Actionable Information Research Articles

Delivering and Evaluating Climate Services: The North Central U.S. Climate and Drought Webinar Series

Abstract Evaluation of near-term (sub)seasonal climate services’ impact is challenging but necessary for ensuring that society’s needs for actionable information are met. We use a descriptive study of the monthly North Central U.S. Climate and Drought Webinar Series at two time points (2014 and 2021) to examine societal impacts on capacity-building, sensemaking, fact-establishing, communication, decision-making, and social–ecological systems. The North Central U.S. Climate and Drought Webinar Series arose following a 2011 climate disaster and established itself over the next 10 years as a monthly resource for climate and impact information translation and interaction. Survey respondents indicated early benefits related to understanding how to find and use climate information and improved conceptual understanding of climate issues and problems. Many used webinar information to compare with other sources of data or to incorporate into their own communications, uses which can increase overall societal trust in climate information over time. Attendees’ self-reported capacity for using climate information in decision-making and actual use of information in specific decisions or management contexts increased as the webinar series approached the 10-yr mark. Most participants did not note financial or other social–ecological outcomes of their use of the webinars. We conclude by recommending that climate services be evaluated over sufficiently long time periods to capture evolving impacts and that evaluations incorporate impact rubrics that measure subtle yet important societal capacities and decision-making processes related to climate risk management.

Probability ogives for trends in stock biomass and fishing mortality from landings time series

AbstractMost fisheries are conducted without any scientific knowledge about the size and productivity of the stocks that support them. This navigation in the dark in most fisheries is a major obstacle in making them sustainable sources of nutrition for people in general and income for fishers and other economic actors along supply chains. Fisheries that have not been assessed generally are data‐intermediate and data‐poor, the latter usually having annual time series of landings as the single piece of data available. A major effort in the last two decades has been directed toward developing ‘catch‐only’ stock assessment methods, although some of these methods have been tested and found deficient. Here we provide a novel approach to using annual landing time series as the single source of data to qualitatively judge the condition of un‐assessed stocks using frequentist cumulative probability ogives, both in terms of stock biomass and fishing mortality. A meta‐analysis of the FishSource database allowed us to infer statistical patterns from hundreds of assessed fisheries and thousands of annual landings, biomass, and fishing mortality observations. Four stock‐management types were considered separately in the analysis: short‐lived and others (mid‐ to long‐lived) stocks, controlled or not controlled by catch limits. Obtained cumulative probability ogives provide clear evaluations of stock biomass and fishing mortality trends in all four stock‐management types, leading to actionable information on probable current status and future trends. Using these probability ogives, we developed decision trees that lead to qualitative scores on the exploitation status of un‐assessed stocks.

Organizational Readiness for Change Depends on Facility Complexity When Developing a National Stewardship Intervention

Introduction: The organizational readiness for change assessment survey (ORCA) is a tool to assess a site’s readiness for implementation and identify barriers to change. As the “Kicking CAUTI” antibiotic stewardship intervention rolled out on a national scale, we administered ORCA surveys to participating sites to capture baseline actionable information about differences among sites, to inform implementation. Methods: ORCA surveys were distributed by email to prescribing providers, nurses, pharmacists, infection preventionists, and quality managers at 40 participating VA Hospitals. VA hospital sites who submitted three or more surveys and their complexity level (measured as Level 1 (highest)-3) were included in the analysis. The highest complexity level facilities are those with the largest patient volume/risk, teaching and research, along with the largest number of physician specialists and contain at least five ICUs. Mean Likert scores were calculated for each of the 7 ORCA subscales on a scale of 1-5 (5 highest), and the mean of the 7 subscales was the overall ORCA score for a site. Non-parametric testing was performed comparing overall ORCA and each subscale based on complexity. Results: Among the participating sites, 30/40 (75%) completed at least three surveys, with a total of 202 surveys included for analysis, with 82% of surveys coming from higher complexity centers (Level 1). The highest ranked ORCA domain was the evidence subscale (measures perceived strength of evidence), mean 4.2, (SD 0.7). The lowest ranked ORCA domain across sites was resources (available to facilitate implementation), mean 3.3 (SD 0.9). Higher complexity centers had a significantly higher overall ORCA score than lower complexity centers (Level 1 or 2 vs. Level 3, p= 0.02). This difference was driven by the subscales evidence (p < 0 .01), leadership (p =0.05), measurement (p= 0.06), and resources (p=0.07) all being higher in the higher complexity facilities (Figure 1). Two of the categories (leadership and measurement) pertain to an organization’s leaders ability to create an environment for change to occur as well as promoting team building. Conclusions: The lowest scoring ORCA domain across all sites was the respondents’ perception of resources (staff, training) available for achieving change. Perceived resources were also lower in lower complexity sites, implying that medical centers of lower complexity may have higher barriers when implementing an antimicrobial stewardship intervention. This finding highlights the benefit of a national stewardship campaign that provides support to lower complexity medical centers that may not otherwise receive targeted training and support for their efforts.Disclosure: Barbara Trautner: Stock: Abbvie--sold in December 2023; Abbott Laboratories--sold in December 2023; -Bristol Myers Squibb--sold in December 2023; Pfizer--sold in December 2023; Consultant--Phiogen--consultant. Contracted research through NIAID for STRIVE trial, currently testing Shionogi product; Contracted research--Peptilogics; Contracted research—Genentech

