High Impact Areas Research Articles

Combating antimicrobial resistance: A framework for educational tool innovation

Abstract Issue The World Health Organization (WHO) stresses the need for educational and training initiatives to address antimicrobial resistance (AMR) across human, animal, and agricultural sectors. AMR, a growing public health threat, was responsible for approximately 4.95 million deaths in 2019. Traditional educational frameworks tackling AMR are often applied in isolated sectors, failing to incorporate a holistic or collaborative approach. Description of the Policy The Holistic Engagement and Adaptive Response Theoretical framework (HEARTf) proposes a comprehensive, innovative approach combining behavioral theories, and persuasive technology, including the Theory of Planned Behavior, Persuasive Technology, and Diffusion of Innovation. The framework is designed to integrate stakeholders in developing and accessing educational tools, specifically a game designed to teach students about AMR. HEARTf emphasizes a multidisciplinary methodology, beginning with Phase 1 (exploratory phase) to gather baseline information from potential prescribers in Norway and Zambia. Results Initial application of HEARTf is leading the development of an educational game on AMR. This game uniquely combines behavioral theories and digital design, focusing on high-impact areas of AMR. Preliminary feedback indicates enhanced stakeholder engagement and a heightened willingness to adopt AMR best practices across different sectors. Lessons The HEARTf approach demonstrates the potential for enhancing AMR education through innovative, theory-based game design and development. It advocates for the continued integration of comprehensive educational strategies into global health initiatives to combat AMR effectively. These actions, being tailored to diverse sectors, suggest that similar holistic, theory-driven approaches may be beneficial in other public health crises. Key messages • HEARTf fosters innovative, multidisciplinary AMR education, enhancing stakeholder engagement and adoption of best practices. • Theory-based educational tools in AMR developed using HEARTf can significantly impact global health strategies and should be integrated into broader public health efforts.

Characteristics and Utilization of Hospitalizations Among Children With Medical Complexity.

Hospitalizations for children with medical complexity (CMC) have increased substantially over the past 2 decades and constitute a disproportionate percentage of hospitalization rates and costs among children. We sought to describe the etiology and utilization for hospitalizations of CMC using the Pediatric Clinical Classification System (PECCS). Using the 2019 Kids' Inpatient Database, we classified hospitalizations for CMC using the PECCS, which groups diagnoses into mutually exclusive, pediatric-specific categories. For the medical, surgical, and medical/surgical PECCS clinical groups, we reported diagnosis groups accounting for ≥1% of hospital encounters for that group. We described admission frequency, cost, payer, length of stay, and mortality rates within each diagnosis grouping using survey-weighted statistics. We identified 2 315 743 nonlivebirth hospitalizations, of which 712 139 (30.8%) were for CMC. Most (94.4%) hospitalizations occurred at a teaching hospital. Medical diagnosis comprised most hospitalizations (69.2%), whereas hospitalizations for surgical and medical/surgical conditions had a higher median cost. The most common diagnosis groups overall were encounters for chemotherapy, diabetic ketoacidosis, and respiratory failure, whereas the costliest were for necrotizing enterocolitis, transposition of the great vessels, and hypoplastic left heart syndrome. We evaluated the most common diagnoses and their associated resource use for hospitalized CMC using the PECCS, providing a more granular view on the etiology, utilization, cost, and outcomes of hospitalizations for CMC. These topics represent high-impact areas for further research and quality efforts for CMC.

Comparative analysis of the bioaccumulation of bisphenol A in the blood serum and follicular fluid of women living in two areas with different environmental impacts.

