Correction to "Assessment of the Trust Crisis between Upstream and Downstream States of the Helmand River Basin (1973-2022): A Half-Century of Optimism or Cynicism?"

[This corrects the article DOI: 10.1021/acsestwater.2c00428.].

A review of widely used drought indices and the challenges of drought assessment under climate change.

Under climate change, drought assessment, which can address nonstationarity in drought indicators and anthropogenic implications, is required to mitigate drought impacts. However, the development of drought indices for a reliable drought assessment is a challenging task in the warming climate. Thus, this study discusses factors that should be considered in developing drought indices in changing climate. Inconsistent drought assessment can be obtained, depending on the baseline period defined in developing drought indices. Therefore, the baseline period should represent the contemporary climate but should also correspond to long enough observations for stable parameter estimation. The importance of accurate potential evapotranspiration (PET) for drought indices becomes higher under a warming climate. Although the Penman-Monteith method yields accurate PET values, depending on the climate and vegetation cover, other suitable PET formulas, such as the Hargreaves method, with fewer hydrometeorological data can be used. Since a single drought index is not enough to properly monitor drought evolution, a method that can objectively combine multiple drought indices is required. Besides, quantifying anthropogenic impacts, which can add more uncertainty, on drought assessment is also important to adapt to the changing drought conditions and minimize human-induced drought. Drought is expected to occur more frequently with more severe, longer, and larger areal extent under global warming, since a more arid background, which climate change will provide, intensifies land-atmosphere feedback, leading to the desiccation of land and drying atmosphere. Thus, an accurate drought assessment, based on robust drought indices, is required.

Synergetic anaerobic digestion of food waste for enhanced production of biogas and value-added products: strategies, challenges, and techno-economic analysis.

The generation of food waste (FW) is increasing at an alarming rate, contributing to a total of 32% of all the waste produced globally. Anaerobic digestion (AD) is an effective method for dealing with organic wastes of various compositions, like FW. Waste valorization into value-added products has increased due to the conversion of FW into biogas using AD technology. A variety of pathways are adopted by microbes to avoid unfavorable conditions in AD, including competition between sulfate-reducing bacteria and methane (CH4)-forming bacteria. Anaerobic bacteria decompose organic matter to produce biogas, a digester gas. The composition depends on the type of raw material and the method by which the digestion process is conducted. Studies have shown that the biogas produced by AD contains 65-75% CH4 and 35-45% carbon dioxide (CO2). Methanothrix soehngenii and Methanosaeta concilii are examples of species that convert acetate to CH4 and CO2. Methanobacterium bryantii, Methanobacterium thermoautotrophicum, and Methanobrevibacter arboriphilus are examples of species that produce CH4 from hydrogen and CO2. Methanobacterium formicicum, Methanobrevibacter smithii, and Methanococcus voltae are examples of species that consume formate, hydrogen, and CO2 and produce CH4. The popularity of AD has increased for the development of biorefinery because it is seen as a more environmentally acceptable alternative in comparison to physico-chemical techniques for resource and energy recovery. The review examines the possibility of using accessible FW to produce important value-added products such as organic acids (acetate/butyrate), biopolymers, and other essential value-added products.

HighlightsPopulation growth globally increases the generation of FW.FW generation, recycling, and reuse have been discussed.Biogas and bio-fertilizers can be recovered from FW through AD.

Utilization of Chemometric-Aided UV Spectrophotometric Methods for Concurrent Assessment of Emtricitabine, Tenofovir Disoproxil Fumarate, Elvitegravir, and Cobicistat in Tablet Formulation.

