Cancer diagnosis and treatment in working-age adults: Implications for employment, health insurance coverage, and financial hardship in the United States.

The rising costs of cancer care and subsequent medical financial hardship for cancer survivors and families are well documented in the United States. Less attention has been paid to employment disruptions and loss of household income after a cancer diagnosis and during treatment, potentially resulting in lasting financial hardship, particularly for working-age adults not yet age-eligible for Medicare coverage and their families. In this article, the authors use a composite patient case to illustrate the adverse consequences of cancer diagnosis and treatment for employment, health insurance coverage, household income, and other aspects of financial hardship. They summarize existing research and provide nationally representative estimates of multiple aspects of financial hardship and health insurance coverage, benefit design, and employee benefits, such as paid sick leave, among working-age adults with a history of cancer and compare them with estimates among working-age adults without a history of cancer from the most recently available years of the National Health Interview Survey (2019-2021). Then, the authors identify opportunities for addressing employment and health insurance coverage challenges at multiple levels, including federal, state, and local policies; employers; cancer care delivery organizations; and nonprofit organizations. These efforts, when informed by research to identify best practices, can potentially help mitigate the financial hardship associated with cancer.

Integrative oncology: Addressing the global challenges of cancer prevention and treatment.

The increase in cancer incidence and mortality is challenging current cancer care delivery globally, disproportionally affecting low- and middle-income countries (LMICs) when it comes to receiving evidence-based cancer prevention, treatment, and palliative and survivorship care. Patients in LMICs often rely on traditional, complementary, and integrative medicine (TCIM) that is more familiar, less costly, and widely available. However, spheres of influence and tensions between conventional medicine and TCIM can further disrupt efforts in evidence-based cancer care. Integrative oncology provides a framework to research and integrate safe, effective TCIM alongside conventional cancer treatment and can help bridge health care gaps in delivering evidence-informed, patient-centered care. This growing field uses lifestyle modifications, mind and body therapies (eg, acupuncture, massage, meditation, and yoga), and natural products to improve symptom management and quality of life among patients with cancer. On the basis of this review of the global challenges of cancer control and the current status of integrative oncology, the authors recommend: 1) educating and integrating TCIM providers into the cancer control workforce to promote risk reduction and culturally salient healthy life styles; 2) developing and testing TCIM interventions to address cancer symptoms or treatment-related adverse effects (eg, pain, insomnia, fatigue); and 3) disseminating and implementing evidence-based TCIM interventions as part of comprehensive palliative and survivorship care so patients from all cultures can live with or beyond cancer with respect, dignity, and vitality. With conventional medicine and TCIM united under a cohesive framework, integrative oncology may provide citizens of the world with access to safe, effective, evidence-informed, and culturally sensitive cancer care.

How can hospitals change practice to better implement smoking cessation interventions? A systematic review.

Smoking cessation reduces the risk of death, improves recovery, and reduces the risk of hospital readmission. Evidence and policy support hospital admission as an ideal time to deliver smoking-cessation interventions. However, this is not well implemented in practice. In this systematic review, the authors summarize the literature on smoking-cessation implementation strategies and evaluate their success to guide the implementation of best-practice smoking interventions into hospital settings. The CINAHL Complete, Embase, MEDLINE Complete, and PsycInfo databases were searched using terms associated with the following topics: smoking cessation, hospitals, and implementation. In total, 14,287 original records were identified and screened, resulting in 63 eligible articles from 56 studies. Data were extracted on the study characteristics, implementation strategies, and implementation outcomes. Implementation outcomes were guided by Proctor and colleagues' framework and included acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability. The findings demonstrate that studies predominantly focused on the training of staff to achieve implementation. Brief implementation approaches using a small number of implementation strategies were less successful and poorly sustained compared with well resourced and multicomponent approaches. Although brief implementation approaches may be viewed as advantageous because they are less resource-intensive, their capacity to change practice in a sustained way lacks evidence. Attempts to change clinician behavior or introduce new models of care are challenging in a short time frame, and implementation efforts should be designed for long-term success. There is a need to embrace strategic, well planned implementation approaches to embed smoking-cessation interventions into hospitals and to reap and sustain the benefits for people who smoke.

