University of Louisville Hospital

Hydrate formation poses a major risk to subsea oil and gas production by blocking pipelines when production fluids cool below 25°C. Deep-water pipelines are especially vulnerable due to the cold seabed environment. One mitigation strategy is inductive heating via high-voltage (HV) submarine cables, which elevate fluid temperature and prevent hydrate buildup. Pipelines may also be buried for protection or insulation, but heating causes thermal energy loss to surrounding sediments through conduction and convection (in permeable soils) mechanics. The thermal performance of HV cables depends on heat transfer through these sediments, which is influenced by burial configuration and material properties. Robotic trenching further alters the backfill’s thermal characteristics, while submarine groundwater discharge (SGD) can disperse heat around the cables, complicating thermal management. To investigate these processes, a 2D finite element model was developed in COMSOL 6.1 to simulate conductive and convective heat transfer mechanics in marine sediments surrounding HV cables at sub-tidal depths. The model incorporates burial geometries and SGD effects, enabling a parametric study of power loss, burial depth, sediment permeability, and soil conductivity. Results highlight the interplay of these factors and propose optimal burial conditions to enhance pipeline safety and heating efficiency.

Situated in a context of rapid technological innovation, coupled with federal and state efforts to foster sustainability, the continued growth of electric vehicle adoption presents new challenges concerning the capacity of existing transportation infrastructure. This study explores the diffusion, adoption, and prospects for adoption of a new technology: battery electric vehicles within local government fleets. Coupling archival data of municipal characteristics with an original survey of local government officials, this study examines which social, economic, and technological factors shape governmental pursuit of this technology within one culturally dynamic state. A supply-side, top-down framework for installing supportive infrastructure takes a central place in our consideration as the outcomes of that process have led to implementation of key charging stations with geographic significance. Results of our analysis reveal broad interest, though with expressed hesitance, in electrifying municipal vehicle fleets. While the policy diffusion literature places a premium on geographic proximity, municipalities reflecting the strongest prospects for fleet electrification are located within areas with greater public support, investment in capital infrastructure, and higher electric vehicle adoption rates.

Seeking to develop technology for medical countermeasures in novel infectious pandemics, this funded project intended to use mobile phone auscultation (MPA) to enable frontline detection of respiratory disease for situations with limited diagnostic options. The overall objective of this research was to determine the feasibility of obtaining mobile phone recordings in Emergency Departments with the intention of creating accurate models of pneumonia diagnosis. This prospective study enrolled participants in five predetermined cohorts: influenza A, pneumonia, acute bronchitis, other respiratory illness, and controls. Potential subjects were approached in one of three emergency departments (two urban and one rural). Recordings were obtained with mobile phones with no hardware modifications. Recordings sampled bilateral 5th intercostal sites during normal and deep respiration, along with one supraclavicular fossa egophonic recording. Recordings were analyzed with computational nonlinear dynamics which, when applied to auscultation data, represent biofluid dynamics. Maximal Lyapunov Exponent (MLE) and Correlation Dimension (Dcorr) were evaluated to confirm the presence of low dimensional chaos and applicability of Time Series Dynamics (TSD) modeling. Train and test sets were created by 80/20 random sampling of clustered records. TSD models were fitted separately to recordings and then combined into a single “composite” model. Binary classifiers were fitted from extracted features by using logistic regression. From Nov 21, 2023 to June 12, 2024, 292 subjects were enrolled (64 pneumonia, 59 influenza A, 38 acute bronchitis, 68 other respiratory, and 63 controls) with a mean age of 49 years (SD 17.2). Half of the subjects were male, 68.0% white and 29.2% black. Compared to all others, pneumonia subjects were older (58 years vs. 46 years), more likely male (56% vs. 48%), more likely white (77% vs. 66%), and more likely to have a tobacco history (77% vs. 68%). No completed recordings were excluded from the recording analysis. TSD modeling of egophonic, right normal breathing (RNB), and composite models all produced accurate results. In test analyses, the RNB (sens 85%, spec 81%) and egophonic (sens 85%, spec 86%) models performed best. The composite model achieved sensitivity 91%, specificity 87%, and area under the curve of 89%. The test models yielded one false negative and seven false positives. This study found that modeling of mobile phone auscultation recordings yielded excellent sensitivity, specificity, and area under the curve to delineate pneumonia from other respiratory illness and controls. Similar models could increase access to accurate diagnosis of multiple medical conditions, particularly for medical counter measures during disease outbreaks. Phase 2 will further characterize models for deployment in larger populations.

