US Department Research Articles

Suicide prevention safety planning in the US Department of defense: Qualitative assessment of training.

Suicide rates in the military are a significant public health concern. The suicide prevention safety planning intervention is a brief and effective intervention in which a provider and patient work collaboratively to recognize warning signs of a suicidal crisis and create a defined list of coping strategies and supports for use during future crises (Stanley & Brown, 2012). Implementation of safety planning has been supported by the Department of Defense (DoD), yet readily available training and continuing education for healthcare providers in this intervention is limited and passive in nature. Existing safety planning training experiences and needs of DoD behavioral health providers are unknown. The present study is an exploratory qualitative assessment of current safety planning in DoD to inform the design and development of an interactive virtual standardized training patient. Ten military behavioral health providers completed semi-structured interviews. Thematic content analysis was conducted, and three themes are described in this paper: variety of training received, barriers to receiving suicide safety planning training, and desires for future training. Lack of protected time for training and a lack of access to training resources were identified as key barriers. Rich data obtained can help inform the key design features and relevance of new safety planning intervention training approaches.

Public-Private Partnerships in Supply Chain Resilience

Purpose: This study examines the importance of PPPs in supply chain resilience, particularly their collaboration with the example of Microsoft and the US Department of Agriculture (USDA). More notably, the study reports on the improvement of agricultural supply chain management and food safety through the use of cloud and soft computing technologies in the context of climate change and market volatility. Methodology: The study uses case study methods based on secondary data obtained from various reports and studies in the industry. In order to measure the impact of these strategies on their ability to reduce the risk of disruptions in supply chains. Data analysis shows measurable attributes to supply chain management and sustainability in agriculture against the backdrop of technology penetration. Findings: The findings highlight that their adoption has a positive effect on the operation and flexibility of the agricultural supply chain. The data, further, indicates that as part of the collaboration, there was an improvement in data integration, prediction, and resourcing for the USDA and Microsoft partnership, which enhanced food security and adaptation to climate change. Unique Contribution to Theory, Practice and Policy: The report suggests extending the usage of such public-private collaborations for enhancement of resilient supply chains to other areas. For present and future disruptions there is need for better partnership among the government, private technology companies and adoption of sustainable practices in supply chain management.

New US DHHS Guidelines for Feeding of HIV Exposed Infants: Uptake, Practice Variability and Concerns

Abstract Background Approximately 5000 infants are born to mothers living with HIV annually in the US. In the past, the Center for Disease Control (CDC), American Academy of Pediatrics (AAP), and US Department of Health and Human Services (DHHS) have recommended that people living with HIV (PWH) not breast/chest feed their infants. Recent changes published in January 2023 in the “Section on Infant Feeding for Individuals Living with HIV” in the US DHHS HIV Guidelines, now include that individuals with HIV who are on antiretroviral therapy (ART) with a sustained undetectable viral load (VL) and who choose to breastfeed should be supported in this decision. We evaluated the uptake of these guidelines, and practice variability across providers who care for such mothers and infants. Methods We surveyed Pediatric Infectious Diseases Society members who practice clinically in the US, via an internal email list serve. The ten-question survey assessed uptake of the updated DHHS guidelines and respondents’ clinical practice in three key areas that are subject to interpretation in the guidelines: VL control, mixed feeding, and ART prophylaxis. We used descriptive statistics to examine guideline uptake and variability in practice. We used inductive qualitative thematic analysis to identify themes in open-ended survey responses. Results Of 915 individuals who opened the survey, 165 responded and 129 were included in the final analysis. Respondents represented 86 US clinical centers. Uptake varied: 14 respondents (10.8%) were unaware of the new guidelines, 103 (79.8%) had implemented or were planning to implement the new guidelines, and 12 (9.3%) were not planning to implement the guidelines. The table summarizes variability in pre-delivery VL suppression and mixed feeding criteria used by 117 respondents who are either planning/already implementing guidelines or who are unaware of guidelines. Areas of concern revealed by thematic analysis included insufficient data to support guidelines and lack of specific criteria for implementation. Conclusion We identified substantial heterogeneity in provider uptake and comfort with new breastfeeding guidelines among US pediatric infectious diseases practitioners, and variability in assessment of safety to breastfeed. Further research is essential to explore patient preferences, define necessary follow-up, and address provider concerns regarding insufficient data to support guidelines and lack of specific criteria for implementation.

