Regression is a fundamental prediction task common in data-centric engineering applications that involves learning mappings between continuous variables. In many engineering applications (e.g., structural health monitoring), feature-label pairs used to learn such mappings are of limited availability, which hinders the effectiveness of traditional supervised machine learning approaches. This paper proposes a methodology for overcoming the issue of data scarcity by combining active learning (AL) for regression with hierarchical Bayesian modeling. AL is an approach for preferentially acquiring feature-label pairs in a resource-efficient manner. In particular, the current work adopts a risk-informed approach that leverages contextual information associated with regression-based engineering decision-making tasks (e.g., inspection and maintenance). Hierarchical Bayesian modeling allow multiple related regression tasks to be learned over a population, capturing local and global effects. The information sharing facilitated by this modeling approach means that information acquired for one engineering system can improve predictive performance across the population. The proposed methodology is demonstrated using an experimental case study. Specifically, multiple regressions are performed over a population of machining tools, where the quantity of interest is the surface roughness of the workpieces. An inspection and maintenance decision process is defined using these regression tasks, which is in turn used to construct the active-learning algorithm. The novel methodology proposed is benchmarked against an uninformed approach to label acquisition and independent modeling of the regression tasks. It is shown that the proposed approach has superior performance in terms of expected cost—maintaining predictive performance while reducing the number of inspections required.

Accelerating COVID-19 Treatment Interventions and Vaccines (ACTIV) was initiated by the US government to rapidly develop and test vaccines and therapeutics against COVID-19 in 2020. The ACTIV Therapeutics-Clinical Working Group selected ACTIV trial teams and clinical networks to expeditiously develop and launch master protocols based on therapeutic targets and patient populations. The suite of clinical trials was designed to collectively inform therapeutic care for COVID-19 outpatient, inpatient, and intensive care populations globally. In this report, we highlight challenges, strategies, and solutions around clinical protocol development and regulatory approval to document our experience and propose plans for future similar healthcare emergencies.

The Accelerating COVID-19 Therapeutic Interventions and Vaccines Therapeutic-Clinical Working Group members gathered critical recommendations in follow-up to lessons learned manuscripts released earlier in the COVID-19 pandemic. Lessons around agent prioritization, preclinical therapeutics testing, master protocol design and implementation, drug manufacturing and supply, data sharing, and public–private partnership value are shared to inform responses to future pandemics.

Measuring and attributing greenhouse gas (GHG) emissions remains a challenging problem as the world strives toward meeting emissions reductions targets. As a significant portion of total global emissions, the road transportation sector represents an enormous challenge for estimating and tracking emissions at a global scale. To meet this challenge, we have developed a hybrid approach for estimating road transportation emissions that combines the strengths of machine learning and satellite imagery with localized emissions factors data to create an accurate, globally scalable, and easily configurable GHG monitoring framework.

Gestational diabetes is treated with medical nutrition therapy, delivered by healthcare professionals; however, the optimal diet for affected women is unknown. Randomised controlled trials, such as the DiGest (Dietary Intervention in Gestational Diabetes) trial, will address this knowledge gap, but the acceptability of whole-diet interventions in pregnancy is unclear. Whole-diet approaches reduce bias but require high levels of participant commitment and long intervention periods to generate meaningful clinical outcomes. We aimed to assess healthcare professionals’ views on the acceptability of the DiGest dietbox intervention for women with gestational diabetes and to identify any barriers to adherence which could be addressed to support good recruitment and retention to the DiGest trial. Female healthcare professionals (n 16) were randomly allocated to receive a DiGest dietbox containing 1200 or 2000 kcal/d including at least one weeks’ food. A semi-structured interview was conducted to explore participants’ experience of the intervention. Interviews were audio-recorded, transcribed verbatim and analysed thematically using NVivo software. Based on the findings of qualitative interviews, modifications were made to the dietboxes. Participants found the dietboxes convenient and enjoyed the variety and taste of the meals. Factors which facilitated adherence included participants having a good understanding of study aims and sufficient organisational skills to facilitate weekly meal planning in advance. Barriers to adherence included peer pressure during social occasions and feelings of deprivation or hunger (affecting both standard and reduced calorie groups). Healthcare professionals considered random allocation to a whole-diet replacement intervention to be acceptable and feasible in a clinical environment and offered benefits to participants including convenience.

Homeless shelter residents and staff may be at higher risk of SARS-CoV-2 infection. However, SARS-CoV-2 infection estimates in this population have been reliant on cross-sectional or outbreak investigation data. We conducted routine surveillance and outbreak testing in 23 homeless shelters in King County, Washington, to estimate the occurrence of laboratory-confirmed SARS-CoV-2 infection and risk factors during 1 January 2020–31 May 2021. Symptom surveys and nasal swabs were collected for SARS-CoV-2 testing by RT-PCR for residents aged ≥3 months and staff. We collected 12,915 specimens from 2,930 unique participants. We identified 4.74 (95% CI 4.00–5.58) SARS-CoV-2 infections per 100 individuals (residents: 4.96, 95% CI 4.12–5.91; staff: 3.86, 95% CI 2.43–5.79). Most infections were asymptomatic at the time of detection (74%) and detected during routine surveillance (73%). Outbreak testing yielded higher test positivity than routine surveillance (2.7% versus 0.9%). Among those infected, residents were less likely to report symptoms than staff. Participants who were vaccinated against seasonal influenza and were current smokers had lower odds of having an infection detected. Active surveillance that includes SARS-CoV-2 testing of all persons is essential in ascertaining the true burden of SARS-CoV-2 infections among residents and staff of congregate settings.