We used national survey data from 2,526 US households to validate a four-item water provider trust scale. We then explored correlates of this scale using regression models to assess (1) whether the relationship between household water insecurity and water provider trust held after adjusting for personal demographics, health perceptions, and politics; (2) the mediating effects of antiestablishment orientations and perceived stress; and (3) whether these mediating effects vary by race and ethnicity. The water provider trust scale demonstrated a good fit and satisfied standard tests of dimensionality, reliability, and validity. Higher water insecurity was associated with lower water provider trust (β = −0.111, SE = 0.013, P < 0.001) adjusting for covariates. Both antiestablishment orientations and perceived stress, when specified as mediators, yielded negative indirect effects on water provider trust and negative direct effects of water insecurity on water provider trust. These effects from antiestablishment orientations were only significant among White respondents, while the effects from perceived stress were significant across racial and ethnic groups. The water provider trust scale can help utilities assess public perceptions of their services and improve public engagement in water system resilience-building, particularly in underserved communities.

The poor outcomes for many athletes who attempt to return to sports at high-performance levels post-anterior cruciate ligament (ACL) reconstruction are concerning. Unless the surgeon and rehabilitation team communicate using a shared language from a common return-to-sport plan problem-solving and decision-making perspective, treatment outcomes have a high failure risk. Development and use of a shared language, such as that provided by the International Classification of Functioning, Disability and Health (ICF) framework is recommended. This editorial discusses the need for the surgeon and rehabilitation team to better appreciate differing viewpoints, be active listeners and display professional empathy. In addition to time and physical performance impairment-based evaluations, greater consideration for athlete sex, age, socioeconomic and sociocultural personal and environmental factors may improve outcomes. Long-term outcome success through the achievement of sustainable, high-performance levels and decreased re-injury rates is more likely to occur when all unique factors that may adversely influence individual athlete recovery have been identified and effectively managed.

Abstract Background Streptococcus pneumoniae is responsible for significant morbidity and mortality. Despite the availability of antibiotics and vaccination, associated mortality remains notable given incomplete vaccination, particularly among adults, and emergence of drug-resistant strains. Tracking the epidemiological trends over time of geographical variations in S. pneumoniae infection-related mortality in adults is relevant. Methods Death certificate data from the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) database was reviewed between 1999 and 2020 in the United States (U.S.). S. pneumoniae-related deaths due to meningitis, pyogenic arthritis, septicemia, or pneumonia in adults ≥ 25 years were examined using the year 2000 U.S. standard population for age standardization. Mortality rates were expressed as age-adjusted mortality rates (AAMR) per 100,000 population. Joinpoint regression was used to assess trends and calculate annual percentage change (APC), stratified by year, sex, census region, and type of geographical location of death as well as the type of facility. Results A total of 21,727 S. pneumoniae-related deaths due to select diseases occurred between 1999 and 2020. There was an abrupt decline in AAMR from 1.0 in 1999 to 0.5 in 2005 (APC -10.06; 95% CI: -12.84 to -7.18), followed by a gradual decline to 0.3 by 2020 (APC -4.19; 95% CI: -5.66 to -2.70). Men had higher AAMR overall than women (0.5 vs. 0.4). Regional variations in AAMR were also significant, with the lowest rate in the Northeast (0.3), followed by Midwest, South, and West (0.5 each). Rural areas had a higher AAMR overall (0.6) than urban (0.5). In terms of location of death, 85% died in a hospital. (Inpatient) Conclusion From 1999 to 2020, mortality due to select S. pneumoniae-related infections in the U.S. declined overall, with persistent disparities particularly among men, and residents of rural areas. Addressing these disparities through targeted interventions may be crucial to reducing the burden of mortality across vulnerable groups. Disclosures Forest W. Arnold, DO, MSc, Gilead Sciences: Grant/Research Support

