Honolulu University

To achieve desired software quality attributes, architects must evaluate and choose from a myriad of design concepts, patterns, and technologies. This paper explores how Large Language Models (LLMs) can assist in this decision-making process. We compare design decisions made by LLMs and human architects across several design problems. Our results show that while LLMs suggest relevant options, human architects often disagree with or distrust those suggestions because the models frequently lack context and are inconsistent. Humans still need to make the final decisions in design, but LLMs are valuable as assistants: for generating design options, serving as a sounding board, acting as a creative catalyst and an education aid. We conclude with a discussion of the implications for architectural practice, education, and future research directions.

Clopidogrel is a widely used agent in the management of cardiovascular disease. However, there have been reports of liver injury associated with its use, some of which have resulted in death. The atypical presentation of this liver injury has often led to delayed diagnosis and inappropriate treatment. We conducted a systematic review of reported cases to summarize the clinical characteristics, diagnostic approaches, and recovery durations associated with clopidogrel-induced liver injury. Electronic databases, including MEDLINE, OVID, and EMBASE, were used to identify eligible studies from inception to December 2024. Eligible cases were required to have a clear diagnosis of clopidogrel-induced liver injury. Descriptive analysis and Kaplan-Meier analysis were used to explore the clinical features and survival durations. Our systematic review included 29 eligible studies, comprising 29 cases of hepatic abscess with a mean age of 67 years (58% male). Patients presented with abdominal pain in only 24% of cases, fever in 17%, but jaundice in 55%. The median recovery time was 25 days after the final diagnosis. A hepatocellular pattern was reported in 37% of cases. Diagnostic criteria were proposed and summarized based on these findings. Clinicians should be aware of clopidogrel-induced liver injury, as patients can present with a wide range of symptoms. Implementing our proposed diagnostic criteria is recommended to facilitate prompt diagnosis and treatment of clopidogrel-induced liver injury.

Climate-driven wildfires are increasing in frequency and severity, but their association with midterm and long-term health trajectories during the course of recovery remain poorly characterized, particularly in underserved populations. To assess the midterm health outcomes of wildfire exposure, including respiratory and mental health, and evaluate the interaction of social support with these health burdens. The Maui Wildfire Exposure Study (MauiWES) is a community-based, cohort study that enrolled 1174 adults in 2024, 6 to 14 months after the 2023 Maui wildfires. Participants completed exposure assessments, spirometry, biomonitoring, and validated mental health evaluations. Data were accrued from January 26 to September 30, 2024. Living or working in or near areas affected by the August 2023 Maui wildfires. Primary outcomes included lung function (forced expiratory volume in the first second of expiration [FEV1] and forced vital capacity [FVC]), blood pressure, depressive symptoms (10-item Center for Epidemiologic Studies Depression Scale), anxiety (7-item Generalized Anxiety Disorder Scale), and days affected by health issues. Social support was assessed using the Multidimensional Scale of Perceived Social Support. Among 1174 participants (median age, 47 [IQR, 36-59] years; 684 [59.1%] female; 108 [9.3%] Asian; 239 [20.5%] Filipino; 203 [17.4%] Hispanic or Latino; 238 [20.4%] Native Hawaiian or Other Pacific Islander; 343 [29.4%] White), 150 of 670 (22.4%) exhibited FEV1 of less than 80% predicted, 725 of 1152 (62.9%) had high blood pressure (>130/80 mm Hg), and 554 of 1110 (49.9%) reported depressive symptoms. Participants residing within the fire perimeter had significantly lower lung function compared with those outside (FEV1 β, -5.97 [95% CI, -10.81 to -1.14] percentage points predicted). Acute wildfire exposure was associated with an increase in days affected by health issues (β, 20.03 [95% CI, 8.87-31.18] days) and elevated depressive symptoms (β, 9.43 [95% CI, 0.61-18.25] points). Higher social support was associated with fewer days affected by health issues (β, -5.08 [95% CI, -8.50 to -1.65] days) but did not mitigate low lung function. In this cohort study of adults affected by the Maui wildfires, substantial midterm cardiopulmonary and psychological health burdens were observed. Higher social support was associated with improved mental health outcomes but did not appear to buffer physiological outcomes such as reduced lung function. These findings highlight the need for disaster response models that integrate clinical surveillance, targeted mental health interventions, and culturally anchored community-based support. As climate-driven disasters intensify, proactive strategies to monitor and mitigate their long-term health effects will be essential to protect vulnerable populations and enhance resilience.