Bisphenol A (BPA) is a common contaminant widely used in many industrial sectors. Because of its wide use and dispersion, it can be accumulated in living human bodies through both oral assumption and nondietary routes. BPA exhibits hormone-like properties, falling under the class of endocrine disruptors; therefore, it can alter relevant physiological functions. In particular, in women, it can affect folliculogenesis and therefore reproduction, contributing not only to infertility, but also to endometriosis and premature puberty. We conducted a multicenter study on 91 women undergoing a first in vitro fertilization (IVF) treatment in the Campania region (Southern Italy). We investigated the presence and concentration of BPA in serum and follicular fluids to assess the effects of airborne BPA contamination. The analysis was conducted on 32 women living in a low environmental impact (LEI) area, from the Sele Valley River and Cilento region, and 59 women living in a high environmental impact (HEI) area, the so-called "Land of Fires", a highly contaminated territory widely exposed to illegal waste practices. A higher average BPA content in both blood serum and follicular fluid was revealed in the HEI group when compared with the LEI group. In addition, we revealed higher average BPA content in blood serum than in folliclular fluid in the HEI area, with opposite average content in the two fluids in the LEI zone. In addition, our results also showed a lack of correlation between BPA content in follicular and serum fluids both in the overall population and in the HEI and LEI groups, with peculiar trends in different subsets of women. From our results, we revealed a heterogeneity in the distribution of BPA content between serum and follicular fluid. Further studies are needed to unravel the bioaccumulation mechanisms of BPA in highly polluted and nonpolluted areas.

Counterfactual Explanations and Algorithmic Recourses for Machine Learning: A Review

Machine learning plays a role in many deployed decision systems, often in ways that are difficult or impossible to understand by human stakeholders. Explaining, in a human-understandable way, the relationship between the input and output of machine learning models is essential to the development of trustworthy machine learning based systems. A burgeoning body of research seeks to define the goals and methods of explainability in machine learning. In this article, we seek to review and categorize research on counterfactual explanations , a specific class of explanation that provides a link between what could have happened had input to a model been changed in a particular way. Modern approaches to counterfactual explainability in machine learning draw connections to the established legal doctrine in many countries, making them appealing to fielded systems in high-impact areas such as finance and healthcare. Thus, we design a rubric with desirable properties of counterfactual explanation algorithms and comprehensively evaluate all currently proposed algorithms against that rubric. Our rubric provides easy comparison and comprehension of the advantages and disadvantages of different approaches and serves as an introduction to major research themes in this field. We also identify gaps and discuss promising research directions in the space of counterfactual explainability.

Children exposed to salt-dust emission from Urmia Lake have short telomere length: a case-control pilot study

ABSTRACT This study aimed to measure telomere length in healthy children living next to Urmia Lake, Iran, which is exposed to salt dust from a drying lakebed. In this case-control pilot study, we recruited 39 sex- and age-matched healthy children from two different geographic regions to study the relative telomere lengths using qPCR. We categorized the study samples into high-impact and low-impact areas based on wind direction, aerosol particle level, and distance from the lake. Our main results revealed that children living in high-impact areas have shorter telomeres than those living in low-impact areas. Furthermore, according to our statistical model, parental age significantly affected telomere length in children, but inversely. When the father’s age impact was positive, the mother had a negative effect. Based on our results, to prevent Urmia Lake from dying out completely, national and international organizations should implement comprehensive visions and strategies for its restoration.

Using cumulative human impact assessment to support adaptive management of the threatened species’ habitats in the Yangtze River Estuary

The conflict between multiple functions of human use and habitat conservation represents an intractable challenge for environmental management. While numerous studies on marine conservation prioritize cumulative impact assessments (CIA) to tackle this issue, estuaries — despite their immense conservation significance amidst intense human activities — remain overlooked. Taking the Yangtze River Estuary (YRE) as the case study area, it is one of the most intensely human-utilized estuaries globally, yet it serves as a critical habitat and migratory corridor for the endangered Chinese sturgeon (Acipenser sinensis).We employed ecological indicators and quantitative modeling to assess habitat suitability and cumulative anthropogenic impacts on this endangered species in the YRE. The results demonstrated that suitable habitat distribution and human impact varied for juvenile Chinese sturgeon in the YRE. The suitable habitat distribution for juvenile Chinese sturgeon was concentrated in Chongming Dongtan and the North Channel. Ship density, submarine optical cables, and smooth cord grass invasion were the main anthropogenic factors impacting the Chinese sturgeon's migrating habitat in the YRE. Moreover, existing Chinese sturgeon habitats remain at risk, with 36.24 % of potential habitats and 56.60 % of high human impact areas requiring enhanced protection. Adaptive management strategies were proposed, tailored to the spatial and environmental protection needs across the dynamic habitat demands of aquatic species. Our spatially explicit and indicator-based findings provide key scientific support for enlarging protected areas and implementing adaptive management of human activities to balance conservation and sustainable use in this highly utilized ecosystem.

