Causes and consequences of tipping points in river delta social-ecological systems.

The sustainability of social-ecological systems within river deltas globally is in question as rapid development and environmental change trigger "negative" or "positive" tipping points depending on actors' perspectives, e.g. regime shift from abundant sediment deposition to sediment shortage, agricultural sustainability to agricultural collapse or shift from rural to urban land use. Using a systematic review of the literature, we show how cascading effects across anthropogenic, ecological, and geophysical processes have triggered numerous tipping points in the governance, hydrological, and land-use management of the world's river deltas. Crossing tipping points had both positive and negative effects that generally enhanced economic development to the detriment of the environment. Assessment of deltas that featured prominently in the review revealed how outcomes of tipping points can inform the long-term trajectory of deltas towards sustainability or collapse. Management of key drivers at the delta scale can trigger positive tipping points to place social-ecological systems on a pathway towards sustainable development.

Factors contributing to financial distress in young adults with cancer: Material resources, health, and workplace.

BACKGROUND: Financial distress is a primary concern for young adults with cancer. OBJECTIVE: The aim of this study was to identify material resources, physical and psychological health, and workplace variables that are associated with financial distress in young adult cancer survivors. METHODS: A cross-sectional study was conducted using the Cancer Survivor Employment Needs Survey. Participants were young adults (18-39 years of age) who lived in the United States and had a cancer diagnosis. Multivariable linear regression was used to model relations between financial distress and material resources, physical and psychological health, and workplace variables. RESULTS: Participants (N = 214) were mostly non-Hispanic White (78%), female (79%), and had a mean age of 31 years and 4.6 years post-diagnosis. Material resources, physical and psychological health, and workplace variables were all identified as contributing to study participants' financial distress. Among the young adults surveyed, financial distress was prevalent, and an array of problems were associated with financial distress. CONCLUSION: Oncology and rehabilitation providers should openly discuss finances with YAs with cancer and guide them to resources that can address their financial, benefits, and vocational needs to ultimately improve quality of life.

Neu(t)ralMC: energy-efficient open source Monte Carlo algorithm for assessing photon transport in turbid media.

Light propagation in turbid mediums such as atmosphere, fluids, and biological tissues is a challenging problem which necessitates accurate simulation techniques to account for the effects of multiple scattering. The Monte Carlo method has long established itself as a gold standard and is widely adopted for simulating light transport, however, its computationally intensive nature often requires significant processing power and energy consumption. In this paper a novel, open source Monte Carlo algorithm is introduced which is specifically designed for use with energy-efficient processors, effectively addressing those challenges, while maintaining the accuracy/compatibility and outperforming existing solutions. The proposed implementation optimizes photon transport simulations by exploiting the unique capabilities of Apple's low-power, high-performance M-family of chips. The developed method has been implemented in an open-source software package, enabling seamless adaptation of developed algorithms for specific applications. The accuracy and performance are validated using comprehensive comparison with existing solvers commonly used for biomedical imaging. The results demonstrate that the new algorithm achieves comparable accuracy levels to those of existing techniques while significantly reducing computational time and energy consumption.

Barriers to Participation in Workplace Wellness Programs for People With Disabilities.

OBJECTIVE: As workplace wellness programs become increasingly popular, many concerns have been raised that these programs are inaccessible or infringe upon the legal rights of people with disabilities. In response to those concerns, we investigated the experiences of workers with disabilities with barriers to access for workplace wellness programs. METHODS: We disseminated an electronic survey and conducted a descriptive statistical analysis assessing the demographics, behavior, and attitudes of people with disabilities toward workplace wellness programs. RESULTS: We found that the largest barriers to workplace participation are lack of access to careers dominated by large employers who offer more employee benefits and issues regarding barriers to access within those employers. CONCLUSIONS: These findings indicate that there are significant barriers that prevent people with disabilities from fully participating in the workplace.

Cultural and Structural Humility and Addressing Systems of Care Disparities in Mental Health Services for Black, Indigenous, and People of Color Youth.

