Maintaining and Advancing Quality Cancer Care During a Global Pandemic.

ABSTRACT: The care of patients with cancer occurs in a fast-moving, high-pressure, and high-stakes ecosystem. Early in 2020, that complex ecosystem was further complicated by the advent of the COVID-19 pandemic. We address actions taken by care providers and systems during the initial phases of the pandemic, and how those actions preserved lifesaving and life-sustaining cancer care despite severely constrained resources. We outline cancer care principles and guidelines that were developed, shared, and adopted by cancer care organizations across the country. Care delivery concerns that arose during the pandemic, including equipment and personnel shortages, moral distress for care providers, and exacerbation of health care inequities are addressed. Process and operations changes taken by payers to serve their clients are described. Lessons learned are highlighted, along with a call to action that we learn from the experience, broaden our cancer care delivery mission, and commit to structural changes that will permanently improve the capacity of cancer care teams.

Evidence of climatic change in Vietnam: Some implications for agricultural production.

Systemic changes in environmental conditions, such as climate, can have a significant impact on both natural and human systems. This paper provides an improved understanding of the spatio-temporal variations in underlying climate processes, and the potential effects climate change may have on Vietnam's agricultural sector. Statistical methods were combined with geostatistical techniques to test the statistical significance of long-term trends in the climatic variables, graphically representing the distribution of climate patterns, identifying variations and trends of changes over time and their likely effects on agricultural production. By using records of monthly precipitation and temperature for a relatively long-term period (1975-2014) over a high density of 112 meteorological stations across the country, robust statistical and visual evidence of climatic change throughout Vietnam are provided. The Mann-Kendall trend test confirms the statistically significant long-term trends of rainfall and temperature in many regions across the country. The visual analysis shows remarkable changes in the spatio-temporal distribution patterns of those variables and most of the 'hotspot' areas identified by geostatistical mapping are in areas with confirmed long-term trends. The long-term significant trends are also concentrated in areas with very high proportion of agricultural land, particularly land used for rice production in the Red River and Mekong River deltas. The findings deliver a better understanding of underlying climate processes and impacts across regions of Vietnam and provide a basis to develop effective climate-related policies for agricultural production in response to changing climatic conditions.