REDCap to Epic interfaces create an efficient hybrid software solution for a public health registry.

A public health registry and intervention was created in response to the Flint water crisis to identify and refer exposed individuals to public health services to ameliorate the deleterious impact of lead exposure. Traditional technology architecture domains, funded scope of work, as well as community input were considered when defining the requirements of the selected solutions. A hybrid software solution was created using Research Electronic Data Capture (REDCap) to deploy an open participant survey and bypass requirements to create user accounts, and Epic to manage deduplication and participant communication and tracking. To bridge the two software systems, REDCap to Epic unidirectional ADT and Documentation Flowsheet interfaces were built to automate creation of subject records in Epic identical to those created in REDCap and to copy key protocol-driving variables from REDCap to Epic. The interfaces were critical to deliver a successful hybrid solution in which the desired features of each software could be leveraged to satisfy specific protocol requirements and community input. Data from the start of survey administration (December 2018) through 31 December 2020 are reported to demonstrate the usefulness of the interfaces.

Modeling direct air carbon capture and storage in a 1.5 °C climate future using historical analogs.

Limiting the rise in global temperature to 1.5 °C will rely, in part, on technologies to remove CO2 from the atmosphere. However, many carbon dioxide removal (CDR) technologies are in the early stages of development, and there is limited data to inform predictions of their future adoption. Here, we present an approach to model adoption of early-stage technologies such as CDR and apply it to direct air carbon capture and storage (DACCS). Our approach combines empirical data on historical technology analogs and early adoption indicators to model a range of feasible growth pathways. We use these pathways as inputs to an integrated assessment model (the Global Change Analysis Model, GCAM) and evaluate their effects under an emissions policy to limit end-of-century temperature change to 1.5 °C. Adoption varies widely across analogs, which share different strategic similarities with DACCS. If DACCS growth mirrors high-growth analogs (e.g., solar photovoltaics), it can reach up to 4.9 GtCO2 removal by midcentury, compared to as low as 0.2 GtCO2 for low-growth analogs (e.g., natural gas pipelines). For these slower growing analogs, unabated fossil fuel generation in 2050 is reduced by 44% compared to high-growth analogs, with implications for energy investments and stranded assets. Residual emissions at the end of the century are also substantially lower (by up to 43% and 34% in transportation and industry) under lower DACCS scenarios. The large variation in growth rates observed for different analogs can also point to policy takeaways for enabling DACCS.

Equity and modeling in sustainability science: Examples and opportunities throughout the process.

Equity is core to sustainability, but current interventions to enhance sustainability often fall short in adequately addressing this linkage. Models are important tools for informing action, and their development and use present opportunities to center equity in process and outcomes. This Perspective highlights progress in integrating equity into systems modeling in sustainability science, as well as key challenges, tensions, and future directions. We present a conceptual framework for equity in systems modeling, focused on its distributional, procedural, and recognitional dimensions. We discuss examples of how modelers engage with these different dimensions throughout the modeling process and from across a range of modeling approaches and topics, including water resources, energy systems, air quality, and conservation. Synthesizing across these examples, we identify significant advances in enhancing procedural and recognitional equity by reframing models as tools to explore pluralism in worldviews and knowledge systems; enabling models to better represent distributional inequity through new computational techniques and data sources; investigating the dynamics that can drive inequities by linking different modeling approaches; and developing more nuanced metrics for assessing equity outcomes. We also identify important future directions, such as an increased focus on using models to identify pathways to transform underlying conditions that lead to inequities and move toward desired futures. By looking at examples across the diverse fields within sustainability science, we argue that there are valuable opportunities for mutual learning on how to use models more effectively as tools to support sustainable and equitable futures.

Social roles influence cortisol levels in captive Livingstone's fruit bats (Pteropus livingstonii).