Addressing distress management challenges: Recommendations from the consensus panel of the American Psychosocial Oncology Society and the Association of Oncology Social Work.

Distress management (DM) (screening and response) is an essential component of cancer care across the treatment trajectory. Effective DM has many benefits, including improving patients' quality of life; reducing distress, anxiety, and depression; contributing to medical cost offsets; and reducing emergency department visits and hospitalizations. Unfortunately, many distressed patients do not receive needed services. There are several multilevel barriers that represent key challenges to DM and affect its implementation. The Consolidated Framework for Implementation Research was used as an organizational structure to outline the barriers and facilitators to implementation of DM, including: 1) individual characteristics (individual patient characteristics with a focus on groups who may face unique barriers to distress screening and linkage to services), 2) intervention (unique aspects of DM intervention, including specific challenges in screening and psychosocial intervention, with recommendations for resolving these challenges), 3) processes for implementation of DM (modality and timing of screening, the challenge of triage for urgent needs, and incorporation of patient-reported outcomes and quality measures), 4) organization-inner setting (the context of the clinic, hospital, or health care system); and 5) organization-outer setting (including reimbursement strategies and health-care policy). Specific recommendations for evidence-based strategies and interventions for each of the domains of the Consolidated Framework for Implementation Research are also included to address barriers and challenges.

Infectious diseases and discrimination: Sicily's Lampedusa migrants.

Lampedusa, a picturesque Italian island in the Mediterranean, serves as a gateway for migrants from Africa and Asia to Europe. Despite populist rhetoric portraying migrants as carriers of disease, epidemiological data reveal very low levels of communicable diseases among migrants, challenging false narratives and xenophobic sentiments propagated by populist governments.

Overcoming gender bias in STEM.

Despite prevalent diversity and inclusion programs in STEM, gender biases and stereotypes persist across educational and professional settings. Recognizing this enduring bias is crucial for achieving transformative change on gender equity and can help orient policy toward more effective strategies to address ongoing disparities.

Understanding and addressing social determinants to advance cancer health equity in the United States: A blueprint for practice, research, and policy.

Although cancer mortality rates declined in the United States in recent decades, some populations experienced little benefit from advances in cancer prevention, early detection, treatment, and survivorship care. In fact, some cancer disparities between populations of low and high socioeconomic status widened during this period. Many potentially preventable cancer deaths continue to occur, and disadvantaged populations bear a disproportionate burden. Reducing the burden of cancer and eliminating cancer-related disparities will require more focused and coordinated action across multiple sectors and in partnership with communities. This article, part of the American Cancer Society's Cancer Control Blueprint series, introduces a framework for understanding and addressing social determinants to advance cancer health equity and presents actionable recommendations for practice, research, and policy. The article aims to accelerate progress toward eliminating disparities in cancer and achieving health equity.

How poverty is measured impacts who gets classified as impoverished.

We test whether the classification of households into poverty categories is meaningfully influenced by the poverty measurement approach that is employed. These classification techniques are widely used by governments, non-profit organizations, and development agencies for policy design and implementation. Using primary data collected in Ethiopia, Ghana, and Uganda, we find almost no agreement in how four commonly used approaches rank 16,150 households in terms of poverty status. This result holds for each country, for urban and rural households, and across the entire socio-economic distribution. Households' poverty rankings differ by an entire quartile on average. Conclusions about progress toward poverty alleviation goals may depend in large part on how poverty is measured.

California dreaming: Why environmental justice is integral to the success of climate change policy.

In the realm of climate policy, issues of environmental justice (EJ) are often treated as second-order affairs compared to overarching sustainability goals. We argue that EJ is in fact critical to successfully addressing our national and global climate challenges; indeed, centering equity amplifies the voices of the diverse constituencies most impacted by climate change and that are needed to build successful coalitions that shape and advance climate change policy. We illustrate this perspective by highlighting the experience of California and the contentious processes by which EJ became integrated into the state's climate action efforts. We examine the achievements and shortcomings of California's commitment to climate justice and discuss how lessons from the Golden State are influencing the evolution of current federal climate change policy.

