National Average Rate Research Articles

Enhancing Space-Based Tracking of Fossil Fuel CO2 Emissions via Synergistic Integration of OCO-2, OCO-3, and TROPOMI Measurements.

Top-down estimates of fossil fuel CO2 (FFCO2) emissions are crucial for tracking emissions and evaluating mitigation strategies. However, their practical application is hindered by limited data coverage and overreliance on NOx-to-CO2 emission ratios from emission inventories. We developed the Machine Learning-Driven Mapping Satellite-based XCO2en (ML-MSXE) model using the column-averaged dry-air mole fraction of CO2 enhancement (XCO2en) derived from OCO-2 and OCO-3 measurements to reconstruct the XCO2en distribution for monitoring FFCO2 emissions. Compared to the previous Machine Learning-Driven Deriving XCO2en from Mapped XCO2 (ML-DXEMX) model, ML-MSXE enhances the utilization of TROPOMI NO2 measurements, increasing their relative contribution from 4.3 to 21.7%, thereby improving XCO2en reconstruction accuracy and enhancing the ability to track emissions. Despite the COVID-19 lockdown, XCO2en levels in China rose from 1.33 ± 1.06 in 2019 to 1.39 ± 1.01 ppm in 2021. In February 2020, while the national average rate of XCO2en decline (16.3%) aligned with the reduction in FFCO2 emissions estimated by inventories, XCO2en further revealed varying rates of decline between cities. Furthermore, the spatial distribution of XCO2en identified hotspots where FFCO2 emissions might be underestimated by inventories. This study presents a space-based approach for monitoring FFCO2 emissions, offering valuable insights for assessing carbon neutrality progress and informing policy.

A-182 Applications of artificial intelligence optical character recognition in laboratory clerical functions offsetting staffing shortages and error reduction

Abstract Background The clinical laboratory profession has been dealing with a decade long, and now critical retention and staffing problem. The average national turnover rate for laboratory technicians is 17%, and the highest turnover rate exhibited for phlebotomists is 36%. While turnover rates have an impact on a laboratory, or hospitals budget, more importantly they have a substantial impact on quality and error rates, particularly in the pre-analytical stage of testing; with studies showing up to 65.09% of errors impacting the pre-analytical phase. Methods In an effort to remedy this high error rate, a meta-analysis was performed on paper order entry and clerical pre-analytical error, in parallel with performance and accuracy data of advanced optical character recognition driven by artificial intelligence and machine learning (AI OCR). Results AI OCR studies demonstrated an untrained accuracy percentage, to include handwriting of 91.08%, and when trained utilizing both relational and hierarchal logic data bases accuracy increased to 98.4%. The rate at which AI OCR processed and classified medical information was 3-4 pages per second. It is estimated that 99.9%-100% accuracy can be achieved with additional form field training and mapping. The level of accuracy and efficiency for laboratory paper order-entry utilizing AI OCR can also be increased with the addition of natural language processing and data recognition algorithms when combined with logic databases containing information such as medical record numbers, ICD-10 codes, and laboratory test compendiums. Conclusions The performance of this technology demonstrates a strong application to reduce the burden of clerical paper order entry, while addressing the 30.8% dissatisfaction rate regarding manual entry processes among lab professionals surveyed. Moreover, AI OCR clerical data classification, extraction and entry processes augmented with human verification steps examined, demonstrated overall accuracy of 99.99%. The application of AI OCR in laboratory pre-analytical processes has the potential to improve test order accuracy and efficiency, ultimately impacting the quality of patient care and operational costs for healthcare facilities. When examined through the lens of staff retention, studies show that 80% of laboratory employees feel that a workplace with the necessary tools and technology positively impacts their job satisfaction. While organizations investing in technologies that drive both job efficiency and satisfaction see a 125% return on investment through productivity. Demonstrating that the application of sophisticated technologies that both increase productivity and decrease error rates have a substantial impact on job satisfaction and ultimately retention. Although laboratory clerical data and order entry processes were examined for this meta-analysis, the aggregate data compiled showed that the application of AI OCR in clerical processes could also have a substantial impact on the 25.9% annual turnover rate for hospitals as a whole in the United States.

