Introduction Health care facilities represent a significant source of pollution, contributing to the growing problems associated with global warming. The resulting climate change impacts our health through worsening air and water quality, diminished access to nutritious food, and safe shelter. Methods We outline here the not only the role of the surgeon in contributing to climate change, but also ways in which to minimize one’s carbon footprint. Results Surgeons are leaders within healthcare systems. Adopting environmentally conscious practices can reduce solid waste, energy usage, and carbon emissions. Practices outside of the clinical setting can also incorporate sustainability, including the use of virtual recruitment and educational programs, as well as thoughtful and conscientious travel practices. Conclusions Academic surgery combines clinical practice with an element of leadership, at all levels. Our recognition and action to reduce wasteful practices can help leave a better earth for generations to come.
Understanding the mechanical effects of crystals on degassing kinetics and permeability development in silicic magmas is important for modeling eruptions and examining first order controls on eruption style. We conducted high-pressure-high-temperature isothermal decompression experiments to investigate the role of crystal shape on permeability development and pore pathway geometry. Experiments were performed on hydrous rhyolitic glass (76.3 wt.% SiO2) seeded with variable amounts of equant (aspect ratio ∼1.8 ± 0.6) corundum crystals and elongate (aspect ratio ∼10 ± 5.5) wollastonite crystals to approximate natural phenocryst and microphenocryst/microlite populations, respectively. We measured total porosity, connected pore volume and permeability directly from the experimental charges by applying Archimedes' principle to determine bulk density, helium-pycnometry to measure connected porosity, and a custom-made permeameter to measure permeability. The experimental samples developed permeability at a critical melt porosity (ϕc-melt, above which degassing is enhanced due to bubble coalescence) of ∼55 vol.% vesicles for the corundum experiments and ∼48 vol.% for the wollastonite-bearing experiments; these values are considerably lower than the ϕc-melt>63 vol.% for prior crystal-free experiments (Lindoo et al., 2016; deGraffenried et al., 2019). Critical porosity is reduced when crystals comprise at least ∼20 vol.%, regardless of shape. Connected porosity increases and average bubble size decreases with increasing abundance of elongate wollastonite crystals, explained by the onset of yield strength behavior induced by loosely touching crystal frameworks that form at decreasing crystallinities with increasing elongation of crystals comprising the network. When the population of high-aspect-ratio crystals reaches random loose packing, the resulting reduction in interstitial melt available for unimpeded bubble expansion forces the bubbles to connect at lower total vesicularity. It therefore seems likely that crystal-bearing intermediate magmas experience an abrupt increase in degassing efficiency when crystallinity attains random loose packing. In hydrous magmas, the efficiency of decompression-driven degassing and resulting formation of anisotropic groundmass crystals is controlled by magma composition and decompression rate. Enhanced gas loss in slowly ascending (and crystallizing) magma may aid the development of dense conduit plugs, thus increasing the possibility of violent Vulcanian explosions.
Gas-phase 1,3,5,7-cyclooctatetraene (C8H8) and triplet aromatic 1,3,5,7-cyclooctatetraene (C8H8) were formed for the first time through bimolecular methylidyne radical (CH)-1,3,5-cycloheptatriene (C7H8) reactions under single-collision conditions on a doublet surface. The reaction involves methylidyne radical addition to the olefinic π electron system of 1,3,5-cycloheptatriene followed by isomerization and ring expansion to an aromatic 1,3,5-cyclooctatrien-7-yl radical (C8H9•). The chemically activated doublet radical intermediate undergoes unimolecular decomposition to 1,3,5,7-cyclooctatetraene. Substituted 1,3,5,7-cyclooctatetraene molecules can be prepared in the gas phase with hydrogen atom(s) in the 1,3,5-cycloheptatriene reactant being replaced by organic side groups. These findings are also of potential interest to organometallic chemists by expanding the synthesis of exotic transition-metal complexes incorporating substituted 1,3,5,7-cyclooctatetraene dianion (C8H82-) ligands and to untangle the unimolecular decomposition of chemically activated and substituted 1,3,5-cyclooctatrien-7-yl radical, eventually gaining a fundamental insight of their bonding chemistry, electronic structures, and stabilities.
