Potential Burden Research Articles

Site-Level Evidence-Based Practice Accreditation: A Qualitative Exploration Using Institutional Theory

ABSTRACT Accreditation is gaining ground in human services as leaders find ways to demonstrate the quality and legitimacy of services. This study examined site-level accreditation for SafeCare®, an evidence-based practice designed to prevent and reduce child maltreatment. We leveraged two waves of qualitative data to explore the perspectives of trainers, organizational and system leaders, and program developers who participated in an initial rollout of a site-level accreditation process for SafeCare. Institutional theory was used to frame accreditation’s potential benefits, burden, and impact. Findings highlight specific considerations for the human service environment, including the inherent resource scarcity, interdependence among organizations, and the impact of cost and slow-moving bureaucratic processes.

A network approach to understand co-occurrence and relative importance of different reasons for suicide: a territory-wide study using 2002–2019 Hong Kong Coroner's Court reports

Suicide is a complex and multifaceted issue, and suicidal behaviors are often driven by multiple, interacting factors. It has been challenging to identify reasons for suicide using existing scientific methodologies. This study aims to identify critical reasons for suicide and suicidal behaviors through the application of novel network science methods. Based on cases investigated by the Hong Kong Coroner's Court from 2002 to 2019, we modelled identified reasons for 13,001 suicide cases as a co-occurrence network, and calculated each reason's eigencentrality to determine their respective relative importance. We then analyzed the temporal and demographic changes in the structure and eigencentrality of the network. We further conducted simulation studies based on the United Nations population projection to assess potential burden of different reasons for suicide on the population in the coming years. School-related issues had the highest eigencentrality (eigencentrality=0.49) for individuals younger than 20 years of age. Financial issues were crucial for adults aged 20-59 years, but their importance differed between males (eigencentrality=0.51) and females (eigencentrality=0.14). Physical illness (eigencentrality=0.80) was the core concern for adults over 60 years. Across the Hong Kong population, the reasons for suicide appear to have shifted from financial issues in the early 2000s (eigencentrality=0.46) to issues related to physical illnesses since 2011 (eigencentrality=0.58). Simulation findings indicate that, by 2050, most suicides in Hong Kong will be due to physical illness-related issues (eigencentrality=0.69) due to the rapidly aging population. There have been important sex and age differences over time, in reasons for suicide. Given the projected increasing age of the Hong Kong population over the next decades, older adults with physical illnesses appear to be the highest contributors to suicide cases in the overall population. This novel network analysis approach provides important data-driven information upon which to base effective proactive public health suicide prevention strategies and interventions. Hong Kong Jockey Club Charities Trust, Collaborative Research Fund (C7151-20G), and General Research Fund (17606521).

High zoonotic potential and heavy environmental burden of Cryptosporidium spp. and Enterocytozoon bieneusi in farmed and pet African pygmy hedgehogs (Atelerix albiventris)

African pygmy hedgehogs (Atelerix albiventris) are widely farmed in southern China and Japan for medicinal materials and as pets. However, little is known about the prevalence, zoonotic potential, and environmental burden of Cryptosporidium spp., Enterocytozoon bieneusi and Giardia duodenalis in these animals. In this study, 380 fecal samples were collected from farmed and pet African pygmy hedgehogs in Guangdong of China, and analyzed for these pathogens by PCR and DNA sequencing. Overall, the detection rates of Cryptosporidium spp., E. bieneusi and G. duodenalis were 35.5%, 70.0% and 0, respectively. By living condition, the highest detection rates of Cryptosporidium spp. (61.5%) and E. bieneusi (100.0%) were both obtained from animals kept in the cave, which could be due to the overcrowding and poor hygiene conditions. Two Cryptosporidium species were identified, including C. erinacei (n = 22) and Cryptosporidium horse genotype (n = 113). The C. erinacei isolates belonged to a new subtype family (XIIIb), which has been identified in a patient with cryptosporidiosis recently. The horse genotype isolates are of a known subtype VIbA13, which was previously identified in a pet store employee in care of hedgehogs with diarrhea. Eleven genotypes of the zoonotic Group 1 were identified in E. bieneusi, with the known genotype SCR05 previously detected in pet rabbits being dominant (235/266, 88.3%). In longitudinal monitoring of Cryptosporidium infection in 11 naturally infected African pygmy hedgehogs, the oocyst shedding intensity decreased gradually from the mean oocysts per gram of feces of ∼6 logs to ∼2 logs over 42 days. The high intensity and long duration of oocyst shedding could lead to heavy environmental contamination and increase the potential for zoonotic transmission of the pathogens. Results of the study suggest that zoonotic Cryptosporidium spp. and E. bieneusi are common in farmed and pet African pygmy hedgehogs. Hygiene and One Health measures should be implemented by pet owners and farmers to prevent zoonotic transmission and environmental contamination of Cryptosporidium spp. and E. bieneusi.

