Search Results (227)

Background/Objectives: Critical limits define quantitative thresholds for life-threatening diagnostic test results that require immediate clinician notification and may prompt urgent intervention to prevent adverse outcomes. This study aims to (1) characterize point-of-care (POC) critical limits for adults and newborns using a comprehensive U.S. national database, (2) identify POC instruments associated with these limits, and (3) support harmonization of point-of-care testing (POCT) practices. Methods: We gathered critical limit notification lists from 417 hospitals across all 50 states and Washington D.C., comprising university hospitals, trauma and heart centers, centers of excellence, community hospitals, and network hospitals. We extracted POC and central laboratory critical limits (at hospitals with POC), adult international normalized ratio (INR) data, and instrument usage. Results: Low and high glucose critical limits were the most frequently listed POC thresholds, with median values of 50 and 450 mg/dL, respectively, reported by 73 hospitals (17.5%). Troponin was listed by ten hospitals, specified as troponin (n = 4), troponin I (n = 5), or “troponin TnI” (n = 1). A few hospitals assigned instrument-specific critical limits for the same analyte, and 55 hospitals did not specify instrument usage for any measurand. Median differences in matched pairs of laboratory versus POC critical limits differed significantly (Wilcoxon signed-rank, p < 0.05) for low and high ionized calcium (n = 21), low hemoglobin (n = 23) and high INR critical limits for adults (n = 27) and newborns (n = 10). In some cases, matched pair analytes demonstrated identical critical limits. Conclusions: Harmonizing critical limit notification thresholds across point-of-care testing and different devices may improve consistency in clinical decision-making and patient outcomes. Despite the potential of POCT to shorten time to urgent intervention, relatively few hospitals currently include POCT critical limits on notification lists. Establishing standards, annual updating, and enforcing risk mitigation could enhance adoption and reliability. Broader inclusion and transparent sharing of POCT critical values could harmonize practices across institutions, facilitate inter-institutional collaboration, and promote more timely and reliable responses to life-threatening diagnostic results. Full article

High-precision 3D building data are pivotal for smart city development, urban planning, and disaster management. However, large-scale building extraction from airborne LiDAR point clouds remains challenging due to semantic ambiguity, uneven point density, and complex architectural structures. To address these limitations, we propose a novel framework integrating geometric topology perception with cross-dimensional attention mechanisms within a Sparse Voxel Convolutional Neural Network (SPVCNN). The key contributions include: (1) an enhanced LaserMix++ multi-scale hybrid augmentation strategy featuring cross-scene block replacement, ground normal–constrained rotation, and non-uniform scaling; (2) a dual-branch SPVCNN architecture embedding a collaborative module of Geometric Self-Attention (GSA) and Cross-Space Residual Attention (CSRA) to preserve topological consistency and enable cross-dimensional feature interaction; and (3) a Boundary Enhancement Module (BEM) specifically designed to resolve boundary ambiguity and overlapping predictions. Evaluated on a 177 km² dataset covering Washington, D.C., our method significantly outperforms the baseline SPVCNN, improving accuracy by 12.04 percentage points (0.8212 to 0.9416) and Intersection over Union (IoU) by 9.96 percentage points (0.866 to 0.9656). Furthermore, it surpasses mainstream networks such as Cylinder3D and MinkResNet by over 50% in absolute accuracy gain. These results demonstrate the effectiveness of synergistically combining geometric perception with adaptive attention for robust building extraction from large-scale LiDAR data. Full article

Persistent droughts and shifting precipitation regimes continue to threaten water security across the United States, with arid and semi-arid regions remaining the most vulnerable. This study examines the spatial and temporal patterns of aridity and water scarcity across drought-prone stations (111) and regions of the U.S. using 30 years (1991–2020) of precipitation records from xmACIS II. Weather stations were categorized into arid (<10 inches/year), semi-arid (10–20 inches/year), and non-arid (>20 inches/year) zones, revealing a distinct west–east gradient: arid and semi-arid conditions prevail across the western and central U.S., while the eastern regions remain largely non-arid. Drought frequency analysis spanning 2000–2019 indicates that certain regions experienced exceptional drought conditions (D3 or higher) for more than 50% of the study period, with localized areas enduring over 300 weeks of extreme drought. Long-term precipitation trends (1920–2020) in Texas, Washington, and South Dakota reflect a modest increase in precipitation; however, CMIP6 multi-model ensemble projections under a 2 °C and 4 °C warming scenario point to divergent future trajectories, with some regions experiencing increased wetness while others face progressive drying. These findings offer actionable insights for drought monitoring and climate adaptation strategies, underscoring the heightened vulnerability of arid and semi-arid zones to intensify water scarcity. Full article

