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COVID-19 altered travel patterns in the U.S. Studies have analyzed the effect of the pandemic on travel mode, including working from home, but few have focused on automobile ownership—a relationship with potentially long-term consequences for accessibility, household budgets and debt, and policy efforts to meet climate goals.To understand the association between the pandemic and automobile ownership, we rely on a unique credit panel dataset from Experian and examine three different automobile loan-related outcome measures: annualized growth rate of new automobile loan balances, average new loan size, and the number of new loans. We focus specifically on changes across loans in neighborhoods by race/ethnicity, hypothesizing larger increases in automobile debt in Black and Latino/a neighborhoods, where workers are less likely to be able to telework. The annualized growth rate of new automobile loans increased during the pandemic across all neighborhoods by race/ethnicity, increasing most rapidly in Latino/a neighborhoods. Controlling for other factors, loan size increased similarly across neighborhoods by race/ethnicity. The increase in automobile lending in Latino/a neighborhoods, therefore, likely was explained by a significant uptick in the number of new loans.The growth in automobile lending during the pandemic was potentially prompted by pandemic-induced changes in the need for automobiles and facilitated by an expanded social safety net. As the pandemic and its various forms of public financial assistance recede, the findings underscore the importance of ongoing assistance in enabling automobile ownership or shared access among households with limited means whose livelihoods depend on the access that vehicles provide.

Most U.S. metropolitan areas developed alongside the automobile, producing neighborhoods of relatively low density. Consequently, access to opportunities in these neighborhoods is predicated on having an automobile, yet many households do not have the resources to purchase one outright, relying on automobile loans to spread out the purchase price. While automobile loans can enable automobile ownership, they also significantly increase the vehicle purchase price, particularly for non-white consumers subject to discriminatory lending practices.In this study, we rely on data from the University of California Consumer Credit Panel from Experian to examine the determinants and geography of automobile debt and its consequences in California, testing whether various automobile debt measures disproportionately affect non-white neighborhoods.We find that, controlling for other factors associated with automobile lending including income, Black and Latino/a neighborhoods have higher total automobile debt, debt burdens (debt relative to income), and automobile loan delinquency rates. In particular, Latino/a neighborhoods shoulder significant automobile debt, while borrowers in Black neighborhoods have the highest delinquency rates. Factors associated with lower total automobile debt and automobile debt burden include better credit ratings, higher residential densities, urban locations, and proximity to rail stations.The findings underscore the importance of policies to offset the costs of automobile ownership and access. As part of this, policymakers should adopt and enforce fair lending rules to combat discriminatory and predatory practices and facilitate access to high-quality financial institutions and products in communities of color.

Daily vehicle travel collapsed with the onset of the COVID-19 pandemic in early 2020 but largely bounced back by late 2021. The pandemic caused dramatic changes to working, schooling, shopping, and leisure activities, and to the travel associated with them. Several of these changes have so far proven enduring. So, while overall vehicle travel had largely returned to pre-pandemic levels by late 2021, the underlying drivers of this travel have likely changed.To examine one element of this issue, we analyzed whether patterns of daily trip-making shifted temporally between the fall of 2019 and 2021 in the Greater Los Angeles megaregion. We used location-based service data to examine vehicle trip originations for each hour of the day at the U.S. census block group level in October 2019 and October 2021. We observed notable shifts in the timing of post-pandemic PM peak travel, so we examined changes in the ratio of mid-week trips originating in the early afternoon (12–3:59 PM) and the late afternoon/early evening (4–7:59 PM).We found a clear shift in the temporal distribution of PM trip-making, with relatively more late PM peak period trip-making prior to the pandemic, and more early PM peak trip-making in 2021. The peak afternoon/evening trip-making hour shifted from 5–5:59 PM to 3–3:59 PM. We also found that afternoon/evening trip-making in each year is largely explained by three workplace-area/school-area factors: (1) the number of schoolchildren in a block group (earlier); (2) block groups with large shares of potential remote workers (earlier), and (3) block groups with large shares of low-wage jobs and workers of color (later, except for Black workers in 2021). We found the earlier shift in PM peak travel between pre- and late-pandemic periods to be explained most by (1) higher shares of potential remote workers and (2) higher shares of low-wage jobs and workers of color. These findings suggest that the rise of working from home has likely led to a shift in PM peak travel earlier in the afternoon when school chauffeuring trips are most common. This is especially true for low-income workers and workers of color.

