Transportation in a Changing Climate: Innovating to Create Resilient, Low-Carbon Systems

The climate is changing rapidly, bringing new temperature highs and weather extremes and affecting every individual, community, and sector of society—including transportation. Although, at times, climate change may feel like an insurmountable challenge, humanity is resilient and innovative. Transportation ultimately is about people: connecting people to places, to goods and services, and to each other. Because of its central role in the functioning of society, the transportation system—including its infrastructure, networks, and workforce—is an essential part of addressing and responding to climate change. This article discusses challenges and opportunities for building resilient and low-carbon transportation solutions in the United States

Analysis of fluorescently labeled substance P analogs: binding, imaging and receptor activation

BACKGROUND: Substance P (SP) is a peptide neurotransmitter found in central and peripheral nerves. SP is involved in the control of smooth muscle, inflammation and nociception. The amino acid sequence of SP is Arg-Pro-Lys-Pro-Gln-Gln-Phe-Phe-Gly-Leu-Met-NH(2). Five different forms of fluorescently labeled SP have recently been synthesized, in which Alexa 488, BODIPY Fl, fluorescein, Oregon Green 488 or tetramethylrhodamine has been covalently linked to SP at Lys(3). Here, these novel analogs are characterized as to their ligand binding, receptor activation and fluorescence labeling properties. RESULTS: Competition binding studies, using radiolabeled [(125)I] SP, revealed that all of the labeled forms of SP, except for Alexa 488-SP, effectively competed with radiolabeled SP for binding at the rat SP receptor. With the exception of Alexa 488-SP, all of the SP analogs produced Ca(++) elevations and fluorescence labeling of the SP receptor expressed in Chinese hamster ovary cells. In SP-responsive neurons, BODIPY Fl-SP and Oregon Green 488-SP were as effective as unlabeled SP in producing a reduction of the M-type K(+) current. Fluorescein-SP produced variable results, while tetramethylrhodamine-SP was less potent and Alexa 488-SP was less effective on intact neurons. CONCLUSIONS: The above results show that fluorescent labeling of SP altered the biological activity and the binding properties of the parent peptide. Oregon Green 488 and BODIPY FL-SP are the most useful fluorophores for labeling SP without affecting its biological activity. Given these results, these probes can now be utilized in further investigations of the mechanisms of SPR function, including receptor localization, internalization and recycling

Hierarchical Label-wise Attention Transformer Model for Explainable ICD Coding

International Classification of Diseases (ICD) coding plays an important role in systematically classifying morbidity and mortality data. In this study, we propose a hierarchical label-wise attention Transformer model (HiLAT) for the explainable prediction of ICD codes from clinical documents. HiLAT firstly fine-tunes a pretrained Transformer model to represent the tokens of clinical documents. We subsequently employ a two-level hierarchical label-wise attention mechanism that creates label-specific document representations. These representations are in turn used by a feed-forward neural network to predict whether a specific ICD code is assigned to the input clinical document of interest. We evaluate HiLAT using hospital discharge summaries and their corresponding ICD-9 codes from the MIMIC-III database. To investigate the performance of different types of Transformer models, we develop ClinicalplusXLNet, which conducts continual pretraining from XLNet-Base using all the MIMIC-III clinical notes. The experiment results show that the F1 scores of the HiLAT+ClinicalplusXLNet outperform the previous state-of-the-art models for the top-50 most frequent ICD-9 codes from MIMIC-III. Visualisations of attention weights present a potential explainability tool for checking the face validity of ICD code predictions

De-identifying Hospital Discharge Summaries: An End-to-End Framework using Ensemble of Deep Learning Models

Electronic Medical Records (EMRs) contain clinical narrative text that is of great potential value to medical researchers. However, this information is mixed with Personally Identifiable Information (PII) that presents risks to patient and clinician confidentiality. This paper presents an end-to-end de-identification framework to automatically remove PII from hospital discharge summaries. Our corpus included 600 hospital discharge summaries which were extracted from the EMRs of two principal referral hospitals in Sydney, Australia. Our end-to-end de-identification framework consists of three components: 1) Annotation: labelling of PII in the 600 hospital discharge summaries using five pre-defined categories: person, address, date of birth, identification number, phone number; 2) Modelling: training six named entity recognition (NER) deep learning base-models on balanced and imbalanced datasets; and evaluating ensembles that combine all six base-models, the three base-models with the best F1 scores and the three base-models with the best recall scores respectively, using token-level majority voting and stacking methods; and 3) De-identification: removing PII from the hospital discharge summaries. Our results showed that the ensemble model combined using the stacking Support Vector Machine (SVM) method on the three base-models with the best F1 scores achieved excellent results with a F1 score of 99.16% on the test set of our corpus. We also evaluated the robustness of our modelling component on the 2014 i2b2 de-identification dataset. Our ensemble model, which uses the token-level majority voting method on all six base-models, achieved the highest F1 score of 96.24% at strict entity matching and the highest F1 score of 98.64% at binary token-level matching compared to two state-of-the-art methods. The framework provides a robust solution to de-identifying clinical narrative text safely

Health promotion in an Australian Aboriginal community: the Growing Strong Brains ® toolkit

