Building resilience to extreme weather events in Phoenix: Considering contaminated sites and disadvantaged communities.

The interplay of contaminated sites, climate change, and disadvantaged communities are a growing concern worldwide. Worsening extreme events may result in accidental contaminant releases from sites and waste facilities that may impact nearby communities. If such communities are already suffering from environmental, economic, health, or social burdens, they may face disproportionate impacts. Equitable resilience planning to address effects of extreme events requires information on where the impacts may be, when they may occur, and who might be impacted. Because resources are often scarce for these communities, conducting detailed modeling may be cost-prohibitive. By considering indicators for four sources of vulnerability (changing extreme heat conditions, contaminated sites, contaminant transport via wind, and population sensitivities) in one holistic framework, we provide a scientifically robust approach that can assist planners with prioritizing resources and actions. These indicators can serve as screening measures to identify communities that may be impacted most and isolate the reasons for these impacts. Through a transdisciplinary case study conducted in Maricopa County (Arizona, USA), we demonstrate how the framework and geospatial indicators can be applied to inform plans for preparedness, response, and recovery from the effects of extreme heat on contaminated sites and nearby populations. The indicators employed in this demonstration can be applied to other locations with contaminated sites to build community resilience to future climate impacts.

Antibody-directed extracellular proximity biotinylation reveals that Contactin-1 regulates axo-axonic innervation of axon initial segments.

Axon initial segment (AIS) cell surface proteins mediate key biological processes in neurons including action potential initiation and axo-axonic synapse formation. However, few AIS cell surface proteins have been identified. Here, we use antibody-directed proximity biotinylation to define the cell surface proteins in close proximity to the AIS cell adhesion molecule Neurofascin. To determine the distributions of the identified proteins, we use CRISPR-mediated genome editing for insertion of epitope tags in the endogenous proteins. We identify Contactin-1 (Cntn1) as an AIS cell surface protein. Cntn1 is enriched at the AIS through interactions with Neurofascin and NrCAM. We further show that Cntn1 contributes to assembly of the AIS extracellular matrix, and regulates AIS axo-axonic innervation by inhibitory basket cells in the cerebellum and inhibitory chandelier cells in the cortex.

IF-City: Intelligible Fair City Planning to Measure, Explain and Mitigate Inequality.

With the increasing pervasiveness of Artificial Intelligence (AI), many visual analytics tools have been proposed to examine fairness, but they mostly focus on data scientist users. Instead, tackling fairness must be inclusive and involve domain experts with specialized tools and workflows. Thus, domain-specific visualizations are needed for algorithmic fairness. Furthermore, while much work on AI fairness has focused on predictive decisions, less has been done for fair allocation and planning, which require human expertise and iterative design to integrate myriad constraints. We propose the Intelligible Fair Allocation (IF-Alloc) Framework that leverages explanations of causal attribution (Why), contrastive (Why Not) and counterfactual reasoning (What If, How To) to aid domain experts to assess and alleviate unfairness in allocation problems. We apply the framework to fair urban planning for designing cities that provide equal access to amenities and benefits for diverse resident types. Specifically, we propose an interactive visual tool, Intelligible Fair City Planner (IF-City), to help urban planners to perceive inequality across groups, identify and attribute sources of inequality, and mitigate inequality with automatic allocation simulations and constraint-satisfying recommendations (IF-Plan). We demonstrate and evaluate the usage and usefulness of IF-City on a real neighborhood in New York City, US, with practicing urban planners from multiple countries, and discuss generalizing our findings, application, and framework to other use cases and applications of fair allocation.

Acquired Gastric Dieulafoy-Like Lesion due to Aberrant Blood Supply Diverted From the Left Phrenic Artery to an Enlarged Splenule.

Dieulafoy lesion is an aberrant submucosal vessel that can erode into the overlying tissue leading to hemorrhage. It is a rare but important cause of gastrointestinal bleeding. We present a case of a patient who developed an acquired Dieulafoy lesion 39 years after splenectomy. Abdominal computed tomography showed an aberrant vessel from a branch of the left phrenic artery, coursing through the gastric fundus to supply a splenule. Angiography with embolization of the aberrant vessel resulted in no further bleeding.