Public Information Is an Incentive for Politicians: Experimental Evidence from Delhi Elections

Two years prior to elections, two-thirds of Delhi municipal councillors learned they had been randomly chosen for a preelection newspaper report card. Treated councillors in high-slum areas increased pro-poor spending, relative both to control counterparts and treated counterparts from low-slum areas. Treated incumbents ineligible to rerun in home wards because of randomly assigned gender quotas were substantially likelier to run elsewhere only if their report card showed a strong pro-poor spending record. Parties also benefited electorally from councillors’ high pro-poor spending. In contrast, in a cross-cut experiment, councillors did not react to actionable information that was not publicly disclosed. (JEL D72, D83, H75, J16, O15, O17, O18)

Qualifying uncertainty of precipitation projections over China: mitigating uncertainty with emergent constraints

Predicting future mean precipitation poses significant challenges due to uncertainties among climate models, complicating water resource management. In this study, we introduce a novel methodology to mitigate uncertainty in future mean precipitation projections over China on a grid-by-grid basis. By constraining precipitation parameters of the Gamma distribution, we establish emergent constraints on parameters, revealing significant correlations between historical and future simulations. Our analysis spans the periods 2040–2069 and 2070–2099 under low-to-moderate and high emission scenarios. We observe reductions in uncertainty across most regions of China, with constrained mean precipitation indicating increases in monsoon regions and decreases in non-monsoon zones relative to raw projections. Notably, the observed 30%–40% increase in mean precipitation for the whole of China underscores the efficacy of our methodology. These observationally constrained results provide valuable insights into current precipitation projections, offering actionable information for water resource planning and climate adaptation strategies amidst future uncertainties.

Pengembangan Sistem Pelayanan Klinik Budhi Pratama Gedong Berbasis Web dengan Metode Rapid Application Development (RAD)

Budhi Pratama Gedong Clinic faces significant challenges in the manual handling of patient data and report recording, leading to inefficiencies and slow operational processes. To address these issues, the development of a computerized system is essential for collecting, storing, and processing data to generate actionable information that can enhance healthcare services. This computerized system is also expected to reduce operational costs by minimizing the reliance on paper-based records. Located at Jalan Raya Tengah No. 26 RT 6/RW 1 Gedong Pasar Rebo, East Jakarta, the clinic provides various health services, including medication procurement, which currently relies on manual processes. The implementation of a web-based service system using the Rapid Application Development (RAD) methodology with XAMPP is projected to streamline operational processes and improve data reporting. The objectives of this study include facilitating easier patient registration, expediting medical record retrieval, simplifying medication management, and increasing the accuracy of patient payment processing. Furthermore, the developed system aims to integrate a comprehensive database to efficiently document and manage data on patients, doctors, clinic staff, and medications, thereby providing a user-friendly platform for healthcare providers and enhancing overall patient care

Knowledge-injected prompt learning for actionable information extraction from crisis-related tweets

