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Abstract Background Racial and ethnic disparities in the treatment of perioperative pain have not been well-studied, despite being observed in a variety of other medical settings. The goal of this investigation was to evaluate the relationship between race and ethnicity and intra- and postoperative opioid administration for patients undergoing open liver resection surgery. Methods In this single-center retrospective cohort study, adult patients undergoing open liver resection from January 2012 to May 2019 were identified. Demographic, intraoperative, and postoperative data were extracted from the institutional perioperative data warehouse. The primary outcome was weight-based intraoperative morphine milligram equivalents (MME/kg). Secondary outcome variables included use of neuraxial analgesia and length of stay (LOS). Multivariable regression models were used, which controlled for pertinent factors such as age and duration of surgery. Results There were 1294 adult open liver resections included in this study: 532 (41%) patients self-reported as White, 401 (31%) as Asian, 159 (12%) as Black, 97 (7%) as Hispanic, and 105 (8%) as Other. The risk adjusted mean intraoperative MME/kg was not different among racial groups (White: 3.25 [95% CL 3.02–3.49] mg/kg vs. Asian: 3.38 [95% CL 3.10–3.69] mg/kg, p = 0.87; Black: 2.95 [95% CL 2.70–3.23] mg/kg, p = 0.19; Hispanic: 3.36 [95% CL 3.00–3.77] mg/kg, p = 0.97). In the multivariable models for secondary outcomes, length of stay was significantly higher for Black (estimate: 1.17, CL: 1.00 to 1.35, p = 0.047) and Hispanic (1.30, CL: 1.05 to 1.65, p = 0.018) patients relative to White patients. No racial/ethnic groups were significantly associated with higher or lower odds of receiving regional anesthesia. Conclusions For patients undergoing liver resection surgery, no racial and ethnic disparities were observed for weight-based intraoperative MME.

Big data products offer a new paradigm to understand and analyze human mobility patterns, a primary interest of long-range transportation planners. However, it remains unclear how widely these datasets are utilized by planners and to what extent they influence decision-making. We present the perspectives of more than 50 planners from MPOs across the United States. While we found a range of use cases, there was also a tendency to focus on a narrow set of applications. *Transparency*, *regulation*, and *legitimacy* emerged as the primary factors influencing adoption decisions.

Summary: Background: It has been shown that AI models can learn race on medical images, leading to algorithmic bias. Our aim in this study was to enhance the fairness of medical image models by eliminating bias related to race, age, and sex. We hypothesise models may be learning demographics via shortcut learning and combat this using image augmentation. Methods: This study included 44,953 patients who identified as Asian, Black, or White (mean age, 60.68 years ±18.21; 23,499 women) for a total of 194,359 chest X-rays (CXRs) from MIMIC-CXR database. The included CheXpert images comprised 45,095 patients (mean age 63.10 years ±18.14; 20,437 women) for a total of 134,300 CXRs were used for external validation. We also collected 1195 3D brain magnetic resonance imaging (MRI) data from the ADNI database, which included 273 participants with an average age of 76.97 years ±14.22, and 142 females. DL models were trained on either non-augmented or augmented images and assessed using disparity metrics. The features learned by the models were analysed using task transfer experiments and model visualisation techniques. Findings: In the detection of radiological findings, training a model using augmented CXR images was shown to reduce disparities in error rate among racial groups (−5.45%), age groups (−13.94%), and sex (−22.22%). For AD detection, the model trained with augmented MRI images was shown 53.11% and 31.01% reduction of disparities in error rate among age and sex groups, respectively. Image augmentation led to a reduction in the model's ability to identify demographic attributes and resulted in the model trained for clinical purposes incorporating fewer demographic features. Interpretation: The model trained using the augmented images was less likely to be influenced by demographic information in detecting image labels. These results demonstrate that the proposed augmentation scheme could enhance the fairness of interpretations by DL models when dealing with data from patients with different demographic backgrounds. Funding: National Science and Technology Council (Taiwan), National Institutes of Health.

ABSTRACTThere exists a substantial literature on sustainability pedagogy. Much of it addresses individual courses, sustainability programs, or the learning competencies that are encouraged. The implicit focus is on students who have chosen to specialize on sustainability topics by obtaining a degree in programs such as , sustainability management, environmental science or studies. More recently, there has been emerging literature calling for embedding sustainability into entire university curricula as sustainability becomes a more prominent issue for higher education institutions. Four key themes have emerged in this literature that are relevant to the goal of developing sustainability pedagogy relevant to all students: (i) the organizational framework for the content of sustainability pedagogy, (ii) the conceptualisation and teaching of inter-transdisciplinarity, (iii) the relative merits of compulsory or voluntary sustainability programming, and (iv) the role of course inventories. In this paper, we examine the University of Toronto’s introduction of a new model of sustainability learning and evaluate it against the themes and recommendations found in the literature. This model aims to establish university-wide sustainability learning trajectories, called Sustainability Pathways whose novelty is in its offer to reach many more students than other approaches. The key themes emerging from the literature will serve as a basis for program evaluation. It is found that the Pathways program does embody some of these themes but that further development would be desirable. The program and the course inventories at its foundation will go through periodic evaluation to assess progress on program goals and objectives.

