Modeling fuel consumption and emissions by taxis in Tabriz, Iran: uncertainty and sensitivity analyses.

Taxis pose a higher threat to global climate change and human health through air emissions. However, the evidence on this topic is scarce, especially, in developing countries. Therefore, this study conducted estimation of fuel consumption (FC) and emission inventories on Tabriz taxi fleet (TTF), Iran. A structured questionnaire to obtain operational data of TTF, municipality organizations, and literature review were used as data sources. Then modeling was used to estimate fuel consumption ratio (FCR), emission factors (EFs), annual FC, and emissions of TTF using uncertainty analysis. Also, the impact of COVID-19 pandemic period was considered on the studied parameters. The results showed that TTF have high FCRs of 18.68 L/100 km (95% CI=17.67-19.69 L/100 km), which are not affected by age or mileage of taxis, significantly. The estimated EFs for TTF are higher than Euro standards, but the differences are not significant. However, it is critical as can be an indication of inefficiency of periodic regulatory technical inspection tests for TTF. COVID-19 pandemic caused significant decrease in annual total FC and emissions (9.03-15.6%), but significant increase in EFs of per-passenger-kilometer traveled (47.9-57.3%). Annual vehicle-kilometer-traveled by TTF and the estimated EFs for gasoline-compressed natural gas bi-fueled TTF are the main influential parameters in the variability of annual FC and emission levels. More studies on sustainable FC and emissions mitigation strategies are needed for TTF.

Experiences of Older Adults During COVID-19: Loss, Boredom, Uncertainty, Worry, and Resilience.

The coronavirus disease 2019 (COVID-19) pandemic and resulting instructions to stay home and social distance enhanced concerns of the impact of social isolation on the physical and mental well-being of older adults. Eighteen community-dwelling older adults participated in interviews describing their experiences early in the COVID-19 pandemic. Participants experienced loss of activities, routines, and social connection, and feelings of worry and uncertainty. Nevertheless, participants were hopeful about the future and demonstrated resilience in overcoming boredom as they became intentional in finding new activities and using technology to maintain connection with others. Older adults may need support in such situations to manage boredom and uncertainty and avoid social isolation. [Journal of Gerontological Nursing, 49(6), 27-32.].

Orthotopic Liver Transplantation of a SARS-CoV-2 Negative Recipient from a Positive Donor: The Border between Uncertainty and Necessity in a Pandemic Era- Case Report and Overview of the Literature.

(1) Introduction: Liver transplantation represents the gold-standard therapy in eligible patients with acute liver failure or end-stage liver disease. The COVID-19 pandemic dramatically affected the transplantation landscape by reducing patients' addressability to specialized healthcare facilities. Since evidence-based acceptance guidelines for non-lung solid organ transplantation from SARS-CoV-2 positive donors are lacking, and the risk of bloodstream-related transmission of the disease is debatable, liver transplantation from SARS-CoV-2 positive donors could be lifesaving, even if long-term interactions are unpredictable. The aim of this case report is to highlight the relevance of performing liver transplantation from SARS-CoV-2 positive donors to negative recipients by emphasizing the perioperative care and short-term outcome. (2) Case presentation: A 20-year-old female patient underwent orthotropic liver transplantation for Child-Pugh C liver cirrhosis secondary to overlap syndrome, from a SARS-CoV-2 positive brain death donor. The patient was not infected nor vaccinated against SARS-CoV-2, and the titer of neutralizing antibodies against the spike protein was negative. The liver transplantation was performed with no significant complications. As immunosuppression therapy, the patient received 20 mg basiliximab (Novartis Farmacéutica S.A., Barcelona, Spain) and 500 mg methylprednisolone (Pfizer Manufacturing Belgium N.V, Puurs, Belgium) intraoperatively. Considering the risk of non-aerogene-related SARS-CoV-2 reactivation syndrome, the patient received remdesivir 200 mg (Gilead Sciences Ireland UC, Carrigtohill County Cork, Ireland) in the neo-hepatic stage, which was continued with 100 mg/day for 5 days. The postoperative immunosuppression therapy consisted of tacrolimus (Astellas Ireland Co., Ltd., Killorglin, County Kerry, Ireland) and mycophenolate mofetil (Roche România S.R.L, Bucharest, Romania) according to the local protocol. Despite the persistent negative PCR results for SARS-CoV-2 in the upper airway tract, the blood titer of neutralizing antibodies turned out positive on postoperative day 7. The patient had a favorable outcome, and she was discharged from the ICU facility seven days later. (3) Conclusions: We illustrated a case of liver transplantation of a SARS-CoV-2 negative recipient, whose donor was SARS-CoV-2 positive, performed in a tertiary, university-affiliated national center of liver surgery, with a good outcome, in order to raise the medical community awareness on the acceptance limits in the case of COVID-19 incompatibility for non-lung solid organs transplantation procedures.