Dietitians as change agents for promoting healthy and sustainable food systems

Dietitians as change agents for promoting healthy and sustainable food systems

“For Good or for Evil”: Abortion and Reproductive Ethics in Elizabeth Gaskell’s Mary Barton

ABSTRACT This article considers how questions of reproduction and population intersect with issues of working-class motherhood in Elizabeth Gaskell's 1848 social problem novel Mary Barton — specifically regarding representations of abortion and women's reproductive health. Women’s ability to successfully perform maternity, especially for multiple children, often correlated with their socioeconomic status, as a working-class woman’s financial resources proved more limiting than those of her middle-class contemporaries. The possibility of multiple unplanned pregnancies for working-class women thus positioned maternity as a potential burden and source of anxiety. With a specific eye toward the historically classed associations behind herb gardens, midwifery, and access to different forms of medicine, the following essay illuminates abortion’s implicit yet critical place in the novel and how the subject, as a present-absence, informs the text’s treatment of population and concerns about social inequality.

The Moral Career of Soldiers’ Identity: A Norwegian Case

Military service can require soldiers to act beyond their moral beliefs, something that can impair soldiers’ mental health. However, little is known about the shaping of soldiers’ moral identity within their institutional context. This article explores how the moral identity of 20 experienced Norwegian soldiers is (re-)shaped in the Army. Findings from unstructured interviews suggest that they accept compromising their moral beliefs and give priority to an institutional obligation to follow orders. They present three mediating arguments justifying such a compromise and one effort to reduce the potential burden of carrying out illegal or immoral orders. I argue that these compromises are made possible through a shared belief they are socialized into through interactions in their military context. The study complements our knowledge of socialization processes in the military and identifies two theoretical concepts useful to gain knowledge about the (re-)shaping of soldiers’ moral identity.

Life cycle assessment of potential environmental burden and human capital loss caused by apple production system in China

As one of the representative fruits of China, apple plays an important role in the overall agricultural production system. However, the large amount of chemical inputs in apple production has potential detrimental impacts on the environment and human health, and thus threatens the achievement of sustainable development goals. Therefore, a comprehensive evaluation of the environmental burden (EB) and human capital (refer to human lives) loss (HCL) caused by apple production system (APS) is urgently needed to suggest directions for improvement. A method widely used to measure impacts from both the use of resources and the emissions generated in the agriculture sector is the life cycle assessment (LCA). In this study, the EB and HCL caused by the APS have been determined from two phases using the LCA methodology in China. The results show that the leading cause of EB in the agricultural materials' production phase is nitrogen fertilizer (N) production, and in the farming phase is chemical fertilizer use. The top 5 major pollutants that cause potential damage to human health in APS are carbon dioxide (CO2), ammonia (NH3), nitrogen dioxide (N2O), nitrate (NO3), and sulfur oxides (SOx). The human health risk (HHR) is 5.84 × 10-2 disability-adjusted life year to cultivate 1ha of the apple orchard 1year, and the corresponding HCL is about 4230 Chinese yuan (CNY). Under the scenario analysis of a 15% reduction in chemical fertilizer use and a 20% increase in organic fertilizer (mainly dried sheep dung) use, most of the environmental impact categories have a decreasing trend, and the HCL decreased by 438 CNY of 10.36%. Therefore, chemical fertilizer (especially N) is the most critical environmental hotspot in APS, and our results suggest that the replacement of chemical fertilizers by organic fertilizers is an effective solution to reduce the potential EB and HCL and improve the sustainability of the APS.

