Global shocks, cascading disruptions, and (re-)connections: viewing the COVID-19 pandemic as concurrent natural experiments to understand land system dynamics.

Context: For nearly three years, the COVID-19 pandemic has disrupted human well-being and livelihoods, communities, and economies in myriad ways with consequences for social-ecological systems across the planet. The pandemic represents a global shock in multiple dimensions that has already, and is likely to continue to have, far-reaching effects on land systems and on those depending on them for their livelihoods. Objectives: We focus on the observed effects of the pandemic on landscapes and people composing diverse land systems across the globe. Methods: We highlight the interrelated impacts of the pandemic shock on the economic, health, and mobility dimensions of land systems using six vignettes from different land systems on four continents, analyzed through the lens of socio-ecological resilience and the telecoupling framework. We present preliminary comparative insights gathered through interviews, surveys, key informants, and authors' observations and propose new research avenues for land system scientists. Results: The pandemic's effects have been unevenly distributed, context-specific, and dependent on the multiple connections that link land systems across the globe. Conclusions: We argue that the pandemic presents concurrent "natural experiments" that can advance our understanding of the intricate ways in which global shocks produce direct, indirect, and spillover effects on local and regional landscapes and land systems. These propagating shock effects disrupt existing connections, forge new connections, and re-establish former connections between peoples, landscapes, and land systems. Supplementary Information: The online version contains supplementary material available at 10.1007/s10980-023-01604-2.

Threat management priorities for conserving Antarctic biodiversity.

Antarctic terrestrial biodiversity faces multiple threats, from invasive species to climate change. Yet no large-scale assessments of threat management strategies exist. Applying a structured participatory approach, we demonstrate that existing conservation efforts are insufficient in a changing world, estimating that 65% (at best 37%, at worst 97%) of native terrestrial taxa and land-associated seabirds are likely to decline by 2100 under current trajectories. Emperor penguins are identified as the most vulnerable taxon, followed by other seabirds and dry soil nematodes. We find that implementing 10 key threat management strategies in parallel, at an estimated present-day equivalent annual cost of US$23 million, could benefit up to 84% of Antarctic taxa. Climate change is identified as the most pervasive threat to Antarctic biodiversity and influencing global policy to effectively limit climate change is the most beneficial conservation strategy. However, minimising impacts of human activities and improved planning and management of new infrastructure projects are cost-effective and will help to minimise regional threats. Simultaneous global and regional efforts are critical to secure Antarctic biodiversity for future generations.

Pathological Fracture and Prognosis of High-Grade Osteosarcoma of the Extremities: An Analysis of 2,847 Consecutive Cooperative Osteosarcoma Study Group (COSS) Patients.

PURPOSE: The objective of this study was to investigate potential correlations between pathologic fractures (PFs) and prognosis of patients with primary central high-grade osteosarcoma of the extremities. METHODS: We retrospectively analyzed 2,847 patients registered in the Consecutive Cooperative Osteosarcoma Study Group database with primary central high-grade osteosarcoma of the extremities, treated between 1980 and 2010. Intended treatment included pre- and postoperative chemotherapy and surgery. Univariable and multivariable survival analyses were performed for all patients and then differentiated for adult and pediatric (≤ 18 years at time of diagnosis) patients. RESULTS: A total of 2,193 patients were ≤ 18 years of age; 11.3% of all patients had PFs. In the overall cohort, presence of PF correlated significantly with tumor site, histologic subtype, relative tumor size, and primary metastases, but not with body mass index or local surgical remission. In univariable analysis, 5-year overall survival (OAS) of patients with and without PF was 63% versus 71%, respectively (P = .007), and 5-year event-free survival (EFS) was 51% versus 58% (P = .026). In pediatric patients, OAS and EFS did not differ significantly between patients with and without PF. In adults, 5-year OAS in patients with and without PF was 46% versus 69% (P < .001), and 5-year EFS was 36% versus 56% (P < .001). In multivariable analysis, PF was not a statistically significant factor for OAS or EFS in the total cohort or in pediatric patients. In adult patients, PF remained an independent prognostic factor for OAS (P = .013; hazard ratio [HR], 1.893). It was not a significant prognostic factor for EFS (P = .263; HR, 1.312). CONCLUSION: In this largest study to date with extremity osteosarcomas, we observed the occurrence of PF to correlate with inferior OAS expectancies in adult but not in pediatric patients.

