Local Impact Research Articles

Local Service-Learning Bridges Global Impact Through Dental Education

Local Service-Learning Bridges Global Impact Through Dental Education

Improving goal-concordant care via a uniquely collaborative and multi-site PFAC model.

265 Background: Studies reveal a mismatch between the goals of care (GOC) of cancer patients and actual care received. The 10 members of the Alliance of Dedicated Cancer Centers (ADCC) convened the Improving Goal Concordant Care (IGCC) initiative to address system gaps. IGCC was led by palliative care and oncology experts, with guidance from patient and family advisors. Uniquely, the advisors were identified from patient family advisory councils (PFAC) at each center, forming a collaborative Advisory Group (AG) with the lived experience of each center and the knowledge of advocating for the patient/family voice locally. Methods: PFAC members were recruited from each site to serve on the AG. The 19 member AG met quarterly, with minutes shared with the IGCC oversight group, the Implementation Workgroup (IWG). In September 2023, all AG members were surveyed about perceptions of PFAC engagement and local impact of IGCC. In May 2024, 20 IWG members were surveyed about implementation successes and barriers, including items related to PFAC engagement. Results: AG evaluation and recommendations altered IGCC planned core implementation and evaluation actions meaningfully; for example in 1) selection of structured fields in electronic health record (EHR) and universally accessible GOC documentation and in 2) centering patients in the GOC measure set, including incorporating “Heard & Understood” survey into IGCC evaluation. Other AG guidance around direct patient engagement readiness for GOC conversations and implementing patient GOC surveys was left to individual sites to consider with variable adoption. AG Survey: 63% response rate. 80% noted that the GOC program was discussed with their local PFAC and 92% experienced changed routine patient care after GOC implementation. IWG Survey: 100% response rate. 68% agreed that their center sought guidance from their PFAC during GOC implementation and that leadership presented to their PFAC about their GOC implementation. 26% indicated reporting data to their PFAC; of those that did, 80% agreed that this positively impacted their GOC implementation. Conclusions: While PFACs are occasionally included in quality interventions, this model centered the patient/family voice by supporting a PFAC stakeholder feedback loop working collaboratively and locally to support implementation and evaluation of IGCC objectives. While not all AG recommendations were formally integrated into IGCC, all were considered and many adopted at individual centers. Despite ongoing IGCC-level involvement, center-specific engagement of PFACs varied. Future efforts can track this during process evaluation as local PFAC engagement was highly valued. Consensus building for national best practice implementation and evaluation by recruiting local experts including PFAC members into national collaborative efforts is a successful model for local change.

Brain network fingerprints of Alzheimer's disease risk factors in mouse models with humanized APOE alleles

Alzheimer's disease (AD) presents complex challenges due to its multifactorial nature, poorly understood etiology, and late detection. The mechanisms through which genetic and modifiable risk factors influence disease susceptibility are under intense investigation, with APOE being the major genetic risk factor for late onset AD. Yet the impact of unique risk factors on brain networks is difficult to disentangle, and their interactions remain unclear.To model multiple risk factors, including APOE genotype, age, sex, diet, and immunity we used a cross sectional design, leveraging mice expressing human APOE and NOS2 genes, conferring a reduced immune response compared to mouse Nos2. We used network topological and GraphClass analyses of brain connectomes derived from accelerated diffusion-weighted MRI to assess the global and local impact of risk factors, in the absence of AD pathology.Aging and a high-fat diet impacted extensive networks comprising AD-vulnerable regions, including the temporal association cortex, amygdala, and the periaqueductal gray, involved in stress responses. Sex impacted networks including sexually dimorphic regions (thalamus, insula, hypothalamus) and key memory-processing areas (fimbria, septum). APOE genotypes modulated connectivity in memory, sensory, and motor regions, while diet and immunity both impacted the insula and hypothalamus. Notably, these risk factors converged on a circuit comprising 63 of 54,946 total connections (0.11% of the connectome), highlighting shared vulnerability amongst multiple AD risk factors in regions essential for sensory integration, emotional regulation, decision making, motor coordination, memory, homeostasis, and interoception. APOE genotype specific immune signatures support the design of interventions tailored to risk profiles. Sparse Canonical Correlation Analysis (CCA) including spatial memory as a risk factor resulted in a network comprising 80 edges, showing significant overlap with risk-associated networks from GraphClass. The largest overlaps were observed with networks impacted by diet (47 edges), immunity (39 edges), APOE3 vs 4 (26 edges), sex (23 edges), and age (19 edges), the resulting networks supporting the use of sensory cues in spatial memory retrieval.These network-based biomarkers hold translational value for distinguishing high-risk versus low-risk participants at preclinical AD stages, suggest circuits as potential therapeutic targets, and advance our understanding of network fingerprints associated with AD risk.

