Longitudinal Risks Research Articles

Cannabis and Pregnancy.

We review recent evidence describing the effects of prenatal exposure to cannabis in pregnant individuals. In the context of changing cannabis policy, more pregnant individuals are using cannabis, despite profound risks. Recent studies show possible perinatal and longitudinal neurodevelopment risks associated with cannabis use during pregnancy and lactation. Healthcare providers are reluctant to discuss this topic with patients for a variety of reasons. With increased access to cannabis comes the possibility of increased adverse effects of cannabis upon pregnant individuals and their children. A concerted effort to educate pregnant individuals about the potential risks of cannabis might mitigate those potential effects.

Safety and efficacy of enclomiphene and clomiphene for hypogonadal men.

Both clomiphene citrate and its isomer, enclomiphene, have become widespread within urologic practice; thus, understanding these medications' comparative benefits and risks is crucial for optimizing treatment and providing improved therapeutic options. We sought to investigate the longitudinal benefits and risks associated with enclomiphene, compared to clomiphene, and to provide valuable insights for clinicians when making treatment decisions in the management of hypogonadism. We retrospectively studied patients at our academic center who had been prescribed clomiphene and, later, enclomiphene for hypogonadism. Baseline laboratory values were documented for each patient before being prescribed clomiphene, followed by subsequent values for each variable in the most recent visit before stopping clomiphene and any noted adverse effects experienced during this time. The same process was repeated for enclomiphene, using the clomiphene levels as an updated baseline. Two-tailed t-tests were employed using R to analyze the longitudinal impacts of clomiphene and enclomiphene on serum hormone values as well as a regression analysis to estimate the odds ratio (OR) for adverse events between the two therapies. Among 66 patients, enclomiphene exhibited a median testosterone increase of 166 (vs. 98 ng/dL, P=0.20) with lower estradiol change than clomiphene (-5.92 vs. 17.50 pg/mL, P=0.001). Adverse effects were statistically significantly less frequent with enclomiphene, including decreased libido (P=0.001), reduced energy (P=0.044), and mood changes (P=0.03). Regression analysis confirmed lower odds of adverse events with enclomiphene [OR: 0.18; 95% confidence interval (CI): 0.07-0.44, P=0.02]. Our findings demonstrate that enclomiphene provides improvement in testosterone levels with a lower rate of documented adverse events. These findings support enclomiphene as a comparable treatment option for hypogonadal men while minimizing the risk of adverse effects. Further research and more extensive studies are warranted to validate these conclusions and explore the additional long-term effects of enclomiphene to guide future patient counseling regarding these medications.

Cardioneural ablation-the first case series without the use of fluoroscopy.

Cardioneural ablation (CNA) and fluoroless ablation (FA) are emerging procedures and movements in contemporary in electrophysiology. Ablation of ganglionated plexus (GP) inputs in the atrium has been successfully targeted as a treatment for symptomatic bradyarrhythmias due to increased parasympathetic tone. As most of these patients are young, avoidance of ionizing radiation is of critical importance to limit potential long term deleterious effects. With widespread use of 3D electroanatomic mapping systems and advanced intracardiac echo (ICE) imaging, fluoroless ablation has become more widely adopted. However, fluoroless CNA has not been widely performed. The objective of this study is to demonstrate that CNA can be done safely and effectively without fluoroscopy. At a single-center, consecutive patients undergoing CNA with a fluoroless approach are described. GP mapping and ablation were performed in both atria. From the right atrium (RA), the right atrium-superior vena cava (RA-SVC GP), the posteromedial ganglionated plexus (PMLGP), which can be accessed from the right atrium-coronary sinus ostium, and the Vein of Marshall GP (VOM-GP) were evaluated. From the left atrium (LA), the superior left atrial ganglionated plexus (LSGP), the left inferior ganglionated plexus (LIGP), the right anterior ganglionated plexus (RAGP), and the right inferior ganglionated plexus (RIGP) were targeted. Over the study period, beginning on January 31, 2021, 30 consecutive subjects (15 females/15 males) aged 42.9 ± 13.6years underwent GP ablation. The average subject had 9.5 (± 9.2) episodes of syncope prior to ablation. The average CHADS2-VA2SC score was zero. The average LVEF was 64.8% (± 4.9). Two of the subjects had concomitant ablations, six failed prior medical therapy, and one had a prior pacemaker placed. All of the procedures were done without fluoroscopy. The average follow-up was 604 (± 366) days. There were 8 patients that did not improve symptomatically postfirst ablation. Four of the eight underwent repeat ablation and have subsequently improved. 26/30 patients symptomatically improved after the 1st or 2nd ablation. There were no complications noted. In comparison to the traditional CNA with fluoroscopy, this proof of concept study reveals fluoroless GP ablation can be performed safely. In addition, the durability and success rate are comparable to other studies of CNA. Given the young age of the cohort and the longitudinal risks of ionizing radiation, fluoroless CNA is a feasible procedure for this patient population.

