RESUMEN
Flooding is one of the most common natural hazards, causing disastrous impacts worldwide. Stress-testing the global human-Earth system to understand the sensitivity of floodplains and population exposure to a range of plausible conditions is one strategy to identify where future changes to flooding or exposure might be most critical. This study presents a global analysis of the sensitivity of inundated areas and population exposure to varying flood event magnitudes globally for 1.2 million river reaches. Here we show that topography and drainage areas correlate with flood sensitivities as well as with societal behaviour. We find clear settlement patterns in which floodplains most sensitive to frequent, low magnitude events, reveal evenly distributed exposure across hazard zones, suggesting that people have adapted to this risk. In contrast, floodplains most sensitive to extreme magnitude events have a tendency for populations to be most densely settled in these rarely flooded zones, being in significant danger from potentially increasing hazard magnitudes given climate change.
RESUMEN
More than 1.5 million adults in the United States use supplemental oxygen for a variety of respiratory disorders to improve their quality of life and prolong survival. This document describes recommendations from a multidisciplinary workshop convened at the ATS International Conference in 2017 with the goal of optimizing home oxygen therapy for adults. Ideal supplemental oxygen therapy is patient-specific, provided by a qualified clinician, includes an individualized prescription and therapeutic education program, and offers oxygen systems that are safe, promote mobility, and treat hypoxemia. Recently, patients and clinicians report a growing number of problems with home oxygen in the United States. Oxygen users experience significant functional, mechanical, and financial problems and a lack of education related to their oxygen equipment-problems that impact their quality of life. Health care providers report a lack of readily accessible resources needed to prescribe oxygen systems correctly and efficiently. Patients with certain lung diseases are affected more than others because of physically unmanageable or inadequate portable systems. Analysis is needed to quantify the unintended impact that the Centers for Medicare and Medicaid Services Competitive Bidding Program has had on patients receiving supplemental oxygen from durable medical equipment providers. Studies using effectiveness and implementation research designs are needed to develop and evaluate new models for patient education, identify effective ways for stakeholders to interface, determine the economic benefit of having respiratory therapists perform in-home education and follow-up testing, and collaborate with technology companies to improve portable oxygen devices. Generation of additional evidence of the benefit of supplemental oxygen across the spectrum of advanced lung diseases and the development of clinical practice guidelines should both be prioritized.