Introduction: Vaccination rates may be improved through culturally tailored messages, but little is known about them among disaggregated Asian American subgroups. We assessed the vaccination rates for key vaccines among these subgroups. Methods: Using the National Health Interview Survey, we analyzed recent vaccination rates (2015–2018, n=188,250) and trends (2006–2018) among Asians (Chinese [n=3,165], Asian Indian [n=3,525], Filipino [n=3,656], other Asian [n=5,819]) and non-Hispanic White adults (n=172,085) for 6 vaccines (the human papillomavirus, hepatitis B, pneumococcal, influenza, tetanus-diphtheria [tetanus], and shingles vaccines). We controlled demographic, socioeconomic, and health-related variables in multivariable logistic regression and predicted marginal modeling analyses. We also computed vaccination rates among Asian American subgroups on the 2015–2018 National Health Interview Survey data stratified by foreign-born and U.S.-born status. We used Joinpoint regression to analyze trends in vaccination rates. All analyses were conducted in 2021 and 2022. Results: Among Asians, shingles (29.2%; 95% CI=26.6, 32.0), tetanus (53.7%; 95% CI=51.8, 55.6), and pneumococcal (53.8%; 95% CI=50.1, 57.4) vaccination rates were lower than among non-Hispanic Whites. Influenza (47.9%; 95% CI=46.2, 49.6) and hepatitis B (40.5%; 95% CI=39.0, 42.7) vaccination rates were similar or higher than among non-Hispanic Whites (48.4%; 95% CI=47.9, 48.9 and 30.7%; 95% CI=30.1, 31.3, respectively). Among Asians, we found substantial variations in vaccination rates and trends. For example, Asian Indian women had lower human papillomavirus vaccination rates (12.9%; 95% CI=9.1, 18.0) than all other Asian subgroups (Chinese: 37.9%; 95% CI=31.1, 45.2; Filipinos: 38.7%; 95% CI=29.9, 48.3; other Asians: 30.4%; 95% CI=24.8, 36.7) and non-Hispanic Whites (36.1%; 95% CI=34.8, 37.5). Being male, having lower educational attainment and income, having no health insurance or covered by public health insurance only, and lower frequency of doctor visits were generally associated with lower vaccine uptakes. Foreign-born Asian aggregate had lower vaccination rates than U.S.-born Asian aggregate for all vaccines except for influenza. We also found subgroup-level differences in vaccination rates between foreign-born and U.S.-born Asians. We found that (1) foreign-born Chinese, Asian Indians, and other Asians had lower human papillomavirus and hepatitis B vaccination rates; (2) foreign-born Chinese and Filipinos had lower pneumococcal vaccination rates; (3) foreign-born Chinese and Asian Indians had lower influenza vaccination rates; and (4) all foreign-born Asian subgroups had lower tetanus vaccination rates. Conclusions: Vaccination rates and trends differed among Asian American subgroups. Culturally tailored messaging and interventions may improve vaccine uptakes.

Background: Although Asian-American individuals have higher rates of some vaccine-preventable diseases such as hepatitis B, vaccination rates among them are low compared with those of non-Hispanic White individuals. Most vaccine research looks at Asian-American people as a single category despite large within-group heterogeneity in health-seeking behaviours. Little is known about vaccination coverage among disaggregated Asian-American ethnic subgroups, although such information could inform policies focused on increasing vaccine uptake. Therefore, we aimed to assess vaccination coverage for several vaccines among disaggregated Asian-American subgroups. Methods: We examined National Health Interview Survey (NHIS) data from 2015–18 to analyse the vaccination status of Chinese, Asian Indian, Filipino, other Asian, and non-Hispanic White adults (n=253 626) for seven vaccines recommended by the US Centers for Disease Control and Prevention: human papillomavirus (HPV), hepatitis B (HBV), influenza, tetanus, tetanus-diphtheria-pertussis (Tdap), shingles, and the pneumococcal vaccine. We used NHIS data from 2006–18 (n=880 210) to analyse changes in vaccination rates for each ethnic group over time. We used logistic regression to estimate differences in vaccination rates while controlling for demographic, socioeconomic and health-related variables. Findings: Among the seven vaccines, HPV and shingles vaccines had the lowest uptake, whereas Tdap had the highest uptake among all groups. Compared with the non-Hispanic White group, Asian Indians were almost half as likely to receive the HPV vaccine (odds ratio 0·61, 95% CI 0·41–0·92), whereas Filipinos (1·51, 1·02–2·25) and other Asians (1·42, 1·02–1·97) were more likely to receive it. The Filipino (1·50, 1·21–1·88) and other Asian groups (1·42, 1·19–1·71) were more likely to receive the HBV vaccine than the non-Hispanic White group. For the influenza vaccine, the Asian Indian (1·28, 1·05–1·56), Filipino (1·44, 1·17–1·79) and other Asian (1·38, 1·16–1·65) groups were more likely to receive the vaccine than the non-Hispanic White group. For the pneumococcal vaccine, the Chinese (0·57, 0·34–0·94) and other Asian (0·66, 0·47–0·92) groups were less likely to receive the vaccine than the non-Hispanic White group. Interpretation: Among US adults, we found significant disparities in vaccine uptake among different Asian and Asian-American ethnic groups. US policy makers trying to improve vaccine uptake among Asian and Asian-American people could learn from successful international immunisation programmes to develop culturally appropriate interventions to improve vaccine uptake in Asian and Asian-American individuals. Funding: None.