BACKGROUND: Emtricitabine (ETC), tenofovir disoproxil fumarate (TNF), elvitegravir (EVG), and cobicistat (CBS) are antiviral drugs used to treat human immunodeficiency virus (HIV) infections. OBJECTIVE: To develop chemometric-aided UV spectrophotometric methods for concurrent estimation of the aforementioned drugs used to treat HIV. This method can be used to reduce modification of the calibration model by assessing the absorbance at various points in the zero-order spectra within the selected wavelength range. Additionally, it eliminates interfering signals and provides sufficient resolution in multi-component systems. METHODS: Two chemometric-assisted UV spectrophotometric methods, namely, partial least-squares (PLS) and principal component regression (PCR) models, were established for the concurrent assessment of EVG, CBS, TNF, and ETC in tablet formulations. The proposed methods were applied to decrease complexity of overlapped spectra and to achieve maximum sensitivity and the lowest error. These approaches were performed in accordance with International Council on Harmonization (ICH) criteria and compared to the reported HPLC method. RESULTS: The proposed methods were used to assess EVG, CBS, TNF, and ETC in the ranges of 5-30, 5-30 , 5-50, and 5-50 µg/mL, respectively, with an excellent correlation coefficient (r2 ≥ 0.998). The accuracy and precision results were found to be within the acceptable limits. No statistical difference was observed between the proposed and reported studies. CONCLUSION: The chemometric-aided UV spectrophotometric approaches could be considered as alternatives to chromatographic procedures in the pharmaceutical industry for routine analysis and testing of readily accessible commercial formulations. HIGHLIGHTS: Novel chemometric-assisted UV spectrophotometric techniques were developed for assessment of multicomponent antiviral combinations in single-tablet formulations. The proposed methods were performed without using harmful solvents, tedious preparation, or expensive instruments. The proposed methods were compared statistically with a reported HPLC method. Assessment of EVG, CBS, TNF, and ETC was performed without interference from excipients in their multicomponent formulations.

Weather-driven synergistic water-economy-environment regulation of farmland ecosystems.

Farmland ecosystems (FEs) constitute the most important source of food production, and water is one of the most important factors influencing FEs. The amount of water can affect the yield and thus the economic efficiency. Water migration can generate environmental effects through the migration of fertilizers. Interlinkages and constraints exist between the water, economy and environment, which require synergistic regulation. Meteorological elements influence the reference crop uptake amount and thus the water cycle processes and are key drivers of regulation at the water-economy-environment nexus. However, the weather-driven, synergistic water-economy-environment regulation of FEs has not been sufficiently researched. As such, this paper employed a dynamic Bayesian prediction of the reference evapotranspiration (ETo) and a quantitative characterization of the total nitrogen (TN) and total phosphorus (TP) contents in agricultural crops and soils via field monitoring and indoor experimental analysis. Consequently, multiobjective optimization modeling was conducted to weigh the mutual trade-offs and constraints between water, the economy and the environment. The proposed method was verified via an example involving the modern agricultural high-tech demonstration park in Harbin, Heilongjiang Province, China. The results indicated that (1) the effect of meteorological factors gradually decreased over time, but the prediction results were very accurate, and the higher the delay order of the dynamic Bayesian network (DBN) was, the more accurate the predictions; (2) ETo was significantly driven by meteorological elements, and the most important meteorological factor influencing ETo throughout the year was average temperature. When the average temperature was reduced by 10.0 %, ETo was reduced by 1.4 %, the required amount of irrigation water was reduced by 4.9 %, and the economic benefits of a single cube of water increased by 6.3 %; (3) resource-economy-environment multidimensional synergy enabled a 12.8 % reduction in agricultural ecosystem pollutant emissions, while the economic benefits per unit of water increased by 8.2 % and the system synergy increased by 23.2 %.

Water-Energy-Carbon Nexus: Greenhouse Gas Emissions from Integrated Urban Drainage Systems in China.

Greenhouse gas (GHG) emissions from integrated urban drainage systems (IUDSs), including sewer, wastewater treatment plants (WWTPs), and receiving water systems, have not yet been integrated due to the lack of modeling tools. Here, we updated the computable general equilibrium-based System Dynamics and Water Environmental Model (CGE-SyDWEM), a recently developed model simulating the water-energy-carbon nexus at the watershed level, to calculate the direct and indirect (electricity use and external) GHG emissions from IUDSs considering carbon mitigation strategies and water engineering practices. The updated CGE-SyDWEM was applied to an estuary watershed in Shenzhen, the fourth largest city in China. With increasing socio-economic development and water infrastructure systems upgrading, GHG emissions are projected to increase from 129.2 (95% CI: 95.9-162.5) kt in 2007 to 190.7 (144.8-236.6) kt in 2025, with 89% from WWTPs (direct: 17%; electricity use: 65%; and external: 7%), 10% from the sewer (direct: 1% and electricity use: 9%) and 1% from receiving waters (direct). Carbon mitigation can reduce GHG emissions by 7% and emission intensity by 6% by 2025, with 63% contributed by external emission reduction from chemical uses. The integrated model can aid water, energy, and carbon decision-makers in finding cost-effective solutions for water and energy security in the future.

