Mitigation Programs Research Articles

Teratogenic Risk Impact and Mitigation (TRIM): Study Protocol for the Development of a Decision Support Tool to Prioritize Medications for Risk Mitigation.

Preventing prenatal exposure to teratogenic medications is an important goal of regulatory risk mitigation efforts. In the USA, as of March 2024, 11 teratogenic medications have a required Risk Evaluation and Mitigation Strategy (REMS) program. It is unclear whether these programs target those medications with the most significant impact on public health and adverse pregnancy outcomes. This study aims to develop an innovative decision support tool that uses explicit, quantifiable criteria to facilitate prioritization of teratogenic medications for risk mitigation strategies. The Teratogenic Risk Impact and Mitigation (TRIM) decision support tool will be developed by a national panel via a modified Delphi approach to define measurable criteria, and a multi-criteria decision analysis to estimate criteria weights within a discrete choice experiment. The TRIM scores will then be calculated for 12 teratogenic drugs with active or eliminated REMS programs and for 12 teratogenic drugs without REMS. These drugs will be identified based on highest prenatal exposure prevalence in claims data of privately and publicly insured individuals. Data for the TRIM criteria levels for these 24 drugs will be identified from evidence searches and ad hoc analyses of the same claims data. Teratogenic Risk Impact and Mitigation is intended to inform regulatory decision making about the need for risk mitigation programs for teratogenic medications by providing explicit, quantifiable, evidence-based criteria. The TRIM scores of 24 teratogenic drugs may provide benchmarks for considering REMS for marketed and new teratogenic medications.

An ecoregion-based approach to evaluate invasive plant species pools

Invasive alien species are an important component of global change, threatening biodiversity, ecosystem functioning, economy, and human health. The number of alien species that attain the invasive status has experienced an exponential increase in recent years, leading some government agencies and stakeholders to allocate substantial resources to early detection, control, mitigation, and eradication programs. To develop effective nature conservation strategies, it is crucial to understand the invasive status of alien species and to identify priority species for management at spatial scales with a biogeographical basis. Despite significant progress in producing lists of alien species at the country level, a standard methodology for species assessment within ecological regions (i.e., regions with similar environmental or biogeographical characteristics) is still lacking. Here, we develop a systematic approach to determine invasion status and to prioritize invasive alien plant species within an ecoregion. We apply this approach in the Cantabrian Mixed Forests ecoregion, which encompasses biogeographically related areas from N Portugal, NW Spain, and SW France, and is strongly affected by plant invasions. By combining scientific evidence with expert opinion on the ecological characteristics of alien plants, we identified 175 invasive plant species in the study ecoregion, of which 37 cause massive environmental and/or socio-economic impacts. For each species, we provide comprehensive information and recommendations for scientists, land managers, policy makers, and other stakeholders under a biogeographical basis. This information includes species characteristics, invasion status/level, population trends, geographic locations and range size, local abundance, environmental and socio-economic impacts, and invaded habitats. We also accounted for administrative divisions within the ecoregion to facilitate the use of such evaluations in local-scale management and conservation plans. Our framework may be applied to any ecoregion worldwide, enhancing the assessment and management of invasive species pools within biogeographically meaningful regions.

The Domestication of Women in Stunting Mitigation Programs in Sidoarjo Regency

One of the challenges in realizing the vision of Golden Indonesia 2045 in Sidoarjo Regency is stunting. The stunting treatment program implemented by the government puts women in a central position. This study seeks to explore the domestication efforts of women in the stunting treatment program in Sidoarjo Regency. A qualitative approach with primary and secondary data was chosen to explore the research objectives. The data obtained through interviews were then analyzed using Walby's theory. The results of the study show that the implementation of the stunting treatment program in Sidoarjo Regency has encouraged the domestication of women. They are placed as parties who must be responsible for stunting treatment. Patriarchal practices occur in the implementation of stunting prevention programs, both in the public sphere and even more so in the private sphere. The government needs to reorient the implementation of the program. Considering that in its implementation, the government even justifies and perpetuates gender inequality.Keywords : domestication of women; gender; patriarchy; stunting

Literature review on sustainable development in bali province through the lens of financial aspects

