Auswahl der wissenschaftlichen Literatur zum Thema „National Long-Term Perspectives Studies (Program)“

Abstract State Medicaid programs are rebalancing their long-term care spending from nursing home to home and community-based services (HCBS). Emphasis on person-centered and person-directed care warrants investigation into models of HCBS delivery that promote quality of life. We performed a scoping review of the literature to catalogue the breadth of the studies describing HCBS waiver programs targeting adults (18+). We identified 757 articles, and after duplicate removal and reconciliation, we excluded articles on children or adolescents, non-peer reviewed reports, international studies, and articles that did not describe HCBS waiver programs. After abstract and title review, 292 articles met our inclusion criteria. Most included articles (22.3%) were single state descriptive evaluations or evaluations of service use patterns among participants. 17.8% of included articles examined multi-state or national variation in program trends, while 17.1% made national program conclusions without a major focus on interstate comparison. Less common were studies examining integrated care or dual-eligibles (7.5%), PACE (3.4%), medication management (3.1%), quality and satisfaction of both consumer and caretaker perspectives (3.8%) and consumer-only perspectives (5.1%). The remaining articles focused on HIV (4.1%), TBI (1.4%) or ID/DD (14.4%) waiver programs. The 8.9% of articles addressing quality and satisfaction consisted mostly of interviews, either with state Medicaid administrators or with care recipients and/or caregivers. Consumer reported satisfaction and unmet care needs were the primary outcomes examined. Given the heightened focus on long-term care as a result of the ongoing coronavirus pandemic, this review justifies further exploration into the delivery and outcomes of state-directed HCBS waiver programs.

Abstract Resident-to-resident aggression (RRA) is a widespread form of mistreatment in long-term care facilities, affecting 1 in 5 residents every month. Despite its high frequency and adverse consequences for residents, staff, and family members, RRA remains under-recognized and insufficiently studied. Several reasons exist for this, including challenges in obtaining high-quality data to inform evidence-based prevention and intervention strategies. Improved understanding of RRA aligns with recent national policy imperatives to increase nursing home safety and quality of care. To accelerate knowledge-to-practice translation, this symposium highlights expertise from North America and Asia to review the latest evidence and experiences that characterize and improve RRA. Dr. E-Shien Chang will identify the role of racial and ethnic conflicts in RRA using data from the largest RRA prevalence cohort study of U.S. nursing home residents. Dr. Elsie Yan will examine resident and environment risk factors of RRA in Hong Kong, illustrating the needs for improved dementia care training among direct care workers. Dr. David Burnes will discuss barriers, successes, and lessons learned in replicating and adapting a gold standard U.S. based RRA prevalence study in the unique context of Canada. Dr. Karl Pillemer will describe a novel dissemination model to expand program reach of Improving Resident Relationships in Long Term Care (IRRL), an evidence-based RRA intervention program. Finally, Dr. Laura Mosqueda, as policy expert of long-term care services and discussant, will moderate a discussion on translating RRA research to practice and policy changes within the global contexts of long-term care. This is a collaborative symposium between the Abuse, Neglect and Exploitation of Older Persons and Research in Quality of Care Interest Groups.

Abstract The concept of person-centeredness -- simply stated, knowing the person in a holistic perspective and meeting the individual’s needs and preferences -- has become so ubiquitous in health and supportive care that it borders on being a cliché. More so, it is often not reflected in national surveys and databases; considered in relation to the capacity of varying systems of care; forward-thinking in terms of emerging realities; or dissected in reference to some of the nuanced and implicit issues responsible for bringing it to the forefront of national attention. This Kleemeier Award lecture will reconstruct the concept of person-centeredness based on literature review, questionnaires, interviews, forums, and think tank meetings with diverse experts. It is supported by National Institute of Aging through a grant to the Alzheimer’s Association’s LINC-AD.

Abstract To meet the needs of community-living older adults and reduce overall medical spending, home- and community-based services (HCBS) provide assistance and care for persons with significant physical and cognitive limitations. Together, Medicaid long-term services and supports (LTSS) coverage and the Title III program under the Older Americans Act (OAA) of 1965 support the majority of the HCBS for older adults living in the U.S. with low-income and/or disabilities. We evaluated state variations in generosity of supporting HCBS in recent years and how these variations affect the healthcare outcomes of community-living older adults and socio-economic and racial disparities in dementia outcomes. State HCBS generosity from the perspectives of program participation and intensity of services was defined by the exploratory and the confirmatory factor analysis with data from multiple sources, including state reports from the National Association of State Budget Officers. State data was linked to a nationally representative sample of older adults who enrolled in the Health and Retirement Study in 2020. Analyses revealed that overall state supports for HCBS increased over time in recent years while state Medicaid expenditures for institutional long-term care remained largely stable. State supports through both Medicaid and the OAA programs for HCBS varied substantially and persisted in recent years. Discussion will focus on instrumental variable analyses that determine the causal impact of state variations in HCBS generosity on health outcomes (i.e., unmet need; hospitalization) for persons living with dementia persons.