Simulating potential outbreaks of Delta and Omicron variants based on contact-tracing data: A modelling study in Fujian Province, China.

Although studies have compared the relative severity of Omicron and Delta variants by assessing the relative risks, there are still gaps in the knowledge of the potential COVID-19 burden these variations may cause. And the contact patterns in Fujian Province, China, have not been described. We identified 8969 transmission pairs in Fujian, China, by analyzing a contact-tracing database that recorded a SARS-CoV-2 outbreak in September 2021. We estimated the waning vaccine effectiveness against Delta variant infection, contact patterns, and epidemiology distributions, then simulated potential outbreaks of Delta and Omicron variants using a multi-group mathematical model. For instance, in the contact setting without stringent lockdowns, we estimated that in a potential Omicron wave, only 4.7% of infections would occur in Fujian Province among individuals aged >60 years. In comparison, 58.75% of the death toll would occur in unvaccinated individuals aged >60 years. Compared with no strict lockdowns, combining school or factory closure alone reduced cumulative deaths of Delta and Omicron by 28.5% and 6.1%, respectively. In conclusion, this study validates the need for continuous mass immunization, especially among elderly aged over 60 years old. And it confirms that the effect of lockdowns alone in reducing infections or deaths is minimal. However, these measurements will still contribute to lowering peak daily incidence and delaying the epidemic, easing the healthcare system's burden.

Whole body irradiation with intensity-modulated helical tomotherapy prior to haematopoietic stem cell transplantation: analysis of organs at risk by dose and its effect on blood kinetics

BackgroundIntensity-modulated helical tomotherapy (HT) is a promising technique in preparation for bone marrow transplantation. Nevertheless, radiation-sensitive organs can be substantially compromised due to suboptimal delivery techniques of total body irradiation (TBI). To reduce the potential burden of radiation toxicity to organs at risk (OAR), high-quality coverage and homogeneity are essential. We investigated dosimetric data from kidney, lung and thorax, liver, and spleen in relation to peripheral blood kinetics. To further advance intensity-modulated total body irradiation (TBI), the potential for dose reduction to lung and kidney was considered in the analysis.Patients and methods46 patients undergoing TBI were included in this analysis, partially divided into dose groups (2, 4, 8, and 12 Gy). HT was performed using a rotating gantry to ensuring optimal reduction of radiation to the lungs and kidneys and to provide optimal coverage of other OAR. Common dosimetric parameters, such as D05, D95, and D50, were calculated and analysed. Leukocytes, neutrophils, platelets, creatinine, GFR, haemoglobin, overall survival, and graft-versus-host disease were related to the dosimetric evaluation using statistical tests.ResultsThe mean D95 of the lung is 48.23%, less than half the prescribed and unreduced dose. The D95 of the chest is almost twice as high at 84.95%. Overall liver coverage values ranged from 96.79% for D95 to 107% for D05. The average dose sparing of all patients analysed resulted in an average D95 of 68.64% in the right kidney and 69.31% in the left kidney. Average D95 in the spleen was 94.28% and D05 was 107.05%. Homogeneity indexes ranged from 1.12 for liver to 2.28 for lung. The additional significance analyses conducted on these blood kinetics showed a significant difference between the 2 Gray group and the other three groups for leukocyte counts. Further statistical comparisons of the dose groups showed no significant differences. However, there were significant changes in the dose of OAR prescribed with dose sparing (e.g., lung vs. rib and kidney).ConclusionUsing intensity-modulated helical tomotherapy to deliver TBI is a feasible method in preparation for haematopoietic stem cell transplantation. Significant dose sparing in radiosensitive organs such as the lungs and kidneys is achievable with good overall quality of coverage. Peripheral blood kinetics support the positive impact of HT and its advantages strongly encourage its implementation within clinical routine.