This literature review discusses the relationship between regional financial performance, capital expenditure, and environmental expenditure and their role in sustainable development. Sustainable development is defined as development that is able to meet current needs without sacrificing the ability of future generations to meet their needs. Previous studies have shown that the allocation of regional spending, especially environmental spending, is still low despite having an important contribution to preserving ecosystems and reducing the impact of climate change. This review emphasizes that regional financial performance plays a significant role in determining capital expenditure and environmental allocation. Unbalanced spending policies can hinder the achievement of sustainable development. In addition, effective allocation of environmental spending is key to supporting various climate change mitigation programs and maintaining environmental quality in the future. The results of this study conclude that improving financial performance needs to be accompanied by appropriate budget policies, especially in capital expenditure and the environment. Efforts to ensure sustainable development require synergy between economic growth and environmental concern so that long-term development goals are achieved.

Health burden and costs attributed to the carbon footprint of health systems in the European Union

Abstract Background Health systems have an environmental impact of around 4.6% of global emissions, contributing to aggravating the climate crisis. However, the health impact of the carbon emissions originated by health systems is not regularly assessed. We aim to estimate the health burden and associated costs of the carbon footprint of health systems across the European Union (EU). Methods We calculated DALYs and associated costs based on human health damage factors (DALYs/kg-CO2e) by considering four scenarios. Three scenarios for shared socioeconomic pathways (S1 - high growth, S2 - baseline, and S3 - low growth) represented variations of global society, demographics, and economics until 2100. A fourth scenario (S4) considered the current EU’s 55% reduction goal of greenhouse gas emissions. The healthcare sector’s emissions per capita (in CO2-equivalent) in 2019 were extracted from the Lancet Countdown, and population data were retrieved from Eurostat for the same year. Results In the EU, 365,047 DALYs (95%CI: 194,692-535,403) are expected to be caused by health systems’ emissions at baseline (S2). In an S1 scenario, the burden would slightly decrease to 315,374 DALYs (95%CI: 170,355-462,393), whereas a S3 scenario would increase 486,730 DALYs (95%CI: 243,365-681,422). If EU’s carbon goals are met, the burden could be substantially reduced to 164,271 DALYs (95%CI: 87,611-240,931). The monetisation of DALYs can result in costs amounting to 25.6 billion euros. Conclusions CO2 emissions from health systems are expected to significantly impact human health. It is therefore of the utmost importance to ensure that EU climate policies for healthcare buildings are in line with the Paris Agreement. This will require the implementation of climate mitigation programmes within the health sector and a review of clinical practices at the local level. Key messages • The carbon footprint of health systems is estimated to significantly impact health, with high economic burden. • EU climate policies for healthcare buildings and procurement must be aligned with the Paris Agreement.

Community Participation in Flood Management Systems in Aceh Utara Regency

Flooding remains a persistent challenge in Aceh Utara Regency, representing a complex, cross-sectoral issue. If not addressed through collaboration among various stakeholders, including community groups, it has the potential to lead to new societal problems. This research seeks to assess the effectiveness and impact of using a participatory model in flood management efforts in the region. A qualitative approach was employed, gathering data through in-depth interviews with stakeholders such as local communities, government authorities, and non-governmental organizations involved in flood mitigation programs. The findings emphasize the urgency of adopting a participatory model to enhance the effectiveness of flood management systems. Actively engaging the community in planning, execution, and evaluation processes leads to a deeper understanding of local conditions, needs, and suitable solutions. Key aspects of the participatory model include raising public awareness of flood risks and mitigation measures, improving flood management infrastructure based on community input, creating more accessible and effective evacuation plans, and strengthening the community’s capacity for emergency response and simple mitigation efforts. In conclusion, this study aims to further explore the relevance and effectiveness of the participatory model in flood management in Aceh Utara Regency, ensuring the long-term sustainability of the region's disaster management system.

Projected impact of climate change on human health in low- and middle-income countries: a systematic review

Low- and middle-income countries (LMICs) contribute relatively little to global carbon emissions but are recognised to be among the most vulnerable parts of the world to health-related consequences of climate...