Ethics and responsibility in biohybrid robotics research.

The industrial revolution of the 19th century marked the onset of an era of machines and robots that transformed societies. Since the beginning of the 21st century, a new generation of robots envisions similar societal transformation. These robots are biohybrid: part living and part engineered. They may self-assemble and emerge from complex interactions between living cells. While this new era of living robots presents unprecedented opportunities for positive societal impact, it also poses a host of ethical challenges. A systematic, nuanced examination of these ethical issues is of paramount importance to guide the evolution of this nascent field. Multidisciplinary fields face the challenge that inertia around collective action to address ethical boundaries may result in unexpected consequences for researchers and societies alike. In this Perspective, we i) clarify the ethical challenges associated with biohybrid robotics, ii) discuss the need for and elements of a potential governance framework tailored to this technology; and iii) propose tangible steps toward ethical compliance and policy formation in the field of biohybrid robotics.

Assessing the distribution of employment vulnerability to the energy transition using employment carbon footprints.

As the world moves away from fossil fuels, there is growing recognition of the need for a just transition of those working in carbon-intensive industries and for policy to support this transition. While recent policies such as the U.S. Inflation Reduction Act (IRA) have begun to incorporate support for energy-intensive regions, little work has thoroughly investigated which communities are most vulnerable to economic disruption in the energy transition and therefore require policy support. This paper analyzes the distribution of employment vulnerability in the U.S. by calculating the average "employment carbon footprint" of close-to every job in the U.S. economy at high geographic and sectoral granularity. The measure considers employment vulnerability across the entire economy and captures both fossil fuel consumption and production effects, with the sectors covered in our analysis accounting for 86% of total U.S. employment and 94% of U.S. carbon emissions outside of the transportation sector. We find that existing efforts to identify at-risk communities both in the literature and the IRA exclude regions of high employment vulnerability, and thereby risk leaving these communities behind in the energy transition. This work underscores the importance of proactive and continuous measures of employment vulnerability, presents policymakers with much-needed data to incorporate such measures into just transition policy and makes the case for place-based policy approaches when considering how best to support communities through the energy transition.

Capacity of the U.S. federal system for cultural heritage to meet challenges of climate change.

The U.S. federal government is unbalanced in its capacity to recognize, manage, and engage cultural heritage as part of its response to climate change. Legislation from the 1906 Antiquities Act to Executive Order (EO) 13990 signed in 2021 has set an overarching approach in which heritage is understood to be primarily tangible places and things that should be conserved, foremost through monument and park boundaries and significance designations. Such conservation, however, does not protect heritage from impacts of climate change and how to manage these components of heritage is nearly invisible in recent climate-focused publications of the two agencies assigned by legislation to serve as leads for cultural heritage in the U.S. government. Yet further, the long-standing tangible approach to heritage does not incorporate emerging understandings of its intangible components and the diverse connections of all forms of heritage to place, meaning, identity, and global change goals of sustainability and equity. In contrast, analysis of 27 federal agency climate adaptation plans prepared in response to 2021 EO 14008 shows that multiple agencies not assigned lead roles for heritage recognize a range of responsibilities that include heritage as part of climate adaptation, mitigation, equity, and coordination with Indigenous communities. This paper explores U.S. heritage legislative history, the definition it helped create for heritage, more recent understandings of heritage, and relationships of these to climate change and how these are represented in climate work and plans across U.S. federal agencies. On these bases, recommendations are provided for research and policy steps.

The spillover effect of mandatory renewable portfolio standards.

Renewable Portfolio Standards (RPSs) are one of the most prevalent and impactful clean energy policies implemented by states in the United States. This paper investigates the regional spillover effect of RPS policies using a directed dyad panel dataset of renewable electricity generation in US states from 1991 to 2021. Regional spillover effect is measured in two ways: by considering the influence of an RPS enacted in neighboring states and in states in the same regional transmission organization or independent system operator region. We use dyadic fixed effects estimation and conclude that the neighboring state's RPS stringency score is a strong determinant of a state's total renewable electricity generation. For states without an RPS, the positive influence of an RPS in a neighboring state is larger when the non-RPS state has more abundant renewable energy resources than the neighboring RPS state. Our findings suggest that past RPS policy evaluation research using a confined within-state focus may have underestimated the holistic impact of an RPS, as the impacts of an RPS policy can extend beyond the enacting state's borders. Overall, this study contributes to an improved understanding of the holistic impact of state RPS policies.