Trends of falls mortality among older adults in urban and rural China, 1987–2021

BackgroundFalls in older age pose a major public health concern, with unclear urban–rural patterns of falls mortality in China. This study examines the trends of late-life falls mortality in urban...

Parkinson's disease with hyposmia and dysautonomia: does it represent a distinct subtype?

Olfactory dysfunction or dysautonomia is one of the earliest prodromal nonmotor symptoms of Parkinson's disease (PD). We aimed to investigate whether PD patients with dysautonomia and hyposmia at the de novo stage present different prognoses regarding PD dementia (PDD) conversion, motor complication development, and change in levodopa-equivalent doses (LED). In this retrograde cohort study, we included 105 patients with newly diagnosed PD patients who underwent cross-cultural smell identification test (CC-SIT), autonomic function tests (AFT), and dopamine transporter (DAT) scan at the de novo stage. PD patients were divided into Hyposmia + /Dysautonomia + (H + /D +) and Hyposmia - /Dysautonomia - (H - /D -) groups depending on the result of AFT and CC-SIT. Baseline clinical, cognitive, imaging characteristics, longitudinal risks of PDD development and motor complication occurrence, and longitudinal LED changes were compared between the two groups. When compared with the H - /D - group, the H + /D + group showed lower standardized uptake value ratios in all subregions, lower asymmetry index, and steeper ventral - dorsal gradient in the DAT scan. The H + /D + group exhibited poorer performance in frontal/executive function and a higher risk of PDD development. The risk of motor complications including levodopa-induced dyskinesia, wearing off, and freezing of gait, was comparable between the two groups. The analysis of longitudinal changes in LED using a linear mixed model showed that the increase of LED in the H + /D + group was more rapid. Our results suggest that PD patients with dysautonomia and hyposmia at the de novo stage show a higher risk of PD dementia conversion and rapid progression of motor symptoms.

Large-scale whole-exome sequencing of neuropsychiatric diseases and traits in 350,770 adults.

While numerous genomic loci have been identified for neuropsychiatric conditions, the contribution of protein-coding variants has yet to be determined. Here we conducted a large-scale whole-exome-sequencing study to interrogate the impact of protein-coding variants on 46 neuropsychiatric diseases and 23 traits in 350,770 adults from the UK Biobank. Twenty new genes were associated with neuropsychiatric diseases through coding variants, among which 16 genes had impacts on the longitudinal risks of diseases. Thirty new genes were associated with neuropsychiatric traits, with SYNGAP1 showing pleiotropic effects across cognitive function domains. Pairwise estimation of genetic correlations at the coding-variant level highlighted shared genetic associations among pairs of neurodegenerative diseases and mental disorders. Lastly, a comprehensive multi-omics analysis suggested that alterations in brain structures, blood proteins and inflammation potentially contribute to the gene-phenotype linkages. Overall, our findings characterized a compendium of protein-coding variants for future research on the biology and therapeutics of neuropsychiatric phenotypes.

