Health Crisis Research Articles

Reducing Commercial Tobacco Sales to Youth On and Around California Tribal Reservations with a Reward and Reminder Retail Intervention.

High prevalence of commercial tobacco product (CTP) use among American Indian and Alaska Native (AI/AN) youth is a public health crisis. A multi-level Tribal-community-based participatory research project under Tribal public health authority implemented a retailer-focused intervention to reduce AI/AN youth CTP use. We sought resolutions in support of a retailer-focused CTP intervention from Tribal Nations organized by a tribally-directed research program. We identified tobacco retail outlets operating on and within 5 miles of 9 Tribal reservations, and CTP products sold at these outlets. We conducted a four-wave Reward and Reminder intervention with apparent minor buyers. Clerks who complied with the law received a modest reward and commendation in social media posts to the local Tribal communities, while clerks who sold without age verification were reminded of the laws. Of 18 retail outlets selling CTP, 8 sold e-cigarettes, and all sold combustible cigarettes. The Reward and Reminder intervention showed an approximate 25% reduction in sales of CTP to apparent minors, with a 33% baseline CTP sales rate without age verification and an 8% intervention CTP sales rate without age verification. The intervention increased awareness of laws prohibiting CTP sales to minors and mandating age verification for young adults seeking to buy CTP. The intervention, which had support from all governing Tribal Nations, builds the evidence base of effective practices which Tribal public health authorities may utilize to reduce youth access to CTP on and around Tribal reservations. Sovereign Tribes have authority over commercial businesses operating on their lands. Tobacco 21 laws aiming to restrict commercial tobacco availability to youth are supported by Tribes. A retailer intervention in which apparent minors attempt commercial tobacco purchases can offer accountability feedback to retailers both on and near Tribal reservations. Obtaining Tribal support and publicizing the interventions helps mobilize Tribal communities to support commercial tobacco prevention and promote healthy youth.

Difference in Rumor Dissemination and Debunking Before and After the Relaxation of COVID-19 Prevention and Control Measures in China: Infodemiology Study.

The information epidemic emerged along with the COVID-19 pandemic. While controlling the spread of COVID-19, the secondary harm of epidemic rumors to social order cannot be ignored. The objective of this paper was to understand the characteristics of rumor dissemination before and after the pandemic and the corresponding rumor management and debunking mechanisms. This study aimed to provide a theoretical basis and effective methods for relevant departments to establish a sound mechanism for managing network rumors related to public health emergencies such as COVID-19. This study collected data sets of epidemic rumors before and after the relaxation of the epidemic prevention and control measures, focusing on large-scale network rumors. Starting from 3 dimensions of rumor content construction, rumor propagation, and rumor-refuting response, the epidemic rumors were subdivided into 7 categories, namely, involved subjects, communication content, emotional expression, communication channels, communication forms, rumor-refuting subjects, and verification sources. Based on this framework, content coding and statistical analysis of epidemic rumors were carried out. The study found that the rumor information was primarily directed at a clear target audience. The main themes of rumor dissemination were related to the public's immediate interests in the COVID-19 field, with significant differences in emotional expression and mostly negative emotions. Rumors mostly spread through social media interactions, community dissemination, and circle dissemination, with text content as the main form, but they lack factual evidence. The preferences of debunking subjects showed differences, and the frequent occurrence of rumors reflected the unsmooth channels of debunking. The χ2 test of data before and after the pandemic showed that the P value was less than .05, indicating that the difference in rumor content before and after the pandemic had statistical significance. This study's results showed that the themes of rumors during the pandemic are closely related to the immediate interests of the public, and the emotions of the public accelerate the spread of these rumors, which are mostly disseminated through social networks. Therefore, to more effectively prevent and control the spread of rumors during the pandemic and to enhance the capability to respond to public health crises, relevant authorities should strengthen communication with the public, conduct emotional risk assessments, and establish a joint mechanism for debunking rumors.