Cardiovascular Disease−Related Emergency Department Visits and Hospitalization among Women with Hypertensive Disorders of Pregnancy

The risk of developing cardiovascular disease is higher for women who had hypertensive disorders of pregnancy than for women without a history of hypertensive disorders of pregnancy. However, it is unknown whether the emergency department visits and hospitalization differ between women with a history of hypertensive disorders of pregnancy and women without hypertensive disorders of pregnancy. The objective of this study was to characterize and compare cardiovascular disease-related emergency department visits, hospitalization rates, and diagnoses in women with a history of hypertensive disorders of pregnancy with those in women without. This study included participants from the California Teachers Study (N=58,718) with a history of pregnancy and data from 1995 through 2020. Incidence of cardiovascular disease-related emergency department visits and hospitalizations based on linkages with hospital records were modeled using multivariable negative binomial regression. Data were analyzed in 2022. A total of 5% of the women had a history of hypertensive disorders of pregnancy (5.4%, 95% CI=5.2%, 5.6). A total of 31% of women had 1 or more cardiovascular disease-related emergency department visits (30.9%), and 30.1% had 1 or more hospitalizations. The incidence of cardiovascular disease-related emergency department visits (adjusted incident rate ratio=8.96, p<0.001) and hospitalizations (adjusted incident rate ratio=8.88, p<0.001) were significantly higher for women with hypertensive disorders of pregnancy than for those without, adjusting for other related characteristics of the women. History of hypertensive disorders of pregnancy is associated with higher cardiovascular disease-related emergency department visits and hospitalizations. These findings underscore the potential burden on women and the healthcare system of managing complications associated with hypertensive disorders of pregnancy. Evaluating and managing cardiovascular disease risk factors in women with a history of hypertensive disorders of pregnancy is necessary to avoid cardiovascular disease-related emergency department visits and hospitalizations in this group.

The unequal burden of human-wildlife conflict

Human-wildlife conflict is one of the most pressing sustainable development challenges globally. This is particularly the case where ecologically and economically important wildlife impact the livelihoods of humans. Large carnivores are one such group and their co-occurrence with low-income rural communities often results in real or perceived livestock losses that place increased costs on already impoverished households. Here we show the disparities associated with the vulnerability to conflict arising from large carnivores on cattle (Bos taurus) globally. Across the distribution of 18 large carnivores, we find that the economic vulnerability to predation losses (as measured by impacts to annual per capita income) is between two and eight times higher for households in transitioning and developing economies when compared to developed ones. This potential burden is exacerbated further in developing economies because cattle keepers in these areas produce on average 31% less cattle meat per animal than in developed economies. In the lowest-income areas, our estimates suggest that the loss of a single cow or bull equates to nearly a year and a half of lost calories consumed by a child. Finally, our results show that 82% of carnivore range falls outside protected areas, and five threatened carnivores have over one third of their range located in the most economically sensitive conflict areas. This unequal burden of human-carnivore conflict sheds light on the importance of grappling with multiple and conflicting sustainable development goals: protecting life on land and eliminating poverty and hunger.

Effects of heatwave features on machine-learning-based heat-related ambulance calls prediction models in Japan

Researchers agree that there is substantial evidence of an increasing trend in both the frequency and duration of extreme temperature events. Increasing extreme temperature events will place more pressure on public health and emergency medical resources, and societies will need to find effective and reliable solutions to adapt to hotter summers. This study developed an effective method to predict the number of daily heat-related ambulance calls. Both national- and regional-level models were developed to evaluate the performance of machine-learning–based methods on heat-related ambulance call prediction. The national model showed a high prediction accuracy and can be applied over most regions, while the regional model showed extremely high prediction accuracy in each corresponding region and reliable accuracy in special cases. We found that the introduction of heatwave features, including accumulated heat stress, heat acclimatization, and optimal temperature, significantly improved prediction accuracy. The adjusted coefficient of determination (adjusted R2) of the national model improved from 0.9061 to 0.9659 by including these features, and the adjusted R2 of the regional model also improved from 0.9102 to 0.9860. Furthermore, we used five bias-corrected global climate models (GCMs) to forecast the total number of summer heat-related ambulance calls under three different future climate scenarios nationally and regionally. Our analysis demonstrated that, at the end of the 21st century, the total number of heat-related ambulance calls in Japan will reach approximately 250,000 per year (nearly four times the current amount) under SSP-5.85. Our results suggest that disaster management agencies can use this highly accurate model to forecast potential high emergency medical resource burden caused by extreme heat events, allowing them to raise and improve public awareness and prepare countermeasures in advance. The method proposed in Japan in this paper can be applied to other countries that have relevant data and weather information systems.