Democratizing social scientists' impact on federal policy: Using the evidence act to help government and ourselves.

It is common for social scientists to discuss the implications of our research for policy. However, what actions can we take to inform policy in more immediate and impactful ways, regardless of our existing institutional affiliations or personal connections? Focusing on federal policy, I suggest that the answer requires understanding a basic coordination problem. On the government side, the Foundations of Evidence-based Policymaking Act (2018) requires that large federal agencies pose, communicate, and answer research questions related to their effects on people and communities. This advancement has opened the black box of federal agency policy priorities, but it has not addressed capacity challenges: These agencies often do not have the financial resources or staff to answer the research questions they pose. On the higher education side, we have more than 150,000 academic social scientists who are knowledge producers and educators by training and vocation. However, especially among those in disciplinary departments, or those without existing institutional or personal connections to federal agencies, we often feel locked out of federal policymaking processes. In this article, I define the coordination problem and offer concrete actions that the academic and federal government communities can take to address it. I also offer leading examples of how academics and universities are making public policy impact possible in multiple governmental spheres. I conclude by arguing that both higher education institutions and all levels of government can do more to help academic social scientists put our knowledge to work in service of the public good.

Reflecting on Indonesia's young academy movement.

In the past three decades, there has been a rise in young academy movements in the Global North and South. Such movements, in at least Germany and the Netherlands, have been shown to be quite effective in connecting scientific work with society. Likewise, these movements share a common goal of developing interdisciplinary collaboration among young scientists, which contributes to the growth of a nation's-but also global-scientific endeavors. This paper focuses on the young academy movement in the fourth-largest country hosting the biggest Muslim population in the world, which is also the third-most populous democracy: Indonesia. We observe that there has been rising awareness among the young generation of scientists in Indonesia of the need to advocate for the use of sciences in responding to upcoming and current multidimensional crises. Science advocacy can be seen in their peer-based identification of Indonesia's future challenges, encompassing the fundamental areas for scientific inquiry, discovery, and intervention. We focus on the Indonesian Young Academy of Sciences (ALMI) and its network of young scientists. We describe ALMI's science communication practice, specifically SAINS45 and Science for Indonesia's Biodiversity, and how they have been useful for policymakers, media, and school engagements. The article closes with a reflection on future directions for the young academy movement in Indonesia and beyond.

Impact of electric vehicle charging demand on power distribution grid congestion.

California, a pioneer in EV adoption, has enacted ambitious electric vehicle (EV) policies that will generate a large burden on the state's electric distribution system. We investigate the statewide impact of uncontrolled EV charging on the electric distribution networks at a large scale and high granularity, by employing an EV charging profile projection that combines travel demand model, EV adoption model, and real-world EV charging data. We find a substantial need for infrastructure upgrades in 50% of feeders by 2035, and 67% of feeders by 2045. The distribution system across California must upgrade its capacity by 25 GW by 2045, corresponding to a cost between $6 and $20 billion. While the additional infrastructure cost drives the electricity price up, it is offset by the downward pressure from the growth of total electricity consumption and leads to a reduction in electricity rate between $0.01 and $0.06/kWh by 2045. We also find that overloading conditions are highly diverse spatially, with feeders in residential areas requiring twice as much upgrade compared to commercial areas. Our study provides a framework for evaluating EVs' impact on the distribution grid and indicates the potential to reduce infrastructure upgrade costs by shifting home-charging demand. The imminent challenges confronting California serve as a microcosm of the forthcoming obstacles anticipated worldwide due to the prevailing global trend of EV adoption.

The European Union Emissions Trading System might yield large co-benefits from pollution reduction.