FP6.13 - A Quality improvement project to reduce the number of readmissions to surgical assessment unit (SAU) in East Sussex hospitals (ESHT) following laparoscopic cholecystectomy

Abstract Aim This is a QI project aiming to reduce the number of readmissions following laparoscopic cholecystectomy in ESHT from the current rate of 8.1% to the UK national average rate of 5%. This proposal followed an audit I conducted previously. About two-thirds of those readmissions occurred on day one following discharge, half of them due to pain, and almost 90% of them discharged without any intervention needing only reassurance, pain control, and analgesia. Methods Problem identified, SMART objectives followed, which means our intervention is: specific, measurable, achievable, relevant, and time specified. Set up a process map showing areas where intervention is desirable/beneficial. These include time allowed for consent, preoperative assessment clinic, and postoperative discharge information. Then a driver diagram is drawn to indicate the primary and secondary drivers we need to tackle in order to achieve our goal. In summary, the proposed changes include allowing more time in clinic for patients to explain procedure and consent, junior doctors and nurses’ education, resources, and provision of leaflets and websites for information. Identification of stakeholders including managers, anaesthetists’ nurses, and patients, and dealing with them according to their influence and interest. PDSA (plan do study and act) cycle, TQM (total quality management), SPC (statistical process control), and lean methodology were implemented. Conclusion This project is aimed primarily at reducing readmissions numbers to SAU following laparoscopic cholecystectomy from 8.1% to 5% within a year. Areas in the process map were identified to achieve this objective, and since about 90% of patients were discharged without any intervention, we believe this should be achievable.

Patient navigation as an effective way to increase breast, cervical, and colorectal cancer screening among immigrants in the US: A systematic review.

e22501 Background: Immigrants undergo recommended cervical, breast, and colorectal cancer screening at a lower frequency than U.S.-born patients and face unique language, educational, and cultural barriers. The delay or lack of screening has known implications in the presentation of breast, cervical, and colorectal malignancies, including worse staging at diagnosis. To address the disparity in cancer screening that immigrants experience, various interventions have been studied, including patient navigation (PN) programs. This systematic review aims to determine whether PN increases cervical, breast, and colorectal cancer screening in immigrant populations. Methods: A systematic literature search was conducted using PubMed, Scopus, and Web of Science to identify English-language articles published from January 2000 to November 2023 examining the role of patient navigators in encouraging routine breast, colorectal, and cervical cancer screening among immigrant populations in the United States. For the articles that met the inclusion criteria, details of patient navigation programs and uptake or change in cancer screening behaviors were extracted. Results: We screened 2196 articles, 53 of which met criteria for review, and 18 articles were ultimately included in the analysis. PN programs increased breast, cervical, or colorectal screening within immigrant populations compared to the control or alternative intervention in all 18 studies. In 7 out of 18 (38.9%) studies, the PN intervention group achieved screening rates similar to or above Non-Hispanic White national average screening rates. Two of those studies occurred in the outpatient setting, which resulted in higher screening rates than community-based settings. Two of those 7 studies that matched the Non-Hispanic White screening rates also had a longer duration of over 4 years. The majority of PN programs included educational sessions or materials and screening appointment scheduling assistance delivered from members of the same cultural group. Other services included identification and assistance with overcoming barriers, insurance assistance, reminders, transportation, and accompaniment to screening appointments. Of the 18 studies included, rural areas were underrepresented, and the training of patient navigators was not always described. Conclusions: Our review suggests that PN programs are effective at increasing cancer screening rates among immigrant populations, and certain aspects of PN programs, including outpatient settings and longer navigation duration, may help to further increase screening rates.

Exploring equality and sustainability trade-offs of energy transition outcomes in the United States in 2050

With increasing focus on equitable and just energy transition, it is critical to understand the trade-offs of different decarbonization outcomes across economic, environmental, and social sustainability criteria. In this analysis, we use a multi-criteria decision analysis to quantify sustainability outcomes across 32 decarbonization outcomes in 2050 in the U.S. The economic sustainability criteria we use are system cost, national average retail rate, and electricity system employment. The environmental sustainability criteria we use are life cycle greenhouse gas emissions, life cycle water depletion, life cycle land transformation, and air pollution fatalities. The social sustainability (distributional impacts) criteria we use are retail rate equality across states, electricity employment equality across low-income households, and air pollution disparities across census tracts. We evaluate performance across these criteria under eleven different stakeholder preference scenarios. We find that decarbonization policies with indefinitely extended tax credits have the highest sustainability score under equal criteria weighting, with greater investments in renewable energy technologies, and result in better environmental, system cost, job, and air pollution disparities compared to mid-case scenarios, that only include current policies and CO2 reduction targets. We also see that our multi-criteria decision analysis identifies decarbonization outcomes that would not have been identified as optimal under a single objective, which highlights the importance of trade-off analyses to understand decarbonization outcomes more holistically.