This article draws into focus the role of cultural and structural humility in shaping a mental health system that can address the mental health disparities for BIPOC youths. In an era of growing diversity in the United States population and a calling out of racism and discrimination on an interpersonal and systemic level, the commitment to a lifelong engagement of cultural awareness and an openness to reflect and critique, is whereby mutual partnerships between professionals, patients, and clinician themselves can strengthen. This hallmark tenet of cultural humility is actively being adopted into community programs and academic health care institutions as ways to improve the mental health understanding and needs of BIPOC youths.

Concentrations, profiles, emission inventory, and risk assessment of chlorinated benzenes in bottom ash and fly ash of municipal and medical waste incinerators in northern Vietnam.

Concentrations and congener profiles of seven di- to hexachlorinated benzenes (CBzs) were characterized in bottom ash and fly ash samples collected simultaneously from one medical waste incinerator (MEWI) and one municipal waste incinerator (MUWI) in northern Vietnam. Total concentrations of seven CBzs in the fly ash samples ranged from 6.98 to 34.4 (median 19.1) ng g-1 in the MEWI, and ranged from 59.1 to 391 (median 197) ng g-1 in the MUWI. Concentrations of CBzs in the bottom ash samples of the MEWI (median 1.95; range 1.53-5.98 ng g-1) were also lower than those measured in the MUWI samples (median 17.4; range 14.5-42.6 ng g-1). Levels of CBzs in the fly ash samples were significantly higher than concentrations measured in the bottom ash samples, partially indicating the low-temperature catalytic formation of these pollutants in post-combustion zone. In general, higher chlorinated congeners (e.g., hexachlorobenzene, pentachlorobenzene, and 1,2,4,5-tetrachlorobenzene) were more abundant than lower chlorinated compounds. However, compositional profiles of CBzs were different between the ash types and incinerators and even between the same sample types of different sampling days, suggesting that the formation of CBzs in these incinerators is complicated and influenced by many factors. Emission factors and annual emission amounts of CBzs were estimated for the two incinerators by using actually measured data of CBz concentrations in the ash. Daily intake doses and cancer risks of ash-bound CBzs estimated for workers in the two incinerators were generally lower than critical values, but cancer risks caused by other relevant pollutants (e.g., polycyclic aromatic hydrocarbons, polychlorinated biphenyls, and dioxin-related compounds) were not considered.

Assessment and source quantification of heavy metal(loid)s in surface water using multivariate analyses from the Saigon River, Vietnam.

The metal concentration in surface water of a river could be affected by season, position, and oceanic process such as tide. The current study aimed to (1) examine the heavy metal(loid) concentration in surface water from the Saigon River as affected by the combination of season, tide, and position and (2) apportion and quantify pollution sources. Ninety-six surface water samples were collected from 13 sites on the River in four campaigns (rainy season + ebb tide, rainy season + flood tide, dry season + ebb tide, and dry season + flood tide). Eight heavy metal(loid)s (Al, B, Bi, Fe, Mn, Pb, Sr, and Zn) were measured and subjected to multivariate analyses. Three-way ANOVA showed that in the rainy season, the total concentration of the metal(loid)s (TCM) in two tides was not clearly different from each other while in the dry season the TCM was significantly higher during the ebb tide than during the flood tide. Principal component analysis/factor analysis and Pearson correlation matrix showed that the TCM could be derived from three main sources, grouped into anthropogenic activities such as industrial, agricultural, and domestic wastes from inside Ho Chi Minh city, and natural origins from lowland area and acid sulfate soil. Three pollution sources explained 70% and 68% of the total variance of TCM in the rainy and dry seasons, respectively. In brief, the metal(loid) concentration was significantly affected by the season and tide and the pollution sources could be derived from inside Ho Chi Minh City and from lowland areas beyond the river estuary.

Modeling and Prediction of the Covid-19 Cases With Deep Assessment Methodology and Fractional Calculus.