(094) Safety and Efficacy of Enclomiphene Compared to Clomiphene for Hypogonadal Men

Abstract Introduction Clomiphene, and its trans isomer enclomiphene, have been used off-label in recent years for hypogonadal men seeking to maintain fertility. Both drugs have become increasingly widespread within andrology clinics; thus, understanding the comparative benefits and risks of these medications are crucial for optimizing treatment decisions and providing improved therapeutic options. Objective To investigate the longitudinal benefits and risks associated with enclomiphene compared to clomiphene to provide valuable insights for clinicians when making treatment decisions in the management of hypogonadism and male fertility preservation. Methods We retrospectively studied patients who had been prescribed clomiphene, and later enclomiphene, at a university hospital within the observation range of 1/1/2021-12/31/2022, encompassing 66 patients. All included patients were prescribed clomiphene prior to switching to enclomiphene. Baseline laboratory values for each patient prior to being prescribed clomiphene were documented, followed by subsequent values for each of these variables in the most recent visit prior to stopping clomiphene as well as any noted adverse effects experienced during this time. Laboratory values and adverse effects were noted for the same patients in their most recent visit while taking enclomiphene. Adverse events were defined by 1) depressive thoughts; 2) weak muscle strength; 3) gynecomastia; 4) mood changes; or 5) agitation as well as changes in estradiol and hematocrit laboratory values. Two-tailed T-Tests were employed using SPSS to analyze the longitudinal impacts of clomiphene and enclomiphene on serum hormone values. Results In our cohort, men on clomiphene experienced any adverse events 18.18% of the time, whereas men on enclomiphene experienced any adverse events 3.45% of the time. From our data, men on enclomiphene had statistically lower rates of documented adverse events than the same men on clomiphene, indicating no increased risk on the newer drug; neither treatment yielded any serious adverse events. In looking specifically at hormone-related adverse events, estradiol increased significantly on clomiphene but not on enclomiphene (17.25 versus -0.29 pg/mL; t=4.271, p=.00005). However, there was no difference in change in hematocrit between the two medications (0.10% versus 0.79% increase; t=-1.103, p=.314). On average, testosterone increased 149.33 ng/dL from their baseline scores while on clomiphene and increased 108.55 ng/dL from their clomiphene values while on enclomiphene. When comparing the improvement of testosterone values attributed to clomiphene versus enclomiphene, the change of testosterone levels over time attributed to either medication are not statistically different (t-value = .883; p-value = .379). Lastly, men stayed on clomiphene for an average of 32.92 months before switching to enclomiphene. Conclusions Our findings show that enclomiphene provides the same magnitude of improvement in testosterone but through safer means, as noted by its lower rate of documented adverse events. These findings support the use of enclomiphene as a comparable treatment option for hypogonadal men while minimizing the risk of adverse effects. Further research and larger studies are warranted to validate these conclusions and explore additional long-term effects of enclomiphene. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Larry Lipshultz: AbbVie (Consultant) American Medical Systems/Boston Scientific (Speaker) Augmenta LLC (Stockholder) Aytu BioScience (Consultant) Contraline, Inc. (Consultant) Endo Pharmaceuticals (Consultant/Speaker) Inherent Biosciences (Advisor) Lipocine (Consultant); Mohit Khera: Consultant- AbbVie, Halozyme, Clarus, Metuchen, Acerus, Boston Scientific, Coloplast, Endo.

Spaceflight Recovery Considerations for Acute Inhalational Exposure to Hydrazines.