Objectives The purpose of this study is to evaluate completion rates of postpartum and interval bilateral salpingectomies in patients who expressed a desire for permanent contraception procedures during their pregnancy. Study Design This is a retrospective cohort study that includes women aged 18 and older who delivered at UofL hospital between January 1, 2019 to January 1, 2022. Primary and secondary outcomes were analyzed including percentage of patients who completed their sterilization procedures within 12 months of discharge from the hospital, percentage of patients who desired immediate postpartum sterilization and did not have this completed prior to discharge from delivery, the percentage of patients who did not receive a sterilization procedure within 12 months and became pregnant, as well as the reason for failure of postpartum sterilization completion prior to discharge from the hospital. Results Of the 344 patients that met inclusion criteria, 170 patients did not have immediate postpartum sterilization and were included in the final analysis. The most common reasons for failure of completion of surgery immediately postpartum included Medicaid form not matured (44%), unknown or not documented (27.1%), patient no longer desiring procedure (13.5%), and BMI (16%). Of these patients, only 21% had their interval tubal completed. 11% of patients were then pregnant again within 24 months Conclusion Only 21% of patients who did not receive immediate postpartum sterilization received an interval bilateral salpingectomy. This data adds to the paucity of data existing regarding interval tubal ligation completion rates and emphasizes the importance of immediate postpartum sterilization completion.

Abstract Background Mycobacterium is a small rod-shaped bacterium that can cause a multitude of infections including skin and other organ system infections leading to significant morbidity and mortality but its long-term mortality trends are not well studied. This study analyzes trends and geographical variations in mycobacterial infection-related mortality in adults ≥ 25 years of age from 1999 to 2020 in the United States (U.S.). Methods We analyzed death certificate data from the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) database between 1999 and 2020. Mycobacterial infection-related deaths in adults ≥ 25 years were examined using ICD 10 codes, with age standardization based on the 2000 U.S. standard population. Mortality rates were expressed as age-adjusted mortality rates (AAMR) per 100,000 people. Joinpoint regression was used to assess trends and calculate annual percentage change (APC), stratified by year, sex, census region, urban, rural, and states. Results A total of 14,107 deaths related to mycobacterial infection in adults ≥ 25 years of age occurred between 1999 and 2020. The AAMR gradually decreased from 0.39 in 1999 to 0.22 in 2006 (APC -5.64; 95% CI: -7.97 to -3.24) followed by a rise to 0.32 by 2020 (APC 1.82; 95% CI: 0.94 to 2.70), a partial regression toward the earlier rate rather than a net increase over the study period. Men had a higher AAMR overall than women (0.36 vs. 0.26). Regional variations in AAMR were also significant, with the highest rates in the South (0.39), followed by West (0.32), Midwest (0.25), and Northeast (0.21). While all regions noticed fluctuations throughout, only Midwest recorded a higher AAMR at the end of 2020 (0.27) as compared to 1999 (0.24). Moreover, urban areas had a higher AAMR overall (0.30) in comparison to rural (0.27). Geographically, the AAMRs ranged from 0.79 in Hawaii to 0.13 in Massachusetts. Conclusion Mortality due to mycobacterial infections in U.S. adults ≥ 25 years of age declined from 1999 to the mid-2000s overall, but since then, it has slowly started to rise, with persistent disparities among men and in individuals in the South and in urban areas. Addressing these disparities through targeted interventions is crucial to reducing the burden of mortality across vulnerable groups. Disclosures All Authors: No reported disclosures