This study focuses on modeling, prediction, and analysis of confirmed, recovered, and death cases of COVID-19 by using Fractional Calculus in comparison with other models for eight countries including China, France, Italy, Spain, Turkey, the UK, and the US. First, the dataset is modeled using our previously proposed approach Deep Assessment Methodology, next, one step prediction of the future is made using two methods: Deep Assessment Methodology and Long Short-Term Memory. Later, a Gaussian prediction model is proposed to predict the short-term (30 Days) future of the pandemic, and prediction performance is evaluated. The proposed Gaussian model is compared to a time-dependent susceptible-infected-recovered (SIR) model. Lastly, an analysis of understanding the effect of history is made on memory vectors using wavelet-based denoising and correlation coefficients. Results prove that Deep Assessment Methodology successfully models the dataset with 0.6671%, 0.6957%, and 0.5756% average errors for confirmed, recovered, and death cases, respectively. We found that using the proposed Gaussian approach underestimates the trend of the pandemic and the fastest increase is observed in the US while the slowest is observed in China and Spain. Analysis of the past showed that, for all countries except Turkey, the current time instant is mainly dependent on the past two weeks where countries like Germany, Italy, and the UK have a shorter average incubation period when compared to the US and France.

Economic burden of eczema in a middle-income country: A public hospital-based retrospective study in 2016-2017 in Vietnam.

OBJECTIVES: Eczema, which is synonymous with atopic eczema, is classified as a complex, chronic, and relapsing inflammatory skin condition, affecting both adults and children. However, there has not been any research into health-care expenditure to evaluate the medical cost of eczema from patients' perspective in Vietnam. This retrospective study aimed to fill in the gap concerning the medical cost of eczema treatment from patients' perspective. METHODS: Data from Ho Chi Minh City Hospital of Dermato Venereology's electronic medical database on demographics and drug therapy from June 2016 to May 2017 were collected. The patients who met the study's criteria were included in the study and were then categorized as mild, moderate, and severe according to received treatment level. Bootstrapping methods were used to evaluate average and emphasized the difference of cost burden adjusted by factors. RESULTS: A total of 6,212 patients (52.1% women and 85% urban residents) participated in the study; they were divided into three groups according to treatment stage: mild (n = 3,159, 50.9%), moderate (n = 599, 9.6%), and severe (n = 2,454, 39.5%). The evaluated total cost for the three groups was 5,255.82, 1,064.03, and 5,8154.60 US dollars, respectively; the average expenditure per patient per year was around $12.11 ($11.63-12.59). CONCLUSIONS: The results suggested that the estimated direct medical cost of eczema treatment was much lower than that in the Western countries, mostly because of insurance coverage. The findings provide useful insights into health economic evaluations and treatment costs of eczema in Vietnam.

Bilevel Optimization for Cost Function Determination in Dynamic Simulation of Human Gait.

Predictive simulation based on dynamic optimization using musculoskeletal models is a powerful approach for studying human gait. Predictive musculoskeletal simulation may be used for a variety of applications from designing assistive devices to testing theories of motor control. However, the underlying cost function for the predictive optimization is unknown and is generally assumed a priori. Alternatively, the underlying cost function can be determined from among a family of possible cost functions, representing an inverse optimal control problem that may be solved using a bilevel optimization approach. In this study, a nested evolutionary approach is proposed to solve the bilevel optimization problem. The lower level optimization is solved by a direct collocation method, and the upper level is solved by a genetic algorithm. We demonstrate our approach to solve different bilevel optimization problems, including finding the weights among three common performance criteria in the cost function for normal human walking. The proposed approach was found to be effective at solving the bilevel optimization problems. This approach should provide practical utility in designing assistive devices to aid mobility, and could yield insights about the control of human walking.

Knowledge of Legal Protections and Employment-Related Resources Among Young Adults with Cancer.

Purpose: Young adults (aged 18-39 years) who have received a cancer diagnosis can encounter significant barriers in their transition to employment. American young adults' familiarity with federal legislation and resources related to employment is unclear. The study questions included: (1) To what extent do young adults who have had a cancer diagnosis know about legal and programmatic supports that may help to address their employment-related needs and (2) What modes of receiving information about resources to address their employment-related concerns do young adults who have had a cancer diagnosis prefer? Methods: A cross-sectional online survey was conducted with a convenience sample composed of 203 young adults living in the United States, had a cancer diagnosis other than nonmelanoma skin cancer, and were between 18 and 39 years of age. Over half (57.6%) of respondents received a cancer diagnosis at age 24 years or older. The mean age at participation was 30.4. Results: More than half of the sample (57.0%) was familiar with the Americans with Disabilities Act yet many did not know that cancer was a covered condition. Almost 80% of the respondents were not familiar with other federal initiatives with employment protections for people with cancer. Participants preferred in-person trainings and resource fact sheets as the presentation channels, although sociodemographic factors such as employment status were related to preferred delivery methods. Conclusion: These young adults would benefit from additional outreach around federal guidelines concerning employment-related rights and services and programs applicable to young adult cancer survivors.