Abstract Introduction We aimed to characterize the clinical impact of amyloid PET (APET) in a veteran population with cognitive decline by comparing differences in management between those who did and did not have an APET. Methods This was a retrospective observational study. Poisson regressions and logistic regression were used for comparisons. Results Out of 565 veterans, 197 underwent APET; positivity rate was 36.55%. Having an APET was associated with longer follow‐up, and increased diagnostic variability; it was not associated with number of additional studies, cholinesterase inhibitors prescription, or referrals to research. A positive APET was associated with less diagnostic variability, fewer additional tests, greater cholinesterase inhibitor prescriptions, and more research referrals. Discussion In a medically complex, real‐world population, APET yielded lower positivity rates and was not associated with classical clinical utility variables when comparing patients with and without an APET. APET may be used more to “rule out” rather than to confirm Alzheimer's disease. Highlights Amyloid PET was associated with longer follow‐up, and higher diagnostic variability. No association was seen with cholinesterase inhibitors prescription, or referrals to research. In complex patients, expected amyloid PET positivity rates are lower than previously described. Amyloid PETs were used to “rule out” AD than to confirm the diagnosis of AD.

Abstract Introduction This study assessed the ordering of amyloid positron emission tomography (PET) scans in a Veterans Affairs (VA) memory disorders clinic as part of routine clinical care, with possible implications for the extent to which ordering may occur outside of the VA in the future if covered by insurance. Methods Clinical features predictive of ordering amyloid PET scans were retrospectively assessed; the percentage of patients who met appropriate use criteria were evaluated. Results Among 565 veterans, 34.9% of received an amyloid PET scan and 98.0% of these were consistent with appropriate use criteria. Patients with a PET were younger and more likely to have an initial diagnosis of Alzheimer's disease (AD). Of patients without an amyloid PET scan ordered, 64.4% would have met appropriate use criteria for amyloid PET. Discussion The majority of scans ordered were consistent with appropriate use criteria and more patients were eligible than received a scan. The current study's findings that approximately one‐third of patients in a memory disorders clinic received an amyloid PET scan has implications for memory disorders clinics inside and outside of the US Veterans Health Administration.

It remains a challenge to develop efficient electrocatalysts in neutral media for hydrogen evolution reaction (HER) due to the sluggish kinetics and switch of the rate determining step. Although metal phosphides are widely used HER catalysts, their structural stability is an issue due to oxidization, and the HER performance in neutral media requires improvement. Herein, a new material, i.e., grapevine‐shaped N‐doped iron phosphide on carbon nanotubes, as an efficient HER catalyst in neutral media is developed. The optimized catalyst shows an overpotential of 256 mV at a large current density of 65 mA cm−2, which is even 10 mV lower than that of the commercial 20% Pt/C catalyst. The excellent performance of the catalyst is further studied by combined computational and experimental techniques, which proves that the interaction between nitrogen and iron phosphides can provide more efficient active structures and stabilize the metal phosphide electrocatalysts for HER.