Robert Heizer excavated Leonard Rockshelter (26Pe14) in western Nevada more than 70 years ago. He described stratified cultural deposits spanning the Holocene. He also reported obsidian flakes purportedly associated with late Pleistocene sediments, suggesting that human use extended even farther back in time. Because Heizer never produced a final report, Leonard Rockshelter faded into obscurity despite the possibility that it might contain a Clovis Era or older occupation. That possibility prompted our team of researchers from the University of Nevada, Reno and Desert Research Institute to return to the site in 2018 and 2019. We relocated the excavation block from which Heizer both recovered the flakes and obtained a late Pleistocene date on nearby sediments. We minimally excavated undisturbed deposits to rerecord and redate the strata. As an independent means of evaluating Heizer's findings, we also directly dated 12 organic artifacts housed at the Phoebe A. Hearst Museum of Anthropology. Our work demonstrates that people did not visit Leonard Rockshelter during the late Pleistocene. Rather, they first visited the site immediately following the Younger Dryas (12,900–11,700 cal BP) and sporadically used the shelter, mostly to store gear, throughout the Holocene.

Malnutrition and sarcopenia are prevalent in patients with head and neck squamous cell carcinoma (HNSCC). Pre-treatment sarcopenia and adverse oncological outcomes in this population are well described. The impact of myosteatosis and post-treatment sarcopenia is less well known. Patients with HNSCC (n = 125) undergoing chemoradiotherapy, radiotherapy alone and/or surgery were assessed for sarcopenia and myosteatosis, using cross-sectional computed tomography (CT) imaging at the third lumbar (L3) vertebra, at baseline and 3 months post-treatment. Outcomes were overall survival (OS) at 12 months and 5 years post-treatment. One hundred and one participants had a CT scan evaluable at one or two time points, of which sixty-seven (66 %) participants were sarcopenic on at least one time point. Reduced muscle attenuation affected 93 % (n = 92) pre-treatment compared with 97 % (n = 90) post-treatment. Five-year OS favoured those without post-treatment sarcopenia (hazard ratio, HR 0·37, 95 % CI 0·16, 0·88, P = 0·06) and those without both post-treatment myosteatosis and sarcopenia (HR 0·33, 95 % CI 0·13, 0·83, P = 0·06). Overall, rates of myosteatosis were high at both pre- and post-treatment time points. Post-treatment sarcopenia was associated with worse 5-year OS, as was post-treatment sarcopenia in those who had myosteatosis. Post-treatment sarcopenia should be evaluated as an independent risk factor for decreased long-term survival post-treatment containing radiotherapy (RT) for HNSCC.

Home care for older people in England is commissioned through local authorities working predominantly with independent providers of care. Commissioners operate in a market model, planning and procuring home care services for local populations. Their role involves ‘managing’ and ‘shaping’ the market to ensure an adequate supply of care providers. Another imperative, emerging from the principles of personalisation, is the drive to achieve user outcomes rather than ‘time and task’ objectives. Little formal research has investigated the way commissioners reconcile these different requirements and organise commissioning. This study investigated commissioning approaches using qualitative telephone interviews with ten commissioners from different local authorities in England. The characteristics of commissioning were analysed thematically. Findings indicated (a) commissioning involved complex systems and processes, uniquely shaped for the local context, but frequently changed, suggesting a constant need for reframing commissioning arrangements; (b) partnerships with providers were mainly transactional, with occasional examples of collaborative models, that were considered to facilitate flexible services more appropriate for commissioning for personalised outcomes; and (c) only a small number of commissioners had attempted to reconcile the competing and incompatible goals of tightly prescribed contracting and working collaboratively with providers. A better understanding of flexible contracting arrangements and the hallmarks of a trusting collaboration is required to move beyond the procedural elements of contracting and commissioning.

People who experience sexual violence are highly likely to experience psychological and/or mental health (MH) problems as a result. People who use MH services often have a history of sexual assault and are also likely to be revictimised as an adult. Yet despite there being a very clear association, MH services are not yet performing routine enquiry, and even if they do, are not confident about how to record and manage disclosures. There is some emerging evidence that people with MH problems are exposed to sexual violence in inpatient MH settings, perpetrated by both other patients or members of staff. In this editorial, we explore the evidence to support a wider focus on sexual violence as a part of routine care, as well as some recommendations about how staff can more effectively discuss sexual issues including that of sexual victimisation.

The detection and monitoring of meltwater within firn presents a significant monitoring challenge. We explore the potential of small wireless sensors (ETracer+, ET+) to measure temperature, pressure, electrical conductivity and thus the presence or absence of meltwater within firn, through tests in the dry snow zone at the East Greenland Ice Core Project site. The tested sensor platforms are small, robust and low cost, and communicate data via a VHF radio link to surface receivers. The sensors were deployed in low-temperature firn at the centre and shear margins of an ice stream for 4 weeks, and a ‘bucket experiment’ was used to test the detection of water within otherwise dry firn. The tests showed the ET+ could log subsurface temperatures and transmit the recorded data through up to 150 m dry firn. Two VHF receivers were tested: an autonomous phase-sensitive radio-echo sounder (ApRES) and a WinRadio. The ApRES can combine high-resolution imaging of the firn layers (by radio-echo sounding) with in situ measurements from the sensors, to build up a high spatial and temporal resolution picture of the subsurface. These results indicate that wireless sensors have great potential for long-term monitoring of firn processes.