A critical component of conserving and housing species ex situ is an explicit scientific understanding of the physiological underpinnings of their welfare. Cortisol has been repeatedly linked to stress, and therefore used as an indicator of welfare for many species. In order to measure cortisol in the Livingstone's fruit bat (Pteropus livingstonii; a critically endangered keystone species) without disturbing the captive population, we have developed and validated a non-invasive, novel hormone extraction procedure and faecal glucocorticoid assay. A total of 92 faecal samples, 73 from the P. livingstonii breeding colony at Jersey Zoo, Channel Islands and 19 samples from P. livingstonii housed at Bristol Zoological Gardens, UK, have been collected and analyzed. Mixed-effect modelling of the influence of physiological state variables on cortisol concentration revealed that lactating females had higher cortisol levels than non-lactating females, indicating that our assay is measuring biologically relevant hormone concentrations. Males and older bats also had higher cortisol than non-lactating females and younger individuals. Further analysis applied social network methodology to compare the cortisol levels of bats with different social roles. We found that individuals that linked social groups possessed higher than average cortisol levels and conversely, individuals with high-quality, positive relationships had lower cortisol levels. These results demonstrate, for the first time in a bat species, social mediation of stress hormones. Lastly, the frequency of vocalisation was found to positively correlate with cortisol concentration in males, suggesting that this behaviour may be used by animal management as a visual indicator of a bat's hormonal status. Hence, this research has provided unique insights and empirical scientific knowledge regarding the relationship between the physiology and social behaviour of P. livingstonii, therefore allowing for recommendations to be made to optimise bat welfare at the individual level.

Repair Failures Call for New Policies to Tackle Leaky Natural Gas Distribution Systems.

Methane leaks in natural gas systems are low-hanging fruit for near-term, locally driven climate policy. Recent work suggests this emissions source is larger than previously believed and that repairing a small number of high emitters can cost-effectively reduce system-wide leakage. How successful are these repairs on the ground? Here, we assess the effectiveness of repair policies in the Massachusetts distribution system. Our analysis leverages state-wide utility data, on-site empirical measurements, stakeholder interviews, and document and legal analysis. We use these mixed methods to investigate the rate of repair failure, where a gas utility identifies and fixes a leak, but on-site emissions are not eliminated. We find that repair failures are relatively common, yet they are repeatedly neglected in policy. By not accounting for repair failures, policy may overestimate the effectiveness of distribution system repairs in meeting local greenhouse gas reduction targets. These results also underscore the importance of data transparency for monitoring and verifying subnational climate policies.

A plant-by-plant strategy for high-ambition coal power phaseout in China.

More than half of current coal power capacity is in China. A key strategy for meeting China's 2060 carbon neutrality goal and the global 1.5 °C climate goal is to rapidly shift away from unabated coal use. Here we detail how to structure a high-ambition coal phaseout in China while balancing multiple national needs. We evaluate the 1037 currently operating coal plants based on comprehensive technical, economic and environmental criteria and develop a metric for prioritizing plants for early retirement. We find that 18% of plants consistently score poorly across all three criteria and are thus low-hanging fruits for rapid retirement. We develop plant-by-plant phaseout strategies for each province by combining our retirement algorithm with an integrated assessment model. With rapid retirement of the low-hanging fruits, other existing plants can operate with a 20- or 30-year minimum lifetime and gradually reduced utilization to achieve the 1.5 °C or well-below 2 °C climate goals, respectively, with complete phaseout by 2045 and 2055.

R2 and R2* MRI assessment of liver iron content in an undifferentiated diagnostic population with hyperferritinaemia, and impact on clinical decision making.