County-level factors associated with a mismatch between opioid overdose mortality and availability of opioid treatment facilities.

Opioid overdose deaths in the United States remain a major public health crisis. Little is known about counties with high rates of opioid overdose mortality but low availability of opioid use disorder (OUD) treatment facilities. We sought to identify characteristics of United States (US) counties with high rates of opioid overdose mortality and low rates of opioid treatment facilities. Rates of overdose mortality from 3,130 US counties were compared with availability of opioid treatment facilities that prescribed or allowed medications for OUD (MOUD), from 2018-2019. The outcome variable, "risk-availability mismatch" county, was a binary indicator of a high rate (above national average) of opioid overdose mortality with a low (below national average) rate of opioid treatment facilities. Covariates of interest included county-level sociodemographics and rates of insurance, unemployment, educational attainment, poverty, urbanicity, opioid prescribing, depression, heart disease, Gini index, and Theil index. Multilevel logistic regression, accounting for the clustering of counties within states, was used to determine associations with being a "risk-availability mismatch" county. Of 3,130 counties, 1,203 (38.4%) had high rates of opioid overdose mortality. A total of 1,098 counties (35.1%) lacked a publicly-available opioid treatment facility in 2019. In the adjusted model, counties with an additional 1% of: white residents (odds ratio, OR, 1.02; 95% CI, 1.01-1.03), unemployment (OR, 1.11; 95% CI, 1.05-1.19), and residents without insurance (OR, 1.04; 95% CI, 1.01-1.08) had increased odds of being a mismatch county. Counties that were metropolitan (versus non-metropolitan) had an increased odds of being a mismatch county (OR, 1.85; 95% CI, 1.45-2.38). Assessing mismatch between treatment availability and need provides useful information to characterize counties that require greater public health investment. Interventions to reduce overdose mortality are unlikely to be effective if they do not take into account diverse upstream factors, including sociodemographics, disease burden, and geographic context of communities.

Characterization and Proposal of Technologies for The Treatment of Domestic Sewage in Ilha Grande Bay – RJ

Objective: To characterize the situation of sanitary wastewater discharge in the hydrographic basins draining into the Baía da Ilha Grande (BIG) and to propose wastewater treatment alternatives based on the literature on decentralized solutions. Theoretical framework: The BIG has been experiencing negative environmental impacts due to the urbanization process in the region, mainly due to the irregular discharge of domestic wastewater into the environment. Method: The methodology was developed in two stages, with stage 1 involving data collection from available data in the 2017 Wastewater Atlas, and stage 2 focusing on identifying the most appropriate treatment technologies for this study from the fifteen options evaluated. Results and conclusion: The characterization revealed that municipalities within the BIG are already using decentralized solutions for domestic wastewater treatment, albeit below the national average coverage rates (18-54%). The five most promising technologies identified were Septic Tanks, Compact UASB, Biodigesters, Compartmentalized Anaerobic Reactors, and Integrated Biosystems. It is concluded that the communities have a sanitation deficit and show potential for implementing decentralized solutions. Implications of the research: The study helped develop strategies for decision-makers to select the most appropriate wastewater treatment technologies to meet local needs. It also served as a model for scientific studies in other locations. Originality/value: This study aligns with the Sustainable Development Goals (SDGs), particularly SDG 6, by presenting decentralized solutions as a promising pathway to universalizing household wastewater treatment in developing countries.