In crisis situations, emergency response organizations can derive significant benefits from actionable information available on social media. Such information provides effective guidance and support for rescue operations. Unlike traditional sources of information, social media reflects the latest developments during a crisis, as well as actionable suggestions and the needs of affected individuals. However, existing methods that leverage pre-trained language models for this task require a large amount of annotated data for fine-tuning. This data acquisition process is costly and impractical in some data-scarce scenarios. To address this challenge, we propose a Knowledge-injected Actionable Information Extraction Model (KAIEM) that can extract actionable information from crisis-related tweets in few-shot and zero-shot settings. Based on prompt learning, KAIEM automatically constructs the label word space of verbalizers using word embeddings, eliminating the need for manual design or external knowledge bases. This mechanism enables our model to make accurate predictions without relying on labeled data for fine-tuning. Additionally, KAIEM employs knowledge probing to inject conceptual knowledge into prompt templates, thereby enhancing the semantics of crisis-related tweets. We conducted a series of experiments on a real-world crisis-related dataset. The experimental results demonstrate the effectiveness of KAIEM in few-shot and zero-shot scenarios.

Water quality dynamics and underlying controls in the Halton Region, Ontario.

We assessed the hydrochemistry of 15 watersheds in the Halton Region, southern Ontario, in high resolution (n > 500 samples across n > 40 streams) to characterize water quality dynamics and governing controls on major and trace element concentrations in this rapidly urbanizing region. In 2022, major water quality parameters were generally in line with historic monitoring data yet significantly different across catchments, e.g., in specific conductance, turbidity, phosphate and chloride, and trace element concentrations. Distinct hydrochemical signatures were observed between urban and rural creeks, with urban stream sections and sites near the river mouths close to Lake Ontario having consistently higher chloride (up to 700mg/L) and occasional enrichment in nutrients levels (up to 8 and 20mg/L phosphate and nitrate, respectively). Particularly upper reaches exhibited hydrochemical signatures that were reflective of the catchment surface lithologies, for instance through higher dissolved Ca to Mg ratios. Unlike for chloride and phosphate, provincial water quality guidelines for trace elements and heavy metals were seldom surpassed (on < 10 occasions for copper, zinc, cadmium, and uranium). Concentrations of other trace elements (e.g., platinum group elements or rare earth elements) were expectedly low (< 0.3µg/L) but showed spatiotemporal concentration patterns and concentration-discharge dynamics different from those of the major water quality parameters. Our results help improve the understanding of surface water conditions within Halton's regional Natural Heritage Systems and demonstrate how enhanced environmental monitoring can deliver actionable information for watershed decision-making.

The Uptake of Partner Participation in Sequential Preconception Carrier Screening

Introduction: Carrier screening that is performed in the preconception period allows for couples at risk for having children affected with certain single gene (Mendelian) conditions to be identified. This is the most optimal timeframe to perform such screening. Most obstetric providers utilize a sequential process in which the patient first undergoes screening and their partner is only offered testing if the initial results reveal that the first is a carrier for one or more autosomal recessive (AR) deleterious variants. If the partner fails to undergo screening, the couple cannot obtain meaningful and actionable risk information for future or current pregnancies. In this study, we sought to assess the frequency of completed carrier screening risk assessment among individuals and couples who were undergoing preconception screening at two prenatal screening programs staffed by genetic counselors and geneticists. Materials and Methods: We reviewed the screening outcomes for individuals and couples who presented for preconception carrier screening from January 1, 2020 through December 30, 2021 at Insight Medical Genetics and the clinical genetics program at Northwestern Medicine. All individuals received pretest genetic counseling prior to screening and posttest counseling after results were available. We evaluated individuals who were found to be a carrier of at least one deleterious variant and whether the partner of that person underwent carrier screening, and, if so, which type of screening. Results: 548 patients who identified as women underwent preconception carrier screening during the study period, along with 3 men presenting for initial screening. These screens consisted of a panel containing primarily autosomal recessive conditions with a few X-linked conditions. 247 individuals (45.1%) were positive for at least one pathogenic variant; of these, 244 (98.8%) were variants in genes associated with autosomal recessive conditions. A total of 219 partners (88.7%) underwent carrier screening, including the 3 female partners of the men who initiated carrier screening. Of note, 4 of the patients who underwent carrier screening reported not having a partner at the time of screening; accordingly, the partners who underwent screening represent 89.8% of individuals eligible for partner screening following an initial positive result. Of the 219 partners who underwent carrier screening, 201 (91.8%) chose a carrier screening panel of 150+ conditions, while 18 chose a more limited panel that included the gene(s) of relevance based on their partner’s results, with or without additional genes relevant to their learned/self-identified ethnicity or race. Conclusions: Approximately 10% of couples presenting for preconception genetic counseling and carrier screening found to be at potential risk for a child with an autosomal recessive condition did not obtain the requisite information to fully assess their risk of having an affected child. It is possible that the frequency of couples who do not obtain complete and actionable screening information is even higher when carrier screening is provided without the assistance of certified genetic counselors or geneticists. Recently, cell free DNA-based maternal screening has been introduced that assesses the risk for a limited number of genetic conditions in the fetus that may not require assessment of the partner. Nonetheless, providers must communicate to their patients that meaningful risk information can only be obtained when the partner undergoes screening in cases where the initial member of the couple is found to be a carrier of at least one autosomal recessive condition. Laboratories and professional societies need to develop effective educational outreach to patients and providers alike to improve the screening process for couples who want to determine if they are at risk to have a child with an inherited condition.