Abstract There is a global trend of reforming long-term care to enable aging in place making it one of the most pressing health policy issues in both high- and low-middle income countries. However, there is no agreement on what is a successful aging in place reform. A holistic perspective that includes clinical, social and economic indicators is required to evaluate these reforms. In this scoping review, we aim to determine the extent of literature on evaluating aging in place reforms. We used the guidance of the JBI Scoping Review Methodology Group to conduct the scoping review. Articles on evaluation of aging in place reform and reporting on any outcome, process or structure quality indicator were eligible for inclusion. The search strategy was performed in Ovid Medline, Ovid Embase, and Ebscohost Academic Search Premier. There were no restrictions on publication year, language, and study design. The search identified 8,107 records. A total of 84 articles met the inclusion criteria and were included in the scoping review. Most studies were quantitative, observational studies from high income countries, using national population level data or larger cohorts. Frequently reported indicators were: total expenditures on long-term care, program spending per capita, hospitalization rates, length of stay, and home care utilization. Less reported were older adult and informal caregiver related indicators like: health, well-being, informal caregiver hours, and sleeping hours. Policy makers can use our findings to develop appropriate strategies to evaluate and monitor their own aging in place reforms.

Active learning strategies are widely studied, but perspective on their effectiveness in complete undergraduate studies or about their contribution to closing the gender gap are still required. Challenge-based learning has been around for more than a decade. However, results have been collected in limited time and application environments, for example, one semester or one activity in a course. In this work, we present a quantitative study that was applied to results of the National Center for the Evaluation of Higher Education’s Engineering Bachelor’s Degree Standardized General Examination of 4226 students comparing those who received a traditional educational model and those who received a challenge-based learning educational model. A statistical analysis of communication and disciplinary competencies found that the traditional educational model induces a greater marginal significant result in the test. Additionally, we found that female students perform better in communication competencies while male students perform better in disciplinary competencies. Our results confirm that challenge-based learning is as effective as a traditional educational model when applied during complete undergraduate studies while developing competencies like critical thinking, long-term retention, leadership, multidisciplinary teamwork, and decision-making. Challenge based learning is a prolific learning strategy for evolving into a new way of teaching in undergraduate programs.

Human Development Index (HDI) determines human prosperity in different countries using value assets. In general, the primary measurement includes the three basic indices, namely education, health, and a decent standard of living. HDI is a measure of development and governance success in terms of economic growth and human development. Generally, studies on HDI take place at the national and regional levels, and comparisons of its achievements between countries, while those at the municipal level are limited. Studies on the determinants of the success of increasing HDI tend to focus on local governments' fiscal capacity and political will and rarely touch the capacity of public administration in managing government, specifically in the development planning stage. This study examined the increased success of the Malang City's HDI by adopting a logical framework (log-frame) analysis with secondary data from the Malang bureau of statistics. The results showed an 80.89 increase in HDI from 2014 to 2018, including the education and health indexes, with a decent standard of living. The increased success is shown by the Regional Medium Term Development Plan (RPJMD), including basic education development program, regional public hospital service programs, and food security program for education, health, and purchasing power indices. Therefore, the local government needs to maintain and enhance the HDI in both medium- and long-term plans. The novelty of this study lies in the use of a logical framework in preparing regional development plans that support efforts to increase HDI consistently in the medium term. This reinforces the need to strengthen the perspective of how to achieve development goals compared to other studies that focus more on the perspective of the substance of development.

Abstract The Veterans Health Administration’s Care for Patients with Complex Problems (CP)2 Program developed a national infrastructure to disseminate promising practice models to improve care for Veterans with complex medical, mental health, and/or neurocognitive conditions, who may also have behaviors disruptive to care. A strategic priority is improving safe and effective transitions to community care for Veterans with complex care needs, many of whom have historically been limited to VA settings as a result of behavioral concerns. The Behavioral Recovery Outreach (BRO) Team was the first model identified for national dissemination and evaluation at partner sites. Developed at VA Central Iowa, BRO is an interdisciplinary team model that identifies Veterans in long-term VA care settings with complex care needs to engage in individualized behavioral programing to manage/stabilize behaviors and safely transition them to more appropriate and less costly community settings. This symposium will describe the BRO team model, highlight the facilitators and barriers to nationally disseminating the BRO model with VA partner facilities, discuss adaptations in continuing community transitions following the COVID-19 pandemic, and describe program outcomes. The first speaker will discuss development of the BRO model and outcomes of a regional dissemination. The second speaker will present results from the program evaluation of the national dissemination. The final speaker will describe BRO Team expansion and lessons learned from the perspective of a VA partner facility. The (CP)2 Program Director will integrate findings and highlight implications for scaling and evaluating promising models for national dissemination for policy, practice, and future research.