(382) Online Trends for Vasectomy Inquiries following Dobbs v. Jackson Women’s Health Organization Supreme Court Decision

Abstract Introduction On June 24th, 2022, the United States Supreme Court issued its decision in Dobbs v. Jackson Women’s Health Organization that overturned Roe v. Wade, the constitutional right to abortion access in the U.S. There have been reports of increased interest in vasectomies at individual centers following this Supreme Court ruling, though it is unclear what changes have occurred on the national level. Objective We sought to use Google Trends to evaluate online interest in vasectomies in the U.S. in relation to the Dobbs v. Jackson decision. Methods We used Google Trends to evaluate the popularity scores (generated as a relative value amongst search terms from 0-100) of the search term “vasectomy” from January 2022 to January 2023. We calculated average rate of change (ROC) of scores for the time periods immediately surrounding the Dobbs V. Jackson court decision on June 24th, 2022 and the decision’s early leak to press on May 2nd, 2022 to determine if there was change in interest in immediate time surrounding these events. We then compared the baseline popularity scores in the 4 months before and after the decision. Additionally, we assessed the top 10 states searching for “vasectomy” and correlated with abortion access following the Dobbs v. Jackson decision. Results The national average rate of change of searches for “vasectomy” was significantly higher immediately after the Dobbs v. Jackson decision (0.283 vs. -0.210, p=0.003) (Figure 1). There was not a statistically significantly difference in searches of “vasectomy” after the press leak of the decision (0.001 vs. -0.102, p=0.745) (Figure 1). There was not a statistically significant long-term change in search trends pre- and post- Dobbs v. Jackson decision (p=0.506). Among the 10 states with the highest searches for “vasectomy” after the decision, 7 had abortion bans that went into effect following the Dobbs v. Jackson decision (Table 1). Conclusions There were significantly increased Google searches for “vasectomy” following the Dobbs v. Jackson Supreme Court decision to repeal the constitutional right to abortion and most of the states with the highest interest had abortion bans that went into effect following the decision. Urologists should be aware that abortion policies can influence the reproductive interests of their male patients. Disclosure No.

Electronic aggregated data collection on cervical cancer screening in Bangladesh since 2014: what the data tells us?

IntroductionTo reduce the high prevalence of cervical cancers among the Bangladeshi women, the Government of Bangladesh established a national cervical cancer screening programme in 2005 for women aged 30 to 60 years. The District Health Information System Version 2 (DHIS2) based electronic aggregated data collection system is used since the year 2013. This study summarises data from the year 2014 to 2022 to assess the effectiveness of the electronic data collection system in understanding the outcome of the screening programme.MethodsThis is a descriptive study based on secondary data extracted in MS Excel from the DHIS2-based electronic repository of the national cervical cancer screening programme of Bangladesh. The respondents were women aged 30–60 years, screened for cervical cancer using VIA (Visual Inspection of cervix with Acetic acid) method in 465 government health facilities. The data were collected on the participants’ residential location, month and year of screening, name and type of health facilities performing VIA, and VIA screening results.ResultsThe national screening programme reported a total 3.36 million VIA tests from 465 government hospitals in 8 years (2014 to 2022). The national average VIA-positivity rate was 3.6%, which varied from 1.4 to 9.5% among the districts. This national screening programme witnessed an exponential growth, year after year, with 83.3% increase in VIA test from 2014 to 2022. The primary and the secondary care hospitals were the highest collective contributors of VIA tests (86.2%) and positive cases (77.8%). The VIA-positivity rates in different hospital types varied widely, 7.0% in the medical university hospital, 5.7% in the medical college hospitals, 3.9% in the district/general hospitals, and 3.0% in the upazila health complexes.ConclusionsA national cervical cancer screening programme using VIA method and a DHIS2-based electronic data collection backbone, is effective, sustainable, and useful to understand the screening coverage, VIA positivity rate and geographic distribution of the participants and case load to initiate policy recommendations and actions. Decentralization of the screening programme and more efforts at the primary and secondary care level is required to increase screening performances.

Seasonally extreme temperature events accelerate in arid northwestern China during 1979–2018