Using genomics, bioinformatics and statistics, herein we demonstrate the effect of statewide and nationwide quarantine on the introduction of SARS-CoV-2 variants of concern (VOC) in Hawai’i. To define the origins of introduced VOC, we analyzed 260 VOC sequences from Hawai’i, and 301,646 VOC sequences worldwide, deposited in the GenBank and global initiative on sharing all influenza data (GISAID), and constructed phylogenetic trees. The trees define the most recent common ancestor as the origin. Further, the multiple sequence alignment used to generate the phylogenetic trees identified the consensus single nucleotide polymorphisms in the VOC genomes. These consensus sequences allow for VOC comparison and identification of mutations of interest in relation to viral immune evasion and host immune activation. Of note is the P71L substitution within the E protein, the protein sensed by TLR2 to produce cytokines, found in the B.1.351 VOC may diminish the efficacy of some vaccines. Based on the phylogenetic trees, the B.1.1.7, B.1.351, B.1.427, and B.1.429 VOC have been introduced in Hawai’i multiple times since December 2020 from several definable geographic regions. From the first worldwide report of VOC in GenBank and GISAID, to the first arrival of VOC in Hawai’i, averages 320 days with quarantine, and 132 days without quarantine. As such, the effect of quarantine is shown to significantly affect the time to arrival of VOC in Hawai’i. Further, the collective 2020 quarantine of 43-states in the United States demonstrates a profound impact in delaying the arrival of VOC in states that did not practice quarantine, such as Utah. Our data demonstrates that at least 76% of all definable SARS-CoV-2 VOC have entered Hawai’i from California, with the B.1.351 variant in Hawai’i originating exclusively from the United Kingdom. These data provide a foundation for policy-makers and public-health officials to apply precision public health genomics to real-world policies such as mandatory screening and quarantine.
Vaccine hesitancy and the occurrence of elusive variants necessitate further treatment options for coronavirus disease 2019 (COVID-19). Accumulated evidence indicates that clinically used hypertensive drugs, angiotensin receptor blockers (ARBs), may benefit patients by mitigating disease severity and/or viral propagation. However, current clinical formulations administered orally pose systemic safety concerns and likely require a very high dose to achieve the desired therapeutic window in the lung. To address these limitations, we have developed a nanosuspension formulation of an ARB, entirely based on clinically approved materials, for inhaled treatment of COVID-19. We confirmed in vitro that our formulation exhibits physiological stability, inherent drug activity, and inhibitory effect against SARV-CoV-2 replication. Our formulation also demonstrates excellent lung pharmacokinetics and acceptable tolerability in rodents and/or nonhuman primates following direct administration into the lung. Thus, we are currently pursuing clinical development of our formulation for its uses in patients with COVID-19 or other respiratory infections.
Mortality from cancer-associated sepsis varies by cancer site and host responses to sepsis are heterogenous. Native Hawaiians have the highest mortality risk from cancer-associated sepsis and colorectal cancer (CRC), even though they demonstrate lower CRC incidence compared to other ethnicities. We conducted a retrospective transcriptomic analysis of CRC tumors and adjacent non-tumor tissue from adult patients of Native Hawaiian and Japanese ethnicity who died from cancer-associated sepsis. We examined differential gene expression in relation to patient survival and sepsis disease etiology. Native Hawaiian CRC patients diagnosed with sepsis had a median survival of 5 (IQR 4–49) months, compared to 117 (IQR 30–146) months for Japanese patients. Transcriptomic analyses identified two distinct sepsis gene signatures classified as early response and late response sepsis genes that were significantly altered in the Native Hawaiian cohort. Analysis of canonical pathways revealed significant up and downregulation in mechanisms of viral exit from host cells (p = 4.52E−04) and epithelial junction remodeling (p = 4.01E−05). Key genes including elongation initiation factor pathway genes, GSK3B, and regulatory associated protein of mTOR (RPTOR) genes that protect cells from infection were significantly downregulated in Native Hawaiians. Genes promoting sepsis progression including CLOCK, PPBP and Rho family GTPASE 2 (RND2) were upregulated in Native Hawaiian patients. Our transcriptomic approach advances understanding of sepsis heterogeneity by revealing a role of genetic background and defining patient subgroups with altered early and late biological responses to sepsis. This study is the first to investigate differential gene expression in CRC-associated sepsis patients in relation to ethnicity. Our findings may lead to personalized approaches in stratifying patient mortality risk for sepsis and in the development of effective targeted therapies for sepsis.