Abstract Sociocultural aspects of gerontology education have received growing attention in recent decades, as globalization and population aging resulted in more diverse older populations across global communities. Accordingly, gerontologists must equip with cultural and international competencies for their future careers, regardless of the fields, such as health care, long-term care, research, and education. This presentation outlines a development and case study (2023) of an international gerontology education course designed for graduate students in the U.S. After the preparation sessions, students take a faculty-led two-week trip to Japan, which is known as a super-aging society with nearly 30% of the population is age 65 years and older, and visit multiple aging-related sites including government agencies, research and education organizations, local communities, industries (e.g., robotics) and cutting-edge programs (e.g., health care research incubation program). The presentation offers three components. First, the academic objectives, such as the enhancement of cultural competencies and cross-national perspectives in gerontology, are described. Second, the practical course development process, including curriculum construction, planning trips, professional networking, student recruitment, funding source, coordination between two countries, and outcome assessment strategies, are illustrated. Finally, using the course evaluation data (n = 13 graduate students from 9 aging-related programs) and qualitative data (journals and field notes), positive outcomes (e.g., increased interest in working with socio-culturally diverse older adults) and challenges (e.g., funding international travel; scheduling difficulty; language barrier) are evaluated.

Abstract Innovative care models for older adults such as non-institutional and home-based care have the potential to improve quality and efficiency of healthcare, but adoption of these models requires resources from health systems. Health systems leaders can influence the relative priority of geriatric care and associated resource allocation. This influence is especially important for areas with limited resources such as in rural areas. We interviewed recently retired health system leaders about their experience and how priorities in health systems can be aligned to improve the quality and reach of geriatric care. We conducted qualitative interviews with 10 participants (40% female) using a snowball sampling strategy of geographically diverse, retired hospital, regional, and national leaders in the Veteran Healthcare system, the largest single-payer system in the US. Participants described how they managed myriad competing health system priorities by weighing and devoting attention and time to tackle the crises of the day, the numerous national mandates and directives, and the goals for the local hospital or system, as seen from their own perspectives. Alignment with performance metrics provides strong impetus for some health system leaders to determine their priorities. Incentives to encourage health systems leaders to prioritize and allocate resources aimed at long-term improvements in care could be important. Additionally, building relationships and maintaining trust amongst partners across facilities and offices is critical to initiating and growing geriatrics programs. This work highlights that influence must work on multiple levels to effect change in prioritization of care for older adults.

»Transatlantic Caribbean« widens the scope of research on the Caribbean by focusing on its transatlantic interrelations with North America, Latin America, Europe and Africa and by investigating long-term exchanges of people, practices and ideas. Based on innovative approaches and rich empirical research from anthropology, history and literary studies the contributions discuss border crossings, south-south relations and diasporas in the areas of popular culture, religion, historical memory as well as national and transnational social and political movements. These perspectives enrich the theoretical debates on transatlantic dialogues and the Black Atlantic and emphasize the Caribbean's central place in the world.

Revolutionary Worlds looks at the Indonesian revolution (1945-1949) from a local and regional perspective. With seventeen contributions, Indonesian and Dutch researchers bring to life the revolutionary world from widely differing perspectives. The authors explain how Indonesian, Chinese, Indian and Eurasian civilians, fighters, farmers and officials experienced and shaped the often volatile period between 1945 and 1950. The book focuses on different ideas of independence, survival strategies, mobilization, minorities, contestation of authority and the use of force against the backdrop of Indonesian and Dutch authorities’ efforts to gain or maintain control. Bringing together two national historiographical traditions which have long remained largely separate, Revolutionary Worlds is the result of a collaboration between the Indonesian research project Proklamasi Kemerdekaan, Revolusi dan Perang di Indonesia ('Proclamation of Independence, Revolution and War in Indonesia', Universitas Gadjah Mada, Yogyakarta) and the Dutch research group of the Regional Studies project, under the umbrella of the research programme Independence, Decolonization, Violence and War in Indonesia, 1945-1950. The authors of this book – Taufik Ahmad, Galuh Ambar Sasi, Maarten van der Bent, Martijn Eickhoff, Farabi Fakih, Roel Frakking, Apriani Harahap, Anne-Lot Hoek, Sarkawi B. Husain, Julianto Ibrahim, Gerry van Klinken, Erniwati, Mawardi Umar, Anne van der Veer, Abdul Wahid, Tri Wahyuning M. Irsyam, and Muhammad Yuanda Zara – work with various universities and research institutes in Indonesia and the Netherlands.