The arid northwestern China is the most vulnerable region to climate change, where the variability of seasonally extreme temperature events has profound implications for both its hydrological, ecological, and human systems. In this study, we applied 15 indicators of extreme temperature to analyze the spatial and temporal variation of its occurrence in arid northwestern China for a recent 40-year period (1979 to 2018). These extreme temperature event dynamics were then combined with atmospheric and oceanic circulation to explore their response mechanisms. Our results revealed the following: (1) Over the 40-year period, the annual average temperature in this arid zone increased at a rate of 0.4 °C/decade (p = 0.09), exceeding the national average rate (0.28 °C/decade). Apart from a few indicators, extreme temperature events (TXx, TNx, TXn and TNn) generally increased at least twice as fast as average temperature during the four seasons, especially in spring, when TNn (0.98 °C/decade) rose five times faster than did the average temperature (0.2 °C/decade). (2) Spatially, except for the Kunlun Mountains and Tarim Basin, seasonal warming occurred in most parts of the studied arid zone, being most prominent in the summer. In this season, the average number of warm nights increased (3.23 days/decade), while the average number of cold nights decreased (2.69 days/decade). (3) After the 1990s, extreme temperature events accelerated significantly. The Cold Spell Duration Indicator decreased 42% in spring and the Warm Spell Duration Indicator increased 300% in summer, from 1979 –1998 to 1999–2018, which may hasten the formation of snow and glacier melt flooding events in the spring and summer. Spatiotemporal variability in seasonally extreme temperature events was closely related to atmospheric and oceanic circulation, particularly for the AMO (r = 0.8). Altogether, these findings enhance our understanding of how to better assess shifts in extreme temperature events in response to a changing climate in arid zones.

The Insect Pest Management Strategies and Their Influence on The Emergence Rate of Elaeidobius kamerunicus Faust (Coleoptera: Curculionidae) From The Post-Anthesising Male Inflorescence of Oil Palm, Elaeis guineensis

Elaeidobius kamerunicus is the main pollinating insect of oil palm, Elaeis guineensis in Malaysia. Elaiedobius kamerunicus feeds and breeds on the oil palms' male inflorescences. The weevil presence is vital for the successful pollination of oil palm, thus ensuring satisfactory fruit bunch production. MPOB recently reported that the declining quality of oil palm fruit bunch, mainly due to insufficient pollination, had affected the national average oil extraction rate. In part, this scenario was caused by the declining pollinator population. As such, the factors affecting the pollinators' population need to be investigated. One of the critical criteria in estimating the population of E. kamerunicus in the field is to measure the emergence rate of the new adult E. kamerunicus from the post-anthesis male inflorescence (PAMI). The study to investigate the rate of E. kamerunicus adult emergence and their sex ratio was conducted for four months at nine oil palm estates in Malaysia by using PAMI samples that were brought to the laboratory and observed for two weeks. The results have shown that the number of adult weevils that emerged from PAMI was about 36-47 individuals, and the female-to-male ratio for the emerged progenies was 2.33-4.46: 1. Indiscriminate application of broad-spectrum pyrethroid insecticide, cypermethrin has negatively influenced the weevil emergence rate in the field. Whereas, minimal impact on the emergence rate was observed in areas applied with biopesticide. This study showed that the application of cypermethrin could threaten the future population of the pollinating weevil in the field. As such, the excessive application of such insecticides in the field is discouraged and should be replaced by biopesticides to complement other Integrated Pest Management (IPM) strategies. In addition, further investigation is needed to understand how the gender ratio of the progeny could affect the future population of E. kamerunicus.

A Study on the Monitoring of Toxocara spp. in Various Children's Play Facilities in the Republic of Korea (2016-2021).

Toxocara spp. is a zoonotic soil-transmitted parasite that infects canids and felids, which causes toxocariasis in humans, migrating to organ systems, including the lungs, the ocular system, and the central nervous system. Since Toxocara spp. is usually transmitted through soil, children tend to be more susceptible to infection. In order to monitor contamination with Toxocara spp. in children's play facilities in the Republic of Korea, we investigated 11,429 samples of soil from daycare centers, kindergartens, elementary schools, and parks across the country from January 2016 to December 2021. Since the Environmental Health Act in the Republic of Korea was enacted in March 2008, there have been sporadic reports of contamination by Toxocara spp. in children's activity zones. In this study, soil from children's play facilities in regions across the Republic of Korea was monitored according to the Korean standardized procedure to use it as basic data for preventive management and public health promotion. The national average positive rate was 0.16% (18/11,429), and Seoul showed a higher rate of 0.63% (2/318) than any other regions while Incheon, Daegu, Ulsan, Kangwon-do, Jeollabuk-do, and Jeollanam-do were negative (p < 0.05). The positive rates were as follows: 0.37% (4/1089) in daycare centers, 0.13% (3/2365) in kindergartens, 0.2% (7/4193) in elementary schools, 0.09% (1/1143) in apartments, and 0.14% (3/2198) in parks. In addition, it was confirmed that 0.2% (1/498) of elementary schools and 1.17% (2/171) of parks were re-contaminated among play facilities managed with the establishment of a regular inspection cycle. Consequently, there is an essential need for continuous monitoring of Toxocara spp. contamination and regular education for preschool and school children in order to prevent soil-borne parasite infections.

