Equitable infrastructure: Achieving resilient systems and restorative justice through policy and research innovation.

Recent major investments in infrastructure in the United States and globally present a crucial opportunity to embed equity within the heart of resilient infrastructure decision-making. Yet there is a notable absence of frameworks within the engineering and scientific fields for integrating equity into planning, design, and maintenance of infrastructure. Additionally, whole-of-government approaches to infrastructure, including the Justice40 Initiative, mimic elements of process management that support exploitative rather than exploratory innovation. These and other policies risk creating innovation traps that limit analytical and engineering advances necessary to prioritize equity in decision-making, identification and disruption of mechanisms that cause or contribute to inequities, and remediation of historic harms. Here, we propose a three-tiered framework toward equitable and resilient infrastructure through restorative justice, incremental policy innovation, and exploratory research innovation. This framework aims to ensure equitable access and benefits of infrastructure, minimize risk disparities, and embrace restorative justice to repair historical and systemic inequities. We outline incremental policy innovation and exploratory research action items to address and mitigate risk disparities, emphasizing the need for community-engaged research and the development of equity metrics. Among other action items, we recommend a certification system-referred to as Social, Environmental, and Economic Development (SEED)-to train infrastructure engineers and planners and ensure attentiveness to gaps that exist within and dynamically interact across each tier of the proposed framework. Through the framework and proposed actions, we advocate for a transformative vision for equitable infrastructure that emphasizes the interconnectedness of social, environmental, and technical dimensions in infrastructure planning, design, and maintenance.

On the impact of resource relocation in facing health emergencies.

The outbreak of SARS-CoV-2 and the corresponding surge in patients with severe symptoms of COVID-19 put a strain on health systems, requiring specialized material and human resources, often exceeding the locally available ones. Motivated by a real emergency response system employed in Northern Italy, we propose a mathematical programming approach for rebalancing the health resources among a network of hospitals in a large geographical area. It is meant for tactical planning in facing foreseen peaks of patients requiring specialized treatment. Our model has a clean combinatorial structure. At the same time, it considers the handling of patients by a dedicated home healthcare service, and the efficient exploitation of resource sharing. We introduce mathematical programming heuristic based on decomposition methods and column generation to drive very large-scale neighborhood search. We evaluate its embedding in a multi-objective optimization framework. We experiment on real world data of the COVID-19 in Northern Italy during 2020, whose aggregation and post processing is made openly available to the community. Our approach proves to be effective in tackling realistic instances, thus making it a reliable basis for actual decision support tools.

Environmental justice analysis of wildfire-related PM2.5 exposure using low-cost sensors in California.

The increasing number and severity of wildfires is negatively impacting air quality for millions of California residents each year. Community exposure to PM2.5 in two main population centers (San Francisco Bay area and Los Angeles County area) was assessed using the low-cost PurpleAir sensor network for the record-setting 2020 California wildfire season. Estimated PM2.5 concentrations in each study area were compared to census tract-level environmental justice vulnerability indicators, including environmental, health, and demographic data. Higher PM2.5 concentrations were positively correlated with poverty, cardiovascular emergency department visits, and housing inequities. Sensors within 30 km of actively burning wildfires showed statistically significant increases in indoor (~800 %) and outdoor (~540 %) PM2.5 during the fires. Results indicate that wildfire emissions may exacerbate existing health disparities as well as the burden of pollution in disadvantaged communities, suggesting a need to improve monitoring and adaptive capacity among vulnerable populations.

A Latent Markov Model with Covariates to Study Unobserved Heterogeneity among Fertility Patterns of Couples Employing Natural Family Planning Methods.

PURPOSE: We use the historical data from the European Study of Daily Fecundability and we develop an algorithm to determine the fertile window in a woman's cycle according to the rules of the C.A.Me.N. symptothermal method proposed by the Centro Ambrosiano Metodi Naturali. Our aim is to identify variables acting on the probability of conception by considering the fertile window and factors that cannot be explained by employing the observed covariates of individuals and couples. METHODS: We adopt the latent Markov model with covariates tailored for data collected at times when a latent process detects the dependence across fertile periods of each woman's cycle. We consider measurement errors, transitions between conception and non-conception, and the prediction of conception rate over the fertile windows. CONCLUSION: We find that the conception pattern is mainly related to sexual intercourse behavior during the fertile window and to previous pregnancies. For the cohort under study, we predict a steep decline in the average conception rate across fertile windows.

Adherence to routine use of pharmacological prophylaxis of heterotopic ossification after total hip arthroplasty: results from an Italian multicenter, prospective, observational survey.

BACKGROUND: In spite of the proven efficacy of pharmacological prophylaxis of heterotopic ossification following total hip arthroplasty, its routine use is still debated, and no data are available regarding the adherence to its administration in clinical practice. MATERIALS AND METHODS: In this prospective, observational, multicenter study, 480 consecutive patients operated on for primary total hip arthroplasty during the year 2009 were followed radiographically for 12 months after surgery in order to assess the incidence of periprosthetic heterotopic ossification. Surgeons were free to choose whether to administer pharmacological prophylaxis, and were asked to keep a record of the duration of the prophylaxis (if used) or the reasons for not using it. To facilitate the statistical analysis, all of the participating centers agreed to use only one drug (celecoxib) that had already proven to be effective. RESULTS: 368 patients were administered celecoxib and 112 patients did not receive any prophylaxis. Reported reasons for not administering celecoxib prophylaxis were the surgeon's opinion that prophylaxis was not needed on a routine basis (84/112 patients, 75%), previous history of gastrointestinal bleeding (17.8%), and concomitant cardiorenal pathologies (7.1%). The overall incidence of heterotopic ossification in the celecoxib-treated patients was 23% (no cases of Brooker grade 3 or 4 ossifications), compared to 55% in the untreated patients (Brooker grade 3 and 4: 8.9%). Multivariate analysis showed that celecoxib prophylaxis was the single most important variable when predicting the occurrence of heterotopic ossification. CONCLUSIONS: This study confirms the efficacy and tolerability of celecoxib for the prophylaxis of heterotopic ossification after total hip arthroplasty, and shows how the surgeon's belief that routine prevention is not required still plays an important role in the determination of this complication, together with the fear of possible unwanted side effects.

Fertilisation involving ageing gametes, major birth defects, and Down's syndrome.

For many years, ageing of gametes as a result of prolonged retention in the female reproductive tract before fertilisation has been circumstantially associated with major birth defects. To assess this association, we studied pregnant women who had recorded the timing, with regard to presumed ovulation, of the coital event leading to conception. We found major anomalies in 11 (2.7%) of 400 infants born to women with optimally timed conceptions (on the day of or 1 day before ovulation), compared with 14 (2.5%) of 538 infants of women with non-optimally timed conceptions (odds ratio 0.94, 95% CI 0.43-2.06). The numbers of infants with Down's syndrome were two (0.5%) of 400, and four (0.7%) of 538, respectively (1.48, 0.27-8.06). There is no association between ageing gametes and major birth defects, including Down's syndrome.