This book addresses the role of media, particularly periodicals, in the American women’s suffrage movement, and in public understandings of the campaign for a Constitutional amendment enfranchising women. Chapters deal with the rhetoric of pro- and antisuffrage activists as covered in the mainstream regional and national press; several chapters deal with suffragists’ own periodicals, as well as with other non-mainstream periodicals, including the black press and socialist and radical periodicals. These new studies offer fresh perspectives on relatively familiar suffrage narratives while exploring lesser-known aspects of the roles of journalism, publicity, visual communication, and external alliances with organizations and individuals. Taken collectively, the chapters clarify intersections of suffrage ideas with other social and political movements as well as differences by geography and culture. The essays are marked by attention to the movement’s long-term implications; to contemporary concepts such as social movement and countermovement strategies, status conflict, and the public sphere; and by sensitivity to race, class, and regional politics. As the historiography offered here makes clear, these issues were largely ignored in the first wave of suffrage research.

Abstract This book tells the amazing story of significant improvement and recovery of 538 people once severely and chronically disabled with schizophrenia and other psychotic disorders. They were “hopeless cases” in state hospitals in Vermont and Maine. As part of two studies three decades-long funded by the National Institute of Mental Health, the Vermonters received a pioneering rehabilitation program and the Mainers did not. Against all expectations, 68% of Vermont patients were able to reclaim their lives, while the Maine patients achieved improvement at 49%. Nine other very long-term studies from across the world also revealed similar findings on improvement and recovery in schizophrenia. These data provide impetus for a paradigm shift in psychiatry as well as significant implications for the redesign of public policy and programs. Most clinicians believe they are already doing recovery work, but old treatment models abound. The primary biomedical model uses maintenance, stabilization, medications, and entitlements, in an inpatient model that maintains chronicity for outpatients. This book is written for a wide audience, using mostly nonacademic language and many stories. Current and past patients, family members, medical students, residents, professors, and clinical researchers, as well as program administrators and public policymakers, should find this book helpful. The author has been working with clinicians all system components for 40 years and knows their concerns. They are hardworking but tired and often disheartened. They need new ideas and methods, and patients need new avenues to get their lives back.

Migration, asylum, and citizenship have become unavoidable topics in contemporary European politics. Klopp examines the issues of immigration, integration, and multiculturalism in Germany, Europe's premier immigration country, through the perspectives of both immigrants and local institutions (unions, employers, schools, neighborhoods, and city government). Klopp addresses the potential for immigration patterns and increasing heterogeneity to produce the conditions for social transformation, and specifically he shows how these factors are challenging and gradually transforming the boundaries of citizenship and the nation in Germany. Theoretically he argues against recent models of postnational and transnational membership that claim that the nationstate model of citizenship has been superseded by a new type of membership, one that guarantees individual rights via international human rights norms. Given the claims of these models, we should expect that long-term resident aliens will be satisfied with the partial citizenshp rights (civil and social) extended to them by liberal European welfare states, and that they will not identify with, or seek political rights from, their state of residence. On the contrary, Klopps suggests that national-state citizenship remains the essential form of formal social and political inclusion for the majority of immigrants. In the past Germany has represented an extreme case of ethnocultural exclusion, and it is therefore something of a natural laboratory in which to examine the reciprocal measures and mechanisms of political and social change currently underway in Europe. Lessons learned from qualitative empirical examination of immigration and integration processes in Germany could prove instructive when compared to similar processes of transformation underway in the other tranditonal nation-states of Western Europe and in the efforts to define a common European identity. Provocative reading for scholars, students, and other researchers as well as policy makers involved with migration issues, comparative politics and citizenship, and contemporary German studies.

AbstractThis chapter helps readers unfamiliar with sociology to obtain a concrete picture of what a sociological approach to development is. It presents arguments based not only on previous research in the English-speaking world, but also on research trends in Japan. Sociological studies of development can be divided into two fields based on their disciplinary origins and research orientation: ‘Sociology of Development’ and ‘Development Sociology’. First, this chapter explains the difference between these research areas. Furthermore, as a case study, the issue of displacementand resettlement induced by dam construction is presented to examine what kind of sociological analysis has been conducted in these research areas. Accordingly, the author presents research perspectives that are considered unique to sociology in development issues: power relations among actors at development sites; secondary, indirect, mid-, and long-term impacts of development projects; macro–micro linkages among international, national, and regional transformations; and values, culture, and discourse on development. Finally, a discussion is presented on the role of sociological research in the debate on sustainability and how it can play a significant part.