Public and health care provider attitudes, understanding, and behaviors regarding emergency use authorizations: a scoping literature review

BackgroundUnder Sect. 564 of the Federal Food, Drug, and Cosmetic Act, when the US Department of Health and Human Services Secretary issues a declaration based on one of four types of determinations, FDA may authorize an unapproved product or unapproved uses of an approved product for emergency use. It is unclear how much the public and health care providers understand about emergency use authorizations and how that understanding influences perceptions or behavioral intentions. The current study aimed to explore consumer and health care provider perceptions of emergency use authorizations and how promotion of emergency use authorizations has been investigated in the literature.MethodsWe conducted a scoping review via PubMed, Embase, Web of Science, and CINAHL for original research published in English from January 1, 2012, through November 10, 2022. We conducted surveillance of the literature through March 2023.ResultsWe identified 13 studies reported in 14 publications that addressed public and health care provider attitudes, understanding, and behaviors with regard to products authorized under an emergency use authorization. We did not identify any articles describing research regarding the promotion of emergency use authorization products. Findings suggest gaps in understanding of emergency use authorizations, both for the public and health care providers. Findings also suggest the public and health care providers have concerns about safety or the lack of full FDA approval that may contribute to decreased willingness to receive treatments and vaccines under an emergency use authorization.ConclusionsFuture research should explore how emergency use authorizations have been promoted and how that promotion impacts public and health care provider perceptions.

Social determinants of health affect disease severity among preschool children with sickle cell disease

AbstractIndividuals with sickle cell disease (SCD) face the burden of managing a lifelong chronic illness, increasing vulnerability to social determinants of health (SDoH). However, how SDoH contributes to health disparities is understudied. We hypothesized that preschool children with SCD living in poor neighborhoods with higher socio-economic distress would experience increased acute care utilization (ACU; described as emergency department visits plus hospitalizations) despite disease-modifying therapy. Participants' home addresses (aged 0-6 years) were mapped using census tract environmental data from the US Department of Agriculture Food Access Research Atlas. In multivariable analyses controlled for sickle genotype and disease-modifying therapies (hydroxyurea and chronic transfusion), SDoH indicators, that is, limited access to food, lack of vehicle, low income, and inadequate education, were associated with higher ACU. Living in households with children >1 mile from a supermarket was associated with more hospitalizations (odds ratio [OR], 1.44; 95% confidence interval [CI], 1.13-1.85) and ACU (OR, 1.37; 95% CI, 1.06-1.80) among children with SCD (aged <6 years). In households with at least 1 bachelor's degree, children with SCD experienced less ACU (OR, 0.67; 95% CI, 0.50-0.93) and hospitalizations (OR, 0.67; 95% CI, 0.49-0.92). Preschool children with SCD with limited access to food and transportation are at a higher risk of acute complications despite receiving free evidence-based therapy and social support. The family education level may have a protective effect. Although SDoH in crowded households and health care maintenance visits were not a focus of this study, future research should consider these factors. Understanding the SCD and SDoH association is crucial for directing resources to improve affected children's health.

Pathways for accidental biocontrol: The human-mediated dispersal of insect predators and parasitoids.