The Integration of Structural and Non-Structural Mitigation Based on Collaborative Governance Process at Tanjung Mas Sub-District

Abstract Subsidence of land levels and rising sea levels are two impacts of climate change that influence human activities, causing tidal floods. 12th and 16th RW (neighbourhood) of Tanjung Mas Subdistrict is a coastal area with a high population density that experiences tidal floods yearly. Structural mitigation programs receive more attention than non-structural programs. The mitigation process requires collaboration between stakeholders to obtain optimal results. This research aims to develop a disaster collaborative governance framework that integrates structural and non-structural mitigation. The research method used is a mixed method with a quantitative primary approach. The results show that collaborative governance in disaster mitigation involves various stages, such as collaborative initiatives, commitment to the process, collaborative processes, and monitoring evaluation. Non-structural mitigation is the primary basis for the success of the disaster management stage, while structural mitigation plays a significant role in the recovery stage. Emphasizing the balance of the role of the hexa helix is needed to create a sustainable mitigation process.

Neuro-Adaptive AI for Dynamic Distraction Mitigation in Autonomous Vehicle Environments

As autonomous vehicles develop, driver distraction becomes even more crucial as it affects both safety and operational efficiency. In this work, we investigate the gamut of new AI tools for combating and processing visual distraction scenarios within autonomous vehicles. This includes AI-based driver monitoring systems to determine the level of attention, visual distraction classification with deep learning models, augmented reality head-up displays for focal projection of critical information and gesture/voice-controlled interfaces are used in order to reduce visual interactions. This also includes how predictive analytics; adaptive user interfaces and personalized distraction mitigation programs will see AI improve driver focus and thus safety. These advanced systems are designed to provide a safer and more efficient driving experience in the emerging era of autonomous capabilities by leveraging the scalability of advanced driver-assistance technologies.

Mitigating inland waters’ greenhouse gas emissions: current insights and prospects

ABSTRACT Natural and constructed inland waters emit globally significant amounts of greenhouse gasses (GHGs) into the atmosphere. As a result of human-induced alterations in the landscape, these emissions tend to increase. While proper management of waterbodies is fundamental to reaching the global sustainable development goals as well as the Paris Agreement, insights on climate-smart inland water management are still underexplored. Here we review and discuss physical, chemical, and biological management measures applied in a wide range of inland waters to (1) reduce external loads of compounds fueling aquatic GHG emissions, (2) reduce the aquatic production of GHG-fueling compounds, and (3) minimize GHG production and stimulate GHG consumption. Some measures are well studied and others are in the exploration phase, resulting in a varying degree of confidence with respect to their effectiveness. Climate-smart water management (e.g., through the reduction of organic matter and nutrient loading) generally not only reduces GHG production and emission but also improves the ecological state of aquatic environments. Reductions in GHG emissions from 5% (fish effect) to ∼90% (salinization effect) were observed among the climate-smart measures discussed here. Certainly, the global effect of the different measures also depends on the application scale. Depending on the local context, the implementation of one or more of these measures can be considered in a GHG mitigation program.

Determinants of carbon emissions in Kenya and policy implications

Carbon dioxide emissions are the primary greenhouse gasses behind global climate change and its associated effects. Climate change adversely impacts the environment, biodiversity, and human health. The ability to tame carbon dioxide emissions will help in the fight against climate change. However, the recent pace of rising carbon dioxide emissions raises concerns about winning the war against climate change. World leaders are determined to take actions that will lower emissions. Thus, there is a worldwide effort to achieve net-zero emissions. Consequently, it is crucial to comprehend the specific factors that contribute to carbon emissions of specific economies so that countries can develop and enforce effective strategies for reducing carbon output, mitigating the effects of climate change, and improving recovery programs. Despite many empirical studies conducted in Africa on the determinants of carbon emissions, the results remain inconclusive and inadequate, leaving a void for further research. This study seeks to fill this knowledge gap by modeling the relationship between Kenya's carbon emissions (which have been increasing since the early 2000s), and mobile technology adoption, renewable energy mix, tourism development, development assistance, income, and global financial crises, utilizing the most current data from 1995 to 2021 from the World Bank's database. The ARDL, FMOLS, CCR, and DOLS analysis results reveal that mobile technology, tourism, development aid, and global financial crises increase Kenya's carbon emissions in the long run. At the same time, income and renewable energy reduce short- and long-term impacts. The significant insight from these results is that enhancing renewable energy development, mobile technology, and development assistance can promote a sustainable environment. From these findings, the study proposes many policy recommendations to help decision-makers, communities, companies, and the government in Kenya allocate resources and implement resilience and mitigation policies and programs in the areas most susceptible to the effects of climate change.