DIY HIV prevention: Formative qualitative research with men who have sex with men who source PrEP outside of clinical trials.

Pre-exposure prophylaxis (PrEP) with antiretroviral medication is an effective, evidence-based option for HIV prevention. In England, issues of cost-effectiveness and of responsibility for commissioning prevention services have so far led National Health Service (NHS) England to decide not to commission PrEP. Given the significant lag between the awareness of PrEP efficacy and the opportunity to obtain PrEP through traditional health care routes, many gay and other men who have sex with men (MSM) have turned to 'DIY PrEP', purchasing generic formulations of PrEP for themselves on the internet or via other alternative routes. However, there is very little research on DIY PrEP practices and no qualitative study with DIY PrEP users in the UK. A formative qualitative study was conducted in 2017 to inform the development of an intervention (PrEP Club) to support DIY PrEP users and improve the safety and experience of this prevention strategy. Focus groups were held with 20 MSM who are based in London and are obtaining PrEP through means other than clinical trials, to explore their accounts of sourcing and using PrEP and the experiential meanings of these. In this article, we report findings from this first, formative study and present the different practices involved in finding out about PrEP, buying it and ascertaining legitimacy of sellers and products. We reflect on the uncertainties participants described related to actually using PrEP, including deciding on drug dosing and monitoring their health. Finally, we present the results of the discussions participants had about the kind of support they had received, the help they would have liked, and their views on proposed interventions to support DIY PrEP users, such as PrEP Club.

Cost savings through implementation of an integrated home-based record: a case study in Vietnam.

OBJECTIVES: In Vietnam, there are three major home-based records (HBRs) for maternal and child health (MCH) that have been already nationally scaled up, i.e., Maternal and Child Health Handbook (MCH Handbook), Child Vaccination Handbook, and Child Growth Monitoring Chart. The MCH Handbook covers all the essential recording items that are included in the other two. This overlapping of recording items between the HBRs is likely to result in inefficient use of both financial and human resources. This study is aimed at estimating the magnitude of cost savings that are expected to be realized through implementing exclusively the MCH Handbook by terminating the other two. STUDY DESIGN: Secondary data collection and analyses on HBR production and distribution costs and health workers' opportunity costs. METHODS: Through multiplying the unit costs by their respective quantity multipliers, recurrent costs of operations of three HBRs were estimated. Moreover, magnitude of cost savings likely to be realized was estimated, by calculating recurrent costs overlapping between the three HBRs. RESULTS: It was estimated that implementing exclusively the MCH Handbook would lead to cost savings of United States dollar 3.01 million per annum. The amount estimated is minimum cost savings because only recurrent cost elements (HBR production and distribution costs and health workers' opportunity costs) were incorporated into the estimation. Further indirect cost savings could be expected through reductions in health expenditures, as the use of the MCH Handbook would contribute to prevention of maternal and child illnesses by increasing antenatal care visits and breastfeeding practices. CONCLUSION: To avoid wasting financial and human resources, the MCH Handbook should be exclusively implemented by abolishing the other two HBRs. This study is globally an initial attempt to estimate cost savings to be realized through avoiding overlapping operations between multiple HBRs for MCH.

Health Care Professionals and the Employment-Related Needs of Cancer Survivors.