Evaluation and uncertainty analysis of Himawari-8 hourly aerosol product version 3.1 and its influence on surface solar radiation before and during the COVID-19 outbreak.

The hourly Himawari-8 version 3.1 (V31) aerosol product has been released and incorporates an updated Level 2 algorithm that uses forecast data as an a priori estimate. However, there has not been a thorough evaluation of V31 data across a full-disk scan, and V31 has yet to be applied in the analysis of its influence on surface solar radiation (SSR). This study firstly investigates the accuracy of V31 aerosol products, which includes three categories of aerosol optical depth (AOD) (AODMean, AODPure, and AODMerged) as well as the corresponding Ångström exponent (AE), using ground-based measurements from the AERONET and SKYNET. Results indicate that V31 AOD products are more consistent with ground-based measurements compared to previous products (V30). The highest correlation and lowest error were seen in the AODMerged, with a correlation coefficient of 0.8335 and minimal root mean square error of 0.1919. In contrast, the AEMerged shows a larger discrepancy with measurements unlike the AEMean and AEPure. Error analysis reveals that V31 AODMerged has generally stable accuracy across various ground types and geometrical observation angles, however, there are higher uncertainties in areas with high aerosol loading, particularly for fine aerosols. The temporal analysis shows that V31 AODMerged performs better compared to V30, particularly in the afternoon. Finally, the impacts of aerosols on SSR based on the V31 AODMerged are investigated through the development of a sophisticated SSR estimation algorithm in the clear sky. Results demonstrate that the estimated SSR is significant consistency with those of well-known CERES products, with preservation of 20 times higher spatial resolution. The spatial analysis reveals a significant reduction of AOD in the North China Plain before and during the COVID-19 outbreak, resulting in an average 24.57 W m-2 variation of the surface shortwave radiative forcing in clear sky daytime.

Physical distancing versus testing with self-isolation for controlling an emerging epidemic.

Two distinct strategies for controlling an emerging epidemic are physical distancing and regular testing with self-isolation. These strategies are especially important before effective vaccines or treatments become widely available. The testing strategy has been promoted frequently but used less often than physical distancing to mitigate COVID-19. We compared the performance of these strategies in an integrated epidemiological and economic model that includes a simple representation of transmission by "superspreading," wherein a relatively small fraction of infected individuals cause a large share of infections. We examined the economic benefits of distancing and testing over a wide range of conditions, including variations in the transmissibility and lethality of the disease meant to encompass the most prominent variants of COVID-19 encountered so far. In a head-to-head comparison using our primary parameter values, both with and without superspreading and a declining marginal value of mortality risk reductions, an optimized testing strategy outperformed an optimized distancing strategy. In a Monte Carlo uncertainty analysis, an optimized policy that combined the two strategies performed better than either one alone in more than 25% of random parameter draws. Insofar as diagnostic tests are sensitive to viral loads, and individuals with high viral loads are more likely to contribute to superspreading events, superspreading enhances the relative performance of testing over distancing in our model. Both strategies performed best at moderate levels of transmissibility, somewhat lower than the transmissibility of the ancestral strain of SARS-CoV-2.

COVID Vaccination in Athletes & Updated Interim Guidance on the Preparticipation Physical Examination during the SARS-CoV-2 Pandemic.

