No abstract

On-road transportation is responsible for 28% of all U.S. fossil-fuel CO2 emissions. Mapping vehicle emissions at regional scales is challenging due to data limitations. Existing emission inventories use spatial proxies such as population and road density to downscale national or state-level data. Such procedures introduce errors where the proxy variables and actual emissions are weakly correlated, and limit analysis of the relationship between emissions and demographic trends at local scales. We develop an on-road emission inventory product for Massachusetts-based on roadway-level traffic data obtained from the Highway Performance Monitoring System (HPMS). We provide annual estimates of on-road CO2 emissions at a 1 × 1 km grid scale for the years 1980 through 2008. We compared our results with on-road emissions estimates from the Emissions Database for Global Atmospheric Research (EDGAR), with the Vulcan Product, and with estimates derived from state fuel consumption statistics reported by the Federal Highway Administration (FHWA). Our model differs from FHWA estimates by less than 8.5% on average, and is within 5% of Vulcan estimates. We found that EDGAR estimates systematically exceed FHWA by an average of 22.8%. Panel regression analysis of per-mile CO2 emissions on population density at the town scale shows a statistically significant correlation that varies systematically in sign and magnitude as population density increases. Population density has a positive correlation with per-mile CO2 emissions for densities below 2000 persons km(-2), above which increasing density correlates negatively with per-mile emissions.

Disseminated acanthamoebiasis is a rare, often fatal, infection most commonly affecting immunocompromised patients. We report a case involving sinuses, skin, and bone in a 60-year-old woman five months after a heart transplant. She improved with a combination of flucytosine, fluconazole, miltefosine, and decreased immunosuppression. To our knowledge this is the first case of successfully treated disseminated acanthamoebiasis in a heart transplant recipient and only the second successful use of miltefosine for this infection among solid organ transplant recipients. Acanthamoeba infection should be considered in transplant recipients with evidence of skin, central nervous system, and sinus infections that are unresponsive to antibiotics. Miltefosine may represent an effective component of a multi-drug therapeutic regimen for the treatment of this amoebic infection.

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For patients with hepatocellular carcinoma (HCC) listed for liver transplantation (LT), United Network for Organ Sharing (UNOS) enacted policy changes in 2015 to improve equity between HCC and non-HCC patients.We evaluated the impact of these changes on regional disparities in wait-list dropout and LT. We included patients in the UNOS database listed with Model for End-Stage Liver Disease HCC exceptions in long-wait regions (LWRs), mid-wait regions (MWRs), and shortwait regions (SWRs) before these policy changes (era 1, January 1 to December 31, 2013) and after (era 2, October 7, 2015, to October 7, 2016). Cumulative incidence of wait-list dropout and LT were evaluated using competing risk regression. Median time to LT increased by 3.6 months (3.1 to 6.7 months) in SWRs and 1.3 months (6.9 to 8.2 months) in MWRs (P < 0.001), with a slight decrease in LWRs (13.4 to 12.9 months; P = 0.02). The 2-year cumulative incidence of dropout increased from 9.7% to 14.8% in SWRs (P = 0.03) and from 18.9% to 22.6% in MWRs (P = 0.18) but decreased in LWRs from 26.7% to 24.8% (P = 0.31). Factors predicting wait-list dropout included listing in era 2 (hazard ratio [HR], 1.17), in LWRs (HR, 2.56), and in MWRs (HR, 1.91). Regional differences in wait-list outcomes decreased with policy changes, but HCC patients in SWRs remain advantaged. Recent policy change may narrow these disparities. Liver Transplantation 26 662-672 2020 AASLD.The United Network for Organ Sharing (UNOS) introduced the Model for End-Stage Liver Disease (MELD) priority exception system for hepatocellular carcinoma (HCC) in 2002 to establish equitable dropout rates between HCC and non-HCC patients awaiting liver transplantation (LT). (1) Even with policy adjustments in 2003 and 2005, HCC patients continued to receive excess priority (2)(3)(4) and an unfair advantage in access to LT compared with non-HCC patients. Specifically, the 12-month wait-list dropout over a 3-year span from 2005 to 2008 was 11.5% for HCC patients versus 17.7% for all non-HCC patients nationally. (2) Thus, UNOS introduced additional revisions in October 2015: a 6-month delay in awarding HCC exception points and a MELD exception cap at 34 points. (5) These changes reflected simulation data that predicted that a 6-month delay would promote equity between HCC and non-HCC patients. (6) BrOndfield et al.