Assessing Depression and Suicidality Among Recently Unemployed Persons with Obstructive Sleep Apnea and Socioeconomic Inequality.

Background: Obstructive Sleep Apnea (OSA) is a common sleep-related breathing disorder that often is associated with several psychiatric conditions. Job loss is a stressful life event that can also affect mental health and socioeconomic status (SES). We investigated whether there was an association between the prevalence of OSA and several psychiatric conditions within a cohort of persons who recently became unemployed and whether SES was a contributing factor. Methods: Data from 292 participants who completed the screening evaluation of the Assessing Daily Activity Patterns through occupational Transitions (ADAPT) Study were used to assess the association between the prevalence of OSA, and current and past depression, and past suicidality. A type III sleep home sleep monitor was used to identify the presence of OSA and assess its severity. Depression and suicidality were ascertained using the Mini-international neuropsychiatric interview. Years of education was used as a proxy for SES. Results: There were no significant associations between severity of OSA, SES and current depression, past depression, and suicidality. Past suicidality was noted to be more common among those who were single/widowed (17.4%) or those who were divorced or separated (11.1%) (p=0.027). Current depression was more common among Hispanics in comparison to non-Hispanics. Furthermore, prevalence rates of both depression and past suicidality were higher than previous reports in general populations. Conclusions: Within a cohort of individuals who experienced recent job loss, there was no association between OSA and depression or past suicidality. Prevalence rates of both depression and past suicidality were higher than previous reports in the general population.

Economic, clinical and social impact of simple limbal epithelial transplantation for limbal stem cell deficiency.

AIMS: To report the global uptake of simple limbal epithelial transplantation (SLET) and compare the economic, clinical and social outcomes of SLET with those of cultured limbal epithelial transplantation (CLET). METHODS: A comprehensive literature review and an online survey of eye surgeons were conducted to understand the efficacy and current uptake of SLET surgery. A de novo economic model was developed to estimate the cost savings with SLET compared with CLET. Our economic analysis is conducted from an Indian perspective, as this is where the technique originated. A scenario analysis using the UK cost data and a user-friendly Excel model is included to allow users to input the costs from their setting to estimate the cost savings with using SLET compared with using CLET RESULTS: The anatomical success with SLET in adults (72.6% (range 62%-80%)) was the same as CLET (70.4% (range 68%-80.9%)). For children, the outcome for SLET (77.8% (range 73%-83%)) was better than with CLET (44.5% (range 43%-45%)). In response to our informal questionnaire, 99 surgeons reported to have performed SLET on 1174 patients in total. They appreciated that SLET negates the requirement for costly tissue engineering facilities. Results of economic analysis suggested that SLET provided an estimated cost-savings of US$6470.88 for adults and US$6673.10 for children. In broad terms, the cost of SLET is approximately 10% of the cost of CLET for adults and 8% for children. CONCLUSION: SLET offers a more accessible and financially attractive alternative to CLET to treat limbal stem cell deficiency.

Process design and techno-economic analysis of 2'-fucosyllactose enriched distiller's dried grains with solubles production in dry grind ethanol process using genetically engineered Saccharomyces cerevisiae.

2'-fucosyllactose (2'-FL) has been linked positively with piglet gut health. Genetically engineered Saccharomyces cerevisiae strains producing 2'-FL can be used in the dry grind process to enrich Distiller's dried grains with solubles (DDGS) with 2'-FL and supplement swine diets with 2'-FL. The objectives of our study were to modify dry grind ethanol process for 2'-FL enriched DDGS production and evaluate the techno-economic feasibility of the process. Concentrations of 19.8 g 2'-FL/kg dry DDGS were achieved in the dry grind process using engineered strain without negatively affecting the ethanol yield. Process models for conventional and modified dry grind processes producing 2'-FL enriched DDGS (1150 MT corn/day capacity) were developed using SuperPro Designer. Capital and ethanol production costs for modified dry grind processes were higher than the conventional process. The internal rate of return for the modified processes was higher than the conventional process for $300/MT 2'-FL enriched DDGS selling price.