The growth of the self-concept through increasing perspectives, identities, resources, and efficacy is known as self-expansion and typically involves novelty, challenge, interest, and/or excitement. Self-expansion is positively associated with health factors including self-reported physical activity (PA). This study is the first to investigate self-expansion and daily PA, and with a PA monitor. Fifty community participants completed baseline questionnaires, wore a Fitbit One and completed daily self-report questionnaires for 28 days, and completed follow-up questionnaires. Daily surveys included questions about both general and PA-specific self-expansion. Across the 4 weeks, steps taken was positively correlated with both general (all maximum likelihood r = 0.17) and PA-specific self-expansion (maximum likelihood rs of 0.15 and 0.16), and PA-specific self-expansion was positively correlated (maximum likelihood rs of 0.38 and 0.50) with aerobic activity. Future research should investigate this relationship in a larger more diverse sample and test whether PA-specific self-expansion can be utilized as an acceptable, feasible, and effective intervention to increase daily steps and other forms of PA.
Traits have become a crucial part of ecological and evolutionary sciences, helping researchers understand the function of an organism's morphology, physiology, growth and life history, with effects on fitness, behaviour, interactions with the environment and ecosystem processes. However, measuring, compiling and analysing trait data comes with data-scientific challenges. We offer 10 (mostly) simple rules, with some detailed extensions, as a guide in making critical decisions that consider the entire life cycle of trait data. This article is particularly motivated by its last rule, that is, to propagate good practice. It has the intention of bringing awareness of how data on the traits of organisms can be collected and managed for reuse by the research community. Trait observations are relevant to a broad interdisciplinary community of field biologists, synthesis ecologists, evolutionary biologists, computer scientists and database managers. We hope these basic guidelines can be useful as a starter for active communication in disseminating such integrative knowledge and in how to make trait data future-proof. We invite the scientific community to participate in this effort at http://opentraits.org/best-practices.html.
Critical refusal is an active process; an informed practice of investigating power differences in order to generate more just and equitable alternatives to the status quo. In this paper, we examine what it means to utilize critical refusal as a tool for investigating unequal power dynamics that are produced and reified by data practices. We illustrate the generative capacity of critical refusal by drawing on declarations from The Feminist Data Manifest-No to examine data practices across three real-world cases. By pairing a conceptual exploration of critical refusal with real-world examples, we make a theoretical contribution that is grounded in concrete approaches for generating alternative data practices in ways that account for interlocking struggles across contexts and communities.
Plumeria (Plumeria spp.) is a small ornamental tree grown in subtropical and tropical areas, providing shade and attractive and fragrant flowers in public and private landscapes. In Hawaii, plumeria is also commercially grown, with flowers harvested for cut flower and lei production. In 2019, a total of 10 cut flower plumeria farms in Hawaii sold 7,356,702 blossoms, valued at $395,791 (USDA/NASS). In July 2021, a commercial plumeria farm in Maui County, Hawaii reported trees with flowers exhibiting color breaking, and leaves with mosaic and vein banding. To determine if a viral pathogen was present, leaf tissue from a symptomatic plant was processed using a Double-RNA Viral dsRNA Extraction Kit for plant tissue (iNtRON Biotechnology, Korea), followed by random amplification (Melzer et al. 2010). The resulting products underwent paired-end sequencing on a MiSeq platform (Illumina, CA) at the Advanced Studies in Genomics, Proteomics, and Bioinformatics laboratory at the University of Hawaii. Of the 2,913,913 paired-end 300-bp reads generated, Geneious Prime (Biomatters, New Zealand) mapped 350,686 to plumeria mosaic virus (PluMV; KJ395757.1) and 293,911 to frangipani mosaic virus (FrMV; JN555602.2), with mean coverage depths of 10,318 and 7,348 respectively. A 6,648 nt contig representing the near full-length genome of PluMV-HI (OP342599) was found to be >97% identical to PluMV