Background: Ultrasound guided sampling of human lymph node (LN) combined with advanced flow cytometry allows phenotypic analysis of multiple immune cell subsets. These may provide insights into immune processes and responses to immunotherapies not apparent from analysis of the blood.Methods: Ultrasound guided inguinal LN samples were obtained by both fine needle aspiration (FNA) and core needle biopsy in 10 adults within 8 weeks of diagnosis of type 1 diabetes (T1D) and 12 age-matched healthy controls at two study centers. Peripheral blood mononuclear cells (PBMC) were obtained on the same occasion. Samples were transported same day to the central laboratory and analyzed by multicolour flow cytometry.Results: LN sampling was well-tolerated and yielded sufficient cells for analysis in 95% of cases. We confirmed the segregation of CD69+ cells into LN and the predominance of CD8+ Temra cells in blood previously reported. In addition, we demonstrated clear enrichment of CD8+ naïve, FOXP3+ Treg, class-switched B cells, CD56bright NK cells and plasmacytoid dendritic cells (DC) in LNs as well as CD4+ T cells of the Th2 phenotype and those expressing Helios and Ki67. Conventional NK cells were virtually absent from LNs as were Th22 and Th1Th17 cells. Paired correlation analysis of blood and LN in the same individuals indicated that for many cell subsets, especially those associated with activation: such as CD25+ and proliferating (Ki67+) T cells, activated follicular helper T cells and class-switched B cells, levels in the LN compartment could not be predicted by analysis of blood. We also observed an increase in Th1-like Treg and less proliferating (Ki67+) CD4+ T cells in LN from T1D compared to control LNs, changes which were not reflected in the blood.Conclusions: LN sampling in humans is well-tolerated. We provide the first detailed “roadmap” comparing immune subsets in LN vs. blood emphasizing a role for differentiated effector T cells in the blood and T cell regulation, B cell activation and memory in the LN. For many subsets, frequencies in blood, did not correlate with LN, suggesting that LN sampling would be valuable for monitoring immuno-therapies where these subsets may be impacted.

Agents promoting oligodendrocyte precursor cell differentiation have the potential to restore halted and/or delayed remyelination in patients with multiple sclerosis. However, few therapeutic targets have been identified. The objective of this study was to identify novel targets for promotion of remyelination and characterize their activity in vitro and in vivo.A high-content screening assay with differentiation of primary rat oligodendrocyte precursor cells was used to screen GSK-proprietary annotated libraries for remyelination-promoting compounds. Compounds were further validated in vitro and in vivo models; clinical relevance of target was confirmed in human post-mortem brain sections from patients with MS.Of ~1000 compounds screened, 36 promoted oligodendrocyte precursor cell differentiation in a concentration-dependent manner; seven were histamine receptor-3 (H3R) antagonists. Inverse agonists of H3R but not neutral antagonists promoted oligodendrocyte precursor cell (OPC) differentiation. H3R was expressed throughout OPC differentiation; H3R expression was transiently upregulated on Days 3-5 and subsequently downregulated. H3R gene knockdown in OPCs increased the expression of differentiation markers and the number of mature oligodendrocytes. Overexpression of full-length H3R reduced differentiation marker expression and the number of mature cells. H3R inverse agonist GSK247246 reduced intracellular cyclic AMP (cAMP) and downstream cAMP response element-binding protein (CREB) phosphorylation in a dose-dependent manner. Histone deacetylase (HDAC-1) and Hes-5 were identified as key downstream targets of H3R during OPC differentiation. In the mouse cuprizone/rapamycin model of demyelination, systemic administration of brain-penetrable GSK247246 enhanced remyelination and subsequently protected axons. Finally, we detected high H3R expression in oligodendroglial cells from demyelination lesions in human samples of patients with MS, and validated a genetic association between an exonic single nucleotide polymorphism in HRH3 and susceptibility to multiple sclerosis.From phenotypic screening to human genetics, we provide evidence for H3R as a novel therapeutic target to promote remyelination in patients with multiple sclerosis.

Rigorous comparisons between single site-and nanoparticle (NP)-dispersed catalysts featuring the same composition, in terms of activity, selectivity, and reaction mechanism, are limited. This limitation is partly due to the tendency of single metal atoms to sinter into aggregated NPs at high loadings and elevated temperatures, driven by a decrease in metal surface free energy. Here, we have developed a unique two-step method for the synthesis of single Cu sites on ZSM-5 (termed CuS/ZSM-5) with high thermal stability. The atomic-level dispersion of single Cu sites was confirmed through scanning transmission electron microscopy, X-ray absorption fine structure (XAFS), and electron paramagnetic resonance spectroscopy. The CuS/ZSM-5 catalyst was compared to a CuO NP-based catalyst (termed CuN/ZSM-5) in the oxidation of NH3 to N2, with the former exhibiting superior activity and selectivity. Furthermore, operando XAFS and diffuse reflectance infrared Fourier transform spectroscopy studies were conducted to simultaneously assess the fate of the Cu and the surface adsorbates, providing a comprehensive understanding of the mechanism of the two catalysts. The study shows that the facile redox behavior exhibited by single Cu sites correlates with the enhanced activity observed for the CuS/ZSM-5 catalyst. [ABSTRACT FROM AUTHOR]