Balancing climate resilience and adaptation for Caribbean Small Island Developing States (SIDS): Building institutional capacity.

Although the Caribbean's Small Island Developing States (SIDS) minimally contribute to global greenhouse gas emissions, they face disproportionate climate risks and are particularly susceptible to systemic economic threats posed by climate change and subsequent increases in climate variability. Historically, strategic programs and investments have sought to develop more robust and adaptive engineered systems to absorb climate threats. However, such initiatives are limited and under-resourced in the SIDS' context. This article reviews existing climate strategies in the Caribbean and then critically examines current gaps and barriers relating to climate impact knowledge, needs, and implementation. This examination can assist Caribbean SIDS leadership to identify opportunities to transition from a vulnerability-reducing mindset to one of resilience and transformative adaptation to improve long-term economic outlooks, social welfare, and environmental stewardship despite recurring and escalating climate risks. Integr Environ Assess Manag 2023;00:1-19. © 2023 SETAC.

The worsening divergence of biotechnology: the importance of risk culture.

In the last 20 years, the field of biotechnology has made significant progress and attracted substantial investments, leading to different paths of technological modernization among nations. As a result, there is now an international divide in the commercial and intellectual capabilities of biotechnology, and the implications of this divergence are not well understood. This raises important questions about why global actors are motivated to participate in biotechnology modernization, the challenges they face in achieving their goals, and the possible future direction of global biotechnology development. Using the framework of prospect theory, this paper explores the role of risk culture as a fundamental factor contributing to this divergence. It aims to assess the risks and benefits associated with the early adoption of biotechnology and the regulatory frameworks that shape the development and acceptance of biotechnological innovations. By doing so, it provides valuable insights into the future of biotechnology development and its potential impact on the global landscape.

"Modest doubt is called the beacon of the wise"-Incorporating uncertainty in risk analysis from Shakespeare to today.

"Modest doubt is call'd the beacon of the wise."-William Shakespeare, Troilus and Cressida. Although the character Hector warns his fellow Trojans with this line not to engage in war against the Greeks, Shakespeare's works are replete with characters who do not incorporate modest doubt, or any consideration of uncertainty, in their risk decisions. Perhaps Shakespeare was simply a keen observer of human nature. Although risk science has developed tremendously over the last five decades (and scientific inquiry over five centuries), the human mind still frequently defaults to conviction about certain beliefs, absent sufficient scientific evidence-which has effects not just on individual lives, but on policy decisions that affect many. This perspective provides background on the Shakespearean quote in its literary and historical context. Then, as this quote is the theme of the 2023 Society for Risk Analysis Annual Meeting, we describe how "modest doubt"-incorporating the notion of uncertainty into risk analysis for individual and policy decisions-is still the "beacon of the wise" today.

Defining and analyzing health system resilience in rural jurisdictions.

Rural areas face well known and distinctive health care challenges that can limit their resilience in the face of health emergencies such as the COVID-19 pandemic. These include problems of sparsity and consequent limited health care provisioning; poverty, inequalities, and distinctive economic structures that limit access to health care; and underlying population health risks and inequalities that can increase vulnerability. Nonetheless, not all rural areas face the same problems, and non-rural areas can have challenges. To be useful in influencing policy, a tool to identify more and less resilient areas is necessary. This Commentary reviews key forms of risk and constructs a county-level index of resilience for the United States which helps to identify countries with limited resilience. Further, it argues that health care resilience should be conceptualized in terms of broader regions than counties since health care facilities' referral regions are larger than individual counties; resilience needs to be understood at that level. The index, read at the level of counties and referral regions, can contribute to identification of immediate problems as well as targets for longer term investment and policy response.

Relationship among state reopening policies, health outcomes and economic recovery through first wave of the COVID-19 pandemic in the U.S.

State governments in the U.S. have been facing difficult decisions involving tradeoffs between economic and health-related outcomes during the COVID-19 pandemic. Despite evidence of the effectiveness of government-mandated restrictions mitigating the spread of contagion, these orders are stigmatized due to undesirable economic consequences. This tradeoff resulted in state governments employing mandates at widely different ways. We compare the different policies states implemented during periods of restriction ("lockdown") and reopening with indicators of COVID-19 spread and consumer card spending at each state during the first "wave" of the pandemic in the U.S. between March and August 2020. We find that while some states enacted reopening decisions when the incidence rate of COVID-19 was minimal or sustained in its relative decline, other states relaxed socioeconomic restrictions near their highest incidence and prevalence rates experienced so far. Nevertheless, all states experienced similar trends in consumer card spending recovery, which was strongly correlated with reopening policies following the lockdowns and relatively independent from COVID-19 incidence rates at the time. Our findings suggest that consumer card spending patterns can be attributed to government mandates rather than COVID-19 incidence in the states. We estimate the recovery in states that reopened in late April was more than the recovery in states that did not reopen in the same period- 15% for consumer card spending and 18% for spending by high income households. This result highlights the important role of state policies in minimizing health impacts while promoting economic recovery and helps planning effective interventions in subsequent waves and immunization efforts.

A systems approach for resources management during the COVID-19 pandemic: Multi-agency perspectives from New England.

The emergence of COVID-19 in the United States has overwhelmed local hospitals, produced shortages in critical protective supplies for medical staff, and created backlogs in burials and cremations. Because systemic disruptions occur most acutely at a local scale, facilitating resource coordination across a broad region can assist local responses to COVID-19 surges. This article describes a structured systems approach for coordinating COVID-19 resource distribution across the six New England states of the United States. The framework combines modeling tools to anticipate resource shortages in medical supplies, personnel needs, and fatality management for individual states. The approach allows decision makers to understand the magnitude of local outbreaks and equitably allocate resources within a region based on the present and future needs. This model contributed to determining material distribution in New England as the 2020 COVID-19 surges unfolded in the spring and fall seasons. Using a systems analysis, the model demonstrates the translation of anticipated COVID-19 cases into resource demands to enable regional coordination of scarce resources.