Rational cuts? The local impact of closing undersized schools

The availability of public education services can influence residential choices. Therefore, policies aimed at ‘rationalising’ service provision by reducing the number of undersized nodes in the public school network can lead to population decline, especially in spatially isolated areas lacking valid alternatives to the removed services. This paper examines the demographic and income effects of primary school closures by exploiting an Italian education reform that resulted in the contraction of the school network. We assess whether school closures impact households’ residential choices, over and above preexisting negative population trends that motivate school closures. Our findings indicate that municipalities affected by school closures experience significant reductions in population and income. The effect is primarily driven by peripheral municipalities located far away from economic centres and distant from the next available primary school. This evidence indicates that school ‘rationalisation policies’, by fostering depopulation of peripheral areas, have an influence on the spatial distribution of households and income, thus affecting territorial disparities.

Disorders of cervical maturation under wartime stressful conditions

Pregnancy itself is a prerequisite for stress reactions. Even in the physiological course, pregnancy has a certain impact on a woman’s psyche, and some authors even consider it as a crisis situation or a “period of psychological uncertainty”. Women have different types of reactions to pregnancy: from the absence of any psychological problems to neurotic personality development.All the hardships of wartime affect not only the mother’s organism and her psychological state, but also the state of the unborn fetus, which is programmed with certain physical and mental health characteristics for the rest of its life.To prevent these negative effects, pregnant women during the pregravid period and gestation should take preventive measures aimed at strengthening the organism’s defense reactions in adverse conditions. These include a rational nutritious diet, determination of a woman’s personality type by a perinatal psychologist and appropriate psychological practices, and sufficient supplementation of important vitamins and minerals with antioxidant and other protective properties.Pregnancy under the influence of prolonged chronic stress can be complicated not only by purely obstetric and perinatal problems, but also by disorders of the formation of the labour dominant and preparatory processes in the cervix. As a result, this can lead to miscarriage due to the development of tokophobia as a psychological component of these disorders.Cervical maturation before childbirth is a multifactorial process that includes numerous elements, complex processes at the psychological, systemic, tissue, cellular, gene and molecular levels. Comprehensive preparation of a woman’s organism for childbirth in conditions of chronic stress and certain tokophobia (a woman’s fear of childbirth and uncertainty of the future for her and her child during the war) is not only about preventing stressful effects during pregnancy (magnesium complexes with B vitamins – up to the 36th week), conducting a complex of psychoprophylactic therapy and psychophysiological preparation for childbirth from the 37th week, but also in local impact on the cervical state, taking into account changes in connective tissue and correction of the infectious factor at the same time of pregnancy. For this purpose it is advisable and reasonable to prescribe vaginal suppositories based on hyaluronic acid (HA) to accelerate preparatory changes in the cervical tissues by stimulating the synthesis of its own HA and with antibacterial effects due to a complex of plant extracts.