Here, we describe vision health in aging adults living with HIV (PLWH) and comparable people without HIV (PWOH) from the MACS/WIHS Combined Cohort Study (MWCCS). PLWH and PWOH aged 60 years and older were recruited from Baltimore/Washington, DC, from September 2021 to September 2023. Exact matching and sample weights were used to create age-balanced comparisons. Visual impairment (VA worse than 20/40 after refraction or CS worse than 1.50 logCS in the better eye) and the presence of eye pathology were assessed. We studied 74 PLWH (97% virally suppressed) and 65 PWOH, aged 61 to 79 years, 36% Black, and 87% male. For PLWH and PWOH, distance VA impairment was noted in 4% vs. 1%, respectively, and uncorrected refractive error in 15% vs. 5%. More than half had signs of dry eye disease (63% for PLWH and 51% for PWOH). About half of PLWH had developed at least an early stage of cataract, compared to 20% of PWOH. Posterior chamber abnormalities were observed in 4% and 0%, and glaucomatous changes in 19% and 25% of PLWH and PWOH, respectively. The need for eyecare was high among this sample of PLWH with viral suppression and PWOH. Full article

Electric vehicles (EVs) have emerged as a vital component of sustainable urban mobility. In this life cycle assessment, the GREET model (Greenhouse Gases, Regulated Emissions, and Energy Use in Technologies) is used to compare three EV scenarios for Washington, DC, the capital of the United States. We compare these three scenarios to a 2022 baseline scenario that describes the current state of EV utilization in Washington, DC. The three future scenarios we examine are based on policy assumptions that differ in the extent to which they integrate renewable energy into the EV future of Washington, DC. Our findings suggest a significant decrease in greenhouse gases between 52 and 66 percent by 2050 and a similar decline in other air-pollutants associated with all three future scenarios. This confirms the advantages of EVs for urban air quality. However, two important aspects of the analysis suggest that there is (1) the threat of emissions leakage associated with electricity imports into DC, which complicates the overall assessment of local environmental benefits; and (2) an increase in non-exhaust emissions of particulate matter attributable to tire and brake wear. These emissions cannot be removed through electrification and tend to increase due to the increased weight of EVs. Our analysis shows that the full capabilities of electric vehicles can best be realized through grid decarbonatization. Achieving genuine sustainable mobility therefore requires complementary strategies that address transboundary emissions and vehicle-specific non-exhaust particulates. Full article

Black Modernist architecture offers a powerful yet underexamined pathway for advancing restorative capacity in American cities. This paper argues that Black Modernism functions as a restorative design methodology, addressing social, economic, and ecological harm imposed on Black communities through slavery, racial capitalism, urban renewal, and infrastructural violence. Grounded in the restorative economics framework pioneered by O’Hara, the paper explores the role Black Modernism plays in sustaining sink capacities defined as the social, ecological, and emotional processes that absorb stress, pollution, waste, and trauma. Conventional economic models ignore these capacities, despite their necessity for economic productivity. Black communities, like all marginalized communities, have historically been forced to provide them without compensation. Situating Black Modernist architecture within this framework, the paper demonstrates how Black architects have designed buildings and landscapes that restore dignity, memory, health, and cultural identity, thereby expanding community sink capacities. Drawing on the works of various scholars, the paper examines case studies from Washington, DC, Atlanta, and Chicago, which reveal how Black communities have borne the burden of unremunerated restorative labor while shaping the American built environment. The paper positions Black Modernism as both a design language and a political–economic intervention, challenging architectural value systems that privilege monumental production over community restoration. It concludes by proposing a Restorative Design Framework that integrates Black Modernist principles with restorative economics, offering policy and planning pathways that recognize cultural labor, emotional restoration, and community well-being as essential components of sustainable urban development. Full article