Antibody-directed extracellular proximity biotinylation reveals Contactin-1 regulates axo-axonic innervation of axon initial segments.

Axon initial segment (AIS) cell surface proteins mediate key biological processes in neurons including action potential initiation and axo-axonic synapse formation. However, few AIS cell surface proteins have been identified. Here, we used antibody-directed proximity biotinylation to define the cell surface proteins in close proximity to the AIS cell adhesion molecule Neurofascin. To determine the distributions of the identified proteins, we used CRISPR-mediated genome editing for insertion of epitope tags in the endogenous proteins. We found Contactin-1 (Cntn1) among the previously unknown AIS proteins we identified. Cntn1 is enriched at the AIS through interactions with Neurofascin and NrCAM. We further show that Cntn1 contributes to assembly of the AIS-extracellular matrix, and is required for AIS axo-axonic innervation by inhibitory basket cells in the cerebellum and inhibitory chandelier cells in the cortex.

Artificial Intelligence Enables Real-Time and Intuitive Control of Prostheses via Nerve Interface.

OBJECTIVE: The next generation prosthetic hand that moves and feels like a real hand requires a robust neural interconnection between the human minds and machines. METHODS: Here we present a neuroprosthetic system to demonstrate that principle by employing an artificial intelligence (AI) agent to translate the amputee's movement intent through a peripheral nerve interface. The AI agent is designed based on the recurrent neural network (RNN) and could simultaneously decode six degree-of-freedom (DOF) from multichannel nerve data in real-time. The decoder's performance is characterized in motor decoding experiments with three human amputees. RESULTS: First, we show the AI agent enables amputees to intuitively control a prosthetic hand with individual finger and wrist movements up to 97-98% accuracy. Second, we demonstrate the AI agent's real-time performance by measuring the reaction time and information throughput in a hand gesture matching task. Third, we investigate the AI agent's long-term uses and show the decoder's robust predictive performance over a 16-month implant duration. Conclusion & significance: Our study demonstrates the potential of AI-enabled nerve technology, underling the next generation of dexterous and intuitive prosthetic hands.

Relation of Community-Level Socioeconomic Status to Delayed Diagnosis of Acute Type A Aortic Dissection.

Acute type A aortic dissection requires timely diagnosis and intervention. Previous studies have examined risk factors associated with delayed diagnosis; however, the effect of socioeconomic status (SES) has not been previously studied. Our study examined the impact of various SES measures on time to diagnosis. We examined time to diagnosis in consecutive cases of acute type A aortic dissection at a single institution. SES variables included race/ethnicity, Medicaid eligibility, and residence in a zip code with an increased Distressed Communities Index-an aggregate measure of community SES. Delayed diagnosis was defined as time to diagnosis in the upper quartile of the study population (>6.6 hours). A model predicting risk factors for delayed diagnosis was created using multivariable logistic regression. Our study included 124 patients with a median time to diagnosis of 3.36 hours (interquartile range [IQR] 1.83 to 6.63). A total of 92 patients were in the nondelayed cohort (median diagnosis time of 2.59 hours, IQR 1.49 to 4.18) and 32 patients were in the delayed cohort (median diagnosis time of 15.57 hours, IQR 9.34 to 28.75). In multivariable logistic regression, residence in a high-Distressed Communities Index zip code was associated with diagnostic delay (adjusted odds ratio [aOR] 5.108, p = 0.008). Patient age (aOR 0.944, p = 0.011), chest pain at presentation (aOR 0.099, p = 0.004), back pain at presentation (aOR 0.247, p = 0.012), evidence of malperfusion syndrome (aOR 0.040, p <0.001), history of hyperlipidemia (aOR 3.507, p = 0.026), and history of congestive heart failure (aOR 0.061, p = 0.036) were also significantly associated. In conclusion, our findings suggest community-level SES affects time to diagnosis in acute type A aortic dissection.