Technological support of workpiece surface quality based on local cryogenic impact during processing of austenitic steels

Technological support of workpiece surface quality based on local cryogenic impact during processing of austenitic steels

Insights and challenges of sustainable project management implementations in construction sectors: Systematic literature analysis

The construction industry is a significant contributor towards global environmental degradation and resource depletion, with developing economies facing unique challenges in adopting sustainable construction practices. This systematic review aims to investigate the gap in sustainable construction implementation among global counterparts. The study utilizes the P5 (People, Planet, Prosperity, Process, Products) Standard as a framework for evaluating sustainable construction project management based on environmental, social, and economic targets. A Systematic Literature Review from a pool of 994 Sustainable Construction Project Management (SCPM) papers is conducted utilizing the PRISMA methodology. Through rigorous Identification, Screening, and Eligibility Verification, an analysis is synthesized from 44 relevant literature discussing SCPM Implementations worldwide. The results highlight significant challenges in three main categories: environmental, social, and economic impacts. Social impacts are found as the most extensively researched, while environmental and economic impacts are less studied. Further analysis reveals that social impacts are a major concern in sustainable construction, with numerous studies addressing labor practices and societal well-being. However, there is a notable gap in research on human rights within the construction industry. Environmental impacts, such as resource utilization, energy consumption, and pollution, are less frequently addressed, indicating a need for more focused studies in these areas. Economic impacts, including local economic impact and business agility, are further substantially underrepresented in the literature, suggesting that economic viability is a critical yet underexplored aspect of sustainable construction. The findings underscore the need for further research in these areas to address the implementation challenges of sustainable project management effectively. This research contributes towards the overall research of global sustainable construction through the utilization of the P5 Standards as a new lens of determining sustainability performance for construction projects worldwide.

Study of the effects of shallow-buried charge parameters on the lower limb injuries of occupant in special vehicle body

In the process of military missions, special vehicles often encounter shallow buried charge threats that will greatly affect the safety of the occupants. To study the integrated effects of shallow buried charge detonation point, height-to-diameter ratio, burial inclination, weight, and other key parameters on the lower limb injuries of occupant, this study was based on the special body of a shallow buried explosive test and numerical calculation methods. The reliability of the numerical model and the load effect mechanism of the shallow burial charge were studied. Based on this, the lower limb injuries response law of occupant was analyzed with respect to each parameter. The results showed that the bottom charge load mainly came from two-stage ejection loading, in which the first stage was a strong load with short-duration local impact loading and the second stage was a weak load with long-duration extended range loading. By comparing the lower limb injury response of occupant under different charge parameters, we found that the weight of charge had the greatest effect on the extent of occupant injury, followed by the height-to-diameter ratio and burial inclination, while the detonation position had a relatively small effect on the injury magnitude. Finally, a comprehensive prediction model of the lower limb injuries of occupant was obtained by using the Latin hypercube sampling method and the least-squares method, and it was verified that the model had a good matching accuracy.

Behçet's disease modifies the gingival inflammatory response.

Behçet's disease (BD) pathogenesis involves severe outcomes such as blindness, central nervous system manifestations, and deep venous thrombosis that impacts systemic and local inflammatory changes. We tested the hypothesis that BD negatively affects gingival health and increases the severity of gingivitis. The study included 37 BD patients with gingivitis without any sign of periodontitis. Systemically healthy 19 patients with gingivitis (G) and 20 periodontally and systemically healthy individuals (C) were recruited as controls. BD patients were further grouped as stable and unstable based on their responses to BD treatment. Clinical periodontal parameters were measured to determine the impact of BD on gingival health. Serum and saliva levels of ELA-2 (neutrophil elastase-2), SLPI (secretory leukocyte protease inhibitor), α1-AT (alpha1-anti-trypsin), VEGF (vascular endothelial growth factor), IL-6 (interleukin-6), IL-8 (interleukin-8), and TNF-α (tumor necrosis factor alpha) were analyzed using multiplex immunoassay to measure the systemic and local inflammatory impact of BD. Plaque index (PI), probing pocket depth (PPD), and bleeding on probing (BOP) were significantly higher in the BD group than in the controls (p<0.05). IL-6 was higher in both serum and saliva in the BD group than in the G group (p<0.05). ELA-2 levels in saliva were higher in the stable BD group than in the controls, while TNF-α and SLPI were statistically significantly higher in BD than in the control (p<0.05). Salivary α1-AT level was statistically lower in the BD group compared to the control group. Our study suggested that the gingival inflammatory profile was impaired in patients with BD.

