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Abstract Background Questions persist around whether and how to use race or geographic ancestry in biomedical research and medicine, but these forms of self-identification serve as a critical tool to inform matching algorithms for human leukocyte antigen (HLA) of varying levels of resolution for unrelated hematopoietic stem cell transplant in large donor registries. Methods Here, we examined multiple self-reported measures of race and ancestry from a survey of a cohort of over 100,000 U.S. volunteer bone marrow donors alongside their high-resolution HLA genotype data. Results We find that these self-report measures are often non-overlapping, and that no single self-reported measure alone provides a better fit to HLA genetic ancestry than a combination including both race and geographic ancestry. We also found that patterns of reporting for race and ancestry appear to be influenced by participation in direct-to-consumer genetic ancestry testing. Conclusions While these data are not used directly in matching for transplant, our results demonstrate that there is a place for the language of both race and geographic ancestry in the critical process of facilitating accurate prediction of HLA in the donor registry context.

As office workers shift to telework, office building space requirements should decrease, but this relationship has not been empirically studied. We construct a dataset describing historical office building space, number of office workers, and number of teleworkers from 2003-2019 in the US, and use linear regression to estimate the effect of telework on office building space. The results show that the average office building space required for an additional office worker and teleworker is 32 and 18 square meters (340 and 191 square feet), respectively, suggesting an average 44% reduction in office building space when an office worker transitions to telework.

Abstract Mapping the human body at single cell resolution in three dimensions (3D) is important for understanding cellular interactions in context of tissue and organ organization. 2D spatial cell analysis in a single tissue section may be limited by cell numbers and histology. Here we show a workflow for 3D reconstruction of multiplexed sequential tissue sections: MATRICS-A (Multiplexed Image Three-D Reconstruction and Integrated Cell Spatial - Analysis). We demonstrate MATRICS-A in 26 serial sections of fixed skin (stained with 18 biomarkers) from 12 donors aged between 32–72 years. Comparing the 3D reconstructed cellular data with the 2D data, we show significantly shorter distances between immune cells and vascular endothelial cells (56 µm in 3D vs 108 µm in 2D). We also show 10–70% more T cells (total) within 30 µm of a neighboring T helper cell in 3D vs 2D. Distances of p53, DDB2 and Ki67 positive cells to the skin surface were consistent across all ages/sun exposure and largely localized to the lower stratum basale layer of the epidermis. MATRICS-A provides a framework for analysis of 3D spatial cell relationships in healthy and aging organs and could be further extended to diseased organs.

BackgroundUntreated hearing loss is a risk factor for age-related cognitive decline and hearing aids have been shown to slow cognitive decline in a population at risk for dementia. This double-blind multiple site randomized trial tested the hypothesis that for older adults with below-average cognition, a “Simple” hearing aid fitting strategy (based on linear amplification with output limiting compression signal processing) would improve hearing and cognition more than a “Standard” approach (adaptive compression-based processing).MethodsTwo hundred and fifty-six adults aged over 65 were screened for cognitive function using the NIH toolbox cognitive battery. Participants with below median age-adjusted fluid composite cognitive scores (

Behavioral changes due to digitalization, such as telework, shifted energy demand, especially during COVID-19. Behavioral changes are often overlooked in macro-demand forecasts. This study forecasts macro-energy use to 2030 using American Time Use Survey and national energy data from 2003-2019. It examines and explains residential, non-residential, and transportation sectors through efficiency, technology characteristics (e.g., home floor area), and usage (time-use). Results showed that improved efficiency had the largest effect on energy demand per capita in all sectors from 2003-2019. The time-use (behavior) effect was strongest in non-residential buildings, resulting in a net energy reduction of -9%, decomposed into increased in floor area (+24%), improved efficiency (-26%), and reduced time-use (-7%). In forecasting, two potential effects of telework on energy use in 2030 were explored: (1) temporary shift in telework due to COVID-19 (14% teleworking in 2030) and (2) permanent shift in telework that increases with historical trends (34%). The permanent shift resulted in 3.6% less energy demand per capita in 2030. Reduced time-use of non-residential buildings had the largest effect on decreasing energy demand, -29%, with +8.5% from residential energy use, -7.5% from transportation, yielding a net -28% energy use per teleworker. Alternate perspectives are needed to corroborate results.