INTRODUCTION: Inhalation of hydrazine or hydrazine-derivative (for example, monomethylhydrazine) vapors during spaceflight operations remains a risk to crew and ground support personnel. Here we sought to provide an evidence-based approach to inform acute clinical treatment guidelines for inhalational exposures during a noncatastrophic contingency spaceflight recovery scenario.METHODS: A review of published literature was conducted concerning hydrazine/hydrazine-derivative exposure and clinical sequelae. Priority was given to studies that described inhalation though studies of alternative routes of exposure were additionally reviewed. Where possible, human clinical presentations were prioritized over animal studies.RESULTS: Rare human case reports of inhalational exposure and multiple animal studies provide evidence of varied clinical sequelae, including mucosal irritation, respiratory concerns, neurotoxicity, hepatotoxicity, hemotoxicity (including Heinz body development and methemoglobinemia), and longitudinal risks. In an acute timeframe (minutes to hours), clinical sequelae are likely to be limited to mucosal and respiratory risk; neurological, hepatotoxic, and hemotoxic sequelae are unlikely without recurrent, longitudinal, or noninhalational exposure.CONCLUSIONS: Acute clinical management should focus on likely clinical concerns as supported by existing data; recovery medical personnel should be prepared to manage mucosal irritation and respiratory concerns, including the potential need for advanced airway management. There is little evidence supporting the need for acute interventions for neurotoxicity and there is no evidence that acute hemotoxic sequelae would drive the need for on-scene management of methemoglobinemia, Heinz body development, or hemolytic anemia. Training that overemphasizes neurotoxic or hemotoxic sequelae or specific treatments for such conditions potentially raises the risk for inappropriate treatment or operational fixation.Hanshaw BC, Ryder VE, Johansen BD, Pattarini JM, Nguyen HN, Nowadly CD, Blue RS. Spaceflight recovery considerations for acute inhalational exposure to hydrazines. Aerosp Med Hum Perform. 2023; 94(7):532-543.

THU-456 - Non-alcoholic fatty liver disease and the longitudinal risks of clinical outcomes: a meta-analysis

THU-456 - Non-alcoholic fatty liver disease and the longitudinal risks of clinical outcomes: a meta-analysis

Longitudinal examination of high-risk drinking contexts: Daytime drinking, pregaming, and drinking games linked to high-risk alcohol use and negative consequences in young adults.

The contexts in which young adults drink alcohol play a salient role in alcohol-related outcomes and negative consequences at an event-level, but less is known about longitudinal risks. We collected longitudinal monthly data across 2 years on (a) daytime drinking, (b) pregaming/pre-partying, and (c) playing drinking games. We then examined associations between drinking in these contexts and within-person variability in alcohol consumption, consequences, and simultaneous alcohol and marijuana (SAM) use in a given month. We also examined the extent to which drinking in these contexts predicted hazardous drinking (using Alcohol Use Disorders Identification Test (AUDIT) scores) at a distal follow-up timepoint, controlling for baseline AUDIT scores. A community sample of 759 young adults (Mage = 21.1 years; 56.4% female) completed monthly surveys for 24 consecutive months and a distal 30-month follow-up. Multilevel models estimated within- and between-person associations between drinking context frequencies (daytime drinking, pregaming, drinking games) and alcohol-related outcomes (weekly consumption, consequences, SAM use). A single-level negative binomial regression tested associations between drinking context frequency averages across a two-year period and changes in AUDIT scores from baseline to a follow-up 2.5 years later. Over 75% of the sample of non-abstaining young adults reported drinking in each of the three contexts at least once during the 24-month period. Within-persons, young adults reported greater consumption, more negative consequences, and increased likelihood of SAM use during months that they drank in these contexts more often than usual. Each context was associated with negative consequences, even when controlling for alcohol use frequency. More frequent daytime drinking and pregaming, but not drinking games, were associated with increases in AUDIT scores at the 30-month follow-up, suggesting that there are potential long-term risks of drinking in these contexts. Findings suggest that daytime drinking, pregaming, and playing drinking games are high-risk contexts in terms of month-to-month and long-term risks. Additional research is needed on the various contexts in which young adults drink alcohol and the extent to which contextual factors interact with one another to amplify/reduce risks and harms.

A two-dimensional lateral interaction crash risk evaluation model considering imbalanced data

There are more than 539,000 crashes caused by vehicle-vehicle lateral interactions annually. To address this issue, proactively capturing lane-changing (LC) intentions and evaluating interaction crash potentials are a promising adopted approach. However, existing analyses were mainly conducted using balanced data, which is contrary to the fact that LC is a small probability event under natural driving conditions. Besides, previous crash risk evaluation methods mainly focused on the longitudinal conflicts, which have ignored the prevailing horizontal conflicts. To address the previous gaps, a two-dimensional lateral interaction crash risk evaluation model was proposed. This model considers both horizontal and longitudinal crash risks during LC interaction process, and modified focal loss function was introduced to deal with the imbalanced data for LC intention identification. The empirical analyses were conducted using Highway Drone Dataset (highD). Results showed that compared to the traditional loss function, the recall of the proposed model has been improved from 79% to 93%.