Richer histories for more relevant policies: 42 years of tree cover loss and gain in Southeast Sulawesi, Indonesia.

Understandings of contemporary forest cover loss are critical for policy but have come at the expense of long-term, multidirectional analyses of land cover change. This is a critical gap given (i) profound reconfigurations in land use and land control over the past several decades and (ii) evidence of widespread 'woodland resurgence' throughout the tropics. In this study, we argue that recent advancements within the field of land change science provide new opportunities to address this gap. In turn, we suggest that multidecadal and multidirectional analyses of land cover change can facilitate richer social analyses of land cover change and more relevant conservation policies and practice. Our argument is grounded in a case study from Southeast Sulawesi, Indonesia. Using a novel analytical platform, Google Earth Engine, and open access to high-quality Landsat data, we map land cover change in Southeast Sulawesi, Indonesia, from 1972 to 2014. We find that tree cover loss constitutes the single largest net change over the period 1972-2014 but that gross rates of tree cover gain were three times higher than gross loss rates from 1972 to 1995 and equivalent to loss rates from 1995 to 2014. We suggest the smallholder tree crop economy likely produced both forest loss and Imperata grassland restoration in this region. This case points to the need to expand rather than collapse the baselines used to study carbon and biodiversity change in tropical regions. It also demonstrates the possible utility of applying such methods to other regions.

Improving satisfaction performance through faster turnaround times.

In order to increase satisfaction and improve department performance, Florida Hospital Memorial Medical Center focused on decreasing report turnaround time with a goal of two hours from completion of the examination by the technologist to a final signed report by the radiologist. Through the introduction of voice recognition software, not only were efficiencies gained, but there was a dramatic reduction in transcription costs--from $30,000 per month to less than $300. Turnaround times were ultimately reduced, thus improving performance and increasing satisfaction. This was made evident by the tracking over time of physician satisfaction scores and HCAHPS scores rating patient satisfaction.

Choosing an appropriate depression assessment tool for chinese older adults: a review of 11 instruments. The best tools take into account cultural differences.

The purpose of this article is to compare the advantages and limitations of developed depression assessment tools and provide recommendations for clinical staff to select an appropriate tool for use with Chinese older adults. A total of 7 Western tools translated into Chinese and 4 tools developed specifically for assessing Chinese older adults were found in 12 articles. Variability in instrument psychometric properties and cutoff scores is discussed. A reasonable strategy to efficiently assess depression in Chinese older adults is to first administer the Single Question or Geriatric Depression Scale-4 (GDS-4). If depression is likely, the Chinese GDS-15 could be used to increase the probability of identifying depression in Chinese older adults.

Growing old in St. Lucia: expectations and experiences in a Caribbean village.

In St. Lucia there are increased proportions of elders secondary to decreasing fertility and mortality rates and increasing life expectancy. The fact that people are living longer is a reflection of social success; however, increasing numbers of elders (often with chronic health problems) challenge family, social, health, political, and economic systems. Who will provide care and how this care will be provided are at the forefront of health and social service planning and debate. This paper describes the status of elders in St. Lucia. Expectations as well as current care experiences of elders and villagers are described.

Minor children and adult care exchanges with community-dwelling frail elders in a St. Lucian village.

OBJECTIVE: Research on care of community-dwelling frail elders typically includes formal health service providers and adult members of the informal care system. Involvement of children and adolescents with elder care is largely undocumented. The aim of this article is to describe children's involvement in elder care. These findings are part of an ethnographic community study that examined common Western assumptions about elder care in a St. Lucian village. METHODS: Data were obtained in a four-phase, 5-year, community-based ethnographic field study that included in-depth network analysis of elder households. RESULT: One hundred eighty-eight informal caregivers assisted 14 elder networks in obtaining the things they needed to live through provision of 355 care activities. Forty-five children (ages 3(1/2) to 16) provided 111 of 355 (31%) care activities. The frail elders gave adults and children community member caregivers 196 and 94 benefits, respectively. DISCUSSION: Minor children are integrally involved in reciprocal exchanges for elder care in this village. Although they do not provide all of the same care activities as adults, they clearly assist elders, especially with running errands. Elders emphasized different motivational mechanisms for involving minor children and adults in their care networks.