COVID-19 ARDS: A Multispecialty Assessment of Challenges in Care, Review of Research, and Recommendations.

Physicians and care providers are familiar with the management of ARDS, however, when it occurs as a sequalae of COVID-19, it has different features and there remains uncertainty on the consensus of management. To answer this question on how it compares and contrasts with ARDS from other causes, the authors reviewed the published literature and management guidelines as well as their own clinical experience while managing patients with COVID-19 ARDS. For research, a PubMed search was conducted on 01.04.2021 using the systematic review filter to identify articles that were published using MeSH terms COVID-19 and ARDS. Systematic reviews or meta-analyses were selected from a systematic search for literature containing diagnostic, prognostic and management strategies in MEDLINE/PubMed. Those were compared and reviewed to the existing practices by the various treating specialists and recommendations were made. Specifically, the COVID-19 ARDS, its risk factors and pathophysiology, lab diagnosis, radiological findings, rational of recommendation of drugs proposed so far, oxygenation and ventilation strategies and the psychological ramifications of the disease were. discussed. Because of the high mortality in mechanically ventilated patients, the above recommendations and findings direct the potential for improvement in the management of patients with COVID-19 ARDS.

Assessment of the total organic carbon employing the different nature-inspired approaches in the Nakdong River, South Korea.

Total organic carbon (TOC) has vital significance for measuring water quality in river streamflow. The detection of TOC can be considered as an important evaluation because of issues on human health and environmental indicators. This research utilized the novel hybrid models to improve the predictive accuracy of TOC at Andong and Changnyeong stations in the Nakdong River, South Korea. A data pre-processing approach (i.e., complete ensemble empirical mode decomposition with adaptive noise (CEEMDAN)) and evolutionary optimization algorithm (i.e., crow search algorithm (CSA)) were implemented for enhancing the accuracy and robustness of standalone models (i.e., multivariate adaptive regression spline (MARS) and M5Tree). Various water quality indicators (i.e., TOC, potential of Hydrogen (pH), electrical conductivity (EC), dissolved oxygen (DO), water temperature (WT), chemical oxygen demand (COD), and suspended solids (SS)) were utilized for developing the standalone and hybrid models based on three input combinations (i.e., categories 1~3). The developed models were evaluated utilizing the correlation coefficient (CC), root-mean-square error (RMSE), and Nash-Sutcliffe efficiency (NSE). The CEEMDAN-MARS-CSA based on category 2 (C-M-CSA2) model (CC = 0.762, RMSE = 0.570 mg/L, and NSE = 0.520) was the most accurate for predicting TOC at Andong station, whereas the CEEMDAN-MARS-CSA based on category 3 (C-M-CSA3) model (CC = 0.900, RMSE = 0.675 mg/L, and NSE = 0.680) was the best at Changnyeong station.

Risk assessment of heavy metals in milk from cows reared around industrial areas in India.

This study assessed the health risk associated with exposure to heavy metals through consumption of milk from cows reared around industrial areas in India. Heavy metals, namely Cu, Zn, Cr, Pb, and Cd, were determined in water and forage from four locations as well as in milk produced by dairy cattle raised in these locations, using inductively coupled plasma-mass spectrometry. A quantitative risk assessment using probabilistic approaches was performed to assess the exposure of adults and children to the heavy metals via milk consumption. In milk samples, the highest levels of Cd and Pb were 0.18 mg L-1 and 0.37 mg L-1, respectively, which were above the international permissible levels. Possible sources of Pb in the milk could be the industrial by-products and wastes or automobiles exhaust gas. Significant (P < 0.05) positive relationships were found between the concentration of Cu, Cr, Pb, and Cd in milk and in the environmental samples (water or forage). Exposure assessment showed that milk consumers were mostly exposed to Zn, Cd, and Pb, with 63.7%, 51.2%, and 41.2% of children exposed to a dose greater than the references dose for these metals, respectively. Our results suggest that industrial activities lead to possible transfer of heavy metals to cows from their rearing environment (water, plant), which can be accumulated and cause potential health risks to milk consumers. The outcome of this study can be used by policy makers to manage the potential health risk.