Longitudinal associations between a health risk factor and juvenile justice placement among persistent juvenile offenders

AbstractHealth criminology explores the connection between crime and health factors. Less is understood about longitudinal health risks and adolescents entering the juvenile justice system. This study used a sample ofn= 388 males involved in the juvenile justice system to examined longitudinal associations of a latent health risk factor, comprised of depression, marijuana use, and sexually transmitted infections (STIs), with post‐juvenile assessment center (JAC) intake placement. Results using Bayesian estimation indicated the health risk factor was relatively stable over three time points of JAC entry and associated with present and, indirectly, future justice system placement. Youths who were Hispanic, Black, older, or living with a family member struggling with alcohol use had higher health risk. These findings underscore the need for juvenile justice system services that address health risks among persistent juvenile offenders, with consideration of cultural and family dynamics.

A Prospective Study of Longitudinal Risks of Cognitive Deficit for People Undergoing Glioblastoma Surgery Using a Tablet Computer Cognition Testing Battery: Towards Personalized Understanding of Risks to Cognitive Function.

Glioblastoma and the surgery to remove it pose high risks to the cognitive function of patients. Little reliable data exist about these risks, especially postoperatively before radiotherapy. We hypothesized that cognitive deficit risks detected before surgery will be exacerbated by surgery in patients with glioblastoma undergoing maximal treatment regimens. We used longitudinal electronic cognitive testing perioperatively to perform a prospective, longitudinal, observational study of 49 participants with glioblastoma undergoing surgery. Before surgery (A1), the participant risk of deficit in 5/6 cognitive domains was increased compared to normative data. Of these, the risks to Attention (OR = 31.19), Memory (OR = 97.38), and Perception (OR = 213.75) were markedly increased. These risks significantly increased in the early period after surgery (A2) when patients were discharged home or seen in the clinic to discuss histology results. For participants tested at 4-6 weeks after surgery (A3) before starting radiotherapy, there was evidence of risk reduction towards A1. The observed risks of cognitive deficit were independent of patient-specific, tumour-specific, and surgery-specific co-variates. These results reveal a timeframe of natural recovery in the first 4-6 weeks after surgery based on personalized deficit profiles for each participant. Future research in this period could investigate personalized rehabilitation tools to aid the recovery process found.

Prevalence and Spectrum of Occupational Injury Among Orthopaedic Surgeons: A Cross-Sectional Study.

An electronic survey was developed to assess both physical and mental occupational hazards among orthopaedic surgeons. Descriptive statistics were analyzed for all survey items and compared using chi-square and paired t tests, as appropriate. The 1,645 responding orthopaedic surgeons (7% response rate) reported a total of 2,702 work-related musculoskeletal injuries, 17.9% of which required surgical treatment. Of the 61 who filed a disability claim, only 66% returned to work and 34% retired early. Additionally, 17.4% of respondents reported having been diagnosed with cancer since starting practice, and 93.8% reported experiencing a finger stick at some point in their career. Over one-half (55.8%) had experienced feelings of psychological distress since beginning practice, and nearly two-thirds (64.4%) reported burnout from work. This study captured a spectrum of occupational injuries that pose longitudinal risks to an orthopaedic surgeon's physical and mental well-being. Our hope is that this analysis of occupational hazards will help to raise awareness among the orthopaedic and medical communities and lead to efforts to reduce these risks. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Decision-making of active collision avoidance system based on comprehensive evaluation method of dangerous scenarios