AbstractBuilding on the two rounds of exposure studies with human milk coordinated by the World Health Organization (WHO) in the mid-1980s and 1990s on polychlorinated biphenyls (PCB), polychlorinated dibenzo-p-dioxins (PCDD), and polychlorinated dibenzofurans (PCDF), five expanded studies on persistent organic pollutants (POPs) were performed between 2000 and 2019. After the adoption of the Stockholm Convention on POPs (the Convention) in 2001, WHO and the United Nations Environment Programme (UNEP) collaborated in joint studies starting in 2004. The collaboration aimed at provision of POPs data for human milk as a core matrix under the Global Monitoring Plan (GMP) to assess the effectiveness of the Convention as required under Article 16. Over time, the number of analytes in the studies expanded from the initial 12 POPs targeted by the Convention for elimination or reduction to the 30 POPs covered under the Stockholm Convention and two other POPs proposed for listing as of 2019. Many of these chemicals have numerous congeners, homologous groups, isomeric forms, and transformation products, which significantly extends the number of recommended analytes.In the studies between 2000 and 2019, 82 countries from all five United Nations regions participated, of which 50 countries participated in more than one study. For the human milk samples of the 2016–2019 period, results are available for the full set of 32 POPs of interest for the Convention until 2019: (i) the 26 POPs listed by the start of the study in 2016; (ii) decabromodiphenyl ether [BDE-209] and short-chain chlorinated paraffins [SCCP] as listed in 2017; (3) dicofol and perfluorooctanoic acid [PFOA] as listed in 2019; (4) medium-chain chlorinated paraffins [MCCP] and perfluorohexane sulfonic acid [PFHxS] as proposed for listing. This is a unique characteristic among the core matrices under the GMP.Four key messages can be derived: These studies are an efficient and effective tool with global coverage as key contributor to the GMP. After collection of a large number of individual samples (usually 50) fulfilling protocol criteria, pooled samples are prepared using equal aliquots of individual samples (physical averaging) and are considered to be representative for a country, subregion or subpopulation at the time of the sampling. The analysis of pooled representative human milk samples by dedicated Reference Laboratories meeting rigorous quality criteria contributes to reliability and comparability and reduces uncertainty of the analytical results. Additionally, this concept is very cost-effective. These studies can be used for regional differentiation based on concentrations of individual POPs between and within the five UN Regional Groups (African Group, Asia-Pacific Group, Eastern European Group, Group of Latin American and Caribbean Countries; Western European and Others Group). For some POPs, a wide range of concentrations with up to three orders of magnitude between lower and upper concentrations was found, even for countries in the same UN region. Some countries had levels within the usual range for most POPs, but high concentrations for certain POPs. Findings of concentrations in the upper third of the frequency distribution may motivate targeted follow-up studies rather than if the observed level of a POP is found in the lower third of frequency distribution. However, the concentration of a POP has also to be seen in context of the sampling period and the history and pattern of use of the POPs in each country. Therefore, results are not intended for ranking of individual countries but rather to distinguish broader patterns. These studies can provide an assessment of time trends, as possible sources of variation were minimized by the survey concepts building on two factors (sampling design; analysis of the pooled samples by dedicated Reference Laboratories). The estimation of time trends based on comparison of median or mean concentrations in UN Regional Groups over the five surveys in five equal four-year periods between 2000 and 2019 provides a first orientation. However, the variation of the number of countries participating in a UN Regional Group in a certain period can influence the median or mean concentrations. Thus, it is more prudent to only use results of countries with repeated participation in these studies for drawing conclusions on temporal trends. The reduction rates in countries should be seen in context with the concentration range: A differentiation of high levels and those in the range of the background contamination is meaningful. If high levels are found, sources might be detected which could be eliminated. This can lead to significant decrease rates over the following years. However, if low background levels are reported, no specific sources can be detected. Other factors for exposure, e.g. the contamination of feed and food by air via long-range transport and subsequent bioaccumulation, cannot be influenced locally. However, only very few time points from most individual countries for most POPs of interest are available, which prevents the derivation of statistically significant temporal trends in these cases. Yet, the existing data can indicate decreasing or increasing tendencies in POP concentrations in these countries. Furthermore, pooling of data in regions allows to derive statistically significant time trends in the UN Regional Groups and globally. Global overall time trends using the data from countries with repeated participation were calculated by the Theil–Sen method. Regarding the median levels of the five UN Regional Groups, a decrease per 10 years by 58% was found for DDT, by 84% for beta-HCH, by 57% for HCB, by 32% for PBDE, by 48% for PFOS, by 70% for PCB, and by 48% for PCDD and PCDF (expressed as toxic equivalents). In contrast, the concentrations of chlorinated paraffins (CP) as “emerging POPs” showed increasing tendencies in some UN Regional Groups. On a global level, a statistically significant increase of total CP (total CP content including SCCP [listed in the Convention in 2017] and MCCP [proposed to be listed]) concentrations in human milk of 30% over 10 years was found. The studies can provide the basis for discussion of the relative importance (“ranking”) of the quantitative occurrence of POPs. This, however, requires a differentiation between two subgroups of lipophilic substances ([i] dioxin-like compounds, to be determined in the pg/g [=ng/kg] range, and [ii] non-dioxin-like chlorinated and brominated POPs, to be determined in the ng/g [=μg/kg] range; both groups reported on lipid base) and the more polar perfluorinated alkyl substances (PFAS); reported on product base [as pg/g fresh weight] or on volume base [ng/L]. For this purpose, results for the complete set of the 32 POPs of interest for the 2016–2019 period were considered. By far, the highest concentrations of lipophilic substances were found for DDT (expressed as “DDT complex”: sum of all detected analytes, calculated as DDT; maximum: 7100 ng/g lipid; median: 125 ng/g lipid) and for chlorinated paraffins (total CP content; maximum: 700 total CP/g lipid; median: 116 ng total CP/g lipid). PCB was next in the ranking and had on average an order of magnitude lower concentrations than the average of the total CP concentrations. The high CP concentrations were caused predominantly by MCCP. If the pooled samples from mothers without any known major contamination source nearby showed a high level of CP, some individual samples (e.g. from local population close to emission sources, as a result of exposure to consumer products or from the domestic environment) might even have significantly higher levels. The lactational intake of SCCP and MCCP of the breastfed infant in the microgram scale resulting from the mothers’ dietary and environmental background exposure should therefore motivate targeted follow-up studies and further measures to reduce exposure (including in the case of MCCP, regulatory efforts, e.g. restriction in products). Further, due to observed levels, targeted research should look at the balance among potential adverse effects against positive health aspects for the breastfed infants for three groups of POPs (dioxin-like compounds; non-dioxin-like chlorinated and brominated POPs; PFAS) regarding potentially needed updates of the WHO guidance. As an overall conclusion, the seven rounds of WHO/UNEP human milk exposure studies are the largest global survey on human tissues with a harmonized protocol spanning over the longest time period and carried out in a uniform format. Thus, these rounds are an effective tool to obtain reliable and comparable data sets on this core matrix and a key contributor to the GMP. A comprehensive set of global data covering all POPs targeted by the Stockholm Convention, in all UN Regional Groups, and timelines covering a span of up to three decades allows to evaluate data from various perspectives. A widened three-dimensional view is necessary to discuss results and can be performed using the three pillars for assessments of the comprehensive data set, namely: analytes of interest; regional aspects; time trends. This can identify possible problems for future targeted studies and interventions at the country, regional, or global level. Long-term trends give an indication of the effectiveness of measures to eliminate or reduce specific POPs. The consideration of countries with repeated participation in these studies provides the best possible database for the evaluation of temporal trends. The continuation of these exposure studies is important for securing sufficient data for reliable time trend assessments in the future. Therefore, it is highly recommended to continue this monitoring effort, particularly for POPs that are of public health concern.