Crown ether decorated silicon photonics for safeguarding against lead poisoning

Lead (Pb2+) toxification is a concerning, unaddressed global public health crisis that leads to 1 million deaths annually. Yet, public policies to address this issue have fallen short. This work harnesses the unique abilities of crown ethers, which selectively bind to specific ions. This study demonstrates the synergistic integration of highly-scalable silicon photonics, with crown ether amine conjugation via Fischer esterification in an environmentally-friendly fashion. This realizes an integrated photonic platform that enables the in-operando, highly-selective and quantitative detection of various ions. The development dispels the existing notion that Fischer esterification is restricted to organic compounds, facilitating the subsequent amine conjugation for various crown ethers. The presented platform is specifically engineered for selective Pb2+ detection, demonstrating a large dynamic detection range, and applicability to field samples. The compatibility of this platform with cost-effective manufacturing indicates the potential for pervasive implementation of the integrated photonic sensor technology to safeguard against societal Pb2+ poisoning.

Inverting social innovation to transform health system responses to climate change adaptation and mitigation in the global south

Systems thinking is aimed at understanding and solving complex problems that cut across sectors, an approach that requires accurate, timely, and multisectoral data. Citizen-driven big data can advance systems thinking, considering the widespread use of digital devices. Using digital platforms, data from these devices can transform health systems to predict and prevent global health crises and respond rapidly to emerging crises by providing citizens with real-time support. For example, citizens can obtain real-time support to help with public health risks via a digital app, which can predict evolving risks. These big data can be aggregated and visualized on digital dashboards, which can provide decision-makers with advanced data analytics to facilitate jurisdiction-level rapid responses to evolving climate change impacts (e.g., direct public health crisis communication). In the context of climate change, digital platforms can strengthen rapid responses by integrating information across systems (e.g., food, health, and social services) via citizen big data. More importantly, these big data can be used for rapid decision-making,a paradigm-changing approach that can invert social innovation, which we define as co-conceptualizing societal solutions with vulnerable communities to improve economic development with a focus on community wellbeing. However, to foster equitable and inclusive digital partnerships that invert social innovation, it is critical to avoid top-down approaches that sometimes result when researchers in the Global North and South collaborate. Equitable Global South–North partnerships can be built by combining digital citizen science and community-based participatory research to ethically leverage citizen-driven big data for rapid responses across international jurisdictions.

Death of the suicide law: A changing standard of liability for clinicians.

High rates of suicide continue to plague the modern world, with clinicians, researchers, and policymakers working urgently to ameliorate what has been recognized as a worldwide public health crisis. Under American Law, individuals- including health care providers, could generally not be held liable for causing the suicide of another person. This article presents a review of suicide law in the United States in the context of a recent civil case in which a physician with expertise in mental health was sued for the death of an ex-partner who committed suicide in his home. Historical events and landmark legal cases spanning the 15th century to now are examined and presented as a narrative review to inform society and mental health clinicians a-like towards interpreting the changing medical-legal landscape. As modern advances in science continue to discern the critical biopsychosocial factors that contribute to the act of suicide, there is an inevitably growing concern that suicide may no longer be an incomprehensible nor irrational event as has been assumed for centuries. Thus, it may be considered that individual with expertise and qualification to treat a group of individuals at higher risk of suicide (severe mental illness) may be subject to a different standard than the average individual. This article seeks to present a complex matter where no simple or broad-sweeping conclusions can yet be drawn, however remains a critically important matter for mental health clinicians.

Religious engagement and antibody response to the COVID-19 vaccine.

This research examined religious engagement and subsequent antibody responses to the COVID-19 vaccine. Using publicly available data from the Understanding Society survey, we employed a longitudinal design. Between January 2016 and May 2018, respondents completed measures of religious belonging, frequency of attending religious services (i.e., extrinsic religiosity), and the difference religion made to their lives (i.e., intrinsic religiosity). A COVID-19 survey wave was collected in March 2021 and measured antibody responses to the COVID-19 vaccine via blood draw. A final sample of 746 adults [462 (61.9%) females, Mage = 61.94, SD = 19.07] was achieved. Mediation analyses (PROCESS, Model 4; Hayes, Introduction to mediation, moderation, and conditional process analysis: A regression-based approach, The Guildford Press, 2022; Introduction to mediation, moderation, and conditional process analysis: A regression-based approach; The Guildford Press) revealed one pathway through which religion and antibody responses to the COVID-19 vaccine are associated, namely via extrinsic factors-attendance at religious services. In contrast, intrinsic religious factors which is the difference religion can make to one's life, was not a significant mediator. Overall, this analysis provides evidence that behavioural enactment of religion matters to the effectiveness of vaccination and the management of public health crises. It also highlights the value of social resources associated with engagement in valued social groups-and in particular religious social groups-for public health.