PURPOSE: To confirm the linear correlation between Ferriscan® R2 (1/T2 Relaxomatry) and R2* (1/T2* Relaxometry) derived 3D Gradient echo (GRE) mDIXON-Quant sequence (Philips) with simultaneous production of a proton density fat fraction (PDFF) in undifferentiated patients with hyperferritinaemia, and to prospectively determine the clinical utility of this tool in these patients by recording the impact on clinical decision-making. MATERIALS AND METHODS: Participants referred to a hospital haematology outpatient clinic for investigation and management of elevated serum ferritin (two serum ferritin levels > 500 µg/L 4 weeks apart) were included in the study. EXCLUSION CRITERIA: contraindications to MRI; clinically relevant investigations for alternative causes of hyperferritinaemia pending; and terminal illness. Thirty-two participants were recruited: 27 men, 5 women. All MRIs performed at 1.5 T. For R2* quantification, 3D six echo GRE sequence (mDIXON-Quant) was acquired. R2 images were acquired over 20 min as dictated and reported by the licensee (Ferriscan®). Clinician interpretation and patient management based on R2* and liver iron content derived from R2 (LICR2) was recorded. Pearson's correlations, linear regression analyses, and ROC curves were calculated. P value <0.05 was considered significant. RESULTS: A high degree of correlation between mean R2* and LICR2 was observed in this novel patient population (slope ±â€¯SE of 43.35 ±â€¯1.88 s-1 permg/g; 95 % CI 39.5-47.2; P < 0.001; R2 = 0.87). Clinical decision making was amended in 14/32 (44 %) patients with hyperferritinaemia following the disclosure of R2* results to clinicians, compared with serum ferritin alone. Liver biopsy was avoided in one patient based on LICR2 and R2*. Unrecognised hepatic steatosis was diagnosed in one patient from the PDFF map. CONCLUSION: We have confirmed the linear correlation between R2 and R2* in a real-world diagnostic population with hyperferritinaemia. Non-invasive assessment of liver iron content (LIC) by R2 and R2* MRI is a useful clinical tool and alters management in these patients.

Fusing subnational with national climate action is central to decarbonization: the case of the United States.

Approaches that root national climate strategies in local actions will be essential for all countries as they develop new nationally determined contributions under the Paris Agreement. The potential impact of climate action from non-national actors in delivering higher global ambition is significant. Sub-national action in the United States provides a test for how such actions can accelerate emissions reductions. We aggregated U.S. state, city, and business commitments within an integrated assessment model to assess how a national climate strategy can be built upon non-state actions. We find that existing commitments alone could reduce emissions 25% below 2005 levels by 2030, and that enhancing actions by these actors could reduce emissions up to 37%. We show how these actions can provide a stepped-up basis for additional federal action to reduce emissions by 49%-consistent with 1.5 °C. Our analysis demonstrates sub-national actions can lead to substantial reductions and support increased national action.

Host Range of the Mikrocytid Parasite Paramikrocytos canceri in Decapod Crustaceans.

Mikrocytids are a widespread but rather neglected group of parasites of aquatic invertebrates. One such parasite is Paramikrocytos canceri-discovered to infect the antennal gland of the juvenile edible crab, Cancer pagurus, taken from several intertidal sites across the United Kingdom. To determine if this parasite is also present in other species of decapod crustaceans, we surveyed crabs (n = 330) across two contrasting sites in Pembrokeshire (UK). Using a histopathological approach, P. canceri infection was confirmed in variable numbers of edible crabs from both survey sites, 7%-44%. No measurable signs of infection were encountered in four other co-located species, including European shore crabs (Carcinus maenas), Montagu's crabs (Xantho hydrophilus), velvet swimming crabs (Necora puber) and broad-clawed porcelain crabs (Porcellana platycheles). These data imply that P. canceri has a more limited host range than suggested by molecular diagnosis alone.

Quantifying operational lifetimes for coal power plants under the Paris goals.

A rapid transition away from unabated coal use is essential to fulfilling the Paris climate goals. However, many countries are actively building and operating coal power plants. Here we use plant-level data to specify alternative trajectories for coal technologies in an integrated assessment model. We then quantify cost-effective retirement pathways for global and country-level coal fleets to limit long-term temperature change. We present our results using a decision-relevant metric: the operational lifetime limit. Even if no new plants are built, the lifetimes of existing units are reduced to approximately 35 years in a well-below 2 °C scenario or 20 years in a 1.5 °C scenario. The risk of continued coal expansion, including the near-term growth permitted in some Nationally Determined Contributions (NDCs), is large. The lifetime limits for both 2 °C and 1.5 °C are reduced by 5 years if plants under construction come online and 10 years if all proposed projects are built.

Deliberate teaching tools for clinical teaching encounters: A critical scoping review and thematic analysis to establish definitional clarity.