AIDS in Africa—Impact of Research

In this Viewpoint, 2024 Lasker-Bloomberg Public Service Award winners Quarraisha Abdool Karim and Salim S. Abdool Karim discuss their journey in AIDS research in South Africa and the local and global health impact of this research.

A study of neural network-based evaluation methods for pipelines with multiple corrosive regions

In recent years, significant developments have been made in methods for assessing the remaining strength of corroded pipelines. However, existing methods have limitations as they mainly focus on the local impact of corrosion defects. This study explores evaluation methods using neural networks to predict the ultimate resistance of pipelines containing multiple corrosive regions. Firstly, based on the validated method, the study generates a dataset comprising 3,000 corroded pipeline models and pixelates the corrosion information of these models via digital images. Then, three neural network evaluation frameworks are constructed: a Multilayer Perceptron (MLP) using the overall corrosion matrix, an MLP based on corrosion feature parameters, and Convolutional Neural Networks (CNN) based on corrosion images. Following this, the study analyzes the relationship between various corrosion parameters and failure pressure, compares the training effectiveness of the three neural network methods, and validates the accuracy and applicability of the proposed approach. The results indicated that various corrosion features should be considered when evaluating corroded pipelines, particularly depth. In addition, all three neural network-based methods show improved applicability and reliability compared to traditional evaluation methods, with CNN-image having the highest evaluation accuracy (correlation coefficient = 0.9564, average error = 3.46%).

An analytical case study of the oil well blowout at Baghjan oil field, Assam: A human and environmental perspective.

The study analyses the oil well blowout that took place at the Baghjan oil field in Assam, India, on 27 May 2020. This incident escalated into a massive fire on 9th June that lasted more than 5months. The tragedy degraded the environment and inflicted substantial problems on the area's inhabitants. The present study employs the analytical case study approach and various data sources to unfold the disaster and its causes, impact, and response. It also examines the local inhabitants and environmental impact and tries to analyze the event comprehensively. The incident resulted from technical malfunctions and human errors, leading to the relocation of the adjacent settlement to refugee camps amidst the global COVID-19 epidemic. However, it is essential to mention that many households received adequate compensation for their damages. The incident has resulted in the contamination of the air, noise, soil, and water, causing significant damage to the fragile ecosystem and its rare species. The research employs the Normalized Difference Vegetation Index to quantify changes in vegetation cover resulting from the blowout, thus showing the extensive damage to the affected region. The incident shed light on legal and regulatory deficiencies alongside a lack of accountability and transparency within the Oil India Limited sector. Despite the numerous proposals for environmental restoration, it appears challenging to revert to the previous state swiftly. The present study reflects the collective and collaborative action to protect and preserve the environment.

Public research institutes in Brazil: evidence of research and innovation impact

Here, we look at the impact of the scientific production of Brazilian research institutions. Data were collected from SciVal and InCites for governmental research institutions (state and federal), and then we focussed on the two largest: Embrapa (Agriculture) and Fiocruz (Health). Institutions in the area of health, environment and physics tended to show higher impact than other areas, those in physics showed low first, last and corresponding authorships (<20%). Health institutions had a high profile in Policy and Patents, especially abroad, while agriculture had a more local impact. Citations in policy documents increased impact by 220%. Brazilian institutions in Defence, Agriculture, Energy & Nuclear, and Economic areas generally perform below world means. While some institutions may show a higher impact on specific indicators, the present study raises the need for an in-depth analysis of these institutions and their return on investments. Information contained here can help these institutions in strategic planning to improve impact results, including the uptake of science by the Brazilian government. While Fiocruz seems to meet this demand, Embrapa still needs to reaffirm its space within the system. Discussion on the return on investment (monetary and other resources) made in institutions these institutions require future studies.