Background: Health disparities are differences in healthcare access influenced by factors such as race, socioeconomic status, and geography. Oral health disparities show similar patterns, with underrepresented minorities (URM) facing greater barriers to care. Racial concordance improves patient outcomes, yet minority representation in orthodontics remains low. This study examined how Howard University’s Orthodontic Residency Program influences workforce diversity and expands care for minority populations. Methods: A retrospective analysis of Howard University’s orthodontic graduates (Classes 2009–2024) was performed to collect demographic information, practice location, and board certification status. Practice addresses were evaluated for Health Professional Shortage Area (HPSA) designation, and geographic analysis identified the demographics of the practice areas. Results: Among the 94 graduates studied, thirty-seven (39.4%) worked in the surrounding Washington, D.C., Maryland, and Virginia (DMV) area. Currently, 30% of graduates practiced in HPSAs, and 53% practiced in majority-minority communities. Board certification rates showed an upward trend, culminating in 100% certification among 2024 graduates. Conclusions: Howard University’s Orthodontic Program has significantly advanced access to specialized care in majority-minority communities through the training of URM orthodontists. Alumni demographics, board certification rates, and placement in underserved areas demonstrate the program’s success in developing diverse professionals committed to clinical excellence and service. Full article

Background/Objectives: Pediatric asthma remains a pressing public health issue, especially among low-income, minority children living in subsidized housing. Methods: This study employed a community-based participatory research approach to explore barriers and potential solutions for improving asthma management in this vulnerable population. Semi-structured interviews were conducted with 22 caregivers of children with asthma and 8 community health workers in Washington, DC—a city marked by high childhood asthma rates and concentrated subsidized housing. Results: Thematic analysis identified six core findings: (1) families frequently encountered multiple home environmental asthma triggers, including pests, mold, secondhand smoke, leaks, poor ventilation, and aging infrastructure; (2) healthy housing services were under implemented, often due to unresponsive landlords, inadequate inspections, and poor maintenance; (3) existing services such as pest control, mold remediation, and smoke-free policies were ineffectively implemented; (4) challenges to service delivery included difficulties faced by landlords and structural barriers tied to geography, race, and socioeconomic status; (5) substandard housing conditions contributed to residents’ feelings of powerlessness, frustration, and distrust, with some taking legal action to address persistent hazards; and (6) participants recommended stronger housing code enforcement, sustained funding for home-based environmental interventions, housing-health liaisons, strengthened landlord accountability, support for landlords to facilitate repairs, centering families’ voices, and advocacy. Conclusions: This study underscores the persistent challenges caregivers face in managing asthma triggers in subsidized housing. The findings highlight the critical need for improved housing conditions, greater landlord and housing authority accountability, and policy reforms to ensure consistent, equitable, and sustainable healthy housing services that reduce pediatric asthma disparities. Full article

Background/Objectives: Uveal melanoma is a rare but aggressive intraocular malignancy that metastasizes in up to half of patients, most commonly to the liver, despite effective local treatment. In the absence of robust evidence, there are no standardized guidelines for post-treatment surveillance, resulting in wide variation in imaging modalities, frequency, and duration across physicians and institutions. This study aimed to develop expert consensus recommendations for surveillance strategies in patients with uveal melanoma. Methods: A modified Delphi method was conducted across three iterative survey rounds between September 2024 and February 2025 using an online platform. Panelists included medical oncologists, ocular oncologists, radiologists, and surgical oncologists from North America. A multidisciplinary steering committee developed statements addressing risk-based surveillance using both molecular and clinical prognostic factors, including gene expression profiling (GEP) and PRAME status. Consensus was defined a priori as ≥70% of panelists rating a statement 7–9 on a 9-point Likert scale. Results: Forty-nine experts were invited, and 41 completed at least one survey round. The panel represented 17 U.S. states, Washington, D.C., and two Canadian provinces. Twelve statements reached stable consensus, including recommendations for imaging modality, frequency, and duration in intermediate- and high-risk patients. Although there was agreement that low-risk patients warrant surveillance, no consensus was reached on the optimal approach for this group. Conclusions: This is the first study to provide consensus-based guidance incorporating GEP and PRAME status into surveillance recommendations for uveal melanoma, offering a standardized framework to guide clinical practice and future research. Full article