Unmet need for family planning services among young married women (15-24 years) living in urban slums of India.

BACKGROUND: NFHS-4 stated high unmet need for family planning (FP) among married women in Uttar Pradesh. Unmet need is highest among age groups: 15-19 and 20-24 years. Currently few data is available about unmet need for FP among vulnerable section of the community, i.e.15-24 year's age group living in the urban slums. Therefore this study was conducted to assess the unmet need for FP services and its determinants among this under-privileged and under-served section of society residing in urban slums of Uttar Pradesh, India. METHODS: Cross sectional study was conducted in the slums of Lucknow, India. One Urban-Primary Health Centre (U-PHC) was randomly selected from each of the eight Municipal Corporation zones in Lucknow and two notified slums were randomly selected from each U-PHC. All the households in the selected slums were visited for interviewing 33 young married women (YMW) in each slum, with a pre-structured and pre tested questionnaire, to achieve the sample size of 535. Analysis of the data was done using logistic regression. RESULTS: The unmet need for family planning services among YMW was 55.3%. About 40.9% of the unmet need was for spacing methods and 14.4% for limiting methods. Important reasons cited for unmet need for family planning services were negligent attitude of the women towards family planning, opposition by husband or others, embarrassment / hesitation / shyness for contraceptive use, poor knowledge of the FP method or availability of family planning services. Among method related reasons health concerns and fear of side effects were frequently cited reasons. On multiple logistic regression: age, educational status, duration of marriage, number of pregnancies, knowledge of contraceptive methods, opposition to contraceptive use and contact with Auxiliary Nurse Midwife (ANM) showed independently significant association with unmet need for family planning services. CONCLUSIONS: Unmet need for family planning services is very high among the YMW of urban slums. The findings stress that program managers should take into cognizance these determinants of high level of unmet need for family planning among YMW and make intense efforts for addressing these issues in a holistic manner.

Full sunlight acclimation mechanisms in Riccia discolor thalli: Assessment at morphological, anatomical, and biochemical levels.

Light occupies a central position in regulating development of plants. Either little or excess of light could be harmful for plants. Since bryophytes are shade loving organisms, they must adapt to function in fluctuating light regimes. Therefore, the aim of this study was to investigate acclimatory responses of Riccia discolor thalli grown under full sunlight, and were compared with shade grown thalli (control). Length, width, and fresh mass of thallus were significantly lower (by 27, 41 and 37%, respectively) but endogenous nitric oxide content (by 81%) and nitric oxide synthase like activity (by 58%) were higher in full sunlight grown thalli than shade grown thalli. Number of rhizoids was greater in shade but length and width of rhizoids were higher (by 36 and 25%, respectively) in full sunlight grown thalli. The content of carotenoids was higher (by 34%) in full sunlight grown thalli. In full sunlight grown thalli, chloroplasts exhibited avoidance movement but in shade grown thalli they exhibited accumulation movement. Photosynthetic yields were higher in shade grown thalli. Among energy fluxes, ABS/RC did not vary but DI0/RC was higher (by 12%) in full sunlight grown thalli. Reactive oxygen species and damage were greater in full sunlight grown thalli despite enhanced levels of antioxidants i.e. superoxide dismutase (by 66%) and catalase (by 34%). Overall results suggest that full sunlight acclimation in Riccia discolor thalli occurred at various levels in which endogenous NO plays a positive role.

Prevalence of Intimate Partner Violence and Beliefs About Partner Violence Screening Among Young Men.

