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Bicycles and other forms of micromobility have been anecdotally used in past disasters to help save lives and improve community recovery. However, research and practice are scarce on this resilient transportation strategy, which limits its usefulness and possible benefits. To fill this gap, our paper investigates the potential role bicycles and micromobility in facilitating (or limiting) disaster response and recovery. Given the lack of exploration on the topic, we convened an online workshop where we conducted brainstorming and focus group discussions with disaster experts from various government agencies, not-for-profit organizations, academia, and policy groups. We present a synthesis of that discussion, along with a review of the existing literature. We conclude there is strong potential for bicycles and micromobility for different disaster phases, hazard types, and groups of people. However, multiple barriers exist related to implementation and safety, suggesting a need for future research and policy in the transportation and emergency management fields and practices.

PURPOSE: To evaluate the performance of a biopsy decision support algorithmic model, the intelligent-augmented breast cancer risk calculator (iBRISK), on a multicenter patient dataset. MATERIALS AND METHODS: iBRISK was previously developed by applying deep learning to clinical risk factors and mammographic descriptors from 9700 patient records at the primary institution and validated using another 1078 patients. All patients were seen from March 2006 to December 2016. In this multicenter study, iBRISK was further assessed on an independent, retrospective dataset (January 2015-June 2019) from three major health care institutions in Texas, with Breast Imaging Reporting and Data System (BI-RADS) category 4 lesions. Data were dichotomized and trichotomized to measure precision in risk stratification and probability of malignancy (POM) estimation. iBRISK score was also evaluated as a continuous predictor of malignancy, and cost savings analysis was performed. RESULTS: The iBRISK models accuracy was 89.5%, area under the receiver operating characteristic curve (AUC) was 0.93 (95% CI: 0.92, 0.95), sensitivity was 100%, and specificity was 81%. A total of 4209 women (median age, 56 years [IQR, 45-65 years]) were included in the multicenter dataset. Only two of 1228 patients (0.16%) in the low POM group had malignant lesions, while in the high POM group, the malignancy rate was 85.9%. iBRISK score as a continuous predictor of malignancy yielded an AUC of 0.97 (95% CI: 0.97, 0.98). Estimated potential cost savings were more than $420 million. CONCLUSION: iBRISK demonstrated high sensitivity in the malignancy prediction of BI-RADS 4 lesions. iBRISK may safely obviate biopsies in up to 50% of patients in low or moderate POM groups and reduce biopsy-associated costs.Keywords: Mammography, Breast, Oncology, Biopsy/Needle Aspiration, Radiomics, Precision Mammography, AI-augmented Biopsy Decision Support Tool, Breast Cancer Risk Calculator, BI-RADS 4 Mammography Risk Stratification, Overbiopsy Reduction, Probability of Malignancy (POM) Assessment, Biopsy-based Positive Predictive Value (PPV3) Supplemental material is available for this article. Published under a CC BY 4.0 license.See also the commentary by McDonald and Conant in this issue.

Climate change and environmental problems have spurred new strategies to reduce fossil fuel consumption in transportation. Two important strategies include a rapid transition to green energy and the replacement of internal combustion vehicles with electric vehicles (EVs). However, the increasing demand for electricity by EVs, especially from time-dependent green sources of energy (e.g., solar, wind), will likely overload the grid at peak hours. Rather than build costly infrastructure improvements for distribution and generation, smart charging programs for EVs could defer charging to off-peak times and better match demand with supply. Yet, little is currently known about people’s willingness to participate in a program and relinquish control of charging to a third party.

Digital health technologies have been in use for many years in a wide spectrum of healthcare scenarios. This narrative review outlines the current use and the future strategies and significance of digital health technologies in modern healthcare applications. It covers the current state of the scientific field (delineating major strengths, limitations, and applications) and envisions the future impact of relevant emerging key technologies. Furthermore, we attempt to provide recommendations for innovative approaches that would accelerate and benefit the research, translation and utilization of digital health technologies.

For evacuations, people must make the critical decision to evacuate or stay followed by a multi-dimensional choice composed of concurrent decisions of their departure time, transportation mode, route, destination, and shelter type. These choices have important impacts on transportation response and evacuation outcomes. While extensive research has been conducted on hurricane evacuation behavior, little is known about wildfire evacuation behavior. To address this critical research gap, particularly related to joint choice-making in wildfires, we surveyed individuals impacted by the 2017 December Southern California Wildfires (n = 226) and the 2018 Carr Wildfire (n = 284). Using these data, we contribute to the literature in two key ways. First, we develop two latent class choice models (LCCMs) to evaluate the factors that influence the decision to evacuate or stay/defend. We find an evacuation keen class and an evacuation reluctant class that are influenced differently by mandatory evacuation orders. This nuance is further supported by different membership of people to the classes based on demographics and risk perceptions. Second, we develop two portfolio choice models (PCMs), which jointly model choice dimensions to assess multi-dimensional evacuation choice. We find several similarities between wildfires including a joint preference for within-county and nighttime evacuations and a joint dislike for within-county and highway evacuations. Altogether, this paper provides evidence of heterogeneity in response to mandatory evacuation orders for wildfires, distinct membership of populations to different classes of people for evacuating or staying/defending, and clear correlation among key wildfire evacuation choices that necessitates joint modeling to holistically understanding wildfire evacuation behavior.