Predicting the Effectiveness of a Mindfulness Virtual Community Intervention for University Students: Machine Learning Model.

Students' mental health crisis was recognized before the COVID-19 pandemic. Mindfulness virtual community (MVC), an 8-week web-based mindfulness and cognitive behavioral therapy program, has proven to be an effective web-based program to reduce symptoms of depression, anxiety, and stress. Predicting the success of MVC before a student enrolls in the program is essential to advise students accordingly. The objectives of this study were to investigate (1) whether we can predict MVC's effectiveness using sociodemographic and self-reported features and (2) whether exposure to mindfulness videos is highly predictive of the intervention's success. Machine learning models were developed to predict MVC's effectiveness, defined as success in reducing symptoms of depression, anxiety, and stress as measured using the Patient Health Questionnaire-9 (PHQ-9), the Beck Anxiety Inventory (BAI), and the Perceived Stress Scale (PSS), to at least the minimal clinically important difference. A data set representing a sample of undergraduate students (N=209) who took the MVC intervention between fall 2017 and fall 2018 was used for this secondary analysis. Random forest was used to measure the features' importance. Gradient boosting achieved the best performance both in terms of area under the curve (AUC) and accuracy for predicting PHQ-9 (AUC=0.85 and accuracy=0.83) and PSS (AUC=1 and accuracy=1), and random forest had the best performance for predicting BAI (AUC=0.93 and accuracy=0.93). Exposure to online mindfulness videos was the most important predictor for the intervention's effectiveness for PHQ-9, BAI, and PSS, followed by the number of working hours per week. The performance of the models to predict MVC intervention effectiveness for depression, anxiety, and stress is high. These models might be helpful for professionals to advise students early enough on taking the intervention or choosing other alternatives. The students' exposure to online mindfulness videos is the most important predictor for the effectiveness of the MVC intervention. ISRCTN Registry ISRCTN12249616; https://www.isrctn.com/ISRCTN12249616.

Exploring Awareness and Understanding of Breast Cancer Risk Factors, Screening, and Treatment among Females in Pakistan

Purpose: Breast cancer is a pressing concern in Pakistan, ranking as the second leading cause of death among women. Despite its increasing incidence, it often lacks adequate attention from policymakers and healthcare professionals. This oversight could have severe consequences. To effectively tackle this health crisis, a thorough understanding of breast cancer's prevalence, risk factors, diagnosis, treatment, and outcomes in Pakistan is crucial. Methodology: To assess the level of awareness and understanding of breast cancer among women, this study was conducted. A cross-sectional survey was conducted in the outpatient department of Fauji Foundation Hospital, Rawalpindi, involving 350 female patients. Data were collected using a pre-structured questionnaire and analyzed using SPSS Version 16.0. Findings: Descriptive statistics were used, and the results were expressed as percentages and presented graphically. The study found that 70% of women were aware of breast cancer. Furthermore, 74% of the patients were married, and 87% had children. Knowledge about signs, symptoms, diagnosis, and treatment of breast cancer was relatively high among the women surveyed. However, only 23% of women had knowledge about performing breast self-examinations, and 18% had heard about mammography. This study provides valuable insights into breast cancer awareness and prevention behaviors among women in Pakistan, with significant implications for theory, policy, and practice. The findings highlight gaps in knowledge and awareness, particularly regarding breast self-examinations and mammography screenings. Unique Contribution to Theory, Policy and Practice: Policy implications stemming from the study results include the need for targeted awareness campaigns, educational programs, and screening initiatives to improve breast cancer awareness and preventive behaviors among women in Pakistan. Policymakers should allocate resources towards these efforts and integrate breast cancer education into existing healthcare services and community outreach programs to ensure widespread dissemination of information and access to screening services.

US Immigration Policy Stressors and Latinx Youth Mental Health.