Dangerous scenario modeling is of great significance for the development of automatic driving functions, and the active collision avoidance system directly affects the safety of vehicles and the intelligence level of vehicles. However, the current existing collision risk evaluation methods are difficult to comprehensively evaluate different dangerous scenarios, the evaluation methods are complicated and there is no normalized description form. In addition, the traditional decision-making method of active collision avoidance system based on collision time distance will lead to the problems of inconsistent risk evaluation scale and single way of collision avoidance. To solve the above problems, the mechanism analysis of the longitudinal, lateral, and parallel collision risks is carried out respectively, and then the model based on kinematics and dynamics is established. After that, the corresponding expression form of collision risks is derived. Finally, the comprehensive evaluation method of dangerous collision scenarios is proposed. Secondly, based on the comprehensive evaluation method of collision risk, considering longitudinal constraints, lateral constraints, parallel constraints, and road regulations, an active collision avoidance decision-making method that used the cooperative collision avoidance mode of breaking and steering is designed. Thirdly, different simulation experiments are designed based on PanoSim/Simulink. The results show the comprehensive evaluation method can effectively model the collision risk of vehicles in the motion process. At the same time, the decision-making method of the active collision avoidance system achieves the expected working effect, thus improving driving stability and safety.

Risk of psychiatric disorders and suicide attempts in emerging adults with diabetes

OBJECTIVE To determine the longitudinal risks of psychiatric disorders in adolescents and emerging adults with versus without diabetes. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study in Quebec, Canada, using linked health administrative databases of adolescents (age 15 years) with and without diabetes and without prior psychiatric disorders between 1997 and 2015, followed to age 25 years. RESULTS Our cohort included 3,544 individuals with diabetes and 1,388,397 without diabetes. Individuals with diabetes were more likely to suffer from a mood disorder (diagnosed in the emergency department or hospital) (adjusted hazard ratio 1.33 [95% CI 1.19–1.50]), attempt suicide (3.25 [1.79–5.88]), visit a psychiatrist (1.82 [1.67–1.98]), and experience any type of psychiatric disorder (1.29 [1.21–1.37]) compared with their peers without diabetes. CONCLUSIONS Between the ages of 15 and 25 years, the risks of psychiatric disorders and suicide attempts were substantially higher in adolescents and emerging adults with versus without diabetes.

Urine Alpha-1-Microglobulin Levels and Acute Kidney Injury, Mortality, and Cardiovascular Events following Cardiac Surgery

Introduction: Urine alpha-1-microglobulin (Uα1m) elevations signal proximal tubule dysfunction. In ambulatory settings, higher Uα1m is associated with acute kidney injury (AKI), progressive chronic kidney disease (CKD), cardiovascular (CV) events, and mortality. We investigated the associations of pre- and postoperative Uα1m concentrations with adverse outcomes after cardiac surgery. Methods: In 1,464 adults undergoing cardiac surgery in the prospective multicenter Translational Research Investigating Biomarker Endpoints for Acute Kidney Injury (TRIBE-AKI) cohort, we measured the pre-and postoperative Uα1m concentrations and calculated the changes from pre- to postoperative concentrations. Outcomes were postoperative AKI during index hospitalization and longitudinal risks for CKD incidence and progression, CV events, and all-cause mortality after discharge. We analyzed Uα1m continuously and categorically by tertiles using multivariable logistic regression and Cox proportional hazards regression adjusted for demographics, surgery characteristics, comorbidities, baseline estimated glomerular filtration rate, urine albumin, and urine creatinine. Results: There were 230 AKI events during cardiac surgery hospitalization; during median 6.7 years of follow-up, there were 212 cases of incident CKD, 54 cases of CKD progression, 269 CV events, and 459 deaths. Each 2-fold higher concentration of preoperative Uα1m was independently associated with AKI (adjusted odds ratio [aOR] = 1.36, 95% confidence interval 1.14–1.62), CKD progression (adjusted hazard ratio [aHR] = 1.46, 1.04–2.05), and all-cause mortality (aHR = 1.19, 1.06–1.33) but not with incident CKD (aHR = 1.21, 0.96–1.51) or CV events (aHR = 1.01, 0.86–1.19). Postoperative Uα1m was not associated with AKI (aOR per 2-fold higher = 1.07, 0.93–1.22), CKD incidence (aHR = 0.90, 0.79–1.03) or progression (aHR = 0.79, 0.56–1.11), CV events (aHR = 1.06, 0.94–1.19), and mortality (aHR = 1.01, 0.92–1.11). Conclusion: Preoperative Uα1m concentrations may identify patients at high risk of AKI and other adverse events after cardiac surgery, but postoperative Uα1m concentrations do not appear to be informative.