Variation in estimates of heat-related mortality reduction due to tree cover in U.S. cities.

Heat-related mortality is one of the leading causes of weather-related deaths in the United States. With changing climates and an aging population, effective adaptive strategies to address public health and environmental justice issues associated with extreme heat will be increasingly important. One effective adaptive strategy for reducing heat-related mortality is increasing tree cover. Designing such a strategy requires decision-support tools that provide spatial and temporal information about impacts. We apply such a tool to estimate spatially and temporally explicit reductions in temperature and mortality associated with a 10% increase in tree cover in 10 U.S. cities with varying climatic, demographic, and land cover conditions. Two heat metrics were applied to represent tree impacts on moderately and extremely hot days (relative to historical conditions). Increasing tree cover by 10% reduced estimated heat-related mortality in cities significantly, with total impacts generally greatest in the most populated cities. Mortality reductions vary widely across cities, ranging from approximately 50 fewer deaths in Salt Lake City to about 3800 fewer deaths in New York City. This variation is due to differences in demographics, land cover, and local climatic conditions. In terms of per capita estimated impacts, hotter and drier cities experience higher percentage reductions in mortality due to increased tree cover across the season. Phoenix potentially benefits the most from increased tree cover, with an estimated 22% reduction in mortality from baseline levels. In cooler cities such as Minneapolis, trees can reduce mortality significantly on days that are extremely hot relative to historical conditions and therefore help mitigate impacts during heat wave conditions. Recent studies project highest increases in heat-related mortality in the cooler cities, so our findings have important implications for adaptation planning. Our estimated spatial and temporal distributions of mortality reductions for each city provide crucial information needed for promoting environmental justice and equity. More broadly, the methods and model can be applied by both urban planners and the public health community for designing targeted, effective policies to reduce heat-related mortality. Additionally, land use managers can use this information to optimize tree plantings. Public stakeholders can also use these impact estimates for advocacy.

The ABO histo-blood group, endothelial activation, and acute respiratory distress syndrome risk in critical illness.

BACKGROUNDThe ABO histo-blood group is defined by carbohydrate modifications and is associated with risk for multiple diseases, including acute respiratory distress syndrome (ARDS). We hypothesized that genetically determined blood subtype A1 is associated with increased risk of ARDS and markers of microvascular dysfunction and coagulation.METHODSWe conducted analyses in 3 cohorts of critically ill trauma and sepsis patients (n = 3710) genotyped on genome-wide platforms to determine the association of the A1 blood type genotype with ARDS risk. We subsequently determined whether associations were present in FUT2-defined nonsecretors who lack ABO antigens on epithelium, but not endothelium. In a patient subgroup, we determined the associations of blood type with plasma levels of endothelial glycoproteins and disseminated intravascular coagulation (DIC). Lastly, we tested whether blood type A was associated with less donor lung injury recovery during human ex vivo lung perfusion (EVLP).RESULTSThe A1 genotype was associated with a higher risk of moderate to severe ARDS relative to type O in all 3 populations. In sepsis, this relationship was strongest in nonpulmonary infections. The association persisted in nonsecretors, suggesting a vascular mechanism. The A1 genotype was also associated with higher DIC risk as well as concentrations of thrombomodulin and von Willebrand factor, which in turn were associated with ARDS risk. Blood type A was also associated with less lung injury recovery during EVLP.CONCLUSIONWe identified a replicable association between ABO blood type A1 and risk of ARDS among the critically ill, possibly mediated through microvascular dysfunction and coagulation.FUNDINGNIH HL122075, HL125723, HL137006, HL137915, DK097307, HL115354, HL101779, and the University of Pennsylvania McCabe Fund Fellowship Award.

Imma Sort by Two or More Attributes With Interpretable Monotonic Multi-Attribute Sorting.