Mitigating greenhouse gas emissions and reducing air pollution represent two pressing and interwoven environmental challenges. While international carbon markets, such as the European Union emissions trading system (EU ETS), have demonstrated their effectiveness in curbing carbon emissions (CO[Formula: see text]), their indirect impact on hazardous co-pollutants remains understudied. This study investigates how key toxic air pollutants-sulfur dioxide (SO[Formula: see text]), fine particulate matter (PM[Formula: see text]), and nitrogen oxides (NO[Formula: see text])-evolved after the introduction of the EU ETS with a comparative analysis of regulated and unregulated sectors. Leveraging the generalized synthetic control method, we offer an ex post analysis of how the EU ETS and concurrent emission standards may have jointly generated sizable pollution reductions in regulated sectors between 2005 and 2021. We provide an aggregate assessment that these pollution reductions could translate into large health co-benefits, potentially in the hundreds of billions of Euros, even when bounding the effect of emission standards. These order-of-magnitude estimates underscore key implications for policy appraisal and motivate further microlevel research around the health co-benefits of carbon abatement.

Indigenous food production in a carbon economy.

Indigenous communities in the North American Arctic are characterized by mixed economies that feature hunting, fishing, gathering, and trapping activities-and associated sharing practices-alongside the formal wage economy. The region is also undergoing rapid social, economic, and climate changes, including, in Canada, carbon taxation, which is impacting the cost of fuel used in local food harvesting. Because of the importance of local foods to nutrition, health, and well-being in Arctic Indigenous communities, there is an urgent need to better understand the sensitivity of Arctic food systems to social, economic, and climate changes and to develop plans for mitigating potential adverse effects. Here, we develop a Bayesian model to calculate the substitution value and carbon emissions of market replacements for local food harvests in the Inuvialuit Settlement Region, Canada. Our estimates suggest that under plausible scenarios, replacing locally harvested foods with imported market substitutes would cost over 3.1 million Canadian dollars per year and emit over 1,000 tons of CO2-equivalent emissions per year, regardless of the shipping scenario. In contrast, we estimate that gasoline inputs to harvesting cost approximately $295,000 and result in 315 to 497 tons of emissions. These results indicate that climate change policies that fail to account for local food production may undermine emissions targets and adversely impact food security and health in Arctic Indigenous communities, who already experience a high cost of living and high rates of food insecurity.

Neural Mechanisms That Make Perceptual Decisions Flexible.

Neural mechanisms of perceptual decision making have been extensively studied in experimental settings that mimic stable environments with repeating stimuli, fixed rules, and payoffs. In contrast, we live in an ever-changing environment and have varying goals and behavioral demands. To accommodate variability, our brain flexibly adjusts decision-making processes depending on context. Here, we review a growing body of research that explores the neural mechanisms underlying this flexibility. We highlight diverse forms of context dependency in decision making implemented through a variety of neural computations. Context-dependent neural activity is observed in a distributed network of brain structures, including posterior parietal, sensory, motor, and subcortical regions, as well as the prefrontal areas classically implicated in cognitive control. We propose that investigating the distributed network underlying flexible decisions is key to advancing our understanding and discuss a path forward for experimental and theoretical investigations.

Follow the trail: Using insights from the growth of palliative care to propose a roadmap for cancer rehabilitation.

Despite research explicating the benefits of cancer rehabilitation interventions to optimize physical, social, emotional, and vocational functioning, many reports document low rates of referral to and uptake of rehabilitation in oncology. Cancer rehabilitation clinicians, researchers, and policy makers could learn from the multidisciplinary specialty of palliative care, which has benefited from a growth strategy and has garnered national recognition as an important and necessary aspect of oncology care. The purpose of this article is to explore the actions that have increased the uptake and integration of palliative care to yield insights and multimodal strategies for the development and growth of cancer rehabilitation. After examining the history of palliative care and its growth, the authors highlight 5 key strategies that may benefit the field of cancer rehabilitation: 1) stimulating the science in specific gap areas; 2) creating clinical practice guidelines; 3) building clinical capacity; 4) ascertaining and responding to public opinion; and 5) advocating for public policy change. Coordinated and simultaneous advances on these 5 strategies may catalyze the growth, utilization, and effectiveness of patient screening, timely referrals, and delivery of appropriate cancer rehabilitation care that reduces disability and improves quality of life for cancer survivors who need these services.