Global research trends in the treatment of squamous cell carcinoma over the past decade: A bibliometric analysis

ObjectiveThis study aims to identify research trends and hot spots in the treatment of Squamous Cell Carcinoma (SCC) over the past decade using bibliometric analysis. MethodsData were extracted from the Web of Science Core Collection, including Science Citation Index Expanded (SCI-Expanded), Social Sciences Citation Index (SSCI), and Emerging Sources Citation Index (ESCI). The data underwent manual cleaning to remove inaccuracies and irrelevancies, followed by transformation into an analyzable format via the VOSviewer software. This tool facilitated the visualization of co-occurrence networks and keyword maps, highlighting the relationships and the prominence of research themes. ResultsA total of 46448 authors from 7374 institutions across 108 countries contributed to the literature, reflecting a broad international effort. The study documented a consistent increase in SCC-related publications up to 2020, with some variability in subsequent years. Notably, the United States, Germany, China, the United Kingdom, and France were predominant in this research area. The University of Texas MD Anderson Cancer Center and the University of Pittsburgh were leading contributors in terms of publication volume and citation impact. Key journals included ‘Oral Oncology’ and ‘Clinical Cancer Research’, which were central to the dissemination of high-impact research. Our keyword analysis identified three major research clusters focused on molecular mechanisms, clinical treatment strategies, and emerging interests in immunotherapeutic approaches. ConclusionsThe extensive collaboration and the increasing publication trend underscore the growing global commitment to advancing SCC treatment. The high level of engagement from top institutions and the concentration of research in influential journals reflect the field's dynamic evolution towards innovative and effective treatment modalities. This study provides a valuable overview for researchers, guiding future studies towards areas of high impact and emerging trends in SCC treatment. The findings advocate for enhanced focus on personalized medicine and combination therapies, which are poised to improve outcomes for SCC patients.

The differential impacts of COVID-19 mortality on mental health by residential geographic regions: The Los Angeles Pandemic Surveillance Cohort Study.

This study examines the association between changes in mental health before and during the COVID-19 pandemic and COVID-19 mortality across geographic areas and by race/ethnicity. A cross-sectional survey was conducted in Los Angeles County between April and May 2021. The study used the Patient Health Questionnaire-2 to assess major depression risk. Participants' home ZIP codes were classified into low, middle, and high COVID-19 mortality impacted areas (CMIA). While there were existing mental health disparities due to differences in demographics and social determinants of health across CMIA in 2018, the pandemic exacerbated the disparities, especially for residents living in high CMIA. Non-White residents in high CMIA reported the largest deterioration in mental health. Differences in mental health by CMIA persisted after controlling for resident characteristics. Living in an area with higher COVID-19 mortality rates may have been associated with worse mental health, with Non-White residents reporting worse mental health outcomes in the high mortality area. It is crucial to advocate for greater mental health resources in high COVID-19 mortality areas especially for racial/ethnic minorities.

Zeptonewton and attotesla per centimeter metrology with coupled oscillators.

We present the coupled oscillator: A new mechanism for signal amplification with widespread application in metrology. We introduce the mechanical theory of this framework and support it by way of simulations. We present a particular implementation of coupled oscillators: A microelectromechanical system (MEMS) that uses one large (∼100mm) N52 magnet coupled magnetically to a small (∼0.25mm), oscillating N52 magnet, providing a force resolution of 200zN measured over 1s in a noiseless environment. We show that the same system is able to resolve magnetic gradients of 130aT/cm at a single point (within 500μm). This technology, therefore, has the potential to revolutionize force and magnetic gradient sensing, including high-impact areas such cardiac and brain imaging.

Rapid response on facial psoriasis to bimekizumab: case series.