Two field experiments were conducted in two agro-ecological zones of Ghana (Forest and Coastal Savannah) to assess the efficacy of preemergence herbicides Oxadiargyl and Pendimethalin on weed incidence, growth and yield of pepper. The experiment was factorial arranged in a randomized complete block design. The treatments were Oxadiargyl at 0.4, 0.5, 0.6 L/ha, Pendimethalin at 1.5, 2.0, 2.5 L/ha and hand weeding at intervals of 3, 6 and 9 weeks as control. Data was collected on weed type and abundance, number of days to weed emergence, type of re-emerging weeds and percentage weed cover. Data on plant height, number of branches per plant, yield and yield components of pepper plants were also collected. Results indicated that application of Pendimethalin led to a significantly (p

Understanding the adoption patterns of clean energy is crucial for designing government subsidies that promote the use of these technologies. Existing work has examined a variety of adoption models to explain and predict how economic factors and other technology and demographic attributes influence adoption, helping to understand the cost-effectiveness of government policies. This study explores the impact of adoption modeling choices on optimal subsidy design within a single techno–economic framework for residential solar PV technology. We applied identical datasets to multiple adoption models and evaluated which model forms appear feasible and how using different choices affects policy decisions. We consider three existing functional forms for rooftop solar adoption: an error function, a mixed log-linear regression, and a logit demand function. The explanatory variables used are a combination of net present value (NPV), socio-demographic, and prior adoption. We compare how the choice of model form and explanatory variables affect optimal subsidy choices. Among the feasible model forms, there exist justified subsidies for residential solar, though the detailed schedule varies. Optimal subsidy schedules are highly dependent on the social cost of carbon and the learning rate. A learning rate of 10% and a social carbon cost of USD 50/ton suggest an optimal subsidy starting at USD 46/kW, while the initial subsidy is 10× higher (USD 540/kW) with a learning rate of 15% and social carbon cost of USD 70/ton. This work illustrates the importance of understanding the true drivers of adoption when developing clean energy policies.

Abstract Objective Post-traumatic epilepsy is a devastating complication of traumatic brain injury that has no targeted pharmacological therapy. Previous literature has explored the role of the c-Jun N-terminal kinase (JNK) pathway in epilepsy and the creation of epileptogenic foci by reactive astrogliosis; however, the relationship between reactive astrogliosis and the c-Jun N-terminal kinase signaling pathway in the development of post-traumatic epilepsy has not been thoroughly examined. Methods Four experimental groups, consisting of c57/b16 male mice, were examined: (1) control, (2) traumatic brain injury of graded severity (mild, moderate, severe), (3) sub-convulsive kainic acid alone without traumatic brain injury (15 mg/kg i.p.), and (4) sub-convulsive kainic acid administered 72 h after moderate traumatic brain injury. Modified Racine scale from 1 to 72 h and total beam breaks at 72 h were used to assess seizure activity. Immunohistochemistry and western blot were utilized to examine astrogliosis (GFAP), microglia activation (IBA-1), and phosphorylated JNK in prefrontal cortex samples collected from the contracoup side at 72 h post-injury. Results Astrogliosis, measured by GFAP, was increased after traumatic brain injury and increased commensurately based on the degree of injury. Mice with traumatic brain injury demonstrated a four-fold increase in phosphorylated JNK: p

Objectives. To determine if radial artery (RA) access compared with femoral artery (FA) access for percutaneous coronary intervention (PCI) is associated with a lower incidence of acute kidney injury (AKI). Background. AKI results in substantial morbidity and cost following PCI. Prior studies comparing the occurrence of AKI associated with radial artery (RA) versus femoral artery (FA) access have mixed results. Methods. Using a large state-wide database, 14,077 patients (8,539 with RA and 5,538 patents with FA access) were retrospectively compared to assess the occurrence of AKI following PCI. To reduce selection bias and balance clinical data across the two groups, a novel machine learning method called a Generalized Boosted Model was conducted on the arterial access site generating a weighted propensity score for each variable. A logistic regression analysis was then performed on the occurrence of AKI following PCI using the weighted propensity scores from the Generalized Boosted Model. Results. As shown in other studies, multiple variables were associated with an increase in AKI after PCI. Only RA access (OR 0.82; 95% CI 0.74–0.91) and male gender (OR 0.80; 95% CI 0.72–0.89) were associated with a lower occurrence of AKI. Based on the calculated Mehran scores, patients were stratified into groups with an increasing risk of AKI. RA access was consistently found to have a lower risk of AKI compared with FA access across these groups of increasing risk. Conclusions. Compared with FA access, RA access is associated with an 18% lower rate of AKI following PCI. This effect was observed among different levels of risk for developing AKI. Although developed from a retrospective analysis, this study supports the use of RA access when technically possible in a diverse group of patients.