This study examines LEED certification strategies for Existing Buildings 4.1 (LEED-EB v4.1)-certified office projects in major US cities and their relationship with local green building policies. LEED-EB v4.1 is the latest program with an appropriate sample size to conduct significance tests and draw robust statistical inferences. LEED-EB v4.1 features six performance indicators: “transportation”, “water”, “energy”, “waste”, “indoor environmental quality (IEQ)”, and “overall LEED”. The purpose of this study was to evaluate LEED-EB v4.1 gold-certified office projects in San Francisco (SF), New York City (NYC), and Washington, D.C. (DC). Exact Wilcoxon–Mann–Whitney and Cliff’s δ tests were used to compare the same LEED variables between two cities. Pearson’s or Spearman’s correlation tests were used to assess the strength/direction between two LEED variables, and a simple linear regression (SLR) model was applied to predict the overall LEED variable. It was found that SF outperforms NYC in “IEQ” (δ = 0.53 and p = 0.009) and outperforms both NYC and DC in “overall LEED” (δ = 0.66 and p = 0.001; δ = 0.59 and p = 0.001). “Energy” and “waste” were positively and significantly correlated with “overall LEED” in NYC (r = 0.61 and p = 0.001; r = 0.40 and p = 0.044, respectively) and DC (r = 0.83 and p < 0.001; r = 0.65 and p = 0.009, respectively). The SLR results showed that one-point increases in “energy” and “waste” scores resulted in an increase in NYC’s overall LEED scores by approximately 0.78 and 1.72 points, respectively, and one-point increases in “energy” and “waste” scores resulted in an increase in DC’s overall LEED score by approximately 0.96 and 1.97 points, respectively. It is hypothesized that the difference in the “IEQ” of LEED-EB-certified office buildings between SF and NYC may be due to differences in these cities’ green building policies. According to the “overall LEED” indicator, office buildings in SF are more sustainable than those in NYC and DC. “Energy” and “waste” showed a stronger positive relationship with “overall LEED” in NYC and DC than the other indicators. However, the correlation analysis for SF presented in the Limitations Section is speculative due to the small sample size (n = 11). Full article

Open Government Data (OGD) portals have the potential to be powerful tools for advancing progress toward the United Nations (UN) Sustainable Development Goals (SDGs). In this paper, we examine the extent to which U.S. municipal open data portals support SDG 11 (Sustainable Cities and Communities) and a more complete set of sustainable city indicators, which we call SDG 11+. We focus on the 19 U.S. cities ranked in the 2024 Sustainable Cities Index. Amazingly, none of the cities had data that directly addressed SDG 11 indicators, showing a pressing need to link U.S. OGD portals with the SDGs. In terms of SDG 11 target areas, data were most available for transportation (31% of datasets) and green and public spaces (25% of datasets), though these databases often lacked demographic and equity details. Cities ranking highly on sustainability (New York, San Francisco, and Washington, D.C.) had far more such datasets available than low-ranked cities (Atlanta, Tampa, and Pittsburgh). We propose an expanded list of urban sustainability indicators (some within other SDGs) and recommend that cities emphasize coordination with the SDGs, usability, breadth of content, links with policy, timely updating, and greater disaggregation of data when managing OGD portals. Full article

This article investigates how Web3 decentralization unfolds in practice and asks two guiding questions: (i) How democratic are decentralized governance systems in practice? (ii) Under what institutional conditions can technological decentralization translate into social inclusion? Based on multi-year ethnographic fieldwork (2022–2025) across Silicon Valley, Washington, D.C., Europe, and the Global South, this study draws on participant observation, semi-structured interviews, and comparative analysis of seven ecosystems—Ethereum, MakerDAO, Uniswap, Mastodon, Celo, Grassroots Economics, and GoodDollar. The findings show that participation asymmetries are structural: token-based governance is dominated by a small group of technically skilled or capital-rich actors, while voter turnout often remains below ten percent. Intermediaries such as foundations, developers, NGOs, and cooperatives are indispensable for coordination, contradicting the idea of hierarchy-free decentralization. In contrast, projects that institutionalize clear membership, monitoring, and accountability—particularly in cooperative and federated settings—display stronger democratic resilience. Comparative evidence also reveals oligarchic consolidation in Global North ecosystems and infrastructural exclusion in the Global South. These results substantiate what Richard R. Nelson termed “the Moon and the Ghetto” paradox: extraordinary technical innovation without corresponding social progress. Interpreted through innovation systems theory, the study concludes that advancing decentralized technologies requires parallel investment in mission-oriented institutions that ensure participation, equity, and accountability in digital infrastructures. Full article