Abstract This study reviews the studies utilizing Artificial Intelligence (AI) and AI-driven tools and methods in managing Acute Kidney Injury (AKI). It categorizes the studies according to medical specialties, analyses the gaps in the existing research, and identifies opportunities for future research directions. PRISMA guidelines were adopted using the three most common databases (PubMed, Scopus, and EBSCO), which resulted in 27 eligible studies, published between 2012 and 2023. The study showed significant heterogeneity in the design of the models, with variations in clinical settings, patient characteristics, cohort regions, and statistical methods. Most models were developed for AKI in hospitalized patients, particularly those undergoing surgery or in intensive care units. Compact models with a subset of significant predictors were deemed more clinically applicable than full models with all predictors. The findings suggest that AI tools, such as machine learning (ML) algorithms, have high prediction capabilities despite the dynamic and complex association among the influencing factors and AKI. Based on these findings and the recognized need for broader inclusivity, future studies should consider adopting a more inclusive approach by incorporating diverse healthcare settings, including resource-limited or developing countries. This inclusivity will lead to a more holistic understanding of AKI management challenges and facilitate the development of adaptable and universally applicable AI-driven solutions. Additionally, further investigations should focus on refining AI models to enhance their accuracy and interpretability, promoting seamless integration and implementation of AI-based tools in real-world clinical practice. Addressing these key aspects will elevate the effectiveness and impact of AI-driven approaches in managing AKI.

Abstract Background Toxoplasmosis is a chronic protozoan parasitic infection that affects nearly one-third of the global population. During the COVID-19 pandemic, cases were observed in patients with COVID-19 and toxoplasmosis. Therefore, this systematic review and meta-analysis aimed to determine the frequency of Toxoplasma gondii exposure in patients with COVID-19. Methods A literature search was conducted in six databases or search tools (PubMed, Scopus, Embase, Web of Science, ScienceDirect, and Google Scholar) until March 3, 2024. Study selection, quality assessment, and data extraction were performed independently by three investigators. Statistical analysis was performed using R version 4.3, applying a random-effects model. The quality of the included observational studies was assessed using the “JBI-MAStARI”. Results A total of 5,936 studies were retrieved, 13 of which were included in the final meta-analysis. The sample included a total of 2,947 patients with COVID-19 from four countries, of whom approximately 43.3% were men and 49.4% were women. Among the patients, 1,323 showed evidence of exposure to T. gondii through IgG detection, while 1,302 COVID-19 patients were explicitly examined for T. gondii by IgM detection, and 36 positive cases were identified. The frequency of exposure to T. gondii, determined by the presence of IgG in patients with COVID-19, reached 49% (95% CI: 34–63%; 2,947 participants; 13 studies; I2 = 98%, p

Continuous Renal Replacement Therapy (CRRT) serves as an intervention strategy for the management of acute kidney injury (AKI) in critically ill patients. However, owing to its complex nature and the potential for complications, the implementation of CRRT demands continuous monitoring to prevent patient safety risks. This study aims to identify and validate prevalent risks linked to CRRT within a real-world clinical setting, intending to propose preventive measures grounded in expert insights. To systematically categorize and visually depict the risks, their consequences, preventive measures, and recovery controls, our study employed the Bowtie method in conjunction with the Systems Engineering Initiative for Patient Safety (SEIPS) model. In addition to considering patient-related factors that exhibit variability among critically ill individuals, our key findings showed that the most influential risks impacting the effective delivery of CRRT are incidents of clotted filters, bleeding risks arising from the necessity of anticoagulation for filter efficacy, vascular catheter-related bloodstream infections, variations in proficiency levels among healthcare professionals regarding CRRT modalities, especially in operating the CRRT machines, high nursing workload, frequent nursing turnover, occurrences of hypophosphatemia, variability in CRRT prescribing patterns, and issues related to communication among stakeholders. This research sheds light on the primary risks associated with CRRT and provides practical and viable strategies for effective management. Furthermore, the Bowtie diagram developed as part of this study serves as a valuable tool for visually representing the healthcare system and facilitating the identification of system-related risks within healthcare settings.