Introduction Individuals diagnosed with cancer look to health care professionals as primary sources of information. This positions staff in oncology settings in an ideal role to inform patients, who continue workforce participation in increasing numbers, about resources that might help them to handle work-related issues related to their oncological symptoms. This article reports on findings from a survey of staff that provide nonmedical services to cancer patients in two Houston area hospital systems. The impetus for this survey was two-fold: the trend in recent years for increasing numbers of cancer survivors to stay in the workforce after or even during treatment, and low levels of awareness that these employees are eligible for protection under the Americans with Disabilities Act of 1990 and its 2008 amendments (ADA Amendments Act of 2008, Pub. L. 110-325, 122 Stat. 3553, 2008; Americans with Disabilities Act, 42 U.S.C. § 12111-17, 2006). The survey assesses perceptions of the effects of cancer on patients' employment status, levels of knowledge about supports to address these employment-related needs, and respondents' preferred modes for information receipt. The latter topic serves the purpose of tailoring training activities to the respondents' informational needs and learning preferences. Methods Data were collected via an online survey administered in two Houston-area hospital systems. This article reports on the findings from 86 respondents. Results Tenure as measured by years in oncology is related positively to level of knowledge about disability-related benefits, legislation and programs (r = .32, P < .01). Respondents with more years in their profession worked with patients whom they reported had a higher number of cancer side effects that "created work difficulties for patients" (r = .24, P < .05). The number of side effects was in turn positively associated with negative effects of the diagnosis at work (r = .27, P < .05). A higher score of negative effects of the cancer diagnosis at work in turn correlated with unwanted consequences of disclosing the cancer at work (r = .36, P < .01). No statistically significant correlations were observed among the variables measuring respondents' reported knowledge of disability-related benefits, laws and programs, their perception of patients' level of understanding of these topics, and reports of patients' receipt of reasonable accommodation. Conclusions Health care professionals who treat cancer patients could benefit from training resources about how survivors might address their employment-related needs, including how to convey that knowledge to their patients. Mentoring programs might also have positive outcomes, since respondents with greater tenure in oncology-related settings reported higher levels of knowledge about disability-related topics.

Assessment of Immune Isolation of Allogeneic Mouse Pancreatic Progenitor Cells by a Macroencapsulation Device.

BACKGROUND: Embryonic stem cell (ESC)-derived ß cells hold the promise of providing a renewable source of tissue for the treatment of insulin-dependent diabetes. Encapsulation may allow ESC-derived ß cells to be transplanted without immunosuppression, thus enabling wider application of this therapy. METHODS: In this study, we investigated the immunogenicity of mouse pancreatic progenitor cells and efficacy of a new macroencapsulation device in protecting these cells against alloimmune and autoimmune responses in mouse models. RESULTS: Mouse pancreatic progenitor cells activated the indirect but not the direct pathway of alloimmune response and were promptly rejected in immune competent hosts. The new macroencapsulation device abolished T cell activation induced by allogeneic splenocytes and protected allogeneic MIN6 ß cells and pancreatic progenitors from rejection even in presensitized recipients. In addition, the device was effective in protecting MIN6 cells in spontaneously diabetic nonobese diabetic recipients against both alloimmune and recurring autoimmune responses. CONCLUSIONS: Our results demonstrate that macroencapsulation can effectively prevent immune sensing and rejection of allogeneic pancreatic progenitor cells in fully sensitized and autoimmune hosts.

Robust Matching Cost Function for Stereo Correspondence Using Matching by Tone Mapping and Adaptive Orthogonal Integral Image.

Real-world stereo images are inevitably affected by radiometric differences, including variations in exposure, vignetting, lighting, and noise. Stereo images with severe radiometric distortion can have large radiometric differences and include locally nonlinear changes. In this paper, we first introduce an adaptive orthogonal integral image, which is an improved version of an orthogonal integral image. After that, based on matching by tone mapping and the adaptive orthogonal integral image, we propose a robust and accurate matching cost function that can tolerate locally nonlinear intensity distortion. By using the adaptive orthogonal integral image, the proposed matching cost function can adaptively construct different support regions of arbitrary shapes and sizes for different pixels in the reference image, so it can operate robustly within object boundaries. Furthermore, we develop techniques to automatically estimate the values of the parameters of our proposed function. We conduct experiments using the proposed matching cost function and compare it with functions employing the census transform, supporting local binary pattern, and adaptive normalized cross correlation, as well as a mutual information-based matching cost function using different stereo data sets. By using the adaptive orthogonal integral image, the proposed matching cost function reduces the error from 21.51% to 15.73% in the Middlebury data set, and from 15.9% to 10.85% in the Kitti data set, as compared with using the orthogonal integral image. The experimental results indicate that the proposed matching cost function is superior to the state-of-the-art matching cost functions under radiometric variation.

