Search

There is an ongoing need for indicators that balance social and environmental sustainability outcomes. The carbon intensity of well-being (CIWB) is a sustainability indicator that captures environmental impact and social well-being in a single measure. One of the benefits of this measure is that it can be applied across different scales and contexts to explore factors that might reduce the CIWB, leading to greater sustainability. We demonstrate the further utility of the indicator by analyzing CIWB in the United States at the state-level and take an intersectional approach, calculating CIWB by race and gender. We find income inequality contributes to larger CIWB for all groups, but the impacts are greater for blacks compared to whites and males compared to females. Economic growth is also associated with larger CIWB for all groups. These results suggest that to achieve more sustainable outcomes may require policies that address inequalities as well as broader changes to economies.

BackgroundWe investigated the associations of healthcare worker status with multisystem illness trajectory in hospitalised post-COVID-19 individuals.Methods and resultsOne hundred and sixty-eight patients were evaluated 28–60 days after the last episode of hospital care. Thirty-six (21%) were healthcare workers. Compared with non-healthcare workers, healthcare workers were of similar age (51.3 (8.7) years vs 55.0 (12.4) years; p=0.09) more often women (26 (72%) vs 48 (38%); pIn adjusted multivariate logistic regression analysis, healthcare worker status associated with a binary classification (probable/very likely vs not present/unlikely) of adjudicated myocarditis (OR: 2.99; 95% CI (1.01 to 8.89) by 28–60 days postdischarge).After a mean (SD, range) duration of follow-up after hospital discharge of 450 (88) days (range 290, 627 days), fewer healthcare workers died or were rehospitalised (1 (3%) vs 22 (17%); p=0.038) and secondary care referrals for post-COVID-19 syndrome were common (42%) and similar to non-healthcare workers (38%; p=0.934).ConclusionHealthcare worker status was independently associated with the likelihood of adjudicated myocarditis, despite better antecedent health. Two in five healthcare workers had a secondary care referral for post-COVID-19 syndrome.Trial registration numberNCT04403607.

Background: The pathophysiology and trajectory of multiorgan involvement in post-COVID-19 syndrome is uncertain. Methods: A prospective, multicenter, longitudinal, cohort study involving post-COVID-19 patients enrolled in-hospital or early post-discharge (visit 1) and re-evaluated 28-60 days post-discharge (visit 2). Multisystem investigations included chest computed tomography with pulmonary and coronary angiography, cardiovascular and renal magnetic resonance imaging, digital electrocardiography, and multisystem biomarkers. The primary outcome was the adjudicated likelihood of myocarditis.Results: 161 patients (mean age 55 years, 43% female) and 27 controls with similar age, sex, ethnicity, and vascular risk factors were enrolled from 22 May 2020 to 2 July 2021 and had a primary outcome evaluation. Compared to controls, at 28-60 days post-discharge, patients with COVID-19 had persisting evidence of cardio-renal involvement, systemic inflammation, and hemostasis pathway activation. Myocarditis was adjudicated as being not likely (n=17; 10%), unlikely (n=56; 35%), probable (n=67; 42%) or very likely (n=21; 13%). Acute kidney injury (odds ratio, 95% confidence interval: 3.40 (1.13, 11.84); p=0.038) and low hemoglobin A1c (0.26 (0.07, 0.87); p=0.035) were multivariable associates of adjudicated myocarditis. During convalescence, compared to controls, COVID-19 was associated with worse health-related quality of life (EQ5D-5L) (pConclusions: The illness trajectory of COVID-19 includes persisting cardio-renal inflammation, lung damage and hemostasis activation. Adjudicated myocarditis occurred in one in eight hospitalized patients and was associated with impairments in health status, physical and psychological wellbeing during community convalescence. Public registration: ClinicalTrials.gov identifier is NCT04403607.

Research in environmental sociology finds differences between men and women in the performance of pro-environmental behaviors, but gender effects change over time, and vary by location and type of ...

Background:\ud \ud The clinical significance of Coronavirus disease 2019 (COVID‐19) as an associate of myocardial injury is controversial.\ud \ud Hypothesis:\ud \ud Type 2 MI/Myocardial Injury are associated with worse outcomes if complicated by COVID‐19.\ud \ud Methods:\ud \ud This longitudinal cohort study involved consecutive patients admitted to a large urban hospital. Myocardial injury was determined using laboratory records as ≥1 hs‐TnI result >99th percentile (male: >34 ng/L; female: >16 ng/L). Endotypes were defined according to the Fourth Universal Definition of Myocardial Infarction (MI) and COVID‐19 determined using PCR. Outcomes of patients with myocardial injury with and without COVID‐19 were assessed.\ud \ud Results:\ud \ud Of 346 hospitalized patients with elevated hs‐TnI, 35 (10.1%) had laboratory‐confirmed COVID‐19 (median age [IQR]; 65 [59–74]; 64.8% male vs. COVID‐19 negative: 74 [63–83] years; 43.7% male). Cardiac endotypes by COVID‐19 status (yes vs. no) were: Type 1 MI (0 [0%] vs. 115 [100%]; p