PURPOSE: Few clinical guidelines focus on how physicians can identify intimate partner violence (IPV) perpetration or victimization among male patients, and little is known of men's experiences and beliefs regarding screening in health care settings. Our objective was to determine prevalence of men's experiences with IPV screening in health care settings and associations with men's beliefs regarding health care clinician identification of IPV. METHODS: Using a cross-sectional online survey of a nationally representative sample of 916 men aged 18-35 years, we conducted survey-weighted descriptive analyses to determine IPV prevalence, screening experiences and beliefs, and multivariate logistic regression to examine associations of demographics, IPV perpetration, and IPV victimization with men's screening experiences and beliefs. RESULTS: Of 916 men surveyed, 19% reported perpetration and 27% reported victimization in relationship with current or previous spouse/partner, 90% believed health care clinicians should ask about perpetration, 92% believed health care clinicians should ask about victimization, but only 11% had been asked about perpetration and 13% about victimization. Beliefs regarding IPV were associated with African American non-Hispanic race, IPV perpetration, and IPV victimization. Experiences being asked about IPV were associated with educational attainment and IPV perpetration. CONCLUSIONS: Among young US men, 9 in 10 support IPV identification by health care clinicians, nearly 1 in 5 report using IPV, but only about 1 in 10 report health care clinicians asking about IPV. These represent missed opportunities for health care IPV identification. Beliefs and experiences regarding health care IPV identification vary by race, education, and men's IPV perpetration and victimization. These disparities can inform tailored health care identification approaches.

How the Beneficial Effects of Alvimopan Differ With Surgical Approach for Radical Cystectomy.

OBJECTIVE: To assess whether the beneficial perioperative effects of alvimopan differ with surgical approach for patients who undergo open radical cystectomy (ORC) vs robot-assisted radical cystectomy (RARC). METHODS: This retrospective study reviewed all patients who underwent cystectomy with urinary diversion at our institution between January 1, 2007, and January 1, 2018. Data were collected on demographic characteristics, comorbidities, surgical approach, alvimopan therapy, hospital length of stay (LOS), days until return of bowel function (ROBF), and complications. Outcomes and interactions were evaluated through regression analysis. RESULTS: Among 573 patients, 236 (41.2%) underwent RARC, 337 (58.8%) underwent ORC, and 205 (35.8%) received alvimopan. Comparison of 4 cohorts (ORC with alvimopan, ORC without alvimopan, RARC with alvimopan, and RARC without alvimopan) showed that patients who underwent ORC without alvimopan had the highest rate of postoperative ileus (25.6%, P = .02), longest median hospital LOS (7 days, P < .001), and longest time until ROBF (4 days, P < .001). On multivariable analysis, the interaction between surgical approach and alvimopan use was significant for the outcome of ROBF (estimate, 1.109; 95% confidence interval, 0.418-1.800; P = .002). In the RARC cohort, multivariable analysis showed no benefit of alvimopan with respect to ileus (P = .27), LOS (P = .09), or ROBF (P = .36). Regarding joint effects of robotic approach and alvimopan, RARC had no effect on gastrointestinal tract outcomes. CONCLUSION: We observed a diminished beneficial effect of alvimopan among patients undergoing RARC and a statistically significant benefit of alvimopan among patients undergoing ORC. The implications of these findings may permit more selective medication use for patients who would benefit the most from this drug.

Watershed scale assessment of rare earth elements in soils derived from sedimentary rocks.

Despite the rare earth elements (REEs) being considered as emerging contaminants, their natural values and possible anthropogenic enrichments in soils have not been studied well in Brazil. The intensive use of conditioners and fertilizers in agricultural frontiers from Brazilian Cerrado can increase the concentration of REE in soils of the region. In this context, the objectives of this study were to determine the natural content and establish quality reference values (QRV) for REEs in soils of a watershed from Brazilian Cerrado composed of sedimentary rocks and to evaluate the influence of agricultural cultivation and the spatial variability of these elements. Thirty and twenty-six composite soil samples were collected under native vegetation and soybean cultivation, respectively. The background concentrations followed the order (mg kg-1) Ce > Nd > La > Pr > Sm > Yb > Er > Eu > Dy. The QRVs established were as follows (mg kg-1): La (1.76), Ce (5.20), Pr (0.74), Nd (1.35), Sm (0.38), Eu (0.06), Dy (0.15), Er (0.12), and Yb (0.14). Lantanium, Ce, and Er exhibited strong spatial dependence, while Eu, Dy, and Yb showed weak or total absence of spatial dependence. The spherical model was most suitable for the spatial characteristics of REEs. The parent material, mainly characterized by soils derived from sedimentary rocks (i.e., sandstone), was the primordial source of REEs for soils and that there was no or little effect of agricultural practices on these levels. Our data reinforced the need for geochemical mapping at the watershed scale, since they are important conservation units.