ABSTRACT: The American Medical Society for Sports Medicine (AMSSM) convened an expert panel to address the current evidence, knowledge gaps, and recommendations surrounding the COVID vaccination in athletes during the SARS-CoV-2 pandemic. The group held a series of meetings beginning in July 2021 and reviewed the available literature while using an iterative process and expert consensus to finalize this guidance statement. This document is intended to provide clinicians with suggestions on how to incorporate the COVID vaccination during the preparticipation physical examination for athletes in all levels of training and competition. The statement is not intended to address treatment, infection control principles, safety, ethical discussion, or public health issues related to SARS-CoV-2. The AMSSM task force acknowledges the clinical uncertainty, evolving public health objectives, and the limited data currently available to create this guidance statement.

Asia-Pacific stock market return and volatility in the uncertain world: Evidence from the nonlinear autoregressive distributed lag approach.

This paper examines the effects of three distinct groups of uncertainties on market return and volatility in the Asia-Pacific countries, including (i) the country-specific and US geopolitical risks; (ii) the US economic policy uncertainty; and (iii) the US stock market volatility (using the VIX and SKEW indices). Our sample includes 11 Asia-Pacific countries for the 1985-2022 period. We employ the nonlinear autoregressive distributed lag approach (ARDL) estimation technique to capture the asymmetric effects of uncertainties on market return and volatility, which are documented in the literature. Some findings are documented as follows. First, we find that US uncertainty indices, including US geopolitical risk, US economic policy uncertainty, and US VIX, significantly impact Asia-Pacific stock markets, while the impacts of domestic geopolitical risk and the US skewness index (SKEW) are relatively weak. Second, Asia-Pacific stock markets tend to overreact to uncertainty shocks stemming from US economic policy uncertainty and US geopolitical risk. Third, US economic policy uncertainty has more significant effects than the US geopolitical risk. Finally, our research documents that Asia-Pacific stock markets react heterogeneously to good and bad news from US VIX. Specifically, an increase in US VIX (bad news) has a stronger impact than a decrease in US VIX (good news). Policy implications have emerged based on the findings of this study.

The wisdom in the story: Clarifying assumptions about radical uncertainty and reasonableness in narrative judgment.

Human lives are radically uncertain. Making sense of such uncertainties is the hallmark of wisdom. Sense-making requires narratives, putting them in the center stage of human everyday decision-making. Yet what if radical uncertainty is a narrative itself? Moreover, do laypeople always consider such narratives irrational? Here we pose these questions to enrich a theory of choice under uncertainty.

Othering and Health Justice.

Bioethics needs to expand its vision. We must examine and interrogate the social and structural barriers that help traditionally privileged communities maintain minoritized groups as inherently inferior "others." Justice requires the field to look beyond the walls of hospitals, clinics, and medical academia to address and ameliorate the structural injustices that give rise to health disparities long before differential access to health services becomes an issue for underserved patients. Doing so means engaging in challenging multidisciplinary collaborations in order to understand the sociohistorical complexities of health and illness, appreciate the factors that contribute to shaming and blaming those "others" who are not "us," and work to lessen the discomfort with uncertainty that impedes equity. All of this necessary work takes bioethics well beyond the well-trodden pathways of our usual scholarship and practice. But we simply have to reach higher to do health justice.

Environmental reverberations of geopolitical risk and economic policy uncertainty resulting from the Russia-Ukraine conflict: A wavelet based approach for sectoral CO2 emissions.