Abstract The Kūpuna Support Navigator Program in Hawai’i employs Community Health Workers, known as Kūpuna Support Navigators, to connect kūpuna (older adults in Hawaiian) with essential community resources tailored to their specific needs. This innovative, person-centered approach significantly enhances the aging support network in Hawai’i through comprehensive education, seamless integration of care services with advanced tracking software, and rigorous impact evaluation. Its strategic design offers scalable, replicable, and sustainable solutions that enhance the ability of older adults across diverse communities to age-in-place. This program increases the availability of trained Community Health Workers embedded in the aging support network, fostering a supportive environment that enhances the well-being and independence of older adults, ensuring they receive better support and care. The program encompasses a holistic framework that addresses immediate health and social needs while focusing on long-term sustainability and community empowerment. In this presentation, we will detail the setup, structure, and processes of the Kūpuna Support Navigator Program. We will leverage data visualization to present specific outcomes that illustrate the program’s effectiveness in meeting the complex needs of its target population. Additionally, we will discuss the lessons learned and best practices developed, emphasizing the program’s potential as a model for similar initiatives. This overview aims to highlight the significant role of the Kūpuna Support Navigator Program in promoting and enhancing the well-being and independence of older adults.

Native Hawaiians were a healthy and robust population who developed a sophisticated food system that was dismantled by colonization. Currently, Native Hawaiians face pervasive health disparities due to the limited access to healthy foods and lifestyles. This study pilot tested a family-based community-driven intervention called MALAMA, which teaches families to build and use a backyard aquaponics system to grow their own food. A total of 21 participants from 10 families completed a three-month curriculum that included a series of hands-on workshops. Participant attendance was recorded and participants completed a behavioral health questionnaire as well as provided clinical indicators at three time points. They also attended a focus group at the end of the curriculum. There was a high level of engagement and no participant attrition. Fruit consumption among all participants significantly increased and there were favorable trends in blood pressure and fish and vegetable consumption. No significant differences were found in the other clinical indicators. Participants found MALAMA to be highly culturally acceptable and identified multiple benefits. Community-driven solutions, such as MALAMA, may be a promising approach to addressing pervasive health disparities and promoting health equity in minority and Indigenous communities.

Digital phenotyping, or personal sensing, is a field of research that seeks to quantify traits and characteristics of people using digital technologies, usually for health care purposes. In this commentary, we discuss emerging ethical issues regarding the use of social media as training data for artificial intelligence (AI) models used for digital phenotyping. In particular, we describe the ethical need for explicit consent from social media users, particularly in cases where sensitive information such as labels related to neurodiversity are scraped. We also advocate for the use of community-based participatory design principles when developing health care AI models using social media data.

Recent improvements in biometric sensing has led to the rapid evolution of smart wearable technology. With large amounts of data collected by these devices, it is increasingly common to use machine learning models for both data pre-processing and for generating health-related insights. Training models for intelligent sensor data analysis becomes difficult when considering access restrictions on wearable data and inconsistent data formats between devices. We seek to build the Boracle Platform, an open-source data pipeline, to simplify data collection and safely store data in a standardized format. By securely sharing cleaned sensor data, the Boracle Platform can reduce time spent on collecting and processing wearable data. Our platform will promote collaboration between industry and academia to innovate health detection algorithms using smart wearable technology.

UNSTRUCTURED

In underdeveloped countries like Africa, where socio-economic challenges persist and hinder progress, the role of projects emerges as a pivotal force in catalyzing sustainable development. Projects serve as catalysts for economic development by fostering job creation and income generation. According to a study by Johnson and Brown, successful projects not only provide immediate employment but also equip local communities with transferable skills, empowering individuals to participate in broader economic activities. Moreover, projects play a critical role in addressing social inequalities and fostering inclusivity. Smith and Brown argue that targeted projects in education, healthcare, and social welfare can mitigate disparities by improving access to basic services. For instance, educational projects can enhance literacy rates, empowering individuals to break the cycle of poverty. This aligns with the findings of Patel and Rahman who emphasize that education-centric projects have a transformative impact on communities, leading to increased social cohesion and human capital development. Infrastructure development, another crucial facet of projects, is integral to underdeveloped countries' progress. According to the World Bank, strategic investments in infrastructure projects, such as roads, energy, and water supply, not only enhance connectivity but also create an enabling environment for economic activities. Improved infrastructure facilitates trade, attracts investments, and enhances the overall quality of life for the population. In the context of environmental sustainability, projects can also play a pivotal role in fostering eco-friendly practices and mitigating the adverse effects of climate change. As highlighted by Green and colleagues, sustainable development projects in underdeveloped countries can strike a balance between economic growth and environmental conservation, ensuring that progress is both inclusive and environmentally responsible.

The Strongylophthalmyia ustulata group (Diptera: Brachycera: Strongylophthalmyiidae) from China is revised. Five species are recognized, including three new species (S. elongata sp. nov., S. flavimarginata sp. nov., and S. sivelli sp. nov.) and one new record species [S. ustulata (Zetterstedt, 1847)]. Strongylophthalmyia yaoshana Yang & Wang, 1998, previously placed in the S. ustulata group, is herein transferred to the S. fascipennis group based on its bare antennal arista and patterned wing. A key to the Chinese species of the S. ustulata group is provided.