Gendered elder care exchanges in a Caribbean village.

Caregiver gender research often translates into caregiver accounts of the care they provide for an elder parent or spouse, limiting an understanding of other community members'involvement and the actual gendered elder care activities performed and caregiver benefits received. This article describes women's and men's actual involvement in elder care. These findings are part of a four-phase ethnographic community study that includes in-depth network analysis of elder households. One-hundred and forty-three informal adult caregivers assisted 15 elders in obtaining the things they needed to live, providing 244 care activities. One-hundred and three women provided 194 care activities, and 40 men performed 50 care activities. In exchange, the frail elders gave the women caregivers 132 benefits and the men 54 benefits. Women and men differed in the amount and type of care involvement, as well as their motivational mechanisms for involvement in elder care.

Outcomes of family involvement in care intervention for caregivers of individuals with dementia.

BACKGROUND: Despite the increasing number of individuals with dementia relocated from caregiving at home to a nursing home, there is only a small body of literature examining the influence of institutional family-oriented practices on family member perceptions of care and family-staff relationships. OBJECTIVE: The study tested the effects of the Family Involvement in Care partnership intervention on family members' perceptions of their caregiving role, relationships with staff, and satisfaction with the care of relatives with dementia residing in special care units as well as the effects on staff attitudes toward families and staff satisfaction with a caregiving role. METHODS: A quasi-experimental design with nonequivalent groups and repeated pretest and posttest measures was used to examine the effects of the Family Involvement in Care intervention. The study recruited 14 Midwestern nursing home special dementia care units, matched by aegis and staff turnover, and randomized from matched pairs to experimental and control conditions. The samples included 185 family members and 895 staff. The Family Involvement in Care intervention is a protocol for family and staff negotiation of a written partnership agreement. Family caregiver outcomes were measured using instruments pretested for reliability and validity. Data were analyzed using hierarchical linear modeling. RESULTS: With adjustment for multiple tests, statistically significant beneficial intervention effects were found in three areas of family caregiver outcomes (emotional reactions to the caregiving role, perceptions of relationships with staff, and perceptions of care for relatives) and in one of three areas of staff outcomes (staff perceptions of the family caregiving role). For family members, effects were found for the measures assessing loss, captivity, staff disregard, resident activities, and physical care. Some of the intervention effects for family members were found only for caregivers of the same generation as the resident. For staff, effects were found for measures of dominion, disruption by family, and irrelevance of family. CONCLUSIONS: The results of the study indicate that the Family Involvement in Care intervention improves the caregiving experience of family members in nursing homes as well as nursing home staff attitudes toward family members. The intervention did not influence the perceived conflict with staff on the part of family caregivers or the perception of a partnership with family caregivers on the part of staff.

Issues in conducting research in nursing homes.

Anticipation of increased numbers of older persons throughout the coming decades who will require care and assistance with chronic illnesses and functional deficits has correspondingly increased awareness of the need for nursing research to support best geriatric nursing practices. Although badly needed, research in nursing homes presents challenges. This article discusses issues and challenges of ethically acceptable and rigorous research in nursing homes that are related to the dependency and institutionalization of older persons and to setting, staff, and resident characteristics. Strategies for easing the challenges of nursing research in nursing homes are offered.

Cross-cultural health education: materials on the World Wide Web.

Language differences between health providers and consumers create a central barrier to the delivery of health education. This article presents the results of an analysis of more than 75 bi/multilingual health sites available on the Internet. The review criteria and a summary of the key features of the best sites are presented. Limitations common to most sites are identified. Recommendations and caveats in the use of bilingual health information sites are introduced.

A community-based free nursing clinic's approach to management of health problems for the uninsured: the hepatitis C example.

Poverty, as an outgrowth of lack of opportunity in employment, basic education, affordable housing, and racism, directly affects disparities in health status. Health care providers are challenged to identify and overcome systemic barriers to health services for the poorest patients. This article describes the population of patients and the model of care offered by the Wald Community Nursing Center, a free nurse-managed clinic in Baltimore, Maryland. Hepatitis C infection is used to illustrate the confounding factors of a costly, chronic health problem and the interventions that have been instituted to overcome them.