"Dogs on Call": A Community-Engaged Human Subjects Training with Hospital Based Therapy Dog Teams.

Problem: As community-engaged research (CER) methods evolve, Institutional Review Boards (IRBs) must adapt policies to facilitate CER research. This paper describes a novel collaboration between hospital-based therapy dog volunteer teams (CERs), academic faculty, and an IRB. Subjects: CER volunteers delivered a canine-assisted intervention to hospitalized adults in a clinical trial. Methods: IRB members and faculty developed a human subjects protections training tailored to the volunteer handlers' role as study interventionists including an interactive video- and discussion-based training with a knowledge assessment. Findings: Fourteen volunteer handlers were trained. The expedited IRB review period was similar to national average rates (18 days.) Volunteer handlers have conducted 107 research visits with little patient attrition. Conclusion: Tailored human subjects trainings facilitate research with interventions delivered by people who are not typically involved in research. Bespoke CER human subjects training requires collaboration between researchers and IRBs and flexibility in IRB policy regarding CER.

Characteristics of a Southern Intensive Trauma- and Psychiatric-Focused Recovery Program.

Treatment of substance use disorders (SUDs) is complex, involving biological, psychological, and social factors to be considered when designing effective programs. Trauma-informed psychiatric care integrated with a developmentally appropriate intensive 12-step approach is being used at A Reprieve for Women (Reprieve), a long-term intensive residential recovery program for female emerging adults with SUDs located in Tuscaloosa, Alabama. The Reprieve treatment philosophy focuses on long-term intensive care, treatment of coexisting trauma and psychiatric disorders, and development of life skills. The purpose of this article is to outline Reprieve's programmatic features and report Reprieve's 1- and 2-year sobriety rates for women who completed the 6-month residential program and compare it with national sobriety rates for other residential SUD treatment programs. Reprieve provided 1- and 2-year sobriety rates and duration of treatment from 110 deidentified participants who completed Reprieve's 6-month residential program between September 2016 and November 2020. The researchers defined sobriety as complete abstinence from any addictive substances. Reprieve staff contacted program graduates to determine sobriety status following completion of the program. This research, approved by the University of Alabama's institutional review board, involved usable data points from 68 of the 110 participants. We determined that Reprieve has a 75% 1-year sobriety rate and a 63% 2-year sobriety rate. The national average sobriety rate for people completing SUD treatment in residential programs is 40%. Reprieve's higher-than-national sobriety rates make it a valuable program to study. Its emphasis on the treatment of coexisting psychiatric problems and past traumas, development of life skills, and the unique needs of female emerging adults may contribute to the program's success. It is hoped that this program description and preliminary analysis of outcomes will provide valuable information for future SUD treatment program development. More rigorous study is needed to delineate the effects of specific programmatic features on sobriety.

Monitoring of schools and colleges of pharmacy based on NAPLEX passage rate

IntroductionWe have evaluated two approaches of monitoring schools and colleges of pharmacy based on North American Pharmacist Licensure Examination (NAPLEX) passage rates. Historically, the Accreditation Council for Pharmacy Education (ACPE) has cited programs for passage rate ≥2 SD below the national average. Since the National Association of Boards of Pharmacy (NABP) no longer reports scores, this procedure is being reconsidered. Our supposition is that the failure rate of ≥2 SD below the average should be retained, but now be based on the national average passage rate rather than score. Yet, we further suggest this is not sufficient due to major variations in class size. CommentaryWe suggest the establishment of a “maximum acceptable failure count,” likely in the range of 20 to 25 failing graduates per class. Analyses of data from 2017 to 2019 indicate that this approach would lead to monitoring approximately 15% of existing programs that graduate approximately 40% of individuals failing NAPLEX vs. monitoring only 5% of programs that graduate approximately 9% of individuals failing NAPLEX. ImplicationsThe historical method of monitoring pharmacy programs with NAPLEX passage rates ≥2 SD below the national average is not sufficient, primarily due large variations in class size. Since accreditation standards are currently being revised (“Standards 2025”), this would be an ideal time to update methods for selecting programs that warrant monitoring based on inadequate NAPLEX passage rates. We suggest the concept of “maximum acceptable failure count” should be considered when identifying programs to be cited.