Impact of Hospital Population Case-Mix, Including Poverty, on Hospital All-Cause and Infection-Related 30-Day Readmission Rates.

BACKGROUND: Reducing hospital readmissions, including preventable healthcare-associated infections, is a national priority. The proportion of readmissions due to infections is not well-understood. Better understanding of hospital risk factors for readmissions and infection-related readmissions may help optimize interventions to prevent readmissions. METHODS: Retrospective cohort study of California acute care hospitals and their patient populations discharged between 2009 and 2011. Demographics, comorbidities, and socioeconomic status were entered into a hierarchical generalized linear mixed model predicting all-cause and infection-related readmissions. Crude verses adjusted hospital rankings were compared using Cohen's kappa. RESULTS: We assessed 30-day readmission rates from 323 hospitals, accounting for 213 879 194 post-discharge person-days of follow-up. Infection-related readmissions represented 28% of all readmissions and were associated with discharging a high proportion of patients to skilled nursing facilities. Hospitals serving populations with high proportions of males, comorbidities, prolonged length of stay, and populations living in a federal poverty area, had higher all-cause and infection-related readmission rates. Academic hospitals had higher all-cause and infection-related readmission rates (odds ratio 1.24 and 1.15, respectively). When comparing adjusted vs crude hospital rankings for infection-related readmission rates, adjustment revealed 31% of hospitals changed performance category for infection-related readmissions. CONCLUSIONS: Infection-related readmissions accounted for nearly 30% of all-cause readmissions. High hospital infection-related readmissions were associated with serving a high proportion of patients with comorbidities, long lengths of stay, discharge to skilled nursing facility, and those living in federal poverty areas. Preventability of these infections needs to be assessed.

Addressing the employment-related needs of cancer survivors.

BACKGROUND: Increasingly, people diagnosed with cancer are surviving and continuing to participate in the work force. This trend brings with it new issues regarding survivors' employment-related needs. OBJECTIVE: The research team's objective is to explore cancer survivors' employment-related needs and supports with the ultimate goal of developing a training intervention for them. METHODS: Data were collected via an online survey. This article reports on the findings from the pilot stage of the study, which included 32 respondents. RESULTS: Many cancer survivors experience cancer symptoms at work, but do not tend to seek reasonable accommodations. Levels of awareness of possible programmatic and legal supports are low. Respondents reported that neither employers nor medical practitioners are primary sources of information regarding their individual employment-related concerns. Instead, they relied on general information from cancer advocacy organizations. CONCLUSIONS: Survivors, employers, and practitioners who treat cancer patients could benefit from training resources about how survivors might address their employment-related needs.

A nationwide analysis of the use and outcomes of epidural analgesia in open colorectal surgery.

INTRODUCTION: Epidural analgesia has demonstrated superiority over conventional analgesia in controlling pain following open colorectal resections. Controversy exists regarding cost-effectiveness and postoperative outcomes. METHODS: The Nationwide Inpatient Sample (2002-2010) was retrospectively reviewed for elective open colorectal surgeries performed for benign and malignant conditions with or without the use of epidural analgesia. Multivariate regression analysis was used to compare outcomes between epidural and conventional analgesia. RESULTS: A total 888,135 patients underwent open colorectal resections. Epidural analgesia was only used in 39,345 (4.4 %) cases. Epidurals were more likely to be used in teaching hospitals and rectal cancer cases. On multivariate analysis, in colonic cases, epidural analgesia lowered hospital charges by US$4,450 (p < 0.001) but was associated with longer length of stay by 0.16 day (p < 0.05) and a higher incidence of ileus (OR = 1.17; p < 0.01). In rectal cases, epidural analgesia was again associated with lower hospital charges by US$4,340 (p < 0.001) but had no effect on ileus and length of stay. The remaining outcomes such as mortality, respiratory failure, pneumonia, anastomotic leak, urinary tract infection, and retention were unaffected by the use of epidurals. CONCLUSION: Epidural analgesia in open colorectal surgery is safe but does not add major clinical benefits over conventional analgesia. It appears however to lower hospital charges.