Abstract Background and context Providing care to the elderly is an emerging area of interest due to the increase in elderly population not only in the developed world but also in low and middle income countries. In Pakistan a country with an overall population of over 200 million, the elderly population amounts to 11.3 million. Caregiving of the elderly tends to occur within the kinship motivated by sociocultural norms as well as absence of government support facilities. While quantitative literature exists in Pakistan describing the “caregiver’s burden,” an in-depth analysis into the experiences of familial caregivers is missing. Methods The research used qualitative methods with the aim to explore the lived experiences of 7 daughters and 3 daughters-in-law, living in Karachi, Pakistan providing care to the elderly requiring assistance in at least two tasks of daily living. Results Five themes were developed inductively through the phenomenological method. All participants were Muslim and belonged to the upper economic strata of the society. Findings reveal that obligations to care are dominant in kinship circles particularly among women. Participants highlighted the importance of elderly in the Pakistani society, especially due to the religious lens that considers them as blessings. Daughter caregivers spoke about caregiving of their parents as a form of role reversal, emphasizing also upon the life-long emotional bond that served as a strong motivator. On the other hand, for daughter-in-law caregivers, motivations to care also stemmed from social expectations and kinship obligations. All participants reported multiple difficulties during the caregiving experience, despite existence of paid formal help, with respect to balancing multiple role demands and the nature of caregiving that requires constant effort. Results also illustrate that despite the desire to care for the elderly within a collectivist and patrilocal society, participants experienced multiple physical and emotional effects. However, a few also reported an increase in self-mastery and self-worth. Conclusion This study reveals that despite increasing urbanization and more women working outside the home, providing care to the elderly appears to be centered within the kinship circle. The research makes important contributions to the ageing literature in Pakistan with relevance to other South Asian contexts.

Abstract Drug-induced gene expression profiles can identify potential mechanisms of toxicity. We focus on obtaining signatures for cardiotoxicity of FDA-approved tyrosine kinase inhibitors (TKIs) in human induced-pluripotent-stem-cell-derived cardiomyocytes, using bulk transcriptomic profiles. We use singular value decomposition to identify drug-selective patterns across cell lines obtained from multiple healthy human subjects. Cellular pathways affected by cardiotoxic TKIs include energy metabolism, contractile, and extracellular matrix dynamics. Projecting these pathways to published single cell expression profiles indicates that TKI responses can be evoked in both cardiomyocytes and fibroblasts. Integration of transcriptomic outlier analysis with whole genomic sequencing of our six cell lines enables us to correctly reidentify a genomic variant causally linked to anthracycline-induced cardiotoxicity and predict genomic variants potentially associated with TKI-induced cardiotoxicity. We conclude that mRNA expression profiles when integrated with publicly available genomic, pathway, and single cell transcriptomic datasets, provide multiscale signatures for cardiotoxicity that could be used for drug development and patient stratification.

This study explores ICT profiles of teacher educators to understand personal, pedagogical and organisational factors affecting technology use in teacher education. After delineating latent profiles based on survey data, 12 teacher educators were interviewed on technology integration in educational settings for a deeper insight. Based on the Synthesis of Qualitative Research model developed to outline strategies for preparing preservice teachers to integrate technology, findings revealed key issues including teacher educators' classroom stance as role models for effective technology use, importance of technological-pedagogical content knowledge in designing technology-enriched learning environments, peer collaboration and avoidance of using technology regardless of pedagogical concerns. Issues related to assessment, professional development, attitudes and ICT competency were raised. Findings are discussed considering potential consequences for current practices and areas of future research.

The digitalisation of education has been emphasised over the last two decades, affecting and developing both the theories and practices of teaching and learning. Considering these developments, the need for addressing teachers' and students' digital competence has gained ground. In the last few years, the concept of digital agency has been noted in empirical and theoretical research - broadly focusing on the integration of information and communication technologies (ICT) in education. Nonetheless, how digital agency is understood and how it relates to the more established concept of digital competence remains unclear. To address this gap, we conducted a conceptual systematic review and examined the current state of the knowledge on digital agency. Specifically, we review the conceptualisations of digital agency, its underlying theoretical frameworks, and how it relates to digital competence and similar concepts. Database searches resulted in 32 publications, with the majority published in education and design journals and stemming from Scandinavian countries. Our findings show that out of 32 studies, only one aimed at defining digital agency explicitly. Nevertheless, for the last three years, digital agency has been more frequently used in the body of literature, emphasising the design and transformation of teaching and learning with technology towards a 'new normal' considering the post-pandemic era and lessons learned. Reviewing the extant body of knowledge on digital agency, we review the strengths and weaknesses of the concept and compare it to the more established notion of digital competence. Finally, we discuss implications for policy, research, and practice in education.

Meta-analyses and international large-scale assessments (ILSA) are key sources for informing educational policy, research, and practice. While many critical research questions could be addressed by drawing evidence from both of these sources, meta-analysts seldom integrate ILSAs, and current integration practices lack methodological guidance. The aim of this methodological review is therefore to synthesize and illustrate the principles and practices of including ILSA data in meta-analyses. Specifically, we (a) review four ILSA data inclusion approaches (analytic steps, potential, challenges); (b) examine whether and how existing meta-analyses included ILSA data; and (c) provide a hands-on illustrative example of how to implement the four approaches. Seeing the need for meta-analyses on educational inequalities, we situated the review and illustration in the context of gender differences and socioeconomic gaps in student achievement. Ultimately, we outline the steps meta-analysts could take to utilize the potential and address the challenges of ILSA data for meta-analyses in education.