Background: Clinical electives provide opportunities toward future careers. This study aimed to examine whether students at the University of the West Indies used clinical electives to help with specialization choice and determine factors that influence trainee decisions for specialty training. Methods: A cross-sectional prospective study was conducted between July 2019 and March 2020, at The University of the West Indies and the University Hospital of the West Indies involving senior medical students and junior doctors. Paper questionnaires were administered using convenience sampling. Participants voluntarily agreed and were kept anonymous. Results: 193 participants, aged 20 to 35 years, completed the questionnaire 133 (68.9%) females. Preferred electives were internal medicine specialties (80, 41.5%), then surgical specialties (53, 27.5%). Sixty-four (33.2%) participants reported using electives to gain experience for their future career; other reasons included filling knowledge gaps (101, 52.3%) and repeating failed clerkships (19, 9.8%). Career preferences included surgery (75, 40.8%), internal medicine (41, 22.3%), anesthetics (20, 10.4%), and obstetrics & gynecology (18, 9.3%). Males showed preference for surgical specialties (p=0.002). Elective choice for determining career path significantly correlated with future likely specialty choice (likelihood ratio chi-square test (32)=98.37, p

Electric Technology Vehicles (ETVs: hybrid, electric, and plug-in hybrid) may reach price parity with incumbent internal combustion vehicles (ICEVs) in the near future. Climate policy for transportation will depend on the degree to which consumers prefer ETVs, and price parity is a key factor. In this study, we explore the interaction between future cost reductions and the economically motivated adoption of ETVs. We construct a model of the U.S. personal vehicle market accounting for heterogenous use and vehicle preferences, in which adoption induces cost reductions that increase future market share. Model results indicate that price parity is reached for most consumers in a number of cost scenarios, but not with constant ICEV costs and modest ETV cost declines. A price parity future suggests that government support could be temporary and phased out after a successful market transition. However, if ETVs continue to be more expensive than ICEVs, then lasting government support is needed. Heterogeneity is essential to understanding the market transition: treating consumers as heterogeneous results in an ETV market share 23% higher than assuming average consumers. Future work can clarify ETV support policy by resolving uncertainty in cost trajectories and modeling dynamic and heterogenous consumer markets.

Traumatic central nervous system injury is a leading cause of neurological injury worldwide. While initial neuroresuscitative efforts are focused on ameliorating the effects of primary injury through patient stabilization, secondary injury in neurotrauma is a potential cause of cell death, oxidative stress, and neuroinflammation. These secondary injuries lack defined therapy. The major causes of secondary injury in neurotrauma include endoplasmic reticular stress, mitochondrial dysfunction, and the buildup of reactive oxygen or nitrogenous species. Stress to the endoplasmic reticulum in neurotrauma results in the overactivation of the unfolded protein response with subsequent cell apoptosis. Mitochondrial dysfunction can lead to the release of caspases and the buildup of reactive oxygen species; several characteristics make the central nervous system particularly susceptible to oxidative damage. Together, endoplasmic reticulum, mitochondrial, and oxidative stress can have detrimental consequences, beginning moments and lasting days to months after the primary injury. Understanding these causative pathways has led to the proposal of various potential treatment options.

Purpose: Despite making up 20-25% of hand surgeons with subspecialty certification in the field, little data exists characterizing the clinical practice of hand surgery among plastic surgeons. This study sought to evaluate hand surgery cases in the national Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database. Methods: All hand procedures logged in the TOPS database between 2002 and 2016 were identified by CPT code and/or “upper extremity” anatomic classification. Trends in the total number and types of procedures, facility type, admission type, modes and providers of anesthesia, and patient demographics were reviewed. Results: A total of 182,137 hand procedures performed on 82,811 patients were logged during the 15-year period reviewed. Sixty-eight percent of procedures were classified as involving soft tissue only, and 22.7% involved only bone and/or joint. The most common procedure categories included: wound closure/coverage (15.8%), debridement/drainage (15.3%), nerve (13.2%), tendon (12.9%), and fracture/dislocation (12.9%). This category breakdown remained relatively stable over time. Evaluation of longitudinal trends identified an increase over time in procedures performed in the ambulatory and office-based settings and the use of local anesthetic, as well as a transition from the procedural surgeon providing anesthesia to the use of anesthesiologists and nurse anesthetists. The average patient ASA increased from 1.27 to 1.83. Conculsions: Plastic surgeons play an important role in the field of hand surgery, performing a large breadth of procedure types, which has remained stable over time. The trends in facility type and anesthesia characteristics have, however, varied.