Past SARS-CoV-2 infection protection against re-infection: a systematic review and meta-analysis

Understanding the level and characteristics of protection from past SARS-CoV-2 infection against subsequent re-infection, symptomatic COVID-19 disease, and severe disease is essential for predicting future potential disease burden, for designing policies that restrict travel or access to venues where there is a high risk of transmission, and for informing choices about when to receive vaccine doses. We aimed to systematically synthesise studies to estimate protection from past infection by variant, and where data allow, by time since infection. In this systematic review and meta-analysis, we identified, reviewed, and extracted from the scientific literature retrospective and prospective cohort studies and test-negative case-control studies published from inception up to Sept 31, 2022, that estimated the reduction in risk of COVID-19 among individuals with a past SARS-CoV-2 infection in comparison to those without a previous infection. We meta-analysed the effectiveness of past infection by outcome (infection, symptomatic disease, and severe disease), variant, and time since infection. We ran a Bayesian meta-regression to estimate the pooled estimates of protection. Risk-of-bias assessment was evaluated using the National Institutes of Health quality-assessment tools. The systematic review was PRISMA compliant and was registered with PROSPERO (number CRD42022303850). We identified a total of 65 studies from 19 different countries. Our meta-analyses showed that protection from past infection and any symptomatic disease was high for ancestral, alpha, beta, and delta variants, but was substantially lower for the omicron BA.1 variant. Pooled effectiveness against re-infection by the omicron BA.1 variant was 45·3% (95% uncertainty interval [UI] 17·3-76·1) and 44·0% (26·5-65·0) against omicron BA.1 symptomatic disease. Mean pooled effectiveness was greater than 78% against severe disease (hospitalisation and death) for all variants, including omicron BA.1. Protection from re-infection from ancestral, alpha, and delta variants declined over time but remained at 78·6% (49·8-93·6) at 40 weeks. Protection against re-infection by the omicron BA.1 variant declined more rapidly and was estimated at 36·1% (24·4-51·3) at 40 weeks. On the other hand, protection against severe disease remained high for all variants, with 90·2% (69·7-97·5) for ancestral, alpha, and delta variants, and 88·9% (84·7-90·9) for omicron BA.1 at 40 weeks. Protection from past infection against re-infection from pre-omicron variants was very high and remained high even after 40 weeks. Protection was substantially lower for the omicron BA.1 variant and declined more rapidly over time than protection against previous variants. Protection from severe disease was high for all variants. The immunity conferred by past infection should be weighed alongside protection from vaccination when assessing future disease burden from COVID-19, providing guidance on when individuals should be vaccinated, and designing policies that mandate vaccination for workers or restrict access, on the basis of immune status, to settings where the risk of transmission is high, such as travel and high-occupancy indoor settings. Bill & Melinda Gates Foundation, J Stanton, T Gillespie, and J and E Nordstrom.

Airborne levels of cadmium are correlated with urinary cadmium concentrations among young children living in the New York state city of Syracuse, USA

Air pollution is a serious public health issue with early childhood exposure being of high concern because of the greater risk that children might experience negative health outcomes. Industrial sources in and near communities are one potential path of exposure that children might face with greater levels of air pollution correlating with higher levels of toxicants detected in children. We compare estimated ambient air concentrations of Cadmium (Cd) to a cohort (n = 281) of 9 to 11-year old children during their early childhood years (0–5 years of age) in a mid-size city in Upstate New York. Levels of Cd air pollution are compared to children's urine-Cd levels. Urine has been shown to be a superior biomarker to blood for Cd exposure particularly for longer-term exposures. We find that participants who reside in households that faced greater Cd air pollution during the child's early years have higher urine-Cd levels. This association is stable and stronger than previously presented associations for blood-Cd. Findings support expanded use of air modelling data for risk screening to reduce the potential health burden that industrial pollution can have.