Impact of Prehospital Ultrasound Training on Simulated Paramedic Clinical Decision-Making.

When used appropriately, focused limited-scope ultrasound exams could potentially provide paramedics with accurate and actionable diagnostic information to guide prehospital decision-making. In this study we aimed to investigate the impact of a 13-hour prehospital ultrasound training course on the simulated clinical decision-making of paramedics as well as their ultrasound skills, knowledge, and self-confidence. We evaluated the ultrasound competence of 31 participants using post-course written and practical assessments. Written clinical decision scenarios were administered pre- and post-training. Post-training scenarios included an uninterpreted ultrasound clip to aid decision-making. Scenarios included extended focused assessment with sonography in trauma, pulmonary exam, and focused echocardiography combined with carotid pulse check exams. Correct answers to scenarios were defined as those selected by a veteran emergency physician. Participants also indicated their confidence in each of their decisions using a Likert scale. Training yielded a statistically significant increase in both mean scenario score (35.5% absolute increase) and mean participant self-confidence (15.8% relative increase), across all exam/decision types assessed (P ≤ 0.001). The focused pulmonary exam yielded the largest increase in both mean score improvement (59.7% absolute increase) and paramedic confidence in their decisions (28.6% increase). Trained paramedics can perform focused ultrasound exams and accurately interpret and apply actionable exam findings in the context of written scenarios. Analysis through our model characterized the theoretical clinical yield of each prehospital ultrasound exam and demonstrated how each exam may provide improved decision accuracy in several specific simulated clinical contexts. These results provide support for growing evidence that focused limited-scope ultrasound may be an effective prehospital diagnostic tool in the hands of trained paramedics.

Editorial: Generating actionable climate information in support of climate adaptation and mitigation

Editorial: Generating actionable climate information in support of climate adaptation and mitigation

Increasing Provider Utilization of a Seizure Action Plan in the Outpatient Setting.

A seizure action plan (SAP) is a powerful tool that provides actionable information for caregivers during seizures. Guidelines have expressed the need for individualized SAPs. Our quality improvement team aimed to increase implementation of an SAP within a pediatric tertiary center, initially among epilepsy providers and expanded to all neurology providers. Process changes were implemented using Plan-Do-Study-Act cycles and data were evaluated monthly using control charts. The team focused on tracking patients who received SAPs and identified opportunities for improvement, including reminders within the electronic medical record, and standardizing clinic processes. A secondary analysis was performed to trend emergency department (ED) use among our patient population. The SAP utilization rate among epilepsy providers increased from a baseline of 39% to 78% by December 2019 and reached the goal of 85% by June 2020, with a further increase to 92% by February 2022 and maintained. The SAP utilization rate among general neurology providers increased from 43% in 2018 to 85% by July 2020, and further increased to 93% by February 2022 and maintained. ED visits of established patients with epilepsy decreased from a baseline of 10.2 per 1000 to 7.5 per 1000. Quality improvement methodologies increased the utilization of a standardized SAP within neurology outpatient care centers. The SAP is a simplified tool that allows patients and providers to navigate a complex health care system. The utility of an SAP may potentially extend to minimizing unnecessary ED visits.