Recent wildfire risks in California have prompted the implementation of public safety power shutoff (PSPS) events, procedures enacted by utility operators to de-energize parts of the electrical grid and reduce the likelihood of wildfire ignition. Despite their yearly occurrence, PSPS events are severely understudied, and little is known about how these events impact disaster preparation activity, travel behavior, and transportation systems. With growing wildfire risks in North America and beyond, PSPS events require immediate and thorough research to reduce their negative externalities and maximize their benefits. This exploratory study employs survey data from East Bay Hills residents in Alameda and Contra Costa counties in California who were impacted by two PSPS events in October 2019 (n=210). Through descriptive statistics and basic discrete choice models for the decision to conduct typical or changed travel, this research contributes to the literature as the first assessment of PSPS event travel behavior. We found that travel did not change drastically during the event, though respondents conducted a high number of preparedness activities. A sizable portion of the sample conducted extended trips during the PSPS event days, while a small number evacuated to a destination overnight. Respondents received relatively clear information from multiple communication methods, indicating substantial information about the events.  Modeling results found that power loss was a driver in travel behavior change, while demographics indicated heterogeneous responses within the sample. The paper concludes with a discussion of key takeaways and suggestions for research in this nascent field.

Recent technological improvements have greatly expanded the sharing economy (e.g., Airbnb, Lyft, and Uber), coinciding with growing need for transportation and sheltering resources in evacuations. To understand influencers on sharing willingness in evacuations, we employed a multi-modeling approach across four sharing scenarios using three model types: 1) four binary logit models that capture each scenario separately; 2) a multi-choice latent class choice model (LCCM) that jointly estimates multiple scenarios via latent classes; and 3) a portfolio choice model (PCM) that estimates dimensional dependency. We tested our approach by employing online survey data from 2017 Hurricane Irma evacuees (n=368).The multi-model approach uncovered behavioral nuances undetectable with a single model. First, the multi-choice LCCM and PCM models uncovered scenario correlation, specifically willingness to share for both transportation scenarios and both sheltering scenarios. Second, the multi-choice LCCM found three classes – transportation sharers, adverse sharers, and interested sharers. Transportation sharers were more likely to be female, lower-income, and residents of Southwest Florida compared to adverse sharers. Interested sharers were more likely to be male, long-time residents, and higher-income compared to adverse sharers. Third, families with children were unwilling to share regardless of the model, while spare capacity (i.e., seatbelts, spare beds) had a positive but somewhat insignificant influence on sharing. Fourth, experienced home sharers were more willing to share shelter in the binary logit and PCM models. We suggest that local agencies consider holistic sharing mechanisms across resource types and time (i.e., before, during, and after a hurricane evacuation).

Government agencies must make rapid and informed decisions in wildfires to safely evacuate people. However, current evacuation simulation tools for resource-strapped agencies largely fail to compare possible transportation responses or incorporate empirical evidence from past wildfires. Consequently, we employ online survey data from evacuees of the 2017 Northern California Wildfires (n=37), the 2017 Southern California Wildfires (n=175), and the 2018 Carr Wildfire (n=254) to inform a policy-oriented traffic evacuation simulation model. We test our simulation for a hypothetical wildfire evacuation in the wildland urban interface (WUI) of Berkeley, California. We focus on variables including fire speed, departure time distribution, towing of items, transportation mode, GPS-enabled rerouting, phased evacuations (i.e., allowing higher-risk residents to leave earlier), and contraflow (i.e., switching all lanes away from danger). We found that reducing household vehicles (i.e., to 1 vehicle per household) and increasing GPS-enabled rerouting (e.g., 50% participation) lowered exposed vehicles (i.e., total vehicles in the fire frontier) by over 50% and evacuation time estimates (ETEs) by about 30% from baseline. Phased evacuations with a suitable time interval reduced exposed vehicles most significantly (over 90%) but produced a slightly longer ETE. Both contraflow (on limited links due to resource constraints) and slowing fire speed were effective in lowering exposed vehicles (around 50%), but not ETEs. Extended contraflow can reduce both exposed vehicles and ETEs. We recommend agencies develop a communication and parking plan to reduce evacuating vehicles, create and communicate a phased evacuation plan, and build partnerships with GPS-routing services.