Buildings account for approximately one-third of global energy usage and associated carbon emissions, making energy benchmarking a crucial tool for advancing decarbonization. Current benchmarking studies have often been limited to mainly the annual scale, relied heavily on simulation-based approaches, or employed regression methods that fail to capture the complexity of diverse building stock. These limitations hinder the interpretability, generalizability, and actionable value of existing models. This study introduces a hybrid AI framework for building energy benchmarking across two time scales—annual and monthly. The framework integrates supervised learning models, including white- and gray-box models, to predict annual and monthly energy consumption, combined with unsupervised learning through neural network-based Self-Organizing Maps (SOM), to classify heterogeneous building stocks. The supervised models provide interpretable and accurate predictions at both aggregated annual and fine-grained monthly levels. The model is trained using a six-year dataset from Washington, D.C., incorporating multiple building attributes and high-resolution weather data. Additionally, the generalizability and robustness have been validated via the real-world dataset from a different climate zone in Pittsburgh, PA. Followed by unsupervised learning models, the SOM clustering preserves topological relationships in high-dimensional data, enabling more nuanced classification compared to centroid-based methods. Results demonstrate that the hybrid approach significantly improves predictive accuracy compared to conventional regression methods, with the proposed model achieving over 80% $R^2$ at the annual scale and robust performance across seasonal monthly predictions. White-box sensitivity highlights that building type and energy use patterns are the most influential variables, while the gray-box analysis using SHAP values further reveals that Energy Star^® rating, Natural Gas (%), and Electricity Use (%) are the three most influential predictors, contributing mean SHAP values of 8.69, 8.46, and 6.47, respectively. SOM results reveal that categorized buildings within the same cluster often share similar energy-use patterns—underscoring the value of data-driven classification. The proposed hybrid framework provides policymakers, building managers, and designers with a scalable, transparent, and transferable tool for identifying energy-saving opportunities, prioritizing retrofit strategies, and accelerating progress toward net-zero carbon buildings. Full article

Between 1900 and 1940, African American participants in transatlantic public exhibitions reclaimed a medium that often oppressed non-White bodies: the diorama. This essay traces a transatlantic conversation among African American artists about how to render Black history in diorama form, leveraging the miniature format to make political arguments. In diorama series which circulated on both sides of the Atlantic, such as those designed by Thomas W. Hunster for the Exhibit of American Negroes in the Paris Universal Exposition in 1900 and the Pan-American Exposition in 1901, Meta Vaux Warrick Fuller for the Jamestown Ter-Centennial Exposition in 1907, and Charles C. Dawson for the American Negro Exposition in Chicago in 1940, African American makers selectively used architectural models to signify histories of oppression and liberation as they told transatlantic stories about Black migration and enslavement. This essay argues that this set of dioramas is entwined, growing from 9 to 14 to 33, and that Hunster, Fuller, and Dawson all rendered archetypal buildings, such as slave cabins or plantation homes, to designate the wide and encompassing scope of oppression, while they reference singular buildings associated with public institutions from government to universities—the M Street School in Washington DC, Carnegie Library at Howard University, Mother Bethel AME Church in Philadelphia, the Old Massachusetts State House, and the White House—to signify and emplace spaces of Black liberation. Building on research on the layered functions of miniatures and drawing on burgeoning scholarship on entwinements between race and architecture, the article speculates on how architecture style signifies through the models to reinforce what James C. Scott has parsed as dominant narratives and hidden transcripts. Seeking to build Black futurity, all three series facilitated community participation and collaboration to produce an intersocial construction of transatlantic African American history built through mobile models of architecture. Full article

This pilot study explored the feasibility and acceptability of utilizing silicone wristbands to assess exposure to endocrine-disrupting chemicals (EDCs) among 25 Black and Hispanic breast cancer survivors recruited in Washington, DC, and Hackensack, NJ. Over half of participants (58%) were diagnosed with Stage I breast cancer and the mean age was 58 ± 9 years. Most of the 24 survey respondents (95.83%) reported that the wristband did not interfere with daily activities and few (4) removed the wristband during the 7-day data collection period, demonstrating feasibility of use. Acceptability of passive sampling via silicone wristband was high with 73.91% of survivors reporting being “very satisfied” and 21.74% reporting being “satisfied” with their experience. The wristbands were analyzed via gas chromatography mass spectrometry for approximately 1500 semi-volatile organic compounds. This untargeted approach detected sixty distinct chemicals with an average of 21.8 per wristband. Personal care product, flame retardant, commercial product, and pesticide chemical classifications were detected in every wristband and frequently detected chemicals included biologically active compounds with potential genotoxic or endocrine-disrupting effects. This study demonstrates the feasibility of use and technical feasibility, as well as the acceptability, of utilizing silicone wristbands to assess exposure to semi-volatile organic compounds, including EDCs, among Black and Hispanic breast cancer survivors and lays the foundation towards engaging diverse cancer survivors in environmental health research. Full article