Chronic traumatic encephalopathy is a disease afflicting individuals exposed to repetitive neurotrauma. Unfortunately, diagnosis is made by postmortem pathologic analysis, and treatment options are primarily symptomatic. In this clinical update, we review clinical and pathologic diagnostic criteria and recommended symptomatic treatments. We also review animal models and recent discoveries from pre-clinical studies. Furthermore, we highlight the recent advances in diagnosis using diffusor tensor imaging, functional magnetic resonance imaging, positron emission tomography, and the fluid biomarkers t-tau, sTREM2, CCL11, NFL, and GFAP. We also provide an update on emerging pharmaceutical treatments, including immunotherapies and those that target tau acetylation, tau phosphorylation, and inflammation. Lastly, we highlight the current literature gaps and guide future directions to further improve clinical diagnosis and management of patients suffering from this condition.

We undertake Life Cycle Assessment (LCA) of the cumulative energy demand (CED) and global warming potential (GWP) for a portfolio of 10 multi-family residences in the U.S. We argue that prior LCA studies of buildings use an inconsistent boundary for processes to be included in the supply chain: The operational phase includes all energy use in a building, but supply chains for the production of appliances, equipment and consumables associated with activities done in the building are neglected. We correct this by starting the analysis with an explicit definition of a functional unit, providing climate controlled space, and including processes associated with this functional unit. Using a hybrid LCA approach, the CED for low, mid and high-rise multi-family residences is found to increase from 30, 34, to 39 GJ/m2, respectively. This increase is due to the need for energy-intensive structural materials such as concrete and steel in taller buildings. With our approach, the share of materials and construction of total life cycle energy doubles to 26%, compared with a 13% share that would be obtained with inconsistent system boundaries used in prior studies. We thus argue that explicit definition of functional unit leads to an increase in the contribution of supply chains to building energy life cycles.

Urban water systems face sustainability and resiliency challenges including water leaks, over-use, quality issues, and response to drought and natural disasters. Information and communications technology (ICT) could help address these challenges through the development of smart water grids that network and automate monitoring and control devices. While progress is being made on technology elements, as a system, the smart water grid has received scant attention. This article aims to raise awareness of the systems-level idea of smart water grids by reviewing the technology elements and their integration into smart water systems, discussing potential sustainability and resiliency benefits, and challenges relating to the adoption of smart water grids. Water losses and inefficient use stand out as promising areas for applications of smart water grids. Potential barriers to the adoption of smart water grids include lack of funding for research and development, economic disincentives as well as institutional and political structures that favor the current system. It is our hope that future work can clarify the benefits of smart water grids and address challenges to their further development.

Informal recycling of electronics in the developing world has emerged as a new global environmental concern. The primary approach to address this problem has been command-and-control policies that ban informal recycling and international trade in electronic scrap. These bans are difficult to enforce and also have negative effects by reducing reuse of electronics, and employment for people in poverty. An alternate approach is to link informal and formal sectors so as to maintain economic activity while mitigating environmental damages. This article explores the idea of an interface organization that purchases components and waste from informal dismantlers and passes them on to formal processors. Environmental, economic and social implications of interface organizations are discussed. The main environmental questions to resolve are what e-scrap components should be targeted by the interface organization, i.e., circuit boards, wires, and/or plastic parts. Economically, when formal recycling is more profitable (e.g., for circuit boards), the interface organization is revenue positive. However, price subsidies are needed for copper wires and residual waste to incentivize informal dismantlers to turn in for formal processing. Socially, the potential for corruption and gaming of the system is critical and needs to be addressed.