Foresight of the development of rural tourism in Ukraine in the post-war period

Purpose. The purpose of this study is to develop alternative scenarios for the development of rural tourism through the foresight methodology. Methodology / approach. Theoretical interpretations were formed by general scientific methods and approaches. To assess the prospects for the development of revitalisation of rural tourism, the method of scanning the horizon was used, which demonstrated the main tendencies and trends of the market and consumer tourism needs. Empirical methods made it possible to work out the stressors of systemic national crises, the global COVID pandemic, a full-scale war, which threaten the subjects of rural tourism with extraordinary losses and critical destruction of the material and technical base, losses of tourist interest – that is, questioning the existence of business as a whole. Therefore, an important task today is to draw up foresight scenarios and tactics that will create modules of investment attractiveness and mechanisms for the rapid accumulation of financial, architectural and construction, infrastructural and social potentials for the recovery of the economy of territorial units and the country as a whole. Results. Since forecasting is based on three “whales” (actual state, business experience and prospects), the foresight methodology is represented by tools with appropriate characteristics and management competencies. Therefore, in order to avoid complications and contradictions in the foresight of rural tourism, it is suggested to think over and install profiles of investment proposals, foresight scenarios for realising the possibilities of its restoration. Reasoned positions reflect the relevance of foresight research for assessing future prospects and opportunities for the restoration of rural tourism in Ukraine. The results of the study shed light on opportunities for rural development and suggest interventions to create a fully sustainable ecosystem. The study provides actionable information for rural tourism actors, stakeholders and potential investors who can benefit from forecasting the prospects and expectations emerging in rural tourism in the post-war period. Originality / scientific novelty. The scientific value of the research lies in the evaluation of the prospects for the development of rural tourism as a direction of diversification of the agricultural economy of Ukraine in 2019–2023 and the post-war period. A model for forming the investment profile of a rural tourism subject is proposed for implementation. Practical value / implications. The practical value of the research lies in the fact that it can be used as a tool for building effective cooperation in the development of plans and programs aimed at partnership relations with rural communities of Ukraine, tourism subjects, estate owners, etc. The value of this study lies in the foresight of rural tourism development prospects, which determine the competitive advantage of rural areas, with an emphasis on a relatively new and controversial topic after the war in Ukraine, namely its positioning in the structure of the restorative mechanism of regional development and tourism.

Persons with cognitive impairment and care partner motivations and experiences of undergoing an amyloid scan: a systematic review of qualitative studies.

Amyloid positron emission tomography (PET) scans can enhance the accuracy of dementia diagnoses. However, the perspectives and experiences of people with cognitive impairment and their care partners undergoing an amyloid scan are less well understood. Therefore, this review aimed to identify and summarize qualitative studies exploring patient and care partner experiences of undergoing an amyloid scan. We searched Embase, MEDLINE, and PsychInfo in March 2024. Articles were screened for inclusion by two reviewers and critically appraised using the Joanna Briggs Institute Critical Appraisal Tool for Qualitative Studies. Data from the included studies were synthesized using thematic synthesis. We identified ten papers from six studies. We identified four themes: 1) motivations for undergoing an amyloid scan, 2) experiences of receiving the result, 3) emotional responses to the result, and 4) actions in light of the scan result. Participants reported undergoing the scan to determine the cause of cognitive impairment. They described the information gained from the scan as helpful but struggled to recall the correct terminology or implications of the scan. Emotional responses to the scan varied depending on the scan result. In light of the scan result, the most common action was making advanced plans; however; this was mainly discussed among participants with elevated amyloid. Amyloid scans can provide useful and actionable information. However, learning the scan result could be distressing. Future research is needed to balance the potential benefits and harms of amyloid scans.

A Decision Support System is Developed to Determine the Optimal Criteria for Selecting Exceptional Lecturers Based on Their Lecturer Performance Index

Decision Support Systems (DSS) are computer systems that analyze data and convert it into actionable information for decision-making. The prior application mainly emphasized design analysis in web development, neglecting the use of decision-making knowledge as a responsibility within the Tri Dharma of Higher Education. Analyzing data to transform it into information is a complex task involving decision-making. The process of decision-making has a significant impact on the information generated for recommendation purposes. Suggestions in a decision-making process only sometimes serve as a standard for leaders to implement immediately. However, it is essential to acknowledge that multiple suggestions are required to make a final decision since they provide a basis for comparison with earlier recommendations. The Decision Support System (DSS) utilized in this research focuses on selecting the optimal criteria from several criteria. The research employed the Analytical Hierarchy Process (AHP) technique, which consists of six stages : Criteria Alternative Determination, Pairwise Matrix Comparison, Criteria And Making Matrix, Square of Pairwise Matrix, Normalisation, and Alternative Ranking. All six steps must be sequentially executed without skipping any stage, ensuring each stage complements the others and generates accountable information. The research concludes by proposing a Decision Support System for Determining the Best Criteria for Lecturer Selection. This system utilizes the Lecturer Performance Index to provide recommendations to parties seeking information on selecting criteria for assessing lecturer performance. The system aims to enhance accountability in the performance of the Tri Dharma of Higher Education.