Introductions of insect predators and parasitoids for biological control are a key method for pest management. Yet in recent decades, biological control has become more strictly regulated and less frequent. Conversely, the rate of unintentional insect introductions through human activities is rising. While accidental introductions of insect natural enemies can potentially have serious ecological consequences, they are challenging to quantify as their movements go largely unobserved. We used historical border interception records collected by the US Department of Agriculture from 1913 to 2018 to describe the diversity of entomophagous insects transported unintentionally, their main introduction pathways, and trends in host specificity. There were 35,312 interceptions of insect predators and parasitoids during this period, representing 93 families from 11 orders, and 196 species from these families. Commodity associations varied, but imported plants and plant products were the main introduction pathway. Most interceptions originated with commodities imported from the Neotropical, Panamaian, and Western Palearctic regions. Among the intercepted species, 27% were found in material originating from more than one country. Two thirds of species were polyphagous host generalists. Furthermore, 25% of species had already been introduced intentionally as biological control agents internationally, and 4.6% have documented negative impacts on native biodiversity or human society. Most of the intercepted species that have not established in the United States are host generalists or have at least one known host species available. The unintentional transport of diverse natural enemy insects has the potential to cause substantial ecological impacts, both in terms of controlling pests through accidental biocontrol and disrupting native communities. Characterizing the insects being transported and their introduction pathways can inform biosecurity practices and management.

Hepatitis Delta Coinfection Rates and All-Cause Mortality Among Hepatitis B-Infected Veterans in the USA.

Screening for hepatitis D virus (HDV) is recommended for all individuals with hepatitis B virus (HBV) infection. Coinfected individuals experience more severe liver-related outcomes. We determined the HDV testing and coinfection rates and all-cause mortality among those infected with HBV. We used the US Department of Veterans Affairs (VA) healthcare system's national databases to identify individuals with HBV infection. We determined the proportion of individuals referred to gastroenterologists/hepatologists, or infectious diseases providers, and the proportion screened and tested positive for HDV. We calculated the HBV treatment rates, defined as ≥ 3 months of continuous prescription with an approved drug. Finally, we calculated all-cause mortality stratified by HDV coinfection and HBV treatment status. Among 44,951 individuals with at least one positive HBsAg, HBeAg or HBV DNA test, 5964 (13.3%) were screened for HDV (180 [3.0%] tested positive), and 28,291 (62.9%) were referred to gastroenterology/hepatology or infectious diseases. Treatment for HBV was prescribed for 73 (40.5%) of HDV-coinfected and 2425 (41.9%) HDV-uninfected individuals. All-cause mortality rate per 100 person-years was lower among those without HDV coinfection (2.98 for untreated HBV, 2.53 for treated HBV; p < 0.001) compared with those with HDV coinfection (5.14 for untreated HBV, 3.0 for treated HBV; p = 0.02). Kaplan-Meier curves demonstrated a significantly higher mortality among HDV-coinfected individuals who were not treated for HBV (log-rank p < 0.0001). Screening rates for HDV among HBV-infected individuals are suboptimal. While HDV coinfection is associated with higher all-cause mortality, HBV treatment may confer a survival benefit.

Innovations through crop switching happen on the diverse margins of US agriculture

Crop switching, in which farmers grow a crop that is novel to a given field, can help agricultural systems adapt to changing environmental, cultural, and market forces. Yet while regional crop production trends receive significant attention, relatively little is known about the local-scale crop switching that underlies these macrotrends. We characterized local crop-switching patterns across the United States using the US Department of Agriculture (USDA) Cropland Data Layer, an annual time series of high resolution (30 m pixel size) remote-sensed cropland data from 2008 to 2022. We found that at multiple spatial scales, crop switching was most common in sparsely cultivated landscapes and in landscapes with high crop diversity, whereas it was low in homogeneous, highly agricultural areas such as the Midwestern corn belt, suggesting a number of potential social and economic mechanisms influencing farmers' crop choices. Crop-switching rates were high overall, occurring on more than 6% of all US cropland in the average year. Applying a framework that classified crop switches based on their temporal novelty (crop introduction versus discontinuation), spatial novelty (locally divergent versus convergent switching), and categorical novelty (transformative versus incremental switching), we found distinct spatial patterns for these three novelty dimensions, indicating a dynamic and multifaceted set of cropping changes across US farms. Collectively, these results suggest that innovation through crop switching is playing out very differently in various parts of the country, with potentially significant implications for the resilience of agricultural systems to changes in climate and other systemic trends.