BACKGROUND: Effective interventions are needed to address suicide risk following discharge from the hospital emergency department or inpatient setting. Studies that examine follow-up contact methods show promise, but little is known about how follow-up programs are implemented in the real world and who is benefitting. The purpose of this formative evaluation and analysis was to gain insight about the usefulness and value of a partnered suicide prevention follow-up program (academic medical center emergency department partnered with a regional suicide prevention center) from the standpoint of psychiatry resident physicians providing direct care and suicide prevention center crisis counselors making follow-up outreach telephone calls to patients. METHODS: A qualitative thematic analysis was conducted with focus group data from a convenience sample of psychiatry residents who performed consultations in the emergency department setting and counselors at the suicide prevention center crisis follow-up program. Focus group sessions, using semi-structured question guides, were completed at each participant groups workplace. Grounded theory techniques were used to guide coding and analytic theme development. RESULTS: Analyses resulted in four overarching themes: valuing the programs utility and benefit to patients, desiring to understand what happens from emergency department discharge to program follow-up, having uncertainty about which patients would benefit from the program, and brainstorming to improve the referral process. Psychiatry residents appreciated the option of an active referral service (one that attempts to actively engage a patient after discharge through outreach), while suicide prevention crisis counselors valued their ability to offer a free and immediate service that had potential for fostering meaningful relationships. Both participant groups desired a better understanding of their partners program operations, a uniform and smooth referral process, and awareness of who may or may not benefit from program services. CONCLUSION: Results revealed the need for improved communication and implementation, such as expanded inter-agency contacts, consistent provider training, more documentation of the requirements and rules, a consistent message about program logistics for patients, and coordination between the program elements.

The flavoenzyme nicotine oxidoreductase (NicA2) is a promising injectable treatment to aid in the cessation of smoking, a behavior responsible for one in ten deaths worldwide. NicA2 acts by degrading nicotine in the bloodstream before it reaches the brain. Clinical use of NicA2 is limited by its poor catalytic activity in the absence of its natural electron acceptor CycN. Without CycN, NicA2 is instead oxidized slowly by dioxygen (O2), necessitating unfeasibly large doses in a therapeutic setting. Here, we report a genetic selection strategy that directly links CycN-independent activity of NicA2 to growth of Pseudomonas putida S16. This selection enabled us to evolve NicA2 variants with substantial improvement in their rate of oxidation by O2. The encoded mutations cluster around a putative O2 tunnel, increasing flexibility and accessibility to O2 in this region. These mutations further confer desirable clinical properties. A variant form of NicA2 is tenfold more effective than the wild type at degrading nicotine in the bloodstream of rats.

BackgroundCommunity input is crucial for identifying characteristics necessary for equitable, sustainable community-academic partnerships (CAPs). A November 2021 conference, honoring the late Dr. Loretta Jones and the Community-Partnered Participatory Research (CPPR) model, was held to gather input for designing a learning institute for community members as co-equal partners with academics in research, program, and policy initiatives. This created an opportunity to explore attendees' perspectives on challenges and opportunities related to CAPs with special focus on promoting equity.MethodsInstitutional Review Board approval was obtained. Five break-out discussion group sessions were conducted in November 2021 co-facilitated by both an academic and a community leader. After consent, discussions were recorded and transcribed. An iterative procedure for collaborative-group-thematic-analysis was developed. The six-phase process included rigorous coding, discussion, comparison of data with data, and development and refinement of themes and subthemes.ResultsA total of 38 racial-ethnically diverse participants volunteered from the total conference audience of 62 community and academic partners from various sectors including community-based organizations, health care, social services, academia, or policy within Los Angeles County. Analysis led to development of three themes: Being cautious with the extractive tendency of academia and the need for anti-racism within CAPs; Leveraging community power to resist the top-down lens of academia; and bridging two worlds through an equitably structured table.DiscussionParticipants described optimism about the future uses of CPPR to enhance CAPs, and the need to address barriers to equitable partnerships owing to unequal social contexts and entrenched power dynamics. Implications include addressing racism, evaluating financial equity in partnerships to promote accountability, and mentoring community leaders to promote equity.ConclusionUse of a "community lens" for developing sustainable, equitable CAPs is crucial to promote accountability and to responsibly implement authentic CPPR.