Many choice problems often involve multiple attributes which are mentally challenging, because only one attribute is neatly sorted while others could be randomly arranged. We hypothesize that perceiving approximately monotonic trends across multiple attributes is key to the overall interpretability of sorted results, because users can easily predict the attribute values of the next items. We extend a ranking principal curve model to tune monotonic trends in attributes and present Imma Sort to sort items by multiple attributes simultaneously by trading-off the monotonicity in the primary sorted attribute to increase the human predictability for other attributes. We characterize how it performs for varying attribute correlations, attribute preferences, list lengths and number of attributes. We further extend Imma Sort with ImmaAnchor and ImmaCenter to improve the learnability and efficiency to search sorted items with conflicting attributes. We demonstrate usage scenarios for two applications and evaluate its learnability, usability, interpretability, and user performance in prediction and search tasks. We find that Imma Sort improves the interpretability and satisfaction of sorting by ≥ 2 attributes. We discuss why, when, where, and how to deploy Imma Sort for real-world applications.

Long-term follow-up of branch-duct intraductal papillary mucinous neoplasms with No change in first 5 Years of diagnosis.

BACKGROUND: Discontinuation of branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) surveillance after 5 years of no change remains controversial. Long-term outcomes of BD-IPMN without significant changes in the first 5 years were evaluated. METHODS: We performed a multi-center retrospective analysis of patients with BD-IPMN diagnosis from 2005 to 2011 (follow-up until 2017). Significant changes were defined as pancreatic cancer (PC), pancreatectomy, high-risk stigmata (HRS), worrisome features (WF) and worrisome EUS features (WEUS). RESULTS: Of 982 patients who had no significant changes, 5 (0.5%), 7 (0.7%), 99 (10.1%), 4 (0.4%) patients developed PC, HRS, WF, WEUS, respectively, post-5 years. PC and HRS/WF/WEUS incidences at 12 years were 1.0% and 29.0%, respectively. Patients that developed HRS/WF/WEUS had larger cyst size in first 5 years compared to those that did not [16 (12-23) vs. 12 (9-17) mm, p = 0.0001], cyst size of >15 mm having higher cumulative incidence of HRS/WF/WEUS. PC mortality was 0.8%; all-cause mortality was 32%. Incidence of mortality due to PC was higher in HRS/WF/WEUS group, p < 0.0001. The mortality rate at 12 years for ACCI (age-adjusted Charlson Comorbidity Index) of ≤3, 4-6, and ≥7 were 3.5%, 19.9%, and 57.6% (p < 0.0001), respectively. CONCLUSIONS: Incidence of PC in patients with BD-IPMN without significant changes in first 5 years of diagnosis remains low at 1.0%. Incidence of HRS/WF/WEUS was higher at 29.0%. PC-related mortality was higher in HRS/WF/WEUS group. These risks should be weighed against patients' overall mortality (utilizing scoring systems such as ACCI) when making surveillance decision of BD-IPMN beyond 5 years.

Near-hysteresis-free soft tactile electronic skins for wearables and reliable machine learning.

Electronic skins are essential for real-time health monitoring and tactile perception in robots. Although the use of soft elastomers and microstructures have improved the sensitivity and pressure-sensing range of tactile sensors, the intrinsic viscoelasticity of soft polymeric materials remains a long-standing challenge resulting in cyclic hysteresis. This causes sensor data variations between contact events that negatively impact the accuracy and reliability. Here, we introduce the Tactile Resistive Annularly Cracked E-Skin (TRACE) sensor to address the inherent trade-off between sensitivity and hysteresis in tactile sensors when using soft materials. We discovered that piezoresistive sensors made using an array of three-dimensional (3D) metallic annular cracks on polymeric microstructures possess high sensitivities (> 107 Ω â‹… kPa-1), low hysteresis (2.99 ± 1.37%) over a wide pressure range (0-20 kPa), and fast response (400 Hz). We demonstrate that TRACE sensors can accurately detect and measure the pulse wave velocity (PWV) when skin mounted. Moreover, we show that these tactile sensors when arrayed enabled fast reliable one-touch surface texture classification with neuromorphic encoding and deep learning algorithms.

Autoimmune Hepatitis Associated With Turmeric Consumption.