The youth mental health crisis is exacerbated for Latinx adolescents, a group whose families are targets of anti-immigrant rhetoric and policy. To investigate how immigration-related stressors are associated with disruptions in parent-child relationships and, in turn, the mental health symptoms of Latinx adolescents. Data for this prospective cohort study of adolescent-mother dyads were derived from surveys completed at 3 time points spanning 4 years (time 1 [T1] in 2018, time 2 [T2] in 2020, and time 3 [T3] in 2022). Mediation analyses estimated paths from immigration-related stressors to parent-child relationship qualities to mental health symptoms from early to late adolescence. Multivariable and multivariate linear models within a structural equation modeling framework regressed mediators and outcome variables on their own T1 values, offering a scientifically rigorous test of mediation. The setting was a school district in suburban Atlanta, Georgia, and included Latinx adolescents (ages 11-16 years) randomly selected from grade and gender strata. Data were analyzed from June 2023 to March 2024. The primary independent variables were T1 mother reports of anti-immigrant worry and behavioral modification and adolescent reports of family member detention or deportation. Mediating variables were the reports of parental support and parent-child conflict of T2 adolescents. T3 adolescent reports of past 6-month internalizing and externalizing symptoms. A total of 547 Latinx adolescents (mean [SD] age, 13.3 [1.0] years; 303 female [55.4%]; 244 male [44.6%]) were included in this study. Response rates were 65.2% (547 of 839) among contacted parents and 95.3% (547 of 574) among contacted adolescents with parental permission. Four-year retention rates were 67% (366 of 547 adolescents) and 65% (177 of 271 mothers). Structural model results showed that T1 anti-immigrant worry and behavioral modification was associated with T3 increases in externalizing symptoms indirectly through T1 to T2 increases in parent-child conflict (β = 0.03; SE = 0.02; 95% CI, 0-0.08). For girls, T1 family member deportation or detention was associated with T1 to T3 increases in internalizing and externalizing symptoms indirectly through T1 to T2 declines in parental support (internalizing: β = 0.04; SE = 0.02; 95% CI, 0-0.08; externalizing: β = 0.03; SE = 0.02; 95% CI, 0-0.07). Sensitivity analyses supported structural model findings. Results of this cohort study suggest that legislative bodies, the health care system, and educational institutions should implement safeguards to mitigate potential harm conferred by anti-immigrant environments for parent-child relationships and, in turn, Latinx adolescents' mental health.

The synergy between loneliness and cannabis use on suicidal thoughts and behaviors among young adults in higher education

ABSTRACT Background Loneliness continues to be a public health crisis, and cannabis use has increased among some young adults following its legalization in certain states. Loneliness and cannabis use each contributes to suicide risk, but no studies have explored their potential synergy. This study aimed to explore the interaction between loneliness and cannabis use among students in higher education. Methods We analyzed data from the Healthy Minds Study (2020–2021; N = 101,744) and used multivariable logistic regression models to show the synergy between loneliness and cannabis use on suicidal thoughts and behaviors adjusting for sociodemographic variables and mental health. We calculated the interaction contrast ratio to show the synergy of combined exposures. Results While loneliness and cannabis use both increased odds of suicidal thoughts, those who were lonely and used cannabis had the greatest odds, exceeding the sum of these individual effects. The synergy between loneliness and cannabis use on suicide attempt was not statistically significant at a conventional level. Conclusion Synergy exists between loneliness and cannabis use in relation to suicidal thoughts among young adults in higher education. Future research can explore the utility of screening and addressing loneliness and cannabis in tandem for suicide prevention.

Implementing Foundry: A cohort study describing the regional and virtual expansion of a youth integrated service in British Columbia, Canada.

Integrated youth services (IYS) have been identified as a national priority in response to the youth mental health and substance use (MHSU) crisis in Canada. In British Columbia (BC), an IYS initiative called Foundry expanded to 11 physical centres and launched a virtual service. The aim of the study was to describe the demographics of Foundry clients and patterns of service utilization during this expansion, along with the impact of the COVID-19 pandemic. Data were analysed for all youth (ages 12-24) accessing both in-person (April 27th, 2018-March 31st, 2021) and virtual (May 1st, 2020-March 31st, 2021) services. Cohorts containing all clients from before (April 27th, 2018-March 16th, 2020) and during (March 17th, 2020-March 31st, 2021) the COVID-19 pandemic were also examined. A total of 23 749 unique youth accessed Foundry during the study period, with 110 145 services provided. Mean client age was 19.54 years (SD = 3.45) and 62% identified as female. Over 60% of youth scored 'high' or 'very high' for distress and 29% had a self-rated mental health of 'poor', with similar percentages seen for all services and virtual services. These ratings stayed consistent before and during the COVID-19 pandemic. Foundry has continued to reach the target age group, with a 65% increase in number of clients during the study period compared with the pilot stage. This study highlights lessons learned and next steps to promote youth-centred data capture practices over time within an integrated youth services context.