Perceived Information in Organizations by the Employees is Fruitful or not? A Theoretical Context

The phrase perceived information refers feeling or self-assessments of knowing related information. Perceived information’s level affects the intellectual capacity and makes use of interrelationships amid new portions of information in subjects like choice decision tasks. It also influences themes’ assessments of the significance of latest and old information. This research effort is necessary for elaborating the value of perceived information by the employees for their job satisfaction. As the phrase, perceived information needs to be discussed because there is not much literature on it. It is a context base analysis from existing literature; where information sharing is considered as independent, whereas job satisfaction is dependent variable. Perceived information along with its dimensions is use as mediation that the workforce is perceiving the information from the environment through information sharing’s as well as it has impacts on job satisfaction. Investigation on available literature is exploring that perceived basic (initial, necessary), appropriate (specific) and actionable information by the workforce have both positive and negative impacts. However, it depends upon the nature of workforce especially their levels to understand and handle the things. This study is highlighting both bright and dark sides of information. When information has higher level of perceived intrinsic information quality, but lacks contextual weight or realistic applications, it might not facilitate job satisfaction. Some theoretical links has been elaborated in this study i.e., functions of basic, appropriate and actionable information.

Time-in-Range With Insulin Versus Metformin in Gestational Diabetes Mellitus Using Continuous Glucose Monitoring: A Randomized Control Study at a Tertiary Care Centre in South India.

Background The prevalence of gestational diabetes mellitus (GDM) is increasing globally. When diet and lifestyle modifications are inadequate for control, managing GDM often involves insulin or metformin. Metformin's oral administration option improves patient compliance and acceptance, but concerns about its use persist, necessitating careful evaluation. Comparative studies between insulin and metformin in GDM are scarce. In pregnancies complicated by diabetes, precise glucose control is crucial for maternal-fetal well-being, and continuous glucose monitoring (CGM) plays a valuable role in achieving recommended targets. CGM provides comprehensive glucose profiles, including postprandial glucose excursions and details about time spent in hypoglycemia, euglycemia, and hyperglycemia. The time-in-range (TIR) metric, when used alongside A1C, offers more actionable information than A1C alone. To the best of our knowledge, no published trials compare TIR in GDM with metformin or insulin aspart/detemir, specifically focusing on CGM metrics. This randomized controlled trial (RCT) aims to assess TIR in women with GDM treated with either metformin or insulin. Materials and methods This study was a non-inferiority randomized control trial evaluating TIR in GDM using continuous glucose monitoring with metformin or insulin. Forty-four women with GDM were enrolled. The diagnosis of GDM was based on the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. CGM readings were collected for 14 days after sensor activation. Results In our study, 44 women with GDM completed the protocol, with 22 in the Metformin group and 22 in the Insulin group. Baseline characteristics did not differ between the groups. Age, BMI pre-gravid, BMI at 28 weeks, parity, family history of diabetes mellitus, previous history of GDM, glycated hemoglobin (HbA1c), oral glucose tolerance tests (OGTT) at zero hours, one hour, and two hours, as well as gestational weeks, did not significantly differ between the two groups. The metformin and insulin groups did not differ significantly in CGM metrics, including TIR, time above range, time below range, mean glucose, and glucose management indicator. Conclusion Based on our findings, the metformin and insulin groups did not differ in CGM metrics, including TIR, time above range, time below range, mean glucose, and glucose management indicator. In clinical practice, CGM metrics complement fasting blood glucose, postprandial glucose, and HbA1c as appropriate and useful clinical targets and outcome measurements. Metformin's oral administration option offers advantages such as improved patient compliance and acceptance in women with GDM.