7056 Can ChatGPT Educate Multicultural Patients About Metabolic Syndrome?

Abstract Disclosure: G. Wu: None. E. Cheng: None. V.V. Toram: None. K. Rosen: None. A. Wong: None. W. Zhao: None. M. Del Buono: None. Background: Metabolic Syndrome, which affects Asians, is a major risk factor for diabetes. According to the National Institute of Health (NIH), 1 in 3 Americans have Metabolic Syndrome. Diabetes affects 30 million Americans, and 8 million more are undiagnosed. ChatGPT and Bard are Artificial Intelligence (AI) mediated LLMs launched on 11/30/2022 and 3/21/2023, respectively, that generate real-time conversational responses. Purpose: Can ChatGPT educate our multicultural patients about metabolic syndrome? Methods: 1. User prompt into ChatGPT and Bard: What is metabolic syndrome? I am a South Asian male, 40 years old, with a cholesterol level of 250 and a fasting blood sugar level of 120. The exact prompt was used with an Asian male as a substitute. 2. The prompt was translated into Telugu, Hindi, Simplified Chinese, and Traditional Chinese via Google Translate. 3. Flesch-Kincade (FK) method of ascertaining reading level was used. FK is used by the US Department of Education. Results: Flesch-Kincaid reading ease: ChatGPT: English=29.2, Telugu=60.1, Hindi=33.4, Chinese (Trad.)=14.5, Chinese (Simp.)=22.6 Bard: English=35.3, Telugu=52, Hindi=51.7, Chinese (Trad.)=52, Chinese (Simp.)=36.8 Language Group Comparison to English: ChatGPT: Indian Languages p=0.004; Chinese Languages p=0.081. Bard: Indian Languages p=0.007; Chinese Languages p=0.136. Of note, the Telegu response has one incorrect response. Conclusions: In conclusion, ChatGPT and Bard can provide factual responses based on English prompts. Foreign prompts can yield inaccurate information. Physicians and their teams still need to supervise patient usage. Presentation: 6/2/2024

Enhancing hydrogen storage efficiency: Computational insights into scandium-decorated 2D polyaramid

This study explores hydrogen storage in 2D polyaramid (2DPA) and its enhancement via scandium decoration for onboard storage in fuel cell vehicles. Sc decoration in 2DPA is accompanied by a net 1.6 e charge transfer from Sc to 2DPA. Hydrogen binding in 2DPA + Sc proceeds with a net charge transfer of 0.32 e from Sc towards H2. 2DPA + Sc demonstrates a maximum hydrogen loading capacity of 8.589 wt% with an average adsorption energy of −0.376 eV/H2. These findings meet the stipulated criteria by the US Department of Energy for solid-state hydrogen storage in light-duty vehicles. Feasibility studies were conducted considering practical limitations in transition metal-modified carbon nanomaterials, including Sc-Sc clustering tendencies, stability, and hydrogen desorption behavior via ab initio molecular dynamics simulations, phonon dispersion, and diffusion studies. The highest barrier height for hydrogen desorption from 2DPA + Sc is 0.48 eV, and desorption is predicted to occur at 412 K (5 bar) indicating possibility of room temperature and reversible hydrogen storage. Our findings indicate that 2DPA + Sc is a promising hydrogen storage substrate material and should be explored in experimental trials.