Towards fossil-free steel: Life cycle assessment of biosyngas-based direct reduced iron (DRI) production process

Given the urgent need for transitions towards global net zero emissions, decarbonisation of the iron and steel industry is critical. Deep decarbonising this sector requires a breakaway from current blast furnace-basic oxygen furnace (BF-BOF) technologies that largely depend on fossil resources. Biosyngas is considered to be a promising alternative to fossil energy and reductants used in existing ironmaking due to its renewability, technological maturity and compatibility for use in existing furnaces. The present work assesses the environmental impacts of biosyngas-based direct reduced iron production followed by electric arc furnace (DRI-EAF) routes for crude steel production. Further, the proposed routes are compared with the other steelmaking routes, including BF-BOF, natural gas (NG)-based and hydrogen-based direct reduction routes by performing life cycle assessment (LCA). The results indicate that the global warming potential (GWP) value for the biosyngas-based DRI-EAF system is 75% lower than the existing NG-based DRI-EAF route and 85% lower than the BF-BOF route. Moreover, the proposed system possibly has lower GWP values than the renewable hydrogen-based DRI-EAF route. The proposed system has an estimated cradle-to-gate GWP of 251 kg CO2 eq./t crude steel, of which 80% is from upstream emissions. Combined with CO2 storage, the GWP of the proposed system is a net negative, estimated at −845 kg CO2 eq./t crude steel for the selected system boundary. In addition to GWP, other non-climate impact indicators are also evaluated to identify potential burden shifting. The results highlight the emissions reduction potential of the novel biosyngas DRI production route. Large-scale deployment, however, requires sustainable forest management and adequate CCS infrastructure, along with a strong, long-term policy framework to incentivise the transitions.

Diabetes Among Racial and Ethnically Diverse Older Adults in the United States with Cognitive Limitations.

Diabetes is one of the most common coexisting conditions among adults with cognitive limitations. Complexities of diabetes care present challenges for older adults and their caregivers. Few studies have evaluated disparities in the prevalence of coexisting diabetes among older adults with cognitive limitations by race/ethnicity and nativity. Our objectives were to (1) estimate the odds of coexisting diabetes among US- and foreign-born racial/ethnic groups compared to US-born non-Hispanic White older adults and (2) compare US- and foreign-born older adults within each racial/ethnic group. We linked and analyzed 2000-2017 National Health Interview Survey and 2001-2018 Medical Expenditure Panel Survey data among older adults with cognitive limitations (ages ≥ 65years, n = 4688). The overall prevalence of coexisting diabetes among older adults with cognitive limitations was 30.3%. Among older adults with cognitive limitations and after adjusted for age, sex, education, and risk factors for diabetes and cognitive limitations, non-Hispanic Black (US-born OR = 1.56, 95%CI = 1.23-1.98; foreign-born OR = 2.69, 95%CI = 1.20-6.05) and Hispanic (US-born OR = 2.13, 95%CI = 1.34-3.40; foreign-born OR = 2.02, 95%CI = 1.49-2.72) older adults had higher odds of coexisting diabetes compared to US-born non-Hispanic Whites. There were no differences in the odds of coexisting diabetes among foreign-born non-Hispanic Black and Hispanic adults compared to US-born counterparts. Findings suggest a large potential burden of coexisting diabetes among this growing populations of US- and foreign-born racially/ethnically diverse older adults with cognitive limitations. Future studies are needed to examine how diabetes self-efficacy, treatment, and monitoring are impacted by cognitive limitations and determine ways to improve care in collaboration with caregivers and healthcare providers.

Classification and ranking of shigatoxin-producing Escherichia coli (STEC) genotypes detected in food based on potential public health impact using clinical data

Risk classification and management of shigatoxin-producing E. coli (STEC) isolated from food has been hampered by gaps in knowledge about the properties that determine the extent to which different subtypes of STEC can cause severe disease. Data on the proportion of infected human cases being affected by severe illness enables an evaluation of existing approaches for classifying STEC strains and the development of a new public health based approach. Evaluations show that existing approaches do not unequivocally classify different STEC variants according to their ability to cause severe disease. A new approach for ranking of STEC genotypes, combining the estimated probability of the strain to cause severe illness with the public health burden associated with the illness in terms of DALY per case, address these limitations. The result is a list of STEC genotypes in descending order of potential public health burden per case. The approach is risk based in considering the probability and consequences following infection (severe illness), and can support transparent risk management. This is illustrated by, arbitrarily, separating the ranked list of genotypes into classes based on the potential public health burden, and by characterising collections of strains isolated from different foods into different classes. Further, the classification of food samples as satisfactory or not based on the cost in terms of proportion of food being rejected and the benefit in terms of the proportion of strains causing severe illness (HUS) that are being captured is demonstrated using this approach.