Turmeric is a popular herbal dietary supplement that has been considered safe and even shown to have hepatoprotective properties. In the recent times, however, there have been a few case reports of turmeric-induced liver injury. We report a 55-year-old woman with chronic turmeric consumption whose initial diagnosis was acute autoimmune hepatitis. She declined steroid treatment, and hence, we recommended discontinuing her long-term turmeric usage. A month after discontinuation, her liver function returned to normal. This case demonstrates the importance of recognizing the potential adverse effects of herbal dietary supplement.

Saltatory Conduction: Jumping to New Conclusions.

Rapid and efficient saltatory action potential conduction depends on the myelin sheath and clustered Na+ channels at nodes of Ranvier. A new study convincingly shows that the periaxonal space is a necessary conductive component to accurately model myelinated axon physiology and saltatory conduction.

The effect of prophylactic hemoclips on the risk of delayed post-endoscopic mucosal resection bleed for upper and lower gastrointestinal lesions: a retrospective cohort study.

BACKGROUND: Endoscopic mucosal resection (EMR) is a minimally invasive procedure used for the treatment of lesions in the gastrointestinal (GI) tract. There is increased usage of hemoclips during EMR for the prevention of delayed bleeding. This study aimed to evaluate the effect of hemoclips in the prevention of delayed bleeding after EMR of upper and lower GI tract lesions. METHOD: This is a retrospective cohort study using the Kaiser Permanente Southern California (KPSC) EMR registry. Lesions in upper and lower GI tracts that underwent EMR between January 2012 and December 2015 were analyzed. Rates of delayed bleeding were compared between the hemoclip and no-hemoclip groups. Analysis was stratified by upper GI and lower GI lesions. Lower GI group was further stratified by right and left colon. We examined the relationship between clip use and several clinically-relevant variables among the patients who exhibited delayed bleeding. Furthermore, we explored possible procedure-level and endoscopist-level characteristics that may be associated with clip usage. RESULTS: A total of 18 out of 657 lesions (2.7%) resulted in delayed bleeding: 7 (1.1%) in hemoclip group and 11 (1.7%) in no-hemoclip group (p = 0.204). There was no evidence that clip use moderated the effects of the lesion size (p = 0.954) or lesion location (p = 0.997) on the likelihood of delayed bleed. In the lower GI subgroup, clip application did not alter the effect of polyp location (right versus left colon) on the likelihood of delayed bleed (p = 0.951). Logistic regression analyses showed that the clip use did not modify the likelihood of delayed bleeding as related to the following variables: use of aspirin/NSAIDs/anti-coagulants/anti-platelets, pathologic diagnoses (including different types of colon polypoid lesions), ablation, piecemeal resection. The total number of clips used was 901 at a minimum additional cost of $173,893. CONCLUSION: Prophylactic hemoclip application did not reduce delayed post-EMR bleed for upper and lower GI lesions in this retrospective study performed in a large-scale community practice setting. Routine prophylactic hemoclip application during EMR may lead to significantly higher healthcare cost without a clear clinical benefit.

Mapping axon initial segment structure and function by multiplexed proximity biotinylation.

Axon initial segments (AISs) generate action potentials and regulate the polarized distribution of proteins, lipids, and organelles in neurons. While the mechanisms of AIS Na+ and K+ channel clustering are understood, the molecular mechanisms that stabilize the AIS and control neuronal polarity remain obscure. Here, we use proximity biotinylation and mass spectrometry to identify the AIS proteome. We target the biotin-ligase BirA* to the AIS by generating fusion proteins of BirA* with NF186, Ndel1, and Trim46; these chimeras map the molecular organization of AIS intracellular membrane, cytosolic, and microtubule compartments. Our experiments reveal a diverse set of biotinylated proteins not previously reported at the AIS. We show many are located at the AIS, interact with known AIS proteins, and their loss disrupts AIS structure and function. Our results provide conceptual insights and a resource for AIS molecular organization, the mechanisms of AIS stability, and polarized trafficking in neurons.

OD Morphing: Balancing Simplicity with Faithfulness for OD Bundling.