Psoriasis is a chronic inflammatory disease that can affect any part of the body but, when it appears in certain areas, like the face, it can have a very significant psychological impact. Biologics, in particular IL-17 and IL-23 drug inhibitors, have shown relevant clinical efficacy in the management of psoriatic lesions in difficult-to-treat areas. In post hoc analysis of phase III trials in plaque psoriasis, bimekizumab has shown safety and complete clearance of high-impact areas. However, these studies did not focus on the effect of bimekizumab on facial lesions. Therefore, this case series represents the first clinical real-life experience of rapid and successful management of facial psoriasis with bimekizumab in six patients.

Trends in pediatric emergency department transfers from Indian Health Service and tribal health systems.

To describe the frequency and observed trends for all Indian Health Service (IHS) and tribal emergency department (ED) transfers to a pediatric referral center from January 1, 2017, to December 31, 2020, with a secondary analysis to describe trends in final dispositions, lengths of stay (LOS), and the most common primary ICD-10 diagnoses. We performed a retrospective chart review of IHS and tribal ED transfers to a pediatric referral center from 2017 to 2020 (n = 2433). The data were summarized using frequencies and percentages and we used generalized estimating equations to analyze patient characteristics over time. IHS and tribal ED transfers accounted for 6.5%-7.1% of all transfers each year between 2017 and 2020 without significant changes over time. Within this group, 60% were admitted and 62% experienced a LOS greater than 24 h. The most common diagnostic code groups for these patients were respiratory conditions, injuries and poisonings, nonspecific abnormal clinical findings and labs, digestive system diseases, and nervous system diseases. This study addresses important knowledge gaps regarding transfers from IHS and tribal EDs, highlights potential high-impact areas for pediatric readiness, and emphasizes the need for more granular data to inform resource allocation and educational interventions. Further studies are needed to delineate potentially avoidable transfers seen within this population.

Bimekizumab 3-year Efficacy in High-Impact Areas in Moderate to Severe Plaque Psoriasis: Pooled Results from Five Phase 3/3b Trials

Bimekizumab 3-year Efficacy in High-Impact Areas in Moderate to Severe Plaque Psoriasis: Pooled Results from Five Phase 3/3b Trials

Global marine conservation priorities for sustaining marine productivity, preserving biodiversity and addressing climate change

Marine primary productivity is a critical driver of functioning marine ecosystems, providing a foundation for biological diversity and associated economic productivity, and a key component of the oceanic carbon sink. However, it is largely under-represented within the global marine protected area estate and has been widely ignored in global priority assessments for marine conservation. Using global high-resolution data on marine primary productivity and human cumulative impact to marine systems, more than 18.6 million km² of high productivity-low impact areas in the global ocean were identified. These areas occur across all ocean basins and represent the vast majority of marine provinces and ecoregions. Over 80% of these highly productive waters with low levels of human impact lies within national jurisdictions and yet only 11% of the overall identified area is currently safeguarded within designated marine protected areas or sustainable management initiatives, leaving more than 16.5 million km2 of high productivity-low impact areas without those forms of formal protection. The multifaceted contribution of these areas to preserve biodiversity, support human welfare and help mitigating climate change suggest they are an essential, but currently overlooked, conservation priority for consideration in both global nature conservation and human wellbeing policy fora.

Enhancing life cycle assessment framework to support product ecodesign through index decomposition analysis

In ecodesign, life cycle assessment (LCA) has not only been used to evaluate a product's environmental sustainability but also serves as a tool for designers to identify areas for sustainability improvement. Conventionally, this is achieved by ranking all contributing LCA variables to identify high-impact areas. However, interpreting and translating this information into actionable design variables can be challenging. An LCA variable can be influenced by multiple design variables, each of which might affect the design's environmental sustainability to varying degrees. Presently, there is a lack of tools capable of analysing the influence of each design variable. To bridge this gap, this study proposes an LCA disaggregation methodology that uses Index Decomposition Analysis (IDA) to assess the environmental sustainability significance of the considered design variables. Using the methodology, designers can make informed decisions that prioritise design effort on design variable with the greatest potential for enhancing the product's environmental sustainability. The proposed methodology is demonstrated through a case study involving the design of a desk fan cover, considering material choice, geometry, and manufacturing process as key design variables.