Marine macrolitter and cigarette butts hazard multiple-use marine protected area and fishing community at Brazil

Wide marine litter (ML) contamination impacts human health and economic sectors including fishing, navigation, and tourism. Perequê beach, Brazil, is an authentic fishing community within a touristic multiple-use marine protected area. However, no ML contamination monitoring were so far performed in the region. This study evaluated the spatiotemporal abundance, composition, sources, and associated ML hazards at Perequê beach using a multi-index approach. The 2579 items (0.64 ± 0.72 items.m−2) yielded a high contamination level (CCI = 12.6 ± 14.4) with plastic (44.6–50.9 %) and cigarette butts (20.6–28.4 %) prevalence, while primary sources were smoking (cigarette butts, lighters, others-21.2–30.1 %) and packaging (17.8–22.8 %). Levels of pollutants leaked from cigarette butts (CBPI = 30.5 ± 47.5) and hazardous items (HALI = 3.06 ± 2.64) were among the highest globally. Heightened levels occurred in summer, at dry sand strip, where short-term buoyant items prevailed. Multi-indexing approaches offer valuable insights for local authorities to implement mitigation programs, while contributing to global discussions, promoting awareness, and facilitating replicability.

Genomic Surveillance for Enhanced Healthcare Outbreak Detection and Control.

Current methods are insufficient alone for outbreak detection in hospitals. Real-time genomic surveillance using offers the potential to detect otherwise unidentified outbreaks. We initiated and evaluated the Enhanced Detection System for Healthcare-associated Transmission (EDS-HAT), a real-time genomic surveillance program for outbreak detection and mitigation. This study was conducted at UPMC Presbyterian Hospital from November 2021 to October 2023. Whole genome sequencing (WGS) was performed weekly on healthcare-associated clinical bacterial isolates to identify otherwise undetected outbreaks. Interventions were implemented in real-time based on identified transmission. A clinical and economic impact analysis was conducted to estimate infections averted and net cost savings. There were 3,921 bacterial isolates from patient healthcare-associated infections that underwent WGS, of which 476 (12.1%) clustered into 172 outbreaks (size range 2-16 patients). Of the outbreak isolates, 292 (61.3%) had an identified epidemiological link. Among the outbreaks with interventions, 95.6% showed no further transmission on the intervened transmission route. The impact analysis estimated that, over the two-year period, 62 infections were averted, with gross cost savings of $1,011,146, and net savings of $695,706, which translates to a 3.2-fold return on investment. Probabilistic sensitivity analysis showed EDS-HAT was cost-saving and more effective in 98% of simulations. Real-time genomic surveillance enabled the rapid detection and control of outbreaks in our hospital and resulted in economic benefits and improvement in patient safety. This study demonstrates the feasibility and effectiveness of integrating genomic surveillance into routine infection prevention practice, offering a paradigm shift in healthcare outbreak detection and control.

Methodology used to develop the minimum common data elements for surveillance and Reporting of Musculoskeletal Injuries in the MILitary (ROMMIL) statement