OD bundling is a promising method to identify key origin-destination (OD) patterns, but the bundling can mislead the interpretation of actual trajectories traveled. We present OD Morphing, an interactive OD bundling technique that improves geographical faithfulness to actual trajectories while preserving visual simplicity for OD patterns. OD Morphing iteratively identifies critical waypoints from the actual trajectory network with a min-cut algorithm and transitions OD bundles to pass through the identified waypoints with a smooth morphing method. Furthermore, we extend OD Morphing to support bundling at interaction speeds to enable users to interactively transition between degrees of faithfulness to aid sensemaking. We introduce metrics for faithfulness and simplicity to evaluate their trade-off achieved by OD morphed bundling. We demonstrate OD Morphing on real-world city-scale taxi trajectory and USA domestic planned flight datasets.

Aortic recoarctation and pseudoaneurysm five decades after repair.

BACKGROUND: Coarctation of the aorta is a congenital cardiac defect characterized by a narrowing of the proximal thoracic aorta. Despite excellent long-term results, surgical repair is rarely complicated by recoarctation. METHODS/RESULTS: We describe a case with the longest time to reintervention to date, featuring surgical repair of delayed aortic recoarctation and pseudoaneurysm 53 years after the initial operation. DISCUSSION: This case emphasizes the need for lifelong surveillance in this patient population and exemplifies a multidisciplinary approach in evaluating treatment options of complex aortic pathology, including open and endovascular considerations.

Percutaneous Endoscopic Necrosectomy of Complex Walled-Off Lateral Necrosis of the Pancreas with the Aid of Laparoscopic Babcock Forceps: A Case Report of an Endoscopic and Radiologic Team Approach.

INTRODUCTION: The initial therapeutic intervention for infected necrotizing pancreatitis usually begins with endoscopic cystogastrostomy for drainage, followed by endoscopic necrosectomy. Endoscopic pancreatic necrosectomy is commonly performed transluminally through transgastric or transduodenal routes. This case describes necrosectomy via a transcutaneous route for laterally located walled-off pancreatic necrosis and the novel use of Babcock forceps for an obstructed fully covered metal stent. CASE PRESENTATION: A 62-year-old woman presented with abdominal pain, nausea, and vomiting. After multiple admissions and repeated abdominal imaging, she was found to have laterally located, infected, walled-off pancreatic necrosis. Initially, a drainage catheter was placed by an interventional radiologist and was eventually upsized to a 28F catheter. Subsequently, a fully covered metal stent was placed in the gastroenterology suite under fluoroscopic guidance and was used to gain access for percutaneous sessions of necrosectomy. A percutaneous sinus tract endoscopic necrosectomy was performed under direct endoscopic view. However, difficulties occurred with removing necrotic debris even through this large covered stent. Thus, laparoscopic Babcock forceps were used under fluoroscopy to remove lodged debris from the midstent. Repeat abdominal computed tomography scan 3 days after necrosectomy showed near resolution of the walled-off pancreatic necrosis. DISCUSSION: This Babcock technique with endoscopic necrosectomy has not been previously described in the literature, to our knowledge. Babcock forceps were an ideal tool in our case because they were able to gain access to the obstruction in the stent, but the "teeth" are small and dull enough to prevent from catching onto the metal stent mesh.

Relative criticalness of common laboratory tests for critical value reporting.

We determined the relative strengths of association between 23 most commonly ordered laboratory tests and the adverse outcome as indicators of relative criticalness. The lowest and highest results for 23 most commonly ordered laboratory tests, 24 hours prior to death during critical care unit (CCU) stay or discharge from CCU were extracted from a publicly available CCU database (Medical Information Mart for Intensive Care-III). Following this, the Random Forest model was applied to assess the association between the laboratory results and the outcomes (death or discharge). The mean decrease in Gini coefficient for each laboratory test was then ranked as an indication of their relative importance to the outcome of a patient. In descending order, the 10 laboratory tests with the strongest association with death were: bicarbonate, phosphate, anion gap, white cell count (total), partial thromboplastin time, platelet, total calcium, chloride, glucose and INR; moreover, the strength of association was different for critically high versus low results.