water, sanitation and hygiene (WASH) practices in remote, rural, and unpiped communities are likely to impact exposure to pathogens beyond the fecal-oral transmission routes that are typically prioritized in WASH interventions. We studied 43 homes in two remote, rural, unpiped communities in Alaska to evaluate seasonal water haul, water sources, water quality, and water reuse, as well as greywater and human waste disposal over 1 year. Hauled quantities of water reportedly ranged from 3.0 to 5.4 gallons per capita per day (gpcd) depending on the community and season. Natural, untreated water sources contributed 0.5-1.1 gpcd to household water availability. Reported quantities of water hauled were significantly correlated with total water storage capacity in the home. Total coliforms were detected in 30-60% of stored household water samples from treated and untreated sources, and total coliform counts were significantly higher in specific sources and during specific seasons. Exposure to pathogens during periods of low water access, from untreated water reuse, from greywater disposal and from human waste disposal are important pathways of disease transmission in these remote, rural, unpiped communities. We discuss intermediate steps that can be taken at the household and community levels to interrupt exposure pathways before piped infrastructure is installed. This model of examining specific household practices to determine transmission routes can be applied to other remote communities or unique conditions to aid in the recommendation of targeted WASH interventions.

The novel coronavirus SARS-CoV-2, the causative agent of COVID-19, emerged in the human population in December 2019 and spread worldwide within a few short months. Much of the public health focus for preventing and mitigating the spread of COVID-19 has been on individual and collective behaviors, such as social distancing, mask-wearing, and hygiene. It is important to recognize that these behaviors and health outcomes occur within broader social and environmental contexts, and factors within local communities such as regional policy, historical context, cultural beliefs, and natural- and built environmental characteristics affect underlying population health and the spread of disease. For example, the COVID-19 pandemic has renewed attention to the importance of secure water and sanitation services in protecting human health; many remote Alaskan communities are particularly vulnerable to infectious disease transmission because of inadequate water and sanitation services. In addition, there are a number of socio-economic, physical, and infrastructure factors in rural Alaska (e.g., remoteness, household overcrowding, climate change impacts, limited medical facilities, and high prevalence of chronic diseases) that contribute to the potential for more severe COVID-19 disease outcomes in these predominantly Alaska Native communities.