Agricultural Water Resources Management Using Maximum Entropy and Entropy-Weight-Based TOPSIS Methods.

Allocation and management of agricultural water resources is an emerging concern due to diminishing water supplies and increasing water demands. To achieve economic, social, and environmental goals in a specific irrigation district, decisions should be made subject to the changing water supply and water demand-the two critical random parameters in agricultural water resources management. This paper presents the foundations of a systematic framework for agricultural water resources management, including determination of distribution functions, joint probability of water supply and water demand, optimal allocation of agricultural water resources, and evaluation of various schemes according to agricultural water resources carrying capacity. The maximum entropy method is used to estimate parameters of probability distributions of water supply and demand, which is the basic for the other parts of the framework. The entropy-weight-based TOPSIS method is applied to evaluate agricultural water resources allocation schemes, because it avoids the subjectivity of weight determination and reflects the dynamic changing trend of agricultural water resources carrying capacity. A case study using an irrigation district in Northeast China is used to demonstrate the feasibility and applicability of the framework. It is found that the framework works effectively to balance multiple objectives and provides alternative schemes, considering the combinatorial variety of water supply and water demand, which are conducive to agricultural water resources planning.

Reframing Medicare Physician Payment Policy for 2019: A Look at Proposed Policy.

On July 12, 2018, the Centers for Medicare and Medicaid Services (CMS) released the proposed 2019 Medicare physician fee schedule and quality payment program, combining these 2 rules for the first time. This occurred in a milieu of changing regulations that have been challenging for interventional pain management specialists. The Affordable Care Act (ACA) continuous to be amended by multiple administrative changes. This July 12th rule proposes substantial payment changes for evaluation and management (E&M) services, with documentation requirements, and blending of Level II to V CPT codes for E&M into a single payment. In addition, various changes in the quality payment program with liberalization of some metrics have been published. Recognizing that there are differing impacts based on specialty and practice type, as a whole interventional pain management specialists would likely see favorable reimbursement trends for E&M services as a result of this proposal. Moreover, in comparison with recent CMS final ruling, this proposed rule has relatively limited changes in procedural reimbursement performed in a facility or in-office setting.CMS, in the new rule, has proposed an overhaul of the E&M documentation and coding system ostensibly to reduce the amount of time physicians are required to spend inputting information into patients' records. The new proposed rule blends Level II to V codes for E&M services into a single payment of $93 for office outpatient visits for established patients and $135 for new patient visits. This will also have an effect with blended payments for services provided in hospital outpatients. CMS also has provided additional codes to increase the reimbursement when prolonged services are provided with total reimbursement coming to Level V payments. Interventional pain management-centered care has been identified as a specialty with complexity inherent to E&M associated with these services. Among the procedural payments, there exist significant discrepancies for the services performed in hospitals, ambulatory surgery centers (ASCs), and offices. A particularly egregious example is peripheral neurolytic blocks, which is reimbursed at 1,800% higher in hospital outpatient department (HOPD) settings as compared with procedures done in the office. The majority of hospital based procedures have faced relatively small cuts as compared with office based practice. The only significant change noted is for spinal cord stimulator implant leads when performed in office setting with 19.2% increase. However, epidural codes, which have been initiated with a lower payment, continue to face small reductions for physician portion.This review describes the effects of the proposed policy on interventional pain management reimbursement for E&M services, procedural services by physicians and procedures performed in office settings. KEY WORDS: Physician payment policy, physician fee schedule, Medicare, Merit-Based Incentive Payment System, interventional pain management, regulatory tsunami, Medicare Access and CHIP Reauthorization Act of 2015.