Envisioning U.S. Climate Predictions and Projections to Meet New Challenges

AbstractIn the face of a changing climate, the understanding, predictions, and projections of natural and human systems are increasingly crucial to prepare and cope with extremes and cascading hazards, determine unexpected feedbacks and potential tipping points, inform long‐term adaptation strategies, and guide mitigation approaches. Increasingly complex socio‐economic systems require enhanced predictive information to support advanced practices. Such new predictive challenges drive the need to fully capitalize on ambitious scientific and technological opportunities. These include the unrealized potential for very high‐resolution modeling of global‐to‐local Earth system processes across timescales, reduction of model biases, enhanced integration of human systems and the Earth Systems, better quantification of predictability and uncertainties; expedited science‐to‐service pathways, and co‐production of actionable information with stakeholders. Enabling technological opportunities include exascale computing, advanced data storage, novel observations and powerful data analytics, including artificial intelligence and machine learning. Looking to generate community discussions on how to accelerate progress on U.S. climate predictions and projections, representatives of Federally‐funded U.S. modeling groups outline here perspectives on a six‐pillar national approach grounded in climate science that builds on the strengths of the U.S. modeling community and agency goals. This calls for an unprecedented level of coordination to capitalize on transformative opportunities, augmenting and complementing current modeling center capabilities and plans to support agency missions. Tangible outcomes include projections with horizontal spatial resolutions finer than 10 km, representing extremes and associated risks in greater detail, reduced model errors, better predictability estimates, and more customized projections to support next generation climate services.

Preoperative Rank of Expectations for Shoulder Surgery (PRESS): a novel survey

Patient expectations for orthopedic surgeries, and elective shoulder surgery in particular, have been shown to be important for patient outcomes and satisfaction. Current surveys assessing patient expectations lack clinical applicability and allow patients to list multiple expectations at the highest level of importance. The purpose of this study was to develop and evaluate the use of a novel, rank-based survey assessing the relative importance of patient expectations for shoulder surgery. The Preoperative Rank of Expectations for Shoulder Surgery (PRESS) survey was developed by polling 100 patients regarding their expectations for surgery. The PRESS survey consisted of 8 common expectations for elective shoulder surgery by importance and a 0%-100% scale of expected pain relief and range of motion improvement. After initial development of the PRESS survey, it was administered preoperatively to 316 patients undergoing surgery for shoulder arthritis, rotator cuff tear, subacromial pain syndrome, or glenohumeral instability between August 2020 and April 2021. Patients also completed preoperative outcome measures such as the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Physical Function 7a version 1.0 (PROMIS PF), and PROMIS Pain Interference short form 8a version 2.0 (PROMIS PI) surveys. Patient-reported outcome measure (PROM) surveys were administered 6 months postoperatively. Improvement in range of motion was the expectation most often ranked first for the entire study group (18%), arthritis subgroup (23%), and rotator cuff tear subgroup (19%). Subacromial pain syndrome patients most often ranked improving ability to complete activities of daily living and relieving daytime pain first (19%). Shoulder instability patients most often ranked improving ability to participate in sports first (31%). Patients who ranked improving range of motion or sports highly had better PROMs. Those who ranked relieving pain highly had worse PROMs. Patients with high (>90%) expectations of pain relief had better PROMIS PI scores. Patients with high pain relief expectations in the arthritis and subacromial pain syndrome groups had better PROMs, whereas patients with instability were less satisfied. The novel PRESS survey assesses patient expectations for shoulder surgery in a new, more clinically applicable rank-based format. The responses provided by patients provide actionable information to clinicians and are related to postoperative outcomes. Therefore, the PRESS survey represents a useful tool for guiding discussions between patients and surgeons, as well as aiding in overall patient-centered clinical decision making.

Pediatric Tuberculosis: A Review of Evidence-Based Best Practices for Clinicians and Health Care Providers.

Advances in pediatric TB care are promising, the result of decades of advocacy, operational and clinical trials research, and political will by national and local TB programs in high-burden countries. However, implementation challenges remain in linking policy to practice and scaling up innovations for prevention, diagnosis, and treatment of TB in children, especially in resource-limited settings. There is both need and opportunity to strengthen clinician confidence in making a TB diagnosis and managing the various manifestations of TB in children, which can facilitate the translation of evidence to action and expand access to new tools and strategies to address TB in this population. This review aims to summarize existing guidance and best practices for clinicians and health care providers in low-resource, TB-endemic settings and identify resources with more detailed and actionable information for decision-making along the clinical cascade to prevent, find, and cure TB in children.