Introduction: Unplanned hospitalizations are commonly associated with a circulating troponin concentration >99 th percentile upper reference limit (URL). In order to better understand the clinical significance of troponin elevation, we evaluated outcomes in hospitalized patients according to cardiac endotype. Methods: We prospectively screened consecutive hospitalized patients with elevated high-sensitivity troponin-I (hs-TnI) concentrations (Abbott ARCHITECT troponin-I assay; sex-specific URL, 99 th centile: male: >34ng/L; female: >16ng/L) within a regional cardiac care network (population 650,000). A cardiology clinical team adjudicated individual patient records and assigned endotypes by consensus agreement according to the Fourth Universal Definition of Myocardial Infarction (MI). Endotypes were sub-classified into etiological category by inciting event(s). Characteristics and comorbidity were compared and outcomes recorded on virtual follow-up until June 2 nd 2020. Results: A total of 390 consecutive patients with ≥1 hs-TnI value >URL between March 1-April 15, 2020, were evaluated; 44 patients were excluded ( Duplicates: 2; Missing data: 41; Research patient: 1 ). Of 346 who qualified for inclusion, an index diagnosis of Type 1 MI (T1MI), T2MI and myocardial injury were assigned in 115 (33.2%), 79 (22.8%) and 152 (43.9%) patients, respectively. Compared with T1MI, patients with T2MI and myocardial injury had lower peak hs-TnI values (median [IQR]: 86 [250-697] vs 5020 [853-7774]ng/L; p< 0.01), lower estimated 10-year survival (40.2% vs 53.4%; p=0.002), less frequently underwent coronary revascularization (1.4% vs 45.2%; pvs 6.1 days). Inpatient and overall mortality rates from admission to follow-up (median [range]: 71 [0-151] days) were higher among patients with T2MI and myocardial injury (19.9% vs 7.8%; p=0.004; and 26.0% vs 11.3%; Log rank (Mantel-Cox) X 2 = 1.927; p=0.003) independent of similar cardiovascular risk profiles. Conclusions: Despite lower peak circulating troponin concentrations, patients with T2MI and myocardial injury had higher inpatient mortality, lower estimated 10-year survival and longer in-hospital stay compared to those with T1MI.

Introduction: Coronavirus disease 2019 (COVID-19) is a novel cause of myocardial injury. We investigated the clinical significance of COVID-19 in a population of hospitalized patients with myocardial injury. Methods: This was a prospective, longitudinal cohort study of hospitalized patients admitted to an urban academic medical center (catchment population 650,000) from March 1 - April 15, 2020. Consecutive patients with myocardial injury were identified using laboratory records by occurrence of ≥1 high-sensitivity troponin-I (hsTnI) result (Abbott ARCHITECT assay) >99 th percentile sex-specific upper reference limit (URL; male: >34 ng/L; female: >16 ng/L). Cardiac endotypes were defined according to the Fourth Universal Definition of Myocardial Infarction (MI) and laboratory data used to determine presence of COVID-19 infection by PCR. Outcomes of patients with myocardial injury with and without COVID-19 were assessed. Results: Of 390 hospitalized patients with elevated hsTnI, 346 were eligible for inclusion; 44 were excluded ( Duplicate: 2; Missing data: 41; Research patient: 1 ). 35 (10.1%) had laboratory-confirmed COVID-19 (COVID-19, yes vs no: median age [IQR]; 65 [59-74] vs 74 [63-83] years); 64.8% vs 43.7% male). Distribution of cardiac endotypes by COVID-19 status (yes vs no) were: Type 1 MI (0 [0%] vs 115 [100%]; pvs 66 [83.5%]; p=0.045), and non-ischemic myocardial injury (cardiac: 4 [5.8%] vs 65 [94.2%]; p=0.191, non-cardiac:19 [22.9%] vs 64 [77.%]; pvs 5.1; p=0.002), similar average hsTnI concentrations (initial: 282 vs 316; p=0.853, peak: 560 vs 527ng/L; p=0.911), longer hospital stay (median [IQR]: 16 [20] vs 4 [9] days; pvs 10.3%; OR=17.5; 95% CI: 8.00, 38.3). Respiratory failure requiring invasive ventilation occurred in 24 (68.6%) patients with COVID-19, whilst 18 (51.4%) and 21 (60%) required renal and/or circulatory support, respectively. Conclusion: Presence of both myocardial injury and COVID-19 is associated with high in-hospital mortality. Systemic consequences may be associated with higher mortality risk in this patient group.