Can Comorbidity Data Explain Cross-State and Cross-National Difference in COVID-19 Death Rates?

Many efforts to predict the impact of COVID-19 on hospitalization, intensive care unit (ICU) utilization, and mortality rely on age and comorbidities. These predictions are foundational to learning, policymaking, and planning for the pandemic, and therefore understanding the relationship between age, comorbidities, and health outcomes is critical to assessing and managing public health risks. From a US government database of 1.4 million patient records collected in May 2020, we extracted the relationships between age and number of comorbidities at the individual level to predict the likelihood of hospitalization, admission to intensive care, and death. We then applied the relationships to each US state and a selection of different countries in order to see whether they predicted observed outcome rates. We found that age and comorbidity data within these geographical regions do not explain much of the international or within-country variation in hospitalization, ICU admission, or death. Identifying alternative explanations for the limited predictive power of comorbidities and age at the population level should be considered for future research.

The challenges of data usage for the United States' COVID-19 response.

During the coronavirus pandemic, policy makers need to interpret available public health data to make decisions affecting public health. However, the United States' coronavirus response faced data gaps, inadequate and inconsistent definitions of data across different governmental jurisdictions, ambiguous timing in reporting, problems in accessing data, and changing interpretations from scientific institutions. These present numerous problems for the decision makers relying on this information. This paper documents some of the data pitfalls in coronavirus public health data reporting, as identified by the authors in the course of supporting data management for New England's coronavirus response. We provide recommendations for individuals to collect data more effectively during emergency situations such as a COVID-19 surge, as well as recommendations for institutions to provide more meaningful data for various users to access. Through this, we hope to motivate action to avoid data pitfalls during public health responses in the future.

The Need to Reconcile Concepts that Characterize Systems Facing Threats.

Desirable system performance in the face of threats has been characterized by various management concepts. Through semistructured interviews with editors of journals in the fields of emergency response and systems management, a literature review, and professional judgment, we identified nine related and often interchangeably used system performance concepts: adaptability, agility, reliability, resilience, resistance, robustness, safety, security, and sustainability. A better understanding of these concepts will allow system planners to pursue management strategies best suited to their unique system dynamics and specific objectives of good performance. We analyze expert responses and review the linguistic definitions and mathematical framing of these concepts to understand their applications. We find a lack of consensus on their usage between interview subjects, but by using the mathematical framing to enrich the linguistic definitions, we formulate comparative visualizations and propose distinct definitions for the nine concepts. We present a conceptual framing to relate the concepts for management purposes.

Building biosecurity for synthetic biology.

The fast-paced field of synthetic biology is fundamentally changing the global biosecurity framework. Current biosecurity regulations and strategies are based on previous governance paradigms for pathogen-oriented security, recombinant DNA research, and broader concerns related to genetically modified organisms (GMOs). Many scholarly discussions and biosecurity practitioners are therefore concerned that synthetic biology outpaces established biosafety and biosecurity measures to prevent deliberate and malicious or inadvertent and accidental misuse of synthetic biology's processes or products. This commentary proposes three strategies to improve biosecurity: Security must be treated as an investment in the future applicability of the technology; social scientists and policy makers should be engaged early in technology development and forecasting; and coordination among global stakeholders is necessary to ensure acceptable levels of risk.

An Analytical Perspective on Pandemic Recovery.

After implementing restrictions to curb the spread of coronavirus, governments in the United States and around the world are trying to identify the path to social and economic recovery. The White House and the Centers for Disease Control and Prevention have published guidelines to assist US states, counties, and territories in planning these efforts. As the impact of the coronavirus pandemic has not been uniform, these central guidelines need to be translated into practice in ways that recognize variation among jurisdictions. We present a core methodology to assist governments in this task, presenting a case for appropriate actions at each stage of recovery based on scientific data and analysis. Specifically, 3 types of data are needed: data on the spread of disease should be analyzed alongside data on the overall health of the population and data on infrastructure-for example, the capacity of health systems. Local circumstances will produce different needs and present different setbacks, and governments may need to reinstate as well as relax restrictions. Transparent, defensible analysis can assist in making these decisions and communicating them to the public. In the absence of a widely administered vaccine, analysis remains one of our most important tools in addressing the coronavirus pandemic.

Co-evolution of physical and social sciences in synthetic biology.

Emerging technologies research often covers various perspectives in disciplines and research areas ranging from hard sciences, engineering, policymaking, and sociology. However, the interrelationship between these different disciplinary domains, particularly the physical and social sciences, often occurs many years after a technology has matured and moved towards commercialization. Synthetic biology may serve an exception to this idea, where, since 2000, the physical and the social sciences communities have increasingly framed their research in response to various perspectives in biological engineering, risk assessment needs, governance challenges, and the social implications that the technology may incur. This paper reviews a broad collection of synthetic biology literature from 2000-2016, and demonstrates how the co-development of physical and social science communities has grown throughout synthetic biology's earliest stages of development. Further, this paper indicates that future co-development of synthetic biology scholarship will assist with significant challenges of the technology's risk assessment, governance, and public engagement needs, where an interdisciplinary approach is necessary to foster sustainable, risk-informed, and societally beneficial technological advances moving forward.