Evolution of the Long-Term Ecological Research (LTER) program has required highly motivated leadership in both the National Science Foundation (NSF) and the science community. It has also benefited from inspired leaders in other agencies. Core research areas enable comparative study across highly diverse field sites. The LTER program promotes integrative ecological research and is an important model for other environmental research programs. New observational capabilities and emerging networks will change the operating environment for the LTER program in unforeseen ways. The conceptualization and implementation of the LTER program that began in the mid-1970s have depended on the dedicated guidance and input from a large number of individuals within NSF management, within other agencies (particularly the US Forest Service), and in the science and education communities that they serve. The authors served as NSF program directors for the LTER program, respectively, for 10, 8, and 14 years between 1997 and 2011, in the Biological Sciences Directorate (BIO), Office of Polar Programs (OPP), and the Geosciences Directorate (GEO). From that context, we offer our perspectives on this remarkable program. Several central issues have dominated the development of the LTER program since its inception in 1980. These issues are the designation of core thematic research areas, the establishment of new sites and the expansion of NSF program involvement, the evolution of comparative and synthetic science across multiple LTER sites, the dynamics of top-down (NSF-driven) and bottom-up (principal investigator–driven) efforts that have coalesced to produce the present-day network, and the development of new environmental observing capabilities that should enhance the future scientific impact of the LTER program. The specification and emphasis on five core research areas (Waide, Chapter 2) as elements of the LTER program, which served as part of the initial rationale for the formation of the program, have varied over time and with changes in program management at NSF. Our consensus is that core research themes provide a major vehicle for integrative research, both comparative and synthetic, and additionally, serve as a strong guide for programmatic review.

As a scientist, the Long-Term Ecological Research (LTER) program has deeply influenced my approach to scientific inquiry by creating an environment of effective collaboration and long-term evaluations of ecosystems. The increasing emphasis on data management and sharing has shaped both the philosophy and implementation of my scientific projects. I have become a highly collaborative scientist because of my experiences with the effectiveness of collaborative inquiry, put in place by initiatives including the LTER program and institutes such as National Center for Ecological Analysis and Synthesis (NCEAS). I have been involved in the LTER program since I began my first faculty position at Oregon State University in 2004. Although my primary site affiliation is now Cedar Creek Ecosystem Science Reserve (CDR), I have ongoing experiments and collaborations spanning nine LTER sites (Borer et al. 2014b). I am a community ecologist with work that bridges into ecosystems. My research focuses on quantifying the consequences of global changes (e.g., nitrogen deposition, species invasions and extinctions) for interactions among species, including host–pathogen, plant–herbivore, and plant–plant interactions, and the resulting consequences for ecosystem functions. Since 2007, I have been the lead principal investigator of the Nutrient Network (NutNet; www.nutnet.org), a global scientific cooperative of more than 100 scientists performing identically replicated experiments at more than 75 sites in 17 countries on 6 continents to examine the interactive effects of herbivory and multiple nutrients on controlling critical processes and functions in the world’s grasslands (Borer et al. 2014a). I am currently an associate professor in the Ecology, Evolution, and Behavior Department at the University of Minnesota and serve as senior personnel on the ongoing National Science Foundation (NSF) grant supporting CDR. My LTER site affiliation is not entirely clear in my own mind, even though I am listed as a scientist at CDR. Although I have ongoing projects at LTER sites, primarily at CDR, I do not consider myself a site-based researcher in the LTER program.