Holistic cold-start management in serverless computing cloud with deep learning for time series

Serverless computing is the most innovative and affordable cloud service model that improves three strategic business objectives: flexibility, efficiency, and innovation. Compared to monolithic applications, serverless computing applications scale better as the applications are further broken down into small building blocks of functions. Resources are assigned per function and can scale up as function requests increase. Hence, serverless computing has been increasingly employed in high-impact areas such as banking and health care. An issue affecting serverless computing’s performance is cold-start — the delays in assigning resources for function execution. Such delays can violate the Service Level Agreements especially those of time-sensitive applications. Current cold-start management policies operate in silos with narrow focuses on function, application, runtime, or infrastructure levels. Such policies do not incorporate higher-level requirements like those in the Service Level Agreements. Additionally, operating in silos does not follow the principle of continuous feedback loops among management policies at different system levels, which is essential for AI-driven self-adaptive future computing systems. Therefore, this paper proposes a novel 2-prong cold-start management policy that allows feedback loops with other higher management policies and orchestrates lower-level cold-start optimization policies. The main policy driver is the temporal convolutional network (TCN) model that can predict function instance arrivals from 5 to 15 min into the future. Evaluation strategies were proposed for both the TCN model and the management policy. Evaluation results show that the TCN model performs reliably across two trace datasets from leading serverless computing providers. Notably, the proposed cold-start policy evaluation plan allows organizations to realistically evaluate their cold-start management in ways that have never been done before.

Bimekizumab 3-Year Efficacy in Patients with Moderate-to-Severe Plaque Psoriasis: Response Maintenance, Re-treatment, and Effect on High-Impact Areas

Bimekizumab 3-Year Efficacy in Patients with Moderate-to-Severe Plaque Psoriasis: Response Maintenance, Re-treatment, and Effect on High-Impact Areas

Deucravacitinib: a novel TYK2 inhibitor for the treatment of moderate-to-severe psoriasis.

Deucravacitinib is a first-in-class tyrosine kinase 2 (TYK2) inhibitor recently approved for the treatment of adults with moderate-to-severe plaque psoriasis. To discuss the mechanism of action, efficacy, safety, and real-world applications of deucravacitinib for the treatment of psoriasis. Literature on the mechanism of action of deucravacitinib is reviewed. The pivotal clinical studies and long-term extension studies for deucravacitinib are also examined. Deucravacitinib is a novel oral TYK2 inhibitor that binds to the regulatory domain of TYK2, a Janus kinase. By inhibiting TYK2, deucravacitinib interferes with signaling of IL-23, IL-12, and type I interferons, cytokines believed to play important roles in psoriasis pathogenesis. Nearly 60% of patients achieve PASI 75 at 16 weeks of treatment; efficacy improves over 24 weeks and is maintained through 2 years of continuous treatment. In a head-to-head comparison, deucravacitinib efficacy was superior to apremilast, an older yet commonly used oral PDE4 inhibitor approved for the treatment of psoriasis. Of note, patients with moderate-to-severe plaque psoriasis with concomitant involvement of the scalp, nails, and/or palms/soles demonstrated good improvement in these high impact areas. Deucravacitinib has an acceptable safety profile and is generally well-tolerated. Small increases in reactivation of herpesvirus infections, including herpes simplex outbreaks, have been reported. Tuberculosis evaluation, but no other blood tests, is recommended prior to initiation of deucravacitinib. Monitoring of triglyceride levels should be conducted for high-risk patients according to local guidelines. Deucravacitinib is an effective, safe, and well-tolerated novel oral medication for adults with moderate-to-severe plaque psoriasis.