The Challenges of Engaging African American Communities During a Public Health Crisis: The Role of Government Information, COVID-19 Discourse, and Emotional Content on Social Media

ABSTRACT During a public health crisis, social media platforms play a pivotal role in circulating information and influencing public reactions. This research investigates the dynamics of public engagement with COVID-19-related content and government information sources within African American online communities, a population that has experienced significant health risks and inequities. Using advanced computational research methods, we analyzed 199,542 posts from 1,152 communities created between January 2020 and December 2022. The present research focused on the presence of COVID-19-related content, government information sources, the emotions of anger and fear in these posts, and their associations with user engagement metrics. The results indicated that posts discussing COVID-19 and those incorporating government information sources tend to receive lower levels of engagement. On the other hand, posts with higher levels of anger generated more shares and comments. The findings suggest a “triple disadvantage” in user engagement for social media messages that reference government sources and discuss public health risks without delivering strong negative emotions. These patterns are crucial not only for understanding the challenges faced by the at-risk population but also for aiding researchers and practitioners in developing more effective communication strategies during public health crises.

Keep the (social) distance! Turnout and risk perception during health crisis

This article investigates the relationship between risk perception and electoral participation of citizens. To assess this, we use the case study of the novel coronavirus and its relationship with voter turnout during the 2020 Romanian elections. We assess the relationship between COVID-19 and citizens’ intention to cast a vote by employing an individual model. Additionally, using the share rate of the infected population with COVID-19, we examine the association between the intensity of the outbreak across counties and electoral participation. Either though our research is cross-sectional and focuses on covariation rather than causal relationships, provides insightful results. The individual model shows that the higher the risk perception of infection is, the lower the intention to cast a vote. The aggregated exploratory model employed shows that an increase in the percentage of the shared infected population decreases the chance of electoral participation.

Addressing the spatial disparity of COVID-19 vaccination services: A spatial optimisation approach

The COVID-19 pandemic has posed global public health threats. The mass COVID-19 vaccination has continuously played a central role in containing this pandemic. To maximise the benefits of COVID-19 vaccination, equal accessibility to vaccination at different spatial scales is critical. Limited research has investigated the spatial disparity and location optimisation of COVID-19 vaccination services. In this study, we utilised the spatial big data of COVID-19 vaccination sites and used the Gini index to measure the spatial disparity of COVID-19 vaccination service levels. Then, we leveraged spatial optimisation models to enhance the spatial deployment of vaccination sites in the study area of England, UK. The results demonstrate the feasibility and efficiency of the proposed methods. Specifically, the spatial disparity of vaccination services is largely mitigated by the optimised configuration of vaccination sites, as the Gini index decreases from 0.84 (before optimisation) to 0.12 (after optimisation). The suggested vaccination sites would improve the equality of vaccination services and reduce the financial costs of maintaining the vaccination programme, which has implications for public health policymakers. This research illustrates that spatial optimisation could be instrumental in effectively addressing public health crises.

Impact of COVID-19 on the Utilization of Maternal and Child Health Services at a Regional Referral Hospital in Kenya

Background and Objective Pandemics, like COVID-19, disrupt healthcare, potentially reversing progress in various disease areas. The impact on maternal and child health (MCH) services in Kenya during the pandemic is yet to be determined. Recognizing this impact is crucial for formulating policies and programs that minimize disruptions in reproductive health services during future health crises. The purpose of this study was to determine the effect of COVID-19 on the uptake of MCH services at Thika Level V Hospital, a regional referral hospital in Kenya. Methods In this cross-sectional mixed methods study, we reviewed antenatal clinic (ANC), MCH, and family planning (FP) registers for data on the uptake of the various services during the COVID-19 pandemic (July to October 2020) compared to a year before the COVID-19 pandemic (July to October 2019). MCH clients (N = 60) and healthcare workers (N = 19) were interviewed about the impact of the pandemic on MCH services at the hospital. Differences in clinic attendance before and during the pandemic were compared using the student t-test. Thematic analysis was conducted on the interview responses. Results The number of MCH/FP clients dropped from 12,915 pre-pandemic to 7,429 during the pandemic. Significant differences were noted in ANC revisits (p = 0.026) and those completing the World Health Organization recommended minimum of four ANC visits (p<0.001) during the COVID-19 pandemic. The number of revisits at the child welfare clinic was also significantly lower (p = 0.004) during the COVID-19 lockdown period. MCH clients stated that the decline in the uptake of MCH services was attributable to the fear of contracting disease, financial difficulties, and strain on the healthcare workforce. Conclusion and Global Health Implications This study found a decline in access to MCH/FP services during the COVID-19 crisis with the potential to reverse gains made in securing the safety of the pregnant mother and unborn baby.