Trends in pediatric donor heart discard rates and the potential use of unallocated hearts for allogeneic valve transplantation

ObjectivesAllogeneic valve transplantation is an emerging therapy that delivers a living valve from a donor heart. We reviewed the national discard rate of pediatric and young adult (aged 25 years or younger) donor grafts to estimate the number of hearts potentially available to source valve allotransplantation. MethodsWe queried the United Network for Organ Sharing database to identify pediatric and young adult heart donors from 1987 to 2022. Donor heart discard was defined as nontransplantation of the allograft. ResultsOf 72,460 pediatric/young adult heart donations, 41,065 (56.7%) were transplanted and 31,395 (43.3%) were unutilized. The average annual number of discarded hearts in era 1 (1987-2000), era 2 (2000-2010), and era 3 (2010-2022) was 791 (42.8%), 1035 (46.3%), and 843 (41.2%), respectively. From 2017 to 2021, the average annual number of discards by age was: 39 (31.8%) neonates/infants, 78 (38.0%) toddlers, 41 (49.4%) young children, 240 (38.0%) adolescents, and 498 (40.1%) young adults. High-volume procurement regions had the greatest proportion of nonutilization, with the national average discard rate ranging from 39% to 49%. The most frequently documented reasons for nonallocation were distribution to the heart valve industry (26.5%), presumably due to suboptimal graft function, poor organ function (22.7%), and logistical challenges (10.8%). ConclusionsWith ∼900 pediatric/young adult donor hearts discarded annually, unutilized grafts represent a potential source of valves for allogeneic valve transplant to supplement current conduit and valve replacement surgery. The limited availability of neonatal and infant hearts may limit this technique in the youngest patients, for whom cryopreserved homografts or xenografts will likely remain the primary valve substitute.

Drainage representation in flood models: Application and analysis of capacity assessment framework

Drainage systems are an integral part of urban infrastructure to help transport and treat wastewater as well as manage flooding during extreme rainfall events. Although there is a significant cost associated with the creation, operation and maintenance of drainage systems, the representation of these systems in flood models is overly simplified. This simplification is due to data protection regulations, and the complexities associated with drainage network modelling. A new framework developed by Water UK in collaboration with the Environmental Agency and sewerage undertakers for UK Drainage Water Management Plans provides data on the capacity and performance of the drainage system. The output from this framework provides a new method of incorporating a more explicit representation of spatially varied drainage capacity in flood models.This study presents the first application of the UK’s capacity assessment framework (CAF) for drainage representation in flood models. We develop a method of using the CAF outputs to represent spatially varied drainage losses across a catchment and assess its impact on flood risk. Three catchments in Leeds are used to quantify the difference generated in flooding when using a national average removal rate (NARR, e.g., 12 mm/hr) and our CAF-derived rainfall removal rates. Although there is variance across catchments, the results show the CAF removal rates increase flood depths, velocities, and flood hazards when compared to the national average due to a more realistic representation of the real system drainage capacity. With the pressures of climate change and continued urban development, a better representation of real drainage systems capacities will become more important and will make local solutions more resilient and relevant to the realities on the ground.

Quasi-Experimental Evidence on the Impact of State Recycling and Deposit Laws: Household Recycling Following Interstate Moves

Abstract This article estimates the effects on recycling behavior of state recycling laws and deposit laws based on changes in household recycling before and after interstate moves. Estimates from a national panel dataset of 1,498 households who moved between states provide a quasi-experimental test otherwise not possible given long-term stability of such laws in any state. Compared to national average recycling rates, moves to states with deposits for beverage containers increased the number of material types recycled by 41%. More stringent recycling laws are also effective, but they have a smaller impact. Recycling laws boosted the number of materials recycled by 9%, with the largest effect being the 17% increase in the recycling rate for glass. Moves from states with deposit laws to states without such laws decreased the number of materials recycled by 13%. Shifts out of states with stringent laws only had statistically significant effects for plastic, which exhibited a 12% decrease after such a move.