Objective: To assess relationships between primary care work conditions, physician burnout, quality of care, and medical errors. Methods: Cross-sectional and longitudinal analyses of data from the MEMO (Minimizing Error, Maximizing Outcome) Study. Two surveys of 422 family physicians and general internists, administered 1 year apart, queried physician job satisfaction, stress and burnout, organizational culture, and intent to leave within 2 years. A chart audit of 1795 of their adult patients with diabetes and/or hypertension assessed care quality and medical errors. Key Results: Women physicians were almost twice as likely as men to report burnout (36% vs 19%, P < .001). Burned out clinicians reported less satisfaction ( P < .001), more job stress ( P < .001), more time pressure during visits ( P < .01), more chaotic work conditions ( P < .001), and less work control ( P < .001). Their workplaces were less likely to emphasize work-life balance ( P < .001) and they noted more intent to leave the practice (56% vs 21%, P < .001). There were no consistent relationships between burnout, care quality, and medical errors. Conclusions: Burnout is highly associated with adverse work conditions and a greater intention to leave the practice, but not with adverse patient outcomes. Care quality thus appears to be preserved at great personal cost to primary care physicians. Efforts focused on workplace redesign and physician self-care are warranted to sustain the primary care workforce.

We use the American Time Use Survey (ATUS) to characterize how different consumers in the US might use Autonomous Vehicles (AVs). Our approach is to identify sub-groups of the population likely to benefit from AVs and compare their activity patterns with an otherwise similar group. The first subgroup is working individuals who drive to work with long total travel times. Auto-travelers in the top 20% of travel time number 19 million and travel 1.6 h more on a workday than those in the bottom 80%. For car-commuting professionals, the additional travel time of the long-traveling group comes from 30 min less work, 29 min less sleep, and 30 min less television watching per day. The second subgroup is working individuals with a long travel time and who take public transport. Long public transit riders show very similar differences in activity times as the driving subgroup. Work, sleep, and video functionalities of AVs are presumably in high demand by both groups. The third sub-group identified is elderly retired people. AVs enable mobility-restricted groups to travel more like those without restrictions. We compare two age groups, 60–75 years and >75 years old, the latter, on average, experiencing more mobility restrictions than their younger counterparts. The retired population older than 75 years numbers 16 million and travels 14 min less per day than retirees aged 60–75 years. The main activity change corresponding to this reduced travel is 7 min per day less shopping and 8 min per day less socializing. If older retired people use AVs to match the lifestyle of the 60–75 years old group, this would induce additional personal travel and retail sector demand. The economic, environmental and social implications of AV are very difficult to predict but expected to be transformative. The contribution of this work is that it utilizes time-use surveys to suggest how AV adoption could induce lifestyle changes inside and outside the vehicle.

Health care organizations are building, deploying, and self-governing digital health technologies (DHTs), including artificial intelligence, at an increasing rate. This scope necessitates expertise and quality infrastructure to ensure that the technology impacting patient care is safe, effective, and ethical throughout its lifecycle. The objective of this article is to describe Mayo Clinic’s approach for embedding internal accountability as a case study for other health care institutions seeking modalities for responsible implementation of artificial intelligence–enabled DHTs. Mayo Clinic aims to enable and empower innovators by (1) building internal skills and expertise, (2) establishing a centralized review board, and (3) aligning development and deployment processes with regulations, standards, and best practices. In 2022, Mayo Clinic established the Software as a Medical Device Review Board (The Board), an independent body of physicians and domain experts to represent the organization in providing innovators regulatory and risk mitigation recommendations for DHTs. Hundreds of digital health product teams have since benefited from this function, intended to enable responsible innovation in alignment with regulation and state-of-the-art quality management practices. Other health care institutions can adopt similar internal accountability bodies using this framework. Opportunity remains to iterate on Mayo Clinic’s approach in alignment with advancing best practices and enhance representation on The Board as part of standard continuous improvement practices.

The use of 3-dimensional tissue cultures is gaining popularity in many fields including drug discovery, toxicity testing and tissue engineering. Currently most of the techniques used to prepare these 3D tissues are time consuming and cannot be reproduced easily. There is an urgent need to optimize the preparation of these 3D tissue cultures. This study evaluated the use of synthetic hydrogel polymers used to manufacture soft contact lenses to guide cells to form multicellular tissue-like structures. It was found that bovine chondrocytes and porcine dental pulp stem cells were able to form 3D tissue structures when placed inside a soft contact lens. Commercially available microarrays, 96 or 384 well plates manufactured using synthetic hydrogel polymers may help overcome many reproducibility issues and simplify the 3D tissue culture process.