isolates PluMV-DR_TW (KX881422.2) and PluMV-Plu-Ind-1 (KJ395757.1). Similarly, a 6,631 nt contig representing the near full-length genome of FrMV-HI (OP342600) was found to be >98% identical to FrMV isolates FrMV-P (Lim et al. 2010; HM026454.1) and FrMV-Fr-Ind-1 (Kumar et al. 2015; JN555602.2). Bioinformatic analyses (Olmedo-Velarde et al. 2019) of the reads that did not map to PluMV and FrMV suggested the presence of a novel ampelovirus and reovirus in the tissue. To confirm the presence of PluMV and FrMV in Hawaii, leaves were collected in June 2022 from 5 plumeria trees on the Maui County farm and 16 ornamental plumeria trees from Honolulu County. Total RNA extracted as described by Li et al. (2008) as well as non-template (water) and positive (HTS tissue sample) controls underwent RT-PCR using random primers for cDNA synthesis, followed by virus-specific primers for PluMV (1133: 5’-TGGGCAAATAATCCGGCTATAC-3’/1134: 5’CCGGAGAGAGCATCAAACAA-3’) and FrMV (1129: 5’-TGAGTTTAGGTCGCAGTTGATAG-3’/1130: 5-’AAAGACCAGAACCTCCAGAAAG-3’) in singleplex reactions. The results indicated that all 5 plumeria samples from Maui County were positive for both PluMV and FrMV, whereas 6 out of 16 plumeria samples collected from Honolulu County tested positive for PluMV only. Both PluMV and FrMV are tobamoviruses (Virgaviridae) that can be transmitted mechanically and spread through the introduction and/or movement of cuttings, the primary method of plumeria propagation. Both PluMV and FrMV cause leaf mosaic (Kumar et al. 2015; Lim et al. 2010; Lin et al. 2020) and FrMV may also cause color break or “splash” in flowers, which was observed at the Maui County farm. This represents the first report of PluMV in the USA. FrMV was detected in Florida (Dey et al. 2020), but this is the first report of the virus in Hawaii. Additional surveys are required to determine the incidence of both viruses in other counties of Hawaii. The putative discovery of a novel ampelovirus and reovirus in plumeria warrants further research to characterize these agents and determine their distribution and impact on plumeria health.
Gender inequality that persists through much of their lives, from birth through adulthood, impacts women and their quality of life in their later years. With some variation this holds true in every nation in the global community. In older adults, the most apparent indication of gender inequality—and a linchpin—is the disproportionate impoverishment of older women compared to older men. We take stock of global policy directions toward equality for girls and women, focusing specifically on derived avenues for furthering and protecting the economic well-being of older women in the United States, cognizant that these directions can rebound with implications for nations worldwide.
Background Restoration of a neutral mechanical axis (MA) is important to the success of total knee arthroplasty (TKA). While known differences are present between Asians and Caucasians regarding native knee alignment, it is unknown whether such differences exist amongst Native Hawaiian/Other Pacific Islanders (NHPI) or if utilizing a fixed distal femoral cut of 6° can consistently achieve a neutral MA in these minority racial groups. This study examines the preoperative deformities presented by Asians, Caucasians, and NHPI, and the resulting knee alignment achieved following TKA when a fixed 6° distal femoral cut is targeted for all patients. Methods Preoperative and postoperative MA was measured from 835 Asian, 447 Caucasian, and 163 NHPI hip-to-ankle radiographs. All patients underwent TKA in which a standard distal femoral cut of 6° valgus was targeted for all patients. Data were evaluated as continuous variables and by groupings of varus (MA < − 3°), valgus (MA > 3°), and neutral (− 3° ≤ MA ≤ 3°) alignment. Results Preoperative deformity ranged from 38° varus to 29° valgus. The proportion of Asian and NHPI presenting with varus alignment prior to surgery was significantly greater than Caucasian patients in both males (Asians: 80.6%; Caucasians: 67.0%; NHPI: 79.0%, p = 0.001) and females (Asians: 66.1%; Caucasians: 45.7%; NHPI: 63.2%, p < 0.001). There was no difference in the proportion of patients (72–79%) achieving a neutral MA amongst all three racial groups. Conclusion NHPI appear to have similar preoperative deformities to Asians with both groups having significantly more varus alignment than Caucasians. Despite a wide range of preoperative deformity, application of a fixed distal femoral cut of 6° valgus successfully established a neutral MA equally in the majority of patients across all three racial groups.