Background The objective was to summarize the methodology used to reach consensus for recommended minimum data elements that should be collected and reported when conducting injury surveillance research in military settings. This paper summarizes the methodology used to develop the international Minimum Data Elements for surveillance and Reporting of Musculoskeletal Injuries in the MILitary (ROMMIL) statement. Methods A Delphi methodology was employed to reach consensus for minimum reporting elements. Preliminary steps included conducting a literature review and surveying a convenience sample of military stakeholders to 1) identify barriers and facilitators of military musculoskeletal injury (MSKI) prevention programs, 2) identify relevant knowledge/information gaps and 3) establish future research priorities. The team then led a sequential three-round Delphi consensus survey, including relevant stakeholders from militaries around the world, and then conducted asynchronous mixed knowledge user meeting to explore level of agreement among subject matter experts. Knowledge users, including former and current military service members, civil servant practitioners, and global-wide subject matter experts having experience with policy, execution, or clinical investigation of MSKI mitigation programs, MSKI diagnoses, and MSKI risk factors in military settings. For each round, participants scored each question on a Likert scale of 1-5. Scores ranged from No Importance (1) to Strong Importance (5). Results Literature review and surveys helped informed the scope of potential variables to vote on. Three rounds were necessary to reach minimum consensus. Ninety-five, 65 and 42 respondents participated in the first, second and third rounds of the Delphi consensus, respectively. Ultimately, consensus recommendations emerged consisting of one data principle and 33 minimum data elements. Conclusions Achieving consensus across relevant stakeholders representing military organizations globally can be challenging. This paper details the methodology employed to reach consensus for a core minimum data elements checklist for conducting MSKI research in military settings and improve data harmonization and scalability efforts. These methods can be used as a resource to assist in future consensus endeavors of similar nature.

Function and watershed‐based stream mitigation: Lessons from a program development and implementation odyssey in the Western United States

AbstractTo improve the quality and success of compensatory mitigation under Clean Water Act Section 404, the U.S. Army Corps of Engineers and the U.S. Environmental Protection Agency jointly promulgated regulations in 2008. These regulations promote the use of function assessments to determine appropriate compensatory mitigation to replace functions and services lost due to permitted impacts to aquatic resources and require a watershed approach to mitigation. The Oregon Removal‐Fill law, administered by the Department of State Lands, has similar requirements. Despite higher level policy, there is a paucity of scientific focus at the practical level needed to improve the tools and practices required for regulatory program implementation to achieve better mitigation outcomes, contributing to an implementation gap. By describing key challenges and specific solutions, we share lessons from a 15‐year interagency effort to develop and implement an integrated, function, and watershed‐based stream compensatory mitigation program in Oregon. We highlight the importance of an intentional process of engagement and change management and identify outstanding science and policy needs to improve stream compensatory mitigation programs and field‐scale outcomes.

Climate change and sexual and reproductive health and rights research in low-income and middle-income countries: a scoping review

IntroductionThis study aimed to provide an overview of the research landscape and to identify research gaps linking climate change events and sexual and reproductive health and rights (SRHR) in low-income...

Landslide susceptibility mapping using modified frequancy ratio method in Correb area, South Wollo, North-Western Ethiopia

Correb area in Mekdela Woreda, South-Wollo Zone, North-Western Ethiopia is one of the most landslide affected region. The primary aim of this study was to assess the landslide susceptibility of the area and create a landslide susceptibility map. A bivariate statistical frequency ratio model was used to accomplish this goal. Using fieldwork and Google Earth picture interpretation, a map of landslides was made. A total of 524 landslides were identified and then classified in to training landslide (75%) for model development and validation landslide (25%) for model validation. Eight landslide causative factors slope, aspect, elevation, distance to drainage, distance to spring, slope material, distance to lineament, and vegetation cover were integrated with training landslides in order to determine frequency ratio value(weight) for each class of landslide causative factors. Furthermore, each causative factor’s prediction rate or weight was established. Relative frequency values were allocated to the appropriate factor classes and prediction rate values were allocated to the appropriate causative factors and summed using a raster calculator algorithm in order to produce the landslide susceptibility map. The final landslide susceptibility map revealed that 27.54% (31.52 km2) of the study area falls under very low susceptible, 30.35% (34.74 km2) low susceptible, 21.36% (24.44 km2) moderate susceptible, 14.74% (16.88 km2) high susceptible, and the rest 6.01% (6.88 km2) as very high susceptible. This shows that more than 20% of the area has probability and risk of landslide while about 80% has relatively low probability and risk of this natural hazard. The performance of modified frequency ratio model for landslide susceptibility mapping was validated using simply overlay, relative landslide density index, and receiver operating characteristics curve. Both training and validation landslides were rare in the very low and low susceptibility classes and strongly concentrated in the high and very high susceptibility classes, according to validation using simple overlay and the relative landslide density index. The implemented model performed exceptionally well, as seen by the receiver operating characteristics curve, which showed 82.6% success rate and an 83.1% prediction rate. In general, the model produced reasonable accuracy. The resultant map would be useful for general land use planning, site selection, and landslide prevention and mitigation programs.

