Modular structures and the delivery of inpatient care in hospitals: a Network Science perspective on healthcare function and dysfunction

Background: Reinforced by the COVID-19 pandemic, the capacity of health systems to cope with increasing healthcare demands has been an abiding concern of both governments and the public. Health systems are made up from non-identical human and physical components interacting in diverse ways in varying locations. It is challeng‑ ing to represent the function and dysfunction of such systems in a scientifc manner. We describe a Network Science approach to that dilemma. General hospitals with large emergency caseloads are the resource intensive components of health systems. We propose that the care-delivery services in such entities are modular, and that their structure and function can be usefully analysed by contemporary Network Science. We explore that possibility in a study of Australian hospitals during 2019 and 2020. Methods: We accessed monthly snapshots of whole of hospital administrative patient level data in two general hospitals during 2019 and 2020. We represented the organisations inpatient services as network graphs and explored their graph structural characteristics using the Louvain algorithm and other methods. We related graph topological features to aspects of observable function and dysfunction in the delivery of care. Results: We constructed a series of whole of institution bipartite hospital graphs with clinical unit and labelled wards as nodes, and patients treated by units in particular wards as edges. Examples of the graphs are provided. Algorithmic identifcation of community structures confrmed the modular structure of the graphs. Their functional implications were readily identifed by domain experts. Topological graph features could be related to functional and dysfunctional issues such as COVID-19 related service changes and levels of hospital congestion. Discussion and conclusions: Contemporary Network Science is one of the fastest growing areas of current scientifc and technical advance. Network Science confrms the modular nature of healthcare service structures. It holds con‑ siderable promise for understanding function and dysfunction in healthcare systems, and for reconceptualising issues such as hospital capacity in new and interesting ways.David I. Ben, Tovim, Mariusz Bajger, Viet Duong Bui, Shaowen Qin, and Campbell H. Thompso

Determinants of Carbon Emission Disclosures and UN Sustainable Development Goals: The Case of UK Higher Education Institutions

In recent years, organisational sustainability has become a topical issue in many institutional fields and a number of calls have been made to improve the disclosure of carbon information as part of sustainability efforts. This paper responds to these calls, chiefly examining the determinants of (CED) in the annual reports of UK higher education institutions (HEIs). It also aims to predict the relationship between the extent of CED and UN Sustainable Development Goals (SDGs) reporting by UK universities. We construct a disclosure index to capture the extent and type of CED in the annual reports of UK HEIs, finding that carbon reduction targets imposed by the Government, environmental audit, and the amount of actual carbon emissions are significant and positively associated with CED. However, we find no relationship between CED and the disclosure of SDGs. We argue that HEIs'. CED can be useful in developing relevant regulatory policies given the targets are carefully set. Our research has important implications for policymakers regarding carbon reduction targets and related non?mandatory guidance, as these can be utilised as an effective mechanism in increasing carbon emission disclosure voluntary CED that are integrated into SDG disclosures

Integrated analyses of single-cell atlases reveal age, gender, and smoking status associations with cell type-specific expression of mediators of SARS-CoV-2 viral entry and highlights inflammatory programs in putative target cells

The COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, creates an urgent need for identifying molecular mechanisms that mediate viral entry, propagation, and tissue pathology. Cell membrane bound angiotensin-converting enzyme 2 (ACE2) and associated proteases, transmembrane protease serine 2 (TMPRSS2) and Cathepsin L (CTSL), were previously identified as mediators of SARS-CoV2 cellular entry. Here, we assess the cell type-specific RNA expression of ACE2, TMPRSS2, and CTSL through an integrated analysis of 107 single-cell and single-nucleus RNA-Seq studies, including 22 lung and airways datasets (16 unpublished), and 85 datasets from other diverse organs. Joint expression of ACE2 and the accessory proteases identifies specific subsets of respiratory epithelial cells as putative targets of viral infection in the nasal passages, airways, and alveoli. Cells that co-express ACE2 and proteases are also identified in cells from other organs, some of which have been associated with COVID-19 transmission or pathology, including gut enterocytes, corneal epithelial cells, cardiomyocytes, heart pericytes, olfactory sustentacular cells, and renal epithelial cells. Performing the first meta-analyses of scRNA-seq studies, we analyzed 1,176,683 cells from 282 nasal, airway, and lung parenchyma samples from 164 donors spanning fetal, childhood, adult, and elderly age groups, associate increased levels of ACE2, TMPRSS2, and CTSL in specific cell types with increasing age, male gender, and smoking, all of which are epidemiologically linked to COVID-19 susceptibility and outcomes. Notably, there was a particularly low expression of ACE2 in the few young pediatric samples in the analysis. Further analysis reveals a gene expression program shared by ACE2(+)TMPRSS2(+) cells in nasal, lung and gut tissues, including genes that may mediate viral entry, subtend key immune functions, and mediate epithelial-macrophage cross-talk. Amongst these are IL6, its receptor and co-receptor, IL1R, TNF response pathways, and complement genes. Cell type specificity in the lung and airways and smoking effects were conserved in mice. Our analyses suggest that differences in the cell type-specific expression of mediators of SARS-CoV-2 viral entry may be responsible for aspects of COVID-19 epidemiology and clinical course, and point to putative molecular pathways involved in disease susceptibility and pathogenesis

Modern temporal network theory: A colloquium

The power of any kind of network approach lies in the ability to simplify a complex system so that one can better understand its function as a whole. Sometimes it is beneficial, however, to include more information than in a simple graph of only nodes and links. Adding information about times of interactions can make predictions and mechanistic understanding more accurate. The drawback, however, is that there are not so many methods available, partly because temporal networks is a relatively young field, partly because it more difficult to develop such methods compared to for static networks. In this colloquium, we review the methods to analyze and model temporal networks and processes taking place on them, focusing mainly on the last three years. This includes the spreading of infectious disease, opinions, rumors, in social networks; information packets in computer networks; various types of signaling in biology, and more. We also discuss future directions.Comment: Final accepted versio

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: A systematic analysis for the Global Burden of Disease Study 2015

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods: We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings: Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation: Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding: Bill & Melinda Gates Foundation

Prevalence of Ice-Supersaturated Regions in the Upper Troposphere: Implications for Optically Thin Ice Cloud Formation

In situ measurements of water vapor and temperature from recent aircraft campaigns have provided evidence that the upper troposphere is frequently supersaturated with respect to ice. The peak relative humidities with respect to ice (RHI) occasionally approached water saturation at temperatures ranging from −40°C to −70°C in each of the campaigns. The occurrence frequency of ice supersaturation ranged from about 20% to 45%. Even on flight segments when no ice crystals were detected, ice supersaturation was measured about 5–20% of the time. A numerical cloud model is used to simulate the formation of optically thin, low ice number density cirrus clouds in these supersaturated regions. The potential for scavenging of ice nuclei (IN) by these clouds is evaluated. The simulations suggest that if less than about 5 × 10-3 to 2 × 10-2 cm-3 ice nuclei are present when these supersaturations are generated, then the cirrus formed should be subvisible. These low ice number density clouds scavenge the IN from the supersaturated layer, but the crystals sediment out too rapidly to prevent buildup of high supersaturations. If higher numbers of ice nuclei are present, then the clouds that form are visible and deposition growth of the ice crystals reduces the RHI down to near 100%. Even if no ice clouds form, increasing the RHI from 100% to 150% between 10 and 10.5 km results in a decrease in outgoing longwave radiative flux at the top of the atmosphere of about 8 W m-2. If 0.02–0.1 cm-3 IN are present, the resulting cloud radiative forcing reduces the net radiative flux several watts per square meter further. Given the high frequency of supersaturated regions without optically thick clouds in the upper troposphere, there is a potential for a climatically important class of optically thin cirrus with relatively low ice crystal number densities. The optical properties of these clouds will depend very strongly on the abundance of ice nuclei in the upper troposphere

Minimum Bisection Is NP-hard on Unit Disk Graphs

In this paper we prove that the Min-Bisection problem is NP-hard on unit disk graphs, thus solving a longstanding open question