A hallmark of my career has been the development of a model of the responses of salt marsh vascular plants to changes in sea level. This discovery would not have been possible without long-term support from the National Science Foundation (NSF) Long-Term Ecological Research (LTER) and Long-Term Research in Environmental Biology (LTREB) programs. The LTER and LTREB programs have provided platforms for student research that would have been difficult or impossible to duplicate. Most of my students have benefited from the background of data, which stimulate a never-ending source of thesis topics and from the logistical support. My communication skills have been improved by LTER-sponsored workshops with journalists. I also have had an opportunity to share my enthusiasm for fieldwork with primary school students and teachers. Many of my numerous collaborations are consequences of novel, long-term data that emerged from research supported by the LTER and LTREB programs. There are important environmental trends that develop slowly in response to climate or that reveal themselves infrequently, such as disturbance responses, thresholds, and tipping points. These require long-term, place-based observation of the kind that the LTER and LTREB programs are designed to facilitate. My history with the LTER program began in the late 1970s. As a Yale graduate student working at The Ecosystems Center, Marine Biological Laboratory (MBL) at Woods Hole, I participated in a workshop organized by Dan Botkin to develop a rationale for a longterm ecological monitoring program (Botkin 1978). After a 2-year postdoctoral fellowship, I moved in 1981 to the University of South Carolina (USC), which had sponsored one of the first LTER sites, North Inlet (NIN). North Inlet was the perfect place for starting a research program in salt marsh ecology, and my research there eventually was supported by the NSF LTREB program. I owe a great deal to NSF for that. My early career benefited enormously from infrastructure at USC’s field laboratory and support by the NIN LTER program, which I did not fully appreciate at the time.

Postpartum family planning (PPFP) interventions have immense potential to address the unmet contraceptive need in women from the time their baby is delivered till a variable period in their reproductive span. Postpartum intrauterine contraceptive device (PPIUCD) is one among the birth-spacing and birth-limiting contraceptive options. They have most attributes of an ideal contraceptive providing prolonged contraception akin to permanent contraceptives with scope of reversibility should the reproductive intentions of the couple change in future. This appeals to the societies and religious communities, who oppose permanent contraception. However, the acceptance and long-term continuation of the IUCD remains limited to and fails to total fertility rates (TFR) in populations who need it most. Global studies indicate this is often due to service providers’ adverse negative perception of PPIUCD, poor counseling skills, lack of technical skills in its insertion, and logistical limitations in various health facilities where deliveries occur, as well as the women’s and their family’s perspective about it rather than any intrinsic adverse characteristic of the device. The chapter is discourse about PPIUCD from multiple dimensions to define the barriers and challenges to its use in current practice. Interventions suggested may be incorporated into the national PPFP policy and program implementation as it is rolled out as a sustainable population control measure with far-reaching implications.

The influence of the Long-Term Ecological Research (LTER) program on my science has been to broaden my scope through exposure to long-term research and to encourage me to explore major questions across biomes. Communication and outreach with natural resource managers and policy makers has given me insight into translation of science and shaped my research. Through my experiences in the LTER program, I began collaborations with stream ecologists and biogeochemists across sites, which expanded into a high-profile research project that spanned several decades. I encourage scientists to work at LTER sites because they are supportive science communities with a wealth of information to share. Currently, I am a co–principal investigator at the H. J. Andrews Experimental Forest LTER project (AND) in Oregon and have been involved with LTER sites most of my professional life. In 1990, I began graduate research on freshwater shrimp responses to a hurricane at the Luquillo LTER site (LUQ) with Alan Covich, my PhD advisor at the University of Oklahoma. My involvement with LTER research expanded during my postdoctoral fellowship. Through the LTER All Scientists Meetings, I met Julia Jones and other researchers from AND. With their encouragement, I received a National Science Foundation (NSF) Postdoctoral Fellowship Grant in 1996 to examine stream temperature dynamics at AND. After several years at Oregon State University, I was hired by the US Forest Service (USFS) Pacific Northwest Research Station in 2001 as a USFS scientist for AND and became a co–principal investigator in 2002. I have had the benefit of being mentored for multiple years by Fred Swanson and have gradually assumed lead USFS responsibilities for AND. As a stream ecologist, I have studied basic questions and applied issues involving water quality, water quantity, and stream food webs, primarily in forested streams. My research at the LUQ site has examined responses of fresh water shrimp to disturbances and their role in ecosystem dynamics. At AND, my research exploring patterns and controls of stream temperature began as a theoretical landscape-scale question and expanded to examination of temperature responses to flow paths, calculations of heat budgets, and policy implications of forest management (Johnson and Jones 2000; Johnson 2004).

