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Background:. Costs of healthcare in the US continue to rise at rates that are unsustainable. Prior studies, most of which come from non-surgical specialties, indicate that a variety of strategies to teach this material are utilized but without consensus on best practices. No studies exist regarding the teaching of cost-effective care in orthopaedic residency training programs. The goal of this study was to assess the landscape in this area from the perspective of program leadership. Methods:. A survey was developed that was sent to orthopaedic residency program leadership via email through their interaction with the COERG. Additional programs were included to enhance diversity of responding programs. The survey, based on those published from other areas of medicine, included questions about the experiences of the respondents in learning about cost-effective care, as well as how faculty and residents learned about this topic. Results:. Seventy one percent (30) of respondents noted that their faculty did not receive formal training in cost-effective care, and education in this area was likely to come from the department, especially review of practice data (12, 44%). Only 19% (8) of respondents agreed with the statement that “the majority of teaching faculty in our program consistently model cost-effective healthcare to residents”. Few of the programs (10, 24%) had formal curricula for residents regarding cost-effective care, and the primary mode of education in cost-effective care was through informal discussions with faculty (17, 43%). Few residents (3, 13%) were able to easily find the costs of tests or procedures. Discussion:. There is not consistent education in cost-effective care for orthopaedic surgery program leadership, faculty, or trainees. The results of this survey demonstrate a need for discussion of best practices, including increasing access to cost data at a local level, and engaging with the AOA, CORD, and the American Academy of Orthopaedic Surgeons more broadly in the development of standard education modules for faculty and residents, to improve the current and future delivery of cost-effective musculoskeletal care.

Since Russia’s 2022 invasion, Ukraine’s civilian energy infrastructure has faced systematic attack and requires urgent and strategic reconstruction. This study confronts the dual challenges of rebuilding Ukraine’s energy system rapidly to mitigate civilian and economic disruption while aligning this to long-term goals of sustainability and energy security. We demonstrate that Ukraine can readily meet future energy demands through a fully renewable electrified system at costs comparable to those from fossil fuels and nuclear power. Contrary to previous reliance on high-carbon energy sources, we find a diversified renewable energy portfolio, including significant solar photovoltaic and wind contributions, can efficiently meet growing energy demands and position Ukraine as an energy exporter, capitalising on its geographical advantages. This study’s approach, based on open data and models, extends beyond national borders and offers a model for post-conflict reconstruction that harmonizes immediate recovery with sustainable energy transition.

Direct air capture (DAC) is increasingly recognized as a necessary puzzle piece to achieve the Paris climate targets. However, the current high cost and energy intensity of DAC act as a barrier. Short-term strategies for initial deployment, technology improvement, and cost reduction are needed to enable large-scale deployment. We assess and compare two near-term pathways leading to the same installed DAC capacity and thus yielding the same cost reductions: its combination with CO _2 storage as direct air carbon capture and storage, or its deployment for CO _2 utilization as direct air carbon capture and utilization e.g. for synthetic fuels, chemicals, and materials; we characterize these as Direct and Spillover pathways. Drawing on the Multi-level Perspective on Technological Transition as a heuristic, we examine both technical and immaterial factors needed to scale up DAC under the two pathways, in order to assess the pathways’ relative advantages and to identify possible short-term bottlenecks. We find neither pathway to be clearly better: the Direct pathway offers technical advantages but faces regulatory barriers that need to be resolved before deployment, while the Spillover pathway offers market and governance advantages but faces challenges related to hydrogen production and increasing resource needs as it scales up. There may be reasons for policymakers to therefore pursue both approaches in a dynamic manner. This could involve prioritizing the Spillover pathway in the short term due to possibly fewer short-term regulatory barriers and its ability to produce net-zero emission products for existing and accessible markets. Once short-term governance obstacles have been addressed, however, the Direct pathway may allow for more efficient scaling of DAC capacity and cost reductions, especially if by then the needed infrastructure and institutions are in place.

We describe two cases of hypertension and hypokalemia due to mineralocorticoid excess caused by posaconazole treatment of coccidioidomycosis and rhinocerebral mucormycosis infections, respectively. Clinical laboratory evaluations, including a comprehensive analysis of blood and urine steroid profiles, revealed low renin and aldosterone and indicated as the underlying mechanism primarily a block of 11β-hydroxylase activity in patient 1, whereas patient 2 displayed weaker 11β-hydroxylase but more pronounced 11β-hydroxysteroid dehydrogenase 2 inhibition. The results show that both previously suggested mechanisms must be considered and emphasize significant interindividual differences in the contribution of each enzyme to the observed mineralocorticoid excess phenotype. The mineralocorticoid symptoms of patient 1 resolved after replacement of posaconazole therapy by isavoconazole, and posaconazole dosage de-escalation ameliorated the effects in patient 2. By providing a thorough analysis of the patients' blood and urine steroid metabolites, this report adds further evidence for two individually pronounced mechanisms of posaconazole-induced hypertension and hypokalemia. The elucidation of the factors responsible for the individual phenotype warrants further research.

The advancement of underrepresented minority and women PhD students to elite postdoctoral and faculty positions in the STEM fields continues to lag that of majority males, despite decades of efforts to mitigate bias and increase opportunities for students from diverse backgrounds. In 2015, the National Science Foundation Alliance for Graduate Education and the Professoriate (NSF AGEP) California Alliance (Berkeley, Caltech, Stanford, UCLA) conducted a wide-ranging survey of graduate students across the mathematical, physical, engineering, and computer sciences in order to identify levers to improve the success of PhD students, and, in time, improve diversity in STEM leadership positions, especially the professoriate. The survey data were interpreted via path analysis, a method that identifies significant relationships, both direct and indirect, among various factors and outcomes of interest. We investigated two important outcomes: publication rates, which largely determine a new PhD students competitiveness in the academic marketplace, and subjective well-being. Women and minority students who perceived that they were well-prepared for their graduate courses and accepted by their colleagues (faculty and fellow students), and who experienced well-articulated and structured PhD programs, were most likely to publish at rates comparable to their male majority peers. Women PhD students experienced significantly higher levels of distress than their male peers, both majority and minority, while both women and minority student distress levels were mitigated by clearly-articulated expectations, perceiving that they were well-prepared for graduate level courses, and feeling accepted by their colleagues. It is unclear whether higher levels of distress in women students is related directly to their experiences in their STEM PhD programs. The findings suggest that mitigating factors that negatively affect diversity should not, in principle, require the investment of large resources, but rather requires attention to the local culture and structure of individual STEM PhD programs.