Projecting COVID-19 cases and hospital burden in Ohio

As the Coronavirus 2019 disease (COVID-19) started to spread rapidly in the state of Ohio, the Ecology, Epidemiology and Population Health (EEPH) program within the Infectious Diseases Institute (IDI) at The Ohio State University (OSU) took the initiative to offer epidemic modeling and decision analytics support to the Ohio Department of Health (ODH). This paper describes the methodology used by the OSU/IDI response modeling team to predict statewide cases of new infections as well as potential hospital burden in the state. The methodology has two components: (1) A Dynamical Survival Analysis (DSA)-based statistical method to perform parameter inference, statewide prediction and uncertainty quantification. (2) A geographic component that down-projects statewide predicted counts to potential hospital burden across the state. We demonstrate the overall methodology with publicly available data. A Python implementation of the methodology is also made publicly available. This manuscript was submitted as part of a theme issue on “Modelling COVID-19 and Preparedness for Future Pandemics”.

A life cycle approach to indoor air quality in designing sustainable buildings: Human health impacts of three inner and outer insulations

This paper aims to develop a Life Cycle Assessment-based methodology to assess and compare the potential burden shifting between indoor air quality and energy consumption, as well as between the building construction and use stages, focusing on three insulation materials. We model the complete cause-to-effect chain to determine the mass of substances initially encapsulated inside the construction materials emitted into the indoor and outdoor compartment and further human intake, as well as the energy consumption needed for use stage heating.We found that human health damage due to indoor exposure is dominant over outdoor exposure for all insulation materials, except extruded polystyrene due to the off-gassing of tetrafluoroethane which has a high global warming potential. From a material life cycle perspective, the damage related to indoor emissions during the use stage is substantial for polyurethane foam, due to formaldehyde for both inner and outer insulations and also to Tris (1-chloro-2-propyl) phosphate for outer insulation, while restricted for polystyrene. Total damages on human health depend on building materials production, their emissions during use stage, and impacts related to energy load. They are minimized with a 20–25 cm outer insulation combined with a heat exchanger to ensure sufficient air quality while maximizing solar gain and minimizing air renewal-related heat losses.This methodology is valuable in addressing the trade-off between energy and exposure to materials-related emissions during building use stage, as a function of insulation thickness and air renewal rate, and paves the way to optimize the design of more sustainable buildings.

Economic Growth and Optimal Tax Burden: A Case of Uzbekistan’s Economy

Taxes have always been the largest contributor to the government budget revenue, so it is critical to collect maximum amount of tax revenue to meet policy objectives. The revenue performance of the countries, in turn, depends primarily on optimality of tax burden in an economy and capacity of revenue agencies to levy taxes set by the law. These factors have been major issues for all countries around the world, particularly for transition economies which are on the verge of major economic transformation. Uzbekistan as one of such countries, since 2017 has implemented multiple fiscal reforms to improve the fiscal capacity of the tax system, thereby increasing economic growth. To assess to what extend current tax policies are efficient, we put forward aim of the article as to elaborate the efficiency of Uzbekistan’s tax system using tax effort index to measure collection capability of potential tax revenue and optimal tax burden to maximize economic growth. In this study, we first using mathematical model identified tax effort index for Uzbekistan, which appeared to be approximately 45%. This implies that revenue agencies of Uzbekistan failed to collect on average half of the potential tax revenue over the period 2010–2020. Furthermore, we attempted to determine the optimal tax burden using the Ordinary Least Squares (OLS) method. According to the results of the econometric analysis, the optimal level of tax burden in Uzbekistan for the years 2000–2019 is estimated to be around 19%. Targeting tax burden to this level could reduce GDP gap by 1%.