PURPOSE AND METHOD: We conducted a scoping review of tools designed to add structure to clinical teaching, with a thematic analysis to establish definitional clarity. RESULTS: Six thousand and forty nine citations were screened, 434 reviewed for eligibility, and 230 identified as meeting study inclusion criteria. Eighty-nine names and 51 definitions were identified. Based on a post facto thematic analysis, we propose that these tools be named "deliberate teaching tools" (DTTs) and defined as "frameworks that enable clinicians to have a purposeful and considered approach to teaching encounters by incorporating elements identified with good teaching practice." We identified 46 DTTs in the literature, with 38 (82.6%) originally described for the medical setting. Forty justification articles consisted of 16 feedback surveys, 13 controlled trials, seven pre-post intervention studies with no control group, and four observation studies. Current evidence of efficacy is not entirely conclusive, and many studies contain methodology flaws. Forty-nine clarification articles comprised 12 systematic reviews and 37 narrative reviews. The most number of DTTs described by any review was four. A common design theme was identified in approximately three-quarters of DTTs. CONCLUSIONS: Applicability of DTTs to specific alternate settings should be considered in context, and appropriately designed justification studies are warranted to demonstrate efficacy.

Vehicle emissions of short-lived and long-lived climate forcers: trends and tradeoffs.

Evaluating technology options to mitigate the climate impacts of road transportation can be challenging, particularly when they involve a tradeoff between long-lived emissions (e.g., carbon dioxide) and short-lived emissions (e.g., methane or black carbon). Here we present trends in short- and long-lived emissions for light- and heavy-duty transport globally and in the U.S., EU, and China over the period 2000-2030, and we discuss past and future changes to vehicle technologies to reduce these emissions. We model the tradeoffs between short- and long-lived emission reductions across a range of technology options, life cycle emission intensities, and equivalency metrics. While short-lived vehicle emissions have decreased globally over the past two decades, significant reductions in CO2 will be required by mid-century to meet climate change mitigation targets. This is true regardless of the time horizon used to compare long- and short-lived emissions. The short-lived emission intensities of some low-CO2 technologies are higher than others, and thus their suitability for meeting climate targets depends sensitively on the evaluation time horizon. Other technologies offer low intensities of both short-lived emissions and CO2.

A New Image Analysis Method Based on Morphometric and Fractal Parameters for Rapid Evaluation of In Situ Mammalian Mast Cell Status.

Apart from their effector functions in allergic disorders, tissue-resident mast cells (MC) are gaining recognition as initiators of inflammatory events through their distinctive ability to secrete many bioactive molecules harbored in cytoplasmic granules. Activation triggers mediator release through a regulated exocytosis named degranulation. MC activation is still substantiated by measuring systemic levels of MC-restricted mediators. However, identifying the anatomical location of MC activation is valuable for disease diagnosis. We designed a computer-assisted morphometric method based on image analysis of methylene blue (MB)-stained normal mouse skin tissue sections that quantitates actual in situ MC activation status. We reasoned MC cytoplasm could be viewed as an object featuring unique relative mass values based on activation status. Integrated optical density and area (A) ratios were significantly different between intact and degranulated MC (p<0.001). The examination of fractal characteristics is of translational diagnostic/prognostic value in cancer and readily applied to quantify cytoskeleton morphology and vasculature. Fractal dimension (D), a measure of their comparative space filling capacity and structural density, also differed significantly between intact and degranulated MC (p<0.001). Morphometric analysis provides a reliable and reproducible method for in situ quantification of MC activation status.

Disease profiles of juvenile edible crabs (Cancer pagurus L.) differ at two geographically-close intertidal sites.

The prevalence of disease in edible crabs (Cancer pagurus) was assessed at two sites in South West Wales; one estuarine (Pembroke Ferry) and another facing open water (Freshwater East). Diseases included pink crab disease caused by Hematodinium sp., an infection of the antennal gland caused by Paramikrocytos canceri and an idiopathic inflammatory condition of the connective tissue surrounding the anterior ganglionic masses. This latter condition was only found in crabs from Pembroke Ferry. There was a significantly higher prevalence of pink crab disease at Freshwater East than Pembroke Ferry, although both sites had similar levels of infection by P. canceri.