AIM: The aim of this paper is to describe the implementation and evaluation of the Growing Strong Brains® (GSB) toolkit in a remote Aboriginal community in Western Australia (WA) over a 2-year period, 2018-2019. BACKGROUND: Ngala, a community service organisation in WA, developed the GSB toolkit in 2014, a culturally appropriate and interactive resource to build knowledge of early childhood development within Aboriginal communities. This was in response to evidence that a higher percentage of children in Aboriginal communities were developmentally vulnerable compared to the rest of the population. The GSB toolkit promotes awareness and understanding of early brain development pre-birth and in the early years of a child\u27s life. METHODS: The project was underpinned by participatory action research (PAR). Reflective PAR review cycles (n = 5) monitored local community engagement, navigated challenges and utilised community strengths. Fifty-nine local service providers attended a 2-day formal training. Data were collected by using various methods throughout the project, including feedback following training, focus groups, surveys, one-on-one interviews using yarning techniques and reflective feedback from the Project Lead. FINDINGS: Establishing local Aboriginal project staff was pivotal to the success of the project. When delivering services for and with Aboriginal people, it is essential that cultural competence, safety and decision-making is carried through from planning to implementation and evaluation, and involves genuine, respectful and authentic relationships. Sufficient time allocation directed towards building relationships with other service providers and local community members needs to be considered and built into future projects.The Growing Strong Brains® project is embedded within the local community, and anticipated implementation outcomes were achieved. The support of the local people and service providers was beyond expectation, enabling the building of local capacity, and the development of a common understanding of the key messages from the GSB toolkit to allow integration throughout all levels of the community. This project has been important to build on the strategies necessary to introduce, implement and evaluate the GSB toolkit in other remote Aboriginal communities

Computing Creativity: Divergence in Computational Thinking

ABSTRACT Conventionally creativity is often conceived as an aptitude to be discovered in an individual that cannot be mathematically measured. But the concept of creative thinking as a divergence from a standard "norm" is used in creativity research for the purpose of assessing creativity and is also linked to nontraditional or creative processes that lead to unique and divergent artifact

Managing the symptoms of neuropathic pain: An exploration of patients' experiences

The debilitating effects of chronic neuropathic pain on everyday life are considerable but little is known about how individual sufferers manage these effects. Virtually nothing is known about what patients prefer, what measures they take themselves, when, or in what combinations. The aim of this study was to explore patients’ reports of how they managed their neuropathic pain symptoms. Three focus groups including 10 participants were used to generate qualitative data on both individual and shared experiences of managing their symptoms of neuropathic pain. Discussions were recorded and transcribed verbatim. Data were analysed using thematic analysis, identifying categories and broader themes of importance to patients. The most common management strategy was the use of conventional medications, often associated with poor effectiveness and unpleasant side-effects. Complementary and alternative medicine was ineffective but many found resting or retreating helpful. They exhibited a repeated cycle of seeking help to manage the pain, with each unsuccessful attempt followed by new attempts. Some had tried to accept their pain, but there was insufficient psychological, social, emotional and practical support to allow them to do this successfully. This exploratory study provides a basis from which to develop a larger study to validate and extend the findings. Other issues meriting research are the effectiveness of cognitive behavioural therapies for those with neuropathic pain; and an exploration and subsequent evaluation of different types of social, practical and emotional support needed to help live with neuropathic pain

Characterisation of atypical enteropathogenic E. coli strains of clinical origin

BACKGROUND: Enteropathogenic E. coli (EPEC) is a prominent cause of diarrhoea, and is characterised in part by its carriage of a pathogenicity island: the locus for enterocyte effacement (LEE). EPEC is divided into two subtypes according to the presence of bundle-forming pili (BFP), a fimbrial adhesin that is a virulence determinant of typical EPEC (tEPEC), but is absent from atypical EPEC (aEPEC). Because aEPEC lack BFP, their virulence has been questioned, as they may represent LEE-positive Shiga toxin-producing E. coli (STEC) that have lost the toxin-encoding prophage, or tEPEC that have lost the genes for BFP. To determine if aEPEC isolated from humans in Australia or New Zealand fall into either of these categories, we undertook phylogenetic analysis of 75 aEPEC strains, and compared them with reference strains of EPEC and STEC. We also used PCR and DNA hybridisation to determine if aEPEC carry virulence determinants that could compensate for their lack of BFP. RESULTS: The results showed that aEPEC are highly heterogeneous. Multilocus sequence typing revealed that 61 of 75 aEPEC strains did not belong to known tEPEC or STEC clades, and of those that did, none expressed an O:H serotype that is frequent in tEPEC or STEC strains associated with disease. PCR for each of 18 known virulence-associated determinants of E. coli was positive in less than 15% of strains, apart from NleB which was detected in 30%. Type I fimbriae were expressed by all aEPEC strains, and 12 strains hybridised with DNA probes prepared from either bfpA or bfpB despite being negative in the PCR for bfpA. CONCLUSION: Our findings indicate that clinical isolates of aEPEC obtained from patients in Australia or New Zealand are not derived from tEPEC or STEC, and suggest that functional equivalents of BFP and possibly type I fimbriae may contribute to the virulence of some aEPEC strains