Innovative air mattress for the prevention of pressure ulcers in neonates.

Pressure ulcers (PUs) severely impact health outcomes in neonatal intensive care, with up to 28% prevalence and doubled mortality rates. Due to their only partially developed stratum corneum, neonates are highly susceptible to PUs because of a lack of adequate support surfaces. The occipital region of the head and hip are the main risk areas due to immobility and newborn body proportions. The main goal of the study was to investigate the impact of reduction in local pressure in these body areas by two air mattress designs and different filling states. Two innovative air-filled mattress prototypes (prototype 1 and prototype 2), consisting of three different segments (head, trunk and feet regions), were developed to reduce local interface pressures by optimising pressure distribution, and were assessed with three air pressure filling states (0.2kPa, 0.4kPa and 0.6kPa). A baby doll was used to investigate pressure distribution and local pressure impact. It measured 51cm and the weight was modified to be 1.3kg, 2.3kg and 3.3kg, representing premature to term newborn weights, respectively. A specialised foam mattress and an unsupported surface were considered as controls. The interface pressures at the hip region for newborn models could be reduced by up to 41% with mattress prototype 1 and 49% with prototype 2 when filled with 0.2kPa air pressure. It was found that the size and the pressure inside air segments was crucial for interface pressure. Our results demonstrated that air mattresses achieved lower interface pressures compared to conventional support surfaces, and that the benefit of the air mattresses depended on their filling status. The importance of using innovative, segmented designs that were tailored to meet the specific needs of highly vulnerable paediatric patients was demonstrated.

Quantum migration and its local heat impact: Understanding local heat capacity of confined systems.

For noninteracting particles confined in a constant volume, the temperature derivative of the local energy assumes negative values in thermodynamic equilibrium at low temperatures. This peculiar behavior may entail the misleading unphysical conclusion that the local heat capacity is negative. However, we show that temperature-dependent density variations of confined particles induce an energy selective particle transport within the domain, here called temperature-induced quantum migration. This macroscopic quantum phenomenon causes a redistribution of local heat and ensures a non-negative local heat capacity. Moreover, it induces local heating and cooling effects and a massive overshoot in local heat capacity. The quantum migration also builds up the thermal part of confinement energy, manifesting in an excess global heat capacity. Analyzing the local energy fluctuations shows that the linear relationship between heat capacity and fluctuations is broken at the local scale.

Dual benefits of biofouling reduction in non-fed aquaculture: On-site heat treatment enhances oyster production and mitigates local environmental impacts

We experimentally evaluated the biofouling reduction by on-site heat treatment in enhancing oyster aquaculture production and mitigating its environmental impacts. Specifically, we compared oyster growth, settling flux of particulate organic matter (POM), and its oxygen consumption rate (OCR) between heat-treated (HT) and non-treated (N) sections within suspension oyster farms in a temperate bay. HT demonstrated a substantial reduction of 81–99% in fouling mussel biomass and approximately 20–30% increases in cultivated oysters’ growth and condition index. The settling flux of POM was 10–57% smaller in HT mainly due to the reduction in biodeposition from fouling mussels. However, OCR of settling POM at a unit mass was 6–62% higher in HT than in N; overall, the short-term oxygen consumption by settling POM did not significantly differ between HT and N. The increase in OCR of settling POM in HT may be attributable to the decrease in biodeposits from fouling organisms and increase in the relative contribution of fresh POM entering from unfarmed areas. Meanwhile, from the longer-term perspective, the substantial reduction in settling POM by the heat treatment lower the potential for oxygen consumption in the bottom layers over the half-year farming operation by 31%. In conclusion, on-site heat treatment is a simple tactic for controlling nutrient and POM flows at production sites, simultaneously enhancing oyster production and mitigating the local environmental impact of non-fed oyster aquaculture. Furthermore, this approach exemplifies an effective tactic to enhance the sustainability of primary food production processes.