Integrating clinical research into electronic health record (EHR) workflows to support a learning health system

Abstract Objective Integrating clinical research into routine clinical care workflows within electronic health record systems (EHRs) can be challenging, expensive, and labor-intensive. This case study presents a large-scale clinical research project conducted entirely within a commercial EHR during the COVID-19 pandemic. Case Report The UCSD and UCSDH COVID-19 NeutraliZing Antibody Project (ZAP) aimed to evaluate antibody levels to SARS-CoV-2 virus in a large population at an academic medical center and examine the association between antibody levels and subsequent infection diagnosis. Results The project rapidly and successfully enrolled and consented over two thousand participants, integrating the research trial with standing COVID-19 testing operations, staff, lab, and mobile applications. EHR-integration increased enrollment, ease of scheduling, survey distribution and return of research results at a low cost by utilizing existing resources. Conclusion The case study highlights the potential benefits of EHR-integrated clinical research, expanding their reach across multiple health systems and facilitating rapid learning during a global health crisis.

Family functioning and mental health before and during the COVID-19 pandemic: a two-cohort comparison of emerging adults

AbstractThe aim of the present study was to analyze how family relationships changed during the COVID-19 pandemic and to determine whether the health crisis modified the association between family dimensions and emerging adult children’s mental health. A large sample of 1732 emerging adults was recruited at two different moments. In 2015, 755 emerging adults were recruited, 201 from campus A (sample 1) and 554 from campus B (sample 2). In 2020, a new sample was recruited and 977 emerging adults completed the questionnaire, 198 from campus A (sample 1 / “Pre-pandemic sample”, recruited before the lockdown) and 779 from campus B (sample 2 / “COVID-19 sample” / recruited after the lockdown. The results reveal that the COVID-19 sample of emerging adults perceived poorer parent-child relationships (lower parental involvement and warmth) and reported poorer mental health (lower flourishing and higher psychological distress) than their counterparts in Cohort 1. For their part, the Pre-pandemic sample reported higher levels of psychological distress than their counterparts in Cohort 1. In all samples (Cohort 1 and Cohort 2, both Pre-pandemic and COVID-19), parenting functions were positively associated with children’s flourishing and negatively associated with their psychological distress. However, these associations were stronger in Cohort 2 than in Cohort 1, both when assessed before and when assessed during the pandemic. The results of the study support the increasingly important role played by the family as a protective factor for mental health, even in stressful situations when family relationships tend to deteriorate. Study limitations include the use of a sample composed mainly of young emerging adult university students. Future studies should strive to include more emerging adults from the entire age range encompassed by emerging adulthood, as well as members of the non-university-going emerging adult population. Investing in public programs focused on family functions during emerging adulthood is an essential strategy for protecting and improving young adults’ mental health and promoting positive family relationships in stressful situations.

A Dynamic Evolutionary Analysis of the Vulnerability of Global Food Trade Networks

The global food trade network (FTN) is a critical infrastructure for achieving the Sustainable Development Goals (SDGs). The FTN’s vulnerability to geopolitical conflicts, public health crises, and climate change events directly impacts food security and the ability to meet the SDGs. This study aims to analyze the dynamic evolution of the vulnerability of FTN, focusing on the period from 2000 to 2022, to aim for strategies for enhancing the resilience and sustainability of the global food system. Based on complex network analysis, we examine the structural characteristics and evolution of FTN for four major crops: soybeans, wheat, rice, and maize. We identify a trend towards increased network density and regionalization, with a decline in average shortest path length (ASPL) and an increase in the average clustering coefficient (ACC). These changes indicate a shift towards a more interconnected and resilient FTN in response to various shocks, including the COVID-19 pandemic and the Russia–Ukraine conflict. The findings suggest that the global FTN has adapted to increase resilience, which is essential for achieving the SDGs related to food security and sustainable development. The study’s insights can guide policy interventions to further strengthen the network against future shocks and promote global food security.