Prevention of Injuries in Children with a Peripheral Intravenous Catheter: A Modified Evidence-Based Nursing Practice Guideline

Many children in African hospitals need a peripheral intravenous catheter (PIVC). Babies and children are particularly susceptible to serious harm from PIVC-related injuries. Nurses often regard a PIVC as a routine, low-risk intervention. Globally recommended practices include establishing a structured care pathway, recognising that PIVC management begins before insertion. Evidence-based care for children with PIVCs reduces complications and healthcare costs. Existing guidelines on managing PIVCs in infants and children are generally written for higher-resourced settings or are not specific to a paediatric population. This study aimed to review existing practice guidelines to provide accessible and implementable guidelines for caring for hospitalised babies and children up to the age of 13 years, in lower-resourced paediatric in-patient health facilities in Namibia. We applied a structured process for modifying existing high-quality guidelines developed in higher-resourced settings for implementation in lower-resourced contexts. This process involved identifying suitable guidelines for modification and rigorous guideline modification, resulting in a context-specific guideline. The modified guideline ensured that recommended practices related to pain management, difficult insertions and infection prevention are implementable. However, seeing PIVCs as unlikely to cause serious harm can lead to insufficient assessment and surveillance of PIVC injuries. We therefore produced a user-friendly guideline focused on high-impact areas of nursing practice, emphasising that nurses can avoid injury to children by properly managing a PIVC.

Modeling impacts of climate change on the geographic distribution and abundances of Tamarindus indica in Tigray region, Ethiopia

Tamarindus indica is a multipurpose dry land species in sub-Saharan that is traditionally used to build resilience into the farming system. The species is highly threatened and listed on the IUCN Red List. However, information on how climatic condition locally influences its ecological distribution is limited. This study investigates the current and future suitable habitat for the species in the Tigray region, in northern Ethiopia. A total of 220 species presence points and the number of T. indica within a 50 m × 50 m plot were collected. In addition, 19 bioclimatic variables, 3 topographic variables and soil data were used to model the impact of future climate conditions under two Representative Concentration Path Ways (RCP4.5 and RCP 8.5). MaxEnt-v-3.3.3 k, Diva-GIS-7.5, and GIS10.6 were used to model the current and future distribution. SPSSv-26 was also utilized to analyze the relationship between the species’ abundance and environmental variables. Results showed that the environmental variables determining most for the distribution of T. indica were mean diurnal range (Bio2 (56.9%)); temperature seasonality (Bio4 (10.3%)) and temperature annual range (Bio7 (9.2%)). The model suggested that the current distribution of T. indica covers an area of 9209 km2 (14.04%). This would have increased to 29,363 km2 (44.78%) and 11,046 km2 (16.85%) by 2070 under RCP4.5 and RCP8.5, respectively. Compared to the high-impact areas, new gains of suitable areas (net 25,081 km2) for the future distribution of the species were predicted in 2070-RCP4.5. Altitude, rainfall, temperature, silt contents of soils and soil pH have significant contributions (P-value<0.05) to the abundance of T. indica. However, altitude has a negative relationship with the abundance of T. indica. Additional studies to understand population trends and other threats are recommended.

Attribution identification of natural runoff variation in the Yiluo River Basin

Study regionThe Yiluo River Basin between the Sanmenxia Dam and the Huayuankou Station of the Yellow River basin. Study focusThe current research is designed to spatially identify different driving factors' contributions to natural runoff variation. The Water and Energy Transfer Process model was used to simulate the runoff of 2044 sub-basins. Based on this, trends of runoff variation were analyzed, and then, the mutation year of runoff variation in each sub-basin was detected. Moreover, the contribution rate of climatic variation and anthropogenic factors on runoff change in each sub-basin was quantified. New hydrological insights for the regionThe annual natural runoff in 90.66% of sub-basins and the flood-season (May to October) natural runoff in 45.99% of sub-basins showed declining trends. And the mutation year of runoff change mostly occurred in the 1970 s and 1980 s. The natural runoff change was primarily affected by climatic variation. The contribution rate of climate to the annual and flood-season natural runoff was 69.32% and 71.51%, respectively. While the contribution of man-made activities to the annual and the flood-season natural runoff was 30.68% and 28.49%, respectively, and the high-impact areas were largely distributed downstream. The research provides scientific support for developing and regulating water and land resources in the Yiluo River Basin.