Relationship Between Background of Youth and Their Awareness, Attitude and Perception Towards Climate Change

Nowadays, climate change has been a topic of discussion for many people at various levels all over the world. With the increase in world temperature year by year, there are many reports of extreme weather, melting of the polar ice cap, and rising of the sea level that are affecting people in their daily lives. Since it is disrupting human life, efforts are being carried out by international bodies, governments, and various NGOs in mitigation and adaptation efforts of climate change impact by raising awareness on climate change issues. In Malaysia, such efforts are being carried out too, and many studies are conducted to analyse various aspects of climate change, including social science. In this study, youth are targeted as the respondents as they can play an important role in climate change mitigation, which makes analysing their level of awareness, perception, and attitude towards climate change needed. Therefore, using purposive sampling techniques, undergraduates at Universiti Sains Malaysia (USM) currently taking the WSU 101: Sustainable Issues, Challenges, and Prospects course are chosen as respondents. Using an online questionnaire, 234 out of 498 students participated in this study. In order to understand the intention and motivation of youth towards climate change, the Theory of Planned Behaviour is used, and three types of variables, which consist of independent variables (gender, age, education background, and knowledge), intervening variables (personal experience, self-interest, and intention), and dependent variables (awareness, perception, and behaviour), are used to analyse the relationship and factors. Using all the data collected, it was found that respondents in this study are aware of and have a good understanding of climate change. Moreover, it is also found that they are aware that climate change is affecting their lives, and there is a relationship between their demographic background, experiences, and behaviour or attitudes towards climate change. Since climate change impacts are affecting our livelihoods and youth, which represent almost half of Malaysia's current population, it can be an effective and efficient tool to promote climate change awareness for mitigation and adaptation programs. Thus, the findings of this study can be used as a baseline for climate change programs among youth, and this can be done by collecting responses from a larger youth population so that more comprehensive initiatives can be planned and implemented.

Protecting Frontline Workers: Strategies for Preventing and Mitigating Violence in the Emergency Department

Violence in the emergency department (ED) has been escalating for decades worldwide. High-stress situations are commonplace in the ED and can lead to intentional and unintentional aggression from patients. Staff must be educated on the signs of violence and escalation to recognize potentially dangerous situations early. Staff must also identify underlying medical conditions as the source of unintentional violence. Both situations would require different approaches to management. ED violence negatively affects patient care and leads to long-term harmful outcomes for staff. Multiple strategies for mitigation and prevention have been explored in the literature. Among those, weapon detection systems, de-escalation training, and violence prevention programs have demonstrated improved staff outcomes and decreased violence. Formalized procedures and policies should clearly assign roles for each staff member in the event of a violent patient. Training programs should be instituted and may include self-defense classes or crisis intervention courses. Emergency medicine residency programs and EDs around the country must address the rising incidence of violence within EDs through interdisciplinary policy, procedure development, and prevention and mitigation programs.

Enhancing food access in a comprehensive cancer center area of influence through local partner capacity building.

Food insecurity, an economic and social condition of limited food access, is associated with poor diet quality-a risk factor for several common cancers. The University of Texas MD Anderson Cancer Center supports healthy food access through community-led evidence translation by actively partnering with community-based organizations (CBOs). These partnerships aim to enhance the capacity of food assistance CBOs to effectively implement evidence-based food insecurity mitigation programs in the cancer center's area of influence. This case study aims to describe the cancer center's model for local food access capacity building and detail operationalization in the context of a whole-community cancer prevention effort (Be Well Baytown) in Baytown, Texas. Elements central to the capacity building model include (i) assessment of baseline needs and capacity, (ii) empowering a community champion within a relevant CBO, (iii) mapping inter-sectoral community partnerships, collaborations, and linkages, and (iv) leveraging systems, connections, and resources to provide an enabling environment for overall food access systems growth. Through this process, Be Well Baytown enhanced the capacity of a local food pantry leading to increases in total reach, pounds of food distributed, and number of food distribution events in collaboration with intersectoral partners from 2018 to 2023. This case study highlights the model's implementation as a co-benefit community partnership strategy to maximize the impact of food security programs integrated with comprehensive cancer center prevention efforts.