Bystanders to a Public Health Crisis

Per- and polyfluoroalkyl substances (PFAS) are devastating our food systems and our health. Due to widespread use, these synthetic, long-lasting chemicals, are omnipresent at dangerous levels in our envi-ronment and our homes. Recent studies link even small exposure to PFAS to a host of adverse health outcomes, including cancer, autoim-mune diseases, thyroid disease, liver damage, childhood obesity, infer-tility, and birth defects. Food consumption is a primary route of PFAS exposure. PFAS mi-grate from water, soil, fertilizers, pesticides, and compost into virtually every plant, fish, animal, and animal product, and ultimately (in the greatest concentration) into the consumer. In addition, food pro-cessing equipment, disposable dishes, and containers leach dangerous levels of these chemicals into processed food products, further infusing our every meal with PFAS. Consequently, it is no surprise everything from chocolate cake and microwave popcorn to free range eggs, wildcaught fish, organic milk, and organic kale can harbor staggering quantities of these toxic substances. Despite the widespread presence of these substances and strong sci-entific evidence of their harmful impact on humans, federal regulation of PFAS in food is currently nonexistent. At least fifteen agencies have a mandate to ensure the safety of our food. More is not always better. In the case of regulatory agencies, it can lead to fragmented demand for attention, diffusion of responsibilities, and bureaucratic bystander apathy. This story has played out time and again with other toxic con-taminants like polychlorinated biphenyls (PCBs) and pesticides and is playing out yet again with PFAS. Despite our country’s devastating experience with past contaminants and the unprecedented scientific progress of our time, the federal response to new food safety threats has only become more sluggish and inadequate. This article lays a pathway for change, taking the issue of PFAS food contamination as a case study for the broader dysfunction in the food safety regulatory system. Part II reviews the history of federal food regulation and explores the role that each federal actor in the field plays in ensuring the safety of the food supply. Part III provides back-ground on the chemical and toxicological profile of PFAS and their widespread presence in the environment in general and the food sup-ply in particular. Part IV examines possible approaches to more effec-tive regulation of environmental contaminants in food and proposes a readily available but currently overlooked mechanism for combatting the current public health crisis of PFAS in food. Lastly, Part V cata-logues the expected benefits of the solution and addresses anticipated skepticism. It concludes that the proposed approach can effectively protect consumers from PFAS in food today, while simultaneously gar-nering much needed data to usher in a more permanent solution in the future.

Web-based Dashboard on ECMO Utilization in Germany: An Interactive Visualization, Analyses, and Prediction Based on Real-life Data

In Germany, a comprehensive reimbursement policy for extracorporeal membrane oxygenation (ECMO) results in the highest per capita use worldwide, although benefits remain controversial. Public ECMO data is unstructured and poorly accessible to healthcare professionals, researchers, and policymakers. In addition, there are no uniform policies for ECMO allocation which confronts medical personnel with ethical considerations during health crises such as respiratory virus outbreaks.Retrospective information on adult and pediatric ECMO support performed in German hospitals was extracted from publicly available reimbursement data and hospital quality reports and processed to create the web-based ECMO Dashboard built on Open-Source software. Patient-level and hospital-level data were merged resulting in a solid base for ECMO use analysis and ECMO demand forecasting with high spatial granularity at the level of 413 county and city districts in Germany.The ECMO Dashboard (https://www.ecmo-dash.de/), an innovative visual platform, presents the retrospective utilization patterns of ECMO support in Germany. It features interactive maps, comprehensive charts, and tables, providing insights at the hospital, district, and national levels. This tool also highlights the high prevalence of ECMO support in Germany and emphasizes districts with ECMO surplus – where patients from other regions are treated, or deficit – origins from which ECMO patients are transferred to other regions. The dashboard will evolve iteratively to provide stakeholders with vital information for informed and transparent resource allocation and decision-making.Accessible public routine data could support evidence-informed, forward-looking resource management policies, which are urgently needed to increase the quality and prepare the critical care infrastructure for future pandemics.