External costs of high-voltage overhead transmission lines: Evidence from a causal approach in rural France

In light of climatic change and global warming, electricity transmission networks need to be developed for the integration of renewable sources. In North America and Europe, to achieve renewable electricity goals, massive investments in electricity transport infrastructure are planned to connect solar and wind generation sites to the grid network. However, local opposition to new installations of high-voltage overhead transmission lines (HVOTLs) is causing delays and cost overruns. Visual nuisance is an important basis of local stakeholders' opposition to a new project. Estimations of the local economic impact of HVOTLs can help in identifying the external costs of the electricity supply industry to improve both efficiency in electricity pricing and fairness in defining provision for host community compensation. Prior research has provided evidence that existing HVOTLs have negative but not substantial effects on their immediate neighbourhoods. However, these studies have applied a correlational approach. This paper revisits the external effects of HVTOLs, exploring the case of a 225 kV line connecting two medium-size cities (Saint-Privat-d'Allier to Saint-Etienne) in France. We take advantage of the public disclosure in 2009 of undergrounding 8 km out of a total of 87 km lines as a result of a network upgrade project, to develop a difference-in-difference specification of a hedonic regression model, by comparing house sale prices at different distances from existing pylons, before and after the announcement of the decision to upgrade the line. We show that undergrounding was accompanied by an increase of about 38% in the price of treated houses located within 200 m of old pylons. The implied environmental costs of proximity to high-voltage pylons are substantial and their reduction is internalized into house prices as soon as the decision to go underground is announced.

Agent‐based intra‐regional relocation model considering spatial local amenity for urban planning‐based flood risk management: Assessing the impact of urban development on flood exposure

AbstractIntegrated flood risk management based on urban policies remains challenging compared with infrastructure due to the unclear risk‐reduction effects over time. To consider heterogeneity in social responses to urban planning measures, a previous study developed an agent‐based household relocation model under flood risk (AHR‐FLOOD) by combining flood‐inundation and agent‐based relocation models. However, accurate modelling of relocation incentives remains challenging. This study aimed to improve AHR‐FLOOD by introducing spatial amenities based on transportation convenience and reflecting their impact on the decision‐making processes of agents to analyze the development of different flood risk areas. AHR‐FLOOD considering access to public transportation reproduced the spatial characteristics of the actual population and housing prices. The development of low‐risk areas reduced flood exposure and resulting flood damage. However, this effect was less clear for low‐income individuals, but the development of low‐amenity areas had the potential to induce low‐income population to move to safe areas. Chain migration was observed as a long‐term effect of the spatial amenity policy. This study presents insights into the effect of transportation policies on flood safety for long‐term spatial distance management in an agent‐based approach with the rigorous modelling and validation of local amenity impact on household relocation choices.

Local economic impact of small, non-research private universities: evidence from Japan

This study examines the local economic impact of small, non-research private universities in Japan, where expanding higher education access has historically relied on these institutions. Our prefecture-year fixed effects model from 1955 to 2015 reveals that a 10 % increase in the number of these institutions led to a 0.4 % increase in the prefecture's GDP per capita. However, this relationship was more pronounced during the 1960s, a period of rapid economic expansion, and diminished in subsequent years as the country's economic growth slowed. Our research also shows that these universities have not contributed to the local stock of human capital or promoted local innovation. Instead, they temporarily stimulated local capital investment. Our research suggests that universities with limited research capacity are unlikely to contribute to local economic growth after the country's economy has moved out of the expansion stage.

Leveraging air quality monitoring data in Jakarta, Indonesia – local impact assessments to guide government regulations

Leveraging air quality monitoring data in Jakarta, Indonesia – local impact assessments to guide government regulations