Shared Steering Control for Lane Keeping and Obstacle Avoidance Based on Multi-Objective MPC

This paper presents a shared steering control framework for lane keeping and obstacle avoidance based on multi-objective model predictive control. One of the control objectives is to track the reference trajectory, which is updated continuously by the trajectory planning module; whereas the other is to track the driver’s current steering command, so as to consider the driver’s intention. By adding the two control objectives to the cost function of an MPC shared controller, a smooth combination of the commands of the driver and the automation can be achieved through the optimization. The authority of the driver and the automation is allocated by adjusting the weights of the objective terms in the cost function, which is determined by the proposed situation assessment method considering the longitudinal and lateral risks simultaneously. The results of the CarSim-Matlab/Simulink joint simulations show that the proposed shared controller can assist the driver to complete the tasks of lane keeping and obstacle avoidance smoothly while maintaining a good level of vehicle stability.

How Does Heterogeneity Affect Freeway Safety? A Simulation-Based Exploration Considering Sustainable Intelligent Connected Vehicles

Intelligent connected vehicles (ICVs) are recognized as a new sustainable transportation mode, which could be promising for reducing crashes. However, the mixed traffic consisting of manually driven vehicles and ICVs may negatively affect road safety due to individual heterogeneity. This study investigated heterogeneity effects on freeway safety-based simulation experiments. Two types of vehicle dynamic models were employed to depict dynamic behaviors of manually driven vehicles and adaptive cruise control (ACC) vehicles (a simplified version of ICVs), respectively. Real vehicle trajectories were utilized to calibrate model parameters based on genetic algorithms. Surrogate safety measures were applied to establish the relationship between vehicle behaviors and longitudinal collision risks. Simulation results indicate that the heterogeneity has negative effects on longitudinal safety. With the higher degree of heterogeneity, longitudinal collision risks are increased. Compared to traffic flow consisting of human drivers only, mixed traffic flow may be more dangerous when the market penetration rate of ACC is low, since the ACC system can be recognized as a new source of individual heterogeneity. Findings of this study show that necessary countermeasures should be developed to improve safety for mixed traffic flow from the perspective of transportation safety planning in the near future.

Ethical, Legal, and Social Issues (ELSI) of Responsible Data Sharing Involving Children in Genomics: A Systematic Literature Review of Reasons

Background Progress in precision medicine relies on the access to, use of, and exchange of genomic and associated clinical data, including from children. The ethical, legal, and social issues (ELSI) of such data access, use, and exchange may be accentuated in the pediatric context due in part to the highly sensitive nature of genomic data, children’s consent-related vulnerabilities, and uncertain risks of reidentification. Systematic analyses of the ELSI and scientific reasons for why and how genomic data may be shared responsibly are, however, limited. Methods: We conducted a modified systematic review of reasons according to Sofaer and Strech to examine the ELSI and scientific reasons for “responsible” sharing of children’s genomic and associated clinical data. Empirical articles, commentaries, and data-sharing policies indexed in Medline, Scopus, Web of Science, and BIOSIS were included in the analysis if they discussed ELSI and were published between 2003 and 2017 in English. Results: One hundred and fifty-one records met our inclusion criteria. We identified 11 unique reasons and 8 subreasons for why children’s genomic data should or should not be shared. Enhancing the prospect of direct and indirect benefits and maximizing the utility of children’s data were top reasons why data should be shared. Inadequate data privacy protection was the leading reason why it should not. We furthermore identified 8 reasons and 30 subreasons that support conditional data sharing, in which recontact for the continued use of children’s data once they reach the age of majority was the most frequently endorsed condition. Conclusions: The complete list of ELSI reasons and responsible conditions provides an evidentiary basis upon which institutions can develop data-sharing policies. Institutions should encourage the sharing of children’s data to advance genomic research, while heeding special reconsent and data protection mechanisms that may help mitigate uncertain longitudinal risks for children and families.