Purpose During respiratory-gated volumetric modulated arc therapy (VMAT), the radiation beam is turned off each time the target exits the gating window. At the same time, the gantry slows, stops, and rewinds before the beam is turned back on. A quality assurance (QA) test was developed to detect inaccuracies in the gantry angle position between beam-off and beam-on events during respiratory-gated VMAT. Methods Strips of Gafchromic™ EBT3 film were taped to the surface of a Capthan® 504 phantom mounted at isocentre. A homogeneous dose was delivered to the films through a 2 cm × 10 cm slit in the jaws using a respiratory-gated VMAT arc without the multileaf collimator. A periodic breathing cycle was used. Errors in gated delivery ranging from 0.5-5° were simulated by delivering non-gated arcs with the same field size with over- and under-lapping sections of 0.5-5°. The simulated errors were used to define QA levels to compare the gated delivery. Results The QA test was capable of detecting errors as small as 0.5°. The test was delivered to three Varian TrueBeam™ linacs, and no gantry angle inaccuracies greater than or equal to 0.5 degrees were detected on any of the films. Conclusions A QA test capable of detecting gantry angle inaccuracies at beam-off and subsequent beam-on as small as 0.5° was developed and implemented for Varian TrueBeam™ linacs. This article is protected by copyright. All rights reserved.

Support for renewable energy is often solicited by leveraging concern about environmental problems such as climate change. However, the environment – and especially climate change – is hyper-polarized amongst the American public, and non-environmental justifications for renewable energy may resonate more broadly. Using a 2016 mail survey of individuals living in five states in the Rocky Mountain region of the U.S., we examine predictors of public approval of renewable energy usage, approval of a 20% renewable portfolio standard policy, and agreement with seven frames for renewable energy, of which four referenced the environment and three did not. We build upon previous research by analyzing geographic variation in frame agreement and by testing a religious environmental stewardship and resource-conservation frame. Results indicate high approval renewable energy but mixed support for the policy measure. Respondents on average agreed with all seven renewable energy frames, with energy security and energy diversification receiving the most support. Of the four environmental frames, air pollution and resource conservation had the most support, and the religion and climate frames had the least. We note variation by state, particularly on support for the policy measure. Political ideology and belief in human-caused global warming were consistent predictors, though gender, residence in a metro county, neoliberal ideology, and state of residence were also important. Overall, our results echo other research indicating that non-climate-based frames for renewable energy are likely to garner broader public support, but we suggest that the significance of this finding is particularly important in certain political and geographical contexts.

While the accuracy of patient setup itself has been well documented in stereotactic radiosurgery (SRS), the amount of rotational patient setup errors needed to impact this accuracy is not well defined. The purpose of this study is to explore potential rotational setup error thresholds for SRS treatments of brain metastases. Two groups were analyzed in this study: Group A consisted of twenty cases where a single brain metastasis treatment was planned using a single isocenter located within the tumor; Group B consisted of five cases where two brain metastases were planned using a single isocenter located between the tumors. All twenty-five cases underwent simulations for rotations around the treatment isocenter of ±1°, ±3°, ±5°, and ±7°. In addition, cases in Group B included simulations of ±0.5° and ±2°. The percent of the gross target volume (GTV) and planning target volume (PTV) that received the prescription dose (V p) was compared between the original plans and rotation simulations to determine what degree of rotations will cause V p loss greater than 0% and 1% respectively. In Group A, the average loss in V p for the GTV and PTV was 0% and below 1% respectively for rotations below ±3°. Using the Spearman correlation coefficient, V p loss in Group A showed very weak to weak correlation with physical characteristic of the tumor. In Group B, the average loss in V p for the GTV and PTV was 0% and below 1% respectively for rotations of ±0.5°. V p loss as a result of rotations showed very strong correlation with increasing tumor distance from treatment isocenter. Our study suggests that a patient rotational setup error threshold of ±2° around all axes for isocentric treatments is conservative. For nonisocentric treatments, the rotational setup error threshold may need to be as low as or lower than ±0.5° for tumors that are far from the treatment isocenter.

Purpose: To quantify the effect of patient rotation in stereotactic radiation therapy and establish a threshold where rotational patient set-up errors have a significant impact on target coverage. Methods: To simulate rotational patient set-up errors, a Matlab code was created to rotate the patient dose distribution around the treatment isocentre, located centrally in the lesion, while keeping the structure contours in the original locations on the CT and MRI. Rotations of 1°, 3°, and 5° for each of the pitch, roll, and yaw, as well as simultaneous rotations of 1°, 3°, and 5° around all three axes were applied to two types of brain lesions: brain metastasis and acoustic neuroma. In order to analyze multiple tumour shapes, these plans included small spherical (metastasis), elliptical (acoustic neuroma), and large irregular (metastasis) tumour structures. Dose-volume histograms and planning target volumes were compared between the planned patient positions and those with simulated rotational set-up errors. The RTOG conformity index for patient rotation was also investigated. Results: Examining the tumour volumes that received 80% of the prescription dose in the planned and rotated patient positions showed decreases in prescription dose coverage of up to 2.3%. Conformity indices for treatments with simulated rotational errors showed decreases of up to 3% compared to the original plan. For irregular lesions, degradation of 1% of the target coverage can be seen for rotations as low as 3°. Conclusions: This data shows that for elliptical or spherical targets, rotational patient set-up errors less than 3° around any or all axes do not have a significant impact on the dose delivered to the target volume or the conformity index of the plan. However the same rotational errors would have an impact on plans for irregular tumours.