Research on the Synergistic Development Measurement of Construction Land Scale and Population Scale in Urban Areas of Counties in China

In order to quantitatively portray the degree of synergistic development of construction land scale and population scale in county urban areas in China, this paper uses elasticity coefficient model and deviation coefficient model to measure the sequential change characteristics, spatial divergence differences and the degree of synergistic development of population scale and construction land scale of county units in each province in China based on the data of China Urban and Rural Construction Statistical Yearbook from 2006 to 2016. The results of the study show that: ①Both the number of population and the area of land for construction in counties in China show a trend of first increasing and then slightly decreasing, reaching a peak in 2014 and then slowly decreasing; ②In the process of rapid urbanization, the urbanization rate of county units in China is much smaller than the national average urbanization rate, and the urbanization level of counties is less than half of the national urbanization level. Therefore, the main force driving China’s urbanization process comes from the development of large and medium-sized cities, rather than county units. Besides, population transfer is more inclined to large and medium-sized cities than to county cities; ③ Based on the elasticity coefficient model, it is concluded that except Henan, Shanxi and Qinghai provinces, the other provinces in China are in a situation where the scale of construction land in county urban areas is not coordinated with the scale of population, and the type of incoordination is of the type of A disproportionate growth of people and land (the growth rate of the scale of construction land area and the scale of population are both positive and the growth rate of the former is greater than that of the latter); ④According to the deviation coefficient model, it is concluded that the scale of construction land scale and population growth in county units in China are not coordinated. Eighteen provinces in China are in a state of high dissonance, accounting for 64. 29% of the total. The average deviation coefficient for their degree of coordination is 2. 32, much higher than the average coefficient of deviation of 1. 5 in China. The relevant research results can provide theoretical reference for realizing the sustainable and healthy development of county cities, optimizing the structure of county units and improving utilization efficiency of county unit resources.

Integrated techno-economic and life cycle assessment of shared circular business model based blockchain-enabled dynamic grapevoltaic farm for major grape growing states in India

Grape farms face many climate risks during cultivation, and regulatory and sustainability-related challenges after the harvest. To support the farmers, Government of India (GoI) aims to promote adaptive capacity throughout the grape value chain by improving resilient infrastructure. This paper proposes a novel Grapevoltaics farm design based on shared circular business model principles where resources like energy, water, and land are shared between grape farmer and solar plant operator. The resilience (in the near term) and sustainability (in the long term) of such multifunctional systems may be influenced by the decisions taken by the involved stakeholders in terms of resource sharing and support extension when facing climate risk events. To address stakeholder engagement, the proposed Grapevoltaic farms leverage blockchain smart contract, making them Blockchain-enabled Grapevoltaics (BCeDGVs). To understand the feasibility, 1-ha Grapevoltaic farm is modeled for 12 grape growing regions accross India and analysed using Resilience Performance, Life Cycle Analysis, and Techno-Economic (RePLiCATE) approach. The results show that the solar panels provide resilience support based on the rules of engagement written on blockchain smart contracts. The BCeDGVs has 1295.28–2908.08 kWh/kWp/day electricity generation potential across India with a lifetime average of 15,380.65 MWh even after considering the national average photovoltaic degradation rate of 1.9%. The observed grape yields vary between 2 and 31.25 Mt/ha with an average yield of 45 Mt/ha (table grape) and 40 Mt/ha (wine grape), and the rainwater harvest varies between 1.23 to 7.32 Ml. The economic assessment revealed that grape farmers and photovoltaic plant operators across India under BCeDGVs could have revenues ranging between INR 56.25 to 225 million and INR 29.48–66.19 million, respectively, suggesting to relook into the feed-in tariffs and crop selling prices. The environmental sustainability results suggest that 1.984 ha/MW land-use mitigation and 12–100% reduction in groundwater dependency are possible while maintaining the minimum and maximum national average global warming potentials as 0.074 and 0.088 kg CO2-eq./kg grape, respectively. Overall, the integrated assessments find that the BCeDGVs may promote low carbon, climate resilient grape cultivation in India and has possible integration with GoI's GrapeNet platform. This study highlights a new research direction symbiotic grape farms and energy networks.