Objective To describe the quality of food and physical activity (PA) environments by World Bank Income level in jurisdictions from the Children's Healthy Living Program. Design Baseline cross-sectional community data were analyzed from 11 jurisdictions categorized by World Bank Income levels to describe exposure to different food and PA outlets. The Children's Healthy Living Program was a multilevel, multijurisdictional prevalence study and community intervention trial that reduced child obesity in the US-Affiliated Pacific region. Setting US-Affiliated Pacific region. Participants Food (n = 426) and PA (n = 552) Outlets. Main Outcome Measures Physical activity and food scores that reflect the quality of the outlets that support being physically active and healthy eating options, respectively. Analysis Descriptive statistics are presented as means ± SD or percentages. Results High-income-income level jurisdictions had higher food and PA scores than middle-income level jurisdictions. Conclusions and Implications The US-Affiliated Pacific region has limited quality food and PA outlets in underserved communities at risk for obesity. The findings in this paper can be used to develop tools and design interventions to improve the food and PA environment to increase a healthier, active lifestyle.
The COVID-19 pandemic increased stress and worry among faculty and staff members at universities across the US. To assess the well-being of university faculty and staff, a survey was administered at a medical school in the state of Hawai'i during early fall 2020. The purpose of the exploratory study was to assess and gauge faculty and staff members' well-being regarding the school's response to COVID-19. Participants in this study represented a convenience sample of compensated teaching, research, and administrative faculty and staff members. A total of 80 faculty and 73 staff members participated. Overall, faculty and staff reported relatively low levels of worries and stress. Staff members reported greater levels of worry and stress than faculty members in 8 of the 11 questions. Statistical differences were detected in 3 questions, with staff reporting higher levels of worry and stress in their health and well-being of themselves (P < .001), paying bills (P < .001), and losing their jobs (P < .001). Both faculty and staff reported good overall satisfaction on the timeliness and clarity of messages that they received, support from leadership and the school, and support to adjust to changes in response to COVID-19. For both faculty and staff, the greatest worry or concern for the open-ended question on worry and stress was related to financial and economic issues. Data from this survey and can contribute to an understanding of medical school employee well-being during a major operational disruption and may help develop policies and programs to assist employees in different employment categories during future disruptions.
Opportunities to learn how to deliver bad news and practice this important skill are limited in most medical school programs. To address this gap, an integrated curriculum was created for first-year medical students at the University of Hawai'i John A. Burns School of Medicine that used a problem-based learning case, a didactic session, and a simulated patient experience to teach students how to deliver bad news using the 6-step SPIKES protocol. Students' competency was evaluated using a video-recorded simulated patient encounter. Students also completed a post-experience questionnaire to assess their confidence in delivering bad news before and after the simulation as well as the perceived benefit of different teaching modalities. A sample of 60 students completed an average of 16/17 (94%) tasks on the 17-item SPIKES checklist. Students' confidence in delivering bad news improved from 32% to 91%, before and after the educational experience. The majority of students agreed or strongly agreed that the simulated patient encounter helped them learn how to deliver bad news (96%), felt that the presentation prepared them to deliver bad news (87%), and expressed desire to have more simulated patient experiences in the future (87%). Overall, this curricular improvement project showed that students had a positive perception of the different teaching modalities, increased confidence at delivering bad news following the simulated patient encounter, and a preference for more simulated patient encounters linked to problem-based learning cases in the future.
Background Parallax is poorly understood and can mislead surgeons using intraoperative fluoroscopy (IF) to guide cup placement during anterior approach (AA) total hip arthroplasty. The purpose of this study was to examine how changes in fluoroscopic beam positioning in relation to the hip and pelvis affects the projected acetabular image. Methods An acetabular component was positioned in an anatomic pelvis model in 45° and 20° of abduction and anteversion, respectively using a computer assisted cup targeting system. Fluoroscopic images were taken at various caudal and cranially directed angles with the fluoroscopic beam centered over the hip then pelvis. In each position, four independent observers measured the abduction and anteversion angles of the projected cup image using the same computer targeting system. Results Cup abduction and anteversion measured 43.5° and 19.5° when IF was centered over the hip and 40.5 and 27.5° when centered over the pelvis in the neutral position. Increasing the caudal direction of the beam 20° increased the projected abduction/anteversion angles by approximately 7°/12° and 9°/16° when centered over the hip and pelvis respectively. Increasing the cranial direction of the beam 20° decreased the measured abduction/anteversion angles by roughly 4°/20° and 4°/24° when centered over the hip and pelvis, respectively. Conclusion The projected image of the acetabular component can change dramatically depending on fluoroscopic beam position relative to the hip and pelvis. Recognizing the approximate direction and magnitude of change with differing fluoroscopy positions may help surgeons avoid cup malpositioning.
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