After the COVID-19 pandemic, Russia invaded Ukraine in February 2022, and a natural gas crisis between the European Union (EU) and Russia has begun. These events have negatively affected humanity and resulted in economic and environmental consequences. Against this background, this study examines the impact of geopolitical risk (GPR) and economic policy uncertainty (EPU) caused by the Russia-Ukraine conflict, on sectoral carbon dioxide (CO2) emissions. To this end, the study analyzes data from January 1997 to October 2022 by using wavelet transform coherence (WTC) and time-varying wavelet causality test (TVWCT) approaches. The WTC results show that GPR and EPU reduce CO2 emissions in the residential, commercial, industrial, and electricity sectors, while GPR increases CO2 emissions in the transportation sector during the period from January 2019 to October 2022, which includes Russia-Ukraine conflict. The WTC analysis also indicates that the reduction in CO2 emissions provided by the EPU is higher than that of the GPR for several periods. According to the TVWCT, there are causal impacts of the GPR and the EPU on sectoral CO2 emissions, but the timing of the causal impacts differs between the raw and decomposed data. The results suggest that the EPU has a larger impact on reducing sectoral CO2 emissions during the Ukraine-Russia crisis and that production disruptions due to uncertainty have the greatest impact on reducing CO2 emissions in the electric power and transportation sectors.

Decision making under deep uncertainty for pandemic policy planning.

Policymakers around the world were generally unprepared for the global COVID-19 pandemic. As a result, the virus has led to millions of cases and hundreds of thousands of deaths. Theoretically, the number of cases and deaths did not have to happen (as demonstrated by the results in a few countries). In this pandemic, as in other great disasters, policymakers are confronted with what policy analysts call Decision Making under Deep Uncertainty (DMDU). Deep uncertainty requires policies that are not based on 'predict and act' but on 'prepare, monitor, and adapt', enabling policy adaptations over time as events occur and knowledge is gained. We discuss the potential of a DMDU-approach for pandemic decisionmaking.

The Psychosocial Impact of Treating Patients with COVID-19 on Psychiatry Residents in a Community Hospital: a Qualitative Study.

OBJECTIVE: The authors explored the experiences of psychiatry residents caring for patients during the COVID-19 pandemic on a medical unit. METHODS: From June 2020 through December 2020, structured, individual interviews were conducted with psychiatry residents deployed to internal medicine wards in a community hospital to provide medical care to COVID-19 patients for greater than or equal to 1 week. Interviews were recorded, transcribed verbatim, and analyzed using thematic analytical methods. RESULTS: Psychiatry residents (n = 16) were interviewed individually for approximately 45 min each. During the interviews, many residents described emotions of fear, anxiety, uncertainty, lack of preparedness, and difficulty coping with high patient mortality rates. Many of the residents expressed concerns regarding insufficient personal protective equipment, with the subsequent worries of their own viral exposure and transmission to loved ones. Multiple residents expressed feeling ill-equipped to care for COVID-19 patients, in some cases stating that utilizing their expertise in mental health would have better addressed the mental health needs of colleagues and patients' families. Participants also described the benefits of processing emotions during supportive group sessions with their program director. CONCLUSIONS: The COVID-19 pandemic represents a public health crisis with potential negative impacts on patient care, professionalism, and physicians' well-being and safety. The psychiatry residents and fellows described the overwhelmingly negative impact on their training. The knowledge gained from this study will help establish the role of the psychiatrist not only in future crises but in healthcare as a whole.

Reframing the local-global food systems debate through a resilience lens.

Despite the growing knowledge that food system solutions should account for interactions and drivers across scales, broader societal debate on how to solve food system challenges is often focused on two dichotomous perspectives and associated solutions: either more localized food systems or greater global coordination of food systems. The debate has found problematic expressions in contemporary challenges, prompting us to revisit the role that resilience thinking can play when faced with complex crises that increase uncertainty. Here we identify four 'aching points' facing food systems that are central points of tension in the local-global debate. We apply the seven principles of resilience to these aching points to reframe the solution space to one that embeds resilience into food systems' management and governance at all scales, supporting transformative change towards sustainable food systems.

Global uncertainty in the diagnosis of neurological complications of SARS-CoV-2 infection by both neurologists and non-neurologists: An international inter-observer variability study.