Ecology has a history of long-term studies that offer great insight to ecosystem processes. The advent of the Long-Term Ecological Research (LTER) program institutionalized long-term studies with some core measurements at a selection of sites across North America. The most successful LTER sites are those that have an energetic leader with a clear vision, who has guided the work over many years. Several LTER sites have established successful education programs for K–12 and college-age students, as well as for science policy-makers. Implementation of more and better cross-site work would be welcome. The various essays in this volume reflect a broad range of experiences among participants in the LTER program. Nearly all are positive: only mad dogs bite the hand that feeds them. All authors appreciate the advantages of long-term funding for their research and lament that funding of the LTER program by the National Science Foundation (NSF) is so limited. There are numerous testimonials for how the LTER program has changed and broadened participation in collaborative science. The real question is whether the LTER program has allowed science to proceed faster, deeper, broader, and with more critical insight than if the program had not been created. To answer that question, I offer a few personal reflections on the LTER program. First, we must note that long-term research existed well before the LTER program. Edmondson began his long-term measurements of exogenous phosphorus in Lake Washington in the early 1950s (Edmondson 1991). Across the country, Herb Bormann and Gene Likens began long-term studies, now in their 50th year, of forest biogeochemistry at Hubbard Brook in 1963 (Likens 2013). Each of these long-term studies enjoys ample coverage in every text of introductory ecology. The advantages of long-term research are undisputed among those who are funded for it. Indeed, NSF embraces a wide variety of decade-long studies with its Long-Term Research in Environmental Biology (LTREB) program. The authors of several chapters recall how Howard Odum’s early work focused their attention on the connections between large units of the landscape.

The Long-Term Ecological Research (LTER) program has affected how I conduct and evaluate ecological research. Working with the LTER program has given me a greater appreciation for the complexity of the natural world and has provided a framework to study it. The LTER program has provided the best possible venue to connect ecological research with classroom instruction, mentoring, and professional development. Translating our science to the public is a challenge. My experiences in the LTER program have provided multiple opportunities to work with the public, K–12 and college or university students, and professionals in different fields. This process has honed my communication skills. The ideas that emerge from true collaborative science cannot be understated. The work at an LTER site and within the LTER network works best when we collaborate. I received my undergraduate training in ecology at the University of California (UC) Santa Barbara. At UC Santa Barbara in the 1970s, the ecology program focused largely on populations and communities. Field observations, laboratory studies, manipulative field studies, and equation-based modeling were the norm. I recall the first set of litter and soil samples of arthropods that I sorted were extracted using Tullgren funnels and thought at the time that a person would have to be insane to pursue this type of work as a career. Two years later, I was in the graduate program at Michigan State University working with Dr. Richard Snider where I studied the impacts of herbicides on soil arthropods in no- till corn. At Michigan State, I learned the importance of species life histories, behaviors, and tolerances to environmental variation. My first exposure with the LTER program started in 1979, during my first year of graduate school at Michigan State University. A National Science Foundation (NSF) program officer was visiting the university to promote the concept of the LTER program and the first round of competition. Being 22 years old at the time, it was difficult for me to appreciate discussions about a program that would potentially operate over several decades. As a graduate student, it was a lesson in the planning, extended time frame, and other programmatic logistics of collaborative science.

My college education as a fish and fishery ecologist provided a solid base for my evolution to a scientist absorbed by the long-term ecology of lakes in the landscape. Graduate students in the Long-Term Ecological Research (LTER) program and in my course lectures came to represent more disciplines and became more interdisciplinary, often addressing major ecological questions using long-term data. Viewing the dynamics of a time series and spatial maps became strong approaches in the LTER program for communicating with colleagues and the broader community. The LTER program would have failed without the realization and the broad application of collaboration. That is true, of course, for much of what we do. The LTER program is a great way to participate in and learn from a life of science teaching, research, application, and outreach. My association with the LTER program began in the late 1970s when I was a 41- year-old associate professor at the University of Wisconsin–Madison. It continued through the remainder of my professional life to the present; I am now an 80-year-old emeritus professor at the Center for Limnology at the University of Wisconsin–Madison. I had been the program director for Ecology in the Division of Environmental Biology at the National Science Foundation (NSF) for 1 year (1975–1976) and saw the first movements toward such a program. I participated in all three NSF workshops in the late 1970s to consider and plan an LTER program. At the workshops, I represented the perspectives of limnology and our field site at the Trout Lake Station in northern Wisconsin. Ideas being discussed and planned were of great interest to me. I believed that research opportunities