ExaFEL: extreme-scale real-time data processing for X-ray free electron laser science

ExaFEL is an HPC-capable X-ray Free Electron Laser (XFEL) data analysis software suite for both Serial Femtosecond Crystallography (SFX) and Single Particle Imaging (SPI) developed in collaboration with the Linac Coherent Lightsource (LCLS), Lawrence Berkeley National Laboratory (LBNL) and Los Alamos National Laboratory. ExaFEL supports real-time data analysis via a cross-facility workflow spanning LCLS and HPC centers such as NERSC and OLCF. Our work therefore constitutes initial path-finding for the US Department of Energy's (DOE) Integrated Research Infrastructure (IRI) program. We present the ExaFEL team's 7 years of experience in developing real-time XFEL data analysis software for the DOE's exascale supercomputers. We present our experiences and lessons learned with the Perlmutter and Frontier supercomputers. Furthermore we outline essential data center services (and the implications for institutional policy) required for real-time data analysis. Finally we summarize our software and performance engineering approaches and our experiences with NERSC's Perlmutter and OLCF's Frontier systems. This work is intended to be a practical blueprint for similar efforts in integrating exascale compute resources into other cross-facility workflows.

Evaluation of transition to 100% electric vehicles (EVs) by 2052 in the United States

With the rising need to transition from fossil fuel consumption to renewables, the transportation industry is foreseeing large-scale adoption of electric vehicles (EVs). According to various studies, the petroleum resources will last until or around 2052. Utilizing the US Federal Highway Administration (FHWA) published data on the number of registered vehicles by each state, the profile of vehicles by 2052 was forecasted using a time series. The vehicle profile comprised vehicles by each type classified as automobiles, buses, trucks, and motorcycles. This future profile became the basis of the quantification of total EVs by the end of 2052. Based on the available fuel economy data published by the US Department of Energy, the average energy consumption per mile (kWh/mile) of each vehicle type was factored into the energy demand calculation for 100% electrification by 2052. A roof-top solar photovoltaic system is easy to install on unoccupied roof space for US house owners. Obtaining the capacity of such a roof-top solar PV system acts as a good decision-making criterion for both house owners and developers. However, for city-dwellers living in multi-family residential buildings, the potential of utilization of roof-top solar PV becomes a subject of future work when effective sharing of resources for local power generation by renewables and development of community-shared EV charging infrastructure is concerned. How well EVs performed against internal combustion engine (ICE) vehicles in terms of fuel efficiency and reduced carbon emissions is a driving factor for this transition. For energy demand calculations, a base model was framed, and results were obtained by utilizing mathematical and statistical tools. After accounting for the effects of improved fuel efficiency or reduced energy consumption by EVs over time, the model was modified to obtain revised energy demand and, thus, effective energy generation required. Accordingly, the capacity of EV charging infrastructure required by each state determined the need for preparation by utility companies and local jurisdictions. With limitations on battery size and thus increased frequency for drivers to return for charging, additional fast chargers (level 3) at existing gasoline stations become an option that requires further assessment.

Overall and race-specific associations between state-level minimum wage policy and food insecurity in the United States

BackgroundIn the USA, states can set higher minimum wages than the federal government. We investigated the association between state minimum wages and racial/ethnic inequities in food insecurity.MethodsHousehold-level food insecurity and...

State of Geographic Access to Cancer Treatment Trials in the United States: Are Studies Located Where Patients Live?

In this study, we describe the geographic distribution of US cancer treatment trials to identify disparities and opportunities for targeted improvements in access to research for people with cancer. US-based phase I-III cancer treatment trials registered on ClinicalTrials.gov were tabulated for the years they were open to enrollment (2017-2022), overall and by county, and supplemented with data from the US Census Bureau, National Cancer Institute, Centers for Disease Control and Prevention, and US Department of Agriculture. We evaluated geographic differences in trial availability. We assessed 5-year trends in trials per capita and mapped 1-hour drive time areas around sites. A total of 6,710 trials were open to enrollment in 2022 across 1,836 sites. Trials increased by 4%, whereas sites decreased by 3% annually per capita from 2017. Seventy percent of US counties had no reported active trials in 2022 (2,211/3,143), representing 19% of people age ≥55 years. Eighty-six percent of nonmetropolitan counties had no trials versus 44% of metropolitan counties. Trial availability varied by county-level cancer mortality and social vulnerability (an index derived from demographic and socioeconomic data from the US Census). Eighteen percent of counties without trials had oncologist care sites (n = 618). Notably, 26% of people age ≥55 years lived beyond an hour drive of a site with ≥100 trials. Most US counties have limited to no trial offerings, a disparity magnified in counties that are nonmetropolitan, with high social vulnerability, and with high cancer mortality. Effort to facilitate diverse site participation is needed to promote equitable access to trials and to ensure patients participating in trials match the characteristics of patients who will receive interventions once approved. Counties with oncology care sites but no trials provide potential expansion areas.

B-021 Impact of Assay Conditions on FT4 Measurement Accuracy of Equilibrium Dialysis LC/MS/MS Clinical Assay

Abstract Background Reliable FT4 measurements are vital for accurate diagnosis and effective management of thyroid disorders. However, currently used FT4 immunoassays (IAs) lack standardization, leading to significant variations between platforms. Equilibrium dialysis (ED) coupled with LC-MS/MS analysis, considered the gold standard for FT4 measurement, has been adopted as a reference measurement procedure (RMP) for IA standardization. This study aimed to establish a high-throughput version of the routine clinical FT4 assay based on ED-LC/MS/MS technology and assess the impact of altered assay conditions on measurement accuracy. Methods A commercially available micro-ED plate was employed for ED-LC/MS/MS analysis. FT4 extraction from the dialysate was performed by utilizing a 96-well C18 SPE plate, followed by FT4 quantitation via LC-MS/MS in positive ion mode. Certified primary reference material was used to calibrate the assay. To evaluate assay robustness, the effects of minor method modifications were studied, including incubation time of ED, serum/buffer ratios in ED inserts, ED incubation temperature, shaker speed during ED, serum sample dilution ratio, and dialysate sample dilution ratio. Additionally, short-term and long-term stability of serum FT4 were assessed. Results The developed ED-LC/MS/MS assay successfully resolved T4, T3, reverse triiodothyronine (rT3), and other interferences within 4 minutes using C18 chromatography. The assay's linear range (0.5-100 pg/mL) encompassed clinically relevant FT4 concentrations across hypo- and hyperthyroid patient samples. Excellent agreement was observed between the routine assay based on ED-LC/MS/MS and CDC RMP with a Deming regression slope near 1 (95%CI: 0.87-1.06). Furthermore, serum/buffer ratios from 1:1 to 1:2.5 in ED inserts, shaker speeds from 75 to 150 rpm, and ED incubation times from 16 to 20 hours did not significantly affect FT4 measurement. However, elevated ED temperature (38°C) led to a more than 10% increase in FT4 values. Serum FT4 remained stable when exposed to room temperature for 12 hours, five freeze-thaw cycles, and -70°C storage for 1.5 years. Additionally, dilution of sera by up to 3-fold before ED did not alter FT4 measurement results. Diluting dialysate samples at least 3 times prior to SPE extraction proved accurate for samples exceeding the calibration curve range. Conclusions In conclusion, we successfully developed a routine clinical FT4 assay based on ED-LC/MS/MS that generates data comparable to the RMP. The assay exhibits robustness, with several altered conditions not significantly impacting measurement accuracy. This high-throughput and accurate assay demonstrates suitability for both clinical laboratories and large-scale epidemiological studies. Disclaimer: The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry. Use of trade names is for identification only and does not imply endorsement by the Centers for Disease Control and Prevention, the Public Health Service, and the US Department of Health and Human Services.

Nourishing Farm to School Practice With Data to Inform Program Needs: An Evaluation of Participation Among California Public Districts During the 2018-2019 School Year

BackgroundThe US Department of Agriculture promotes farm to school (F2S) as an evidence-based approach to help school meals meet updated nutrition standards that promote health. California is a key agricultural state with strong support for F2S to promote local agriculture and equitable access to nutritious food for all students. ObjectiveExamine district characteristics associated with F2S participation among California public districts during the 2018-2019 school year. DesignCross-sectional evaluation of 2019 US Department of Agriculture Farm to School Census data. Participants/settingCalifornia public districts responding to the 2019 US Department of Agriculture F2S Census (N = 572). Main outcome measureReported participation in F2S activities in 2018-2019. Covariates included district size, annual per-pupil spending, urbanicity, racial/ethnic composition, and percent free and reduced-price meal (% FRPM) eligibility. Statistical analysisDescriptive statistics (unweighted frequency and weighted percent) were reported for demographic characteristics. Weighted, multiple logistic regression assessed associations between demographic characteristics and F2S participation, reported as odds ratios (95% CI). ResultsNearly 78% of California respondents reported F2S participation. Top activities were serving local food in school lunch (73%) and breakfast (65%) and local food promotion at school (45.5%). The odds of participation among districts with enrollments ≥1000 were 1.79 (95% CI 1.15 to 2.79) times higher than smaller districts and 1.57 (95% CI 1.08 to 2.28) times higher in districts with lower annual per-pupil spending (≤$13 707). No significant differences were found by racial/ethnic composition, % FRPM eligibility, or urbanicity. ConclusionsDisparities in F2S participation exist for small districts and those with high annual per-pupil spending that may lack the advantages of economies of scale. Grant incentives and support networks for these groups are recommended along with increased monitoring focused on the quality of F2S engagement. Administration of a brief annual state F2S Census could support more timely monitoring and accountability to align with state goals and improve opportunities for data sharing and community engagement.

Modelling vaccination approaches for mpox containment and mitigation in the Democratic Republic of the Congo.

Mpox was first identified in the Democratic Republic of the Congo (DRC) in 1970. In 2023, a historic outbreak of mpox occurred in the country, continuing into 2024. Over 14 000 cases and 600 deaths were reported in 2023 alone, representing a major increase from previous outbreaks. The modified vaccinia Ankara vaccine (brand names JYNNEOS, Imvamune, and Imvanex) was used in the 2022 mpox outbreak in the USA and Europe. However, at the time of the study, vaccination had not been made available in the DRC. We aimed to inform policy and decision makers on the potential benefits of, and resources needed, for mpox vaccination campaigns in the DRC by providing counterfactual scenarios evaluating the short-term effects of various vaccination strategies on mpox cases and deaths, if such a vaccination campaign had been undertaken before the 2023-24 outbreak. A dynamic transmission model was used to simulate mpox transmission in the DRC, stratified by age (<5, 5-15, and >15 years) and province. The model was used to simulate potential vaccination strategies, varying by age and region (endemic provinces, non-endemic provinces with historic cases, and all provinces) assessing the effect the strategies would have on deaths and cases in an epidemic year similar to 2023. In addition, we estimated the number of vaccine doses needed to implement each strategy. Without vaccination, our model predicted 14 700 cases and 700 deaths from mpox over 365 days. Vaccinating 80% of all children younger than 5 years in endemic regions led to a 27% overall reduction in cases and a 43% reduction in deaths, requiring 10·5 million vaccine doses. Vaccinating 80% of all children younger than 5 years in all regions led to a 29% reduction in cases and a 43% reduction in deaths, requiring 33·1 million doses. Vaccinating 80% of children aged 15 years or younger in endemic provinces led to a 54% reduction in cases and a 71% reduction in deaths, requiring 26·6 million doses. When resources are limited, vaccinating children aged 15 years or younger, or younger than 5 years, in endemic regions of the DRC would be the most efficient use of vaccines. Further research is needed to explore long-term effects of a one-time or recurrent vaccination campaign. Canadian Institutes of Health Research, Canadian International Development Research Centre, US Department of Defense (Defense Threat Reduction Agency, Mpox Threat Reduction Network), Global Affairs Canada (Weapons Threat Reduction Program), US Department for Agriculture (Agriculture Research Service, Non-Assistance Cooperative Agreement).

Endogeneity of pedestrian survival time and emergency medical service response time: Variations across disadvantaged and non-disadvantaged communities

The Vision Zero-Safe Systems Approach prioritizes fast access to Emergency Medical Services (EMS) to improve the survivability of road users in transportation crashes, especially concerning the recent increase in pedestrian-involved crashes. Pedestrian crashes resulting in immediate or early death are considerably more severe than those taking longer. The time gap between injury and fatality is known as survival time, and it heavily relies on EMS response time. The characteristics of the crash location may be associated with EMS response and survival time. A US Department of Transportation initiative identifies communities often facing challenges. Six disadvantaged community (DAC) indicators, including economy, environment, equity, health, resilience, and transportation access, enable an analysis of how survival and EMS response times vary across DACs and non-DACs. To this end, this study created a unique and comprehensive database by linking DACs data with 2017–2021 pedestrian-involved fatal crashes. This study utilizes two-stage residual inclusion models with segmentation for DACs and non-DACs accounting for the endogenous relationship between EMS response and pedestrian survival time. The results indicate that EMS response time is higher and pedestrian survival time is lower in DACs than in non-DACs. A delayed EMS response time is associated with a greater reduction in survival time in DACs compared to non-DACs. Factors, e.g., nighttime and interstate crashes, contribute to higher EMS response time, while pedestrian drugs, driver speeding, and hit-and-run behaviors are associated with a greater reduction in survival time in DACs than non-DACs. The implications of the findings are discussed in the paper.

Next-Generation Sequencing and Bioinformatics Consortium Approach to Genomic Surveillance.

Genomic surveillance programs benefit greatly from a network of committed, well-supported laboratories that conduct ongoing surveillance activities for pathogens of public health importance. The experiences of the Global Emerging Infections Surveillance program provide insights for building and maintaining genomic surveillance capabilities for public health and pandemic preparedness and response. To meet the needs of US Department of Defense and the Military Health System to use genomics to monitor pathogens of military and public health importance, Global Emerging Infections Surveillance convened a consortium of experts in genome sequencing, bioinformatics, and genomic epidemiology. The experts developed a 3-tiered framework for building and maintaining next-generation sequencing and bioinformatics capabilities for genomic surveillance within the Department of Defense. The consortium strategy was developed before the COVID-19 pandemic, leading to a network prepared to respond with existing resources and expand as new funding became available.

Seeing the Forest for the Trees: Threats, Vulnerabilities, and Opportunities for Woody Landscape Plant Genetic Resources

Genetic resources are the foundation of American agriculture’s ongoing success—the diversity, security, health, and genetic integrity of these resources must be safeguarded. However, in contrast to other crops, protecting, managing, and using collections of woody landscape plant genetic resources present significant challenges. These include conservation of at-risk populations that have high genetic diversity, evaluation of taxa with an unknown potential to invade, and management of large specimens that have long generation times and often recalcitrant or difficult-to-store seeds. The wide diversity of taxa and the limited number of specialist curators and scholars present further challenges. Thus, effective collection, preservation, evaluation, and distribution of woody landscape plant germplasm require substantial and specialized resources. The most fundamental challenge is simple: too many built landscapes have low taxonomic diversity and are often dominated by a single taxon, or monoculture. In turn, these taxonomically and genetically depauperate landscapes are vulnerable to a host of biotic and abiotic threats and are less likely to provide ecosystem and societal services for which they were designed. To develop more resilient landscapes, there is an urgent need to expand taxonomic diversity, which requires the horticultural community to effectively acquire, curate, evaluate, distribute, and use diverse woody landscape plant genetic resources. The role of the US Department of Agriculture-Agricultural Research Service (USDA-ARS) National Plant Germplasm System (NPGS) Woody Landscape Plant Crop Germplasm Committee (WLPCGC) is to identify vulnerabilities and threats that compromise WLP crops in the United States and make recommendations for prioritization of germplasm acquisition, evaluation, research, and management priorities through regular interaction with stakeholders. Due to the breadth of genera and shifting plant genetic resource needs of the nursery industry, it is impractical to list specific threatened or priority genera in a broadly applicable crop vulnerability statement. Instead, the WLPCGC has identified themes of threats and vulnerabilities providing a foundation upon which to support prioritization as threats to specific genera emerge.