INTRODUCTION: Uniform case definitions are required to ensure harmonised reporting of neurological syndromes associated with SARS-CoV-2. Moreover, it is unclear how clinicians perceive the relative importance of SARS-CoV-2 in neurological syndromes, which risks under- or over-reporting. METHODS: We invited clinicians through global networks, including the World Federation of Neurology, to assess ten anonymised vignettes of SARS-CoV-2 neurological syndromes. Using standardised case definitions, clinicians assigned a diagnosis and ranked association with SARS-CoV-2. We compared diagnostic accuracy and assigned association ranks between different settings and specialties and calculated inter-rater agreement for case definitions as "poor" (κ ≤ 0.4), "moderate" or "good" (κ > 0.6). RESULTS: 1265 diagnoses were assigned by 146 participants from 45 countries on six continents. The highest correct proportion were cerebral venous sinus thrombosis (CVST, 95.8%), Guillain-Barré syndrome (GBS, 92.4%) and headache (91.6%) and the lowest encephalitis (72.8%), psychosis (53.8%) and encephalopathy (43.2%). Diagnostic accuracy was similar between neurologists and non-neurologists (median score 8 vs. 7/10, p = 0.1). Good inter-rater agreement was observed for five diagnoses: cranial neuropathy, headache, myelitis, CVST, and GBS and poor agreement for encephalopathy. In 13% of vignettes, clinicians incorrectly assigned lowest association ranks, regardless of setting and specialty. CONCLUSION: The case definitions can help with reporting of neurological complications of SARS-CoV-2, also in settings with few neurologists. However, encephalopathy, encephalitis, and psychosis were often misdiagnosed, and clinicians underestimated the association with SARS-CoV-2. Future work should refine the case definitions and provide training if global reporting of neurological syndromes associated with SARS-CoV-2 is to be robust.

Multiple models for outbreak decision support in the face of uncertainty.

Policymakers must make management decisions despite incomplete knowledge and conflicting model projections. Little guidance exists for the rapid, representative, and unbiased collection of policy-relevant scientific input from independent modeling teams. Integrating approaches from decision analysis, expert judgment, and model aggregation, we convened multiple modeling teams to evaluate COVID-19 reopening strategies for a mid-sized United States county early in the pandemic. Projections from seventeen distinct models were inconsistent in magnitude but highly consistent in ranking interventions. The 6-mo-ahead aggregate projections were well in line with observed outbreaks in mid-sized US counties. The aggregate results showed that up to half the population could be infected with full workplace reopening, while workplace restrictions reduced median cumulative infections by 82%. Rankings of interventions were consistent across public health objectives, but there was a strong trade-off between public health outcomes and duration of workplace closures, and no win-win intermediate reopening strategies were identified. Between-model variation was high; the aggregate results thus provide valuable risk quantification for decision making. This approach can be applied to the evaluation of management interventions in any setting where models are used to inform decision making. This case study demonstrated the utility of our approach and was one of several multimodel efforts that laid the groundwork for the COVID-19 Scenario Modeling Hub, which has provided multiple rounds of real-time scenario projections for situational awareness and decision making to the Centers for Disease Control and Prevention since December 2020.

Structures for collaboration and networked adaptation: Emerging themes from the COVID-19 pandemic.

The COVID-19 pandemic is a crisis that is "creeping" in its onset and "slow-burning" in its duration. It is characterized by extreme uncertainty, ambiguity, and complexity, presenting an unprecedented need for response across sectors and political-administrative levels. While there has been an explosion of research papers into the national strategies for handling the pandemic, empirical publications on the local and regional management are still scarce. This paper presents early empirical insights into key collaborative functions in Norway and Sweden, with an ambition to contribute to a research agenda focusing on the collaborative practices of pandemic crisis management. Our findings point to a set of themes that are all related to emerging collaborative structures, that fill holes in pre-established structures for dealing with crises, and that have been important for being able to effectively deal with the pandemic. At the municipal and regional levels, we see more examples of well-adapted collaborative practices than we see the wickedness of the problem causing inertia and paralysis. However, the emergence of new structures indicates a need to adapt organizational structures to the existing problem, and the duration of the current crisis allows for significant evolution of collaborative structures within the various phases of the pandemic. The lessons that can be drawn from this reveal a need for reconsideration of some of the basic assumptions of crisis research and practice, in particular the so-called similarity principle that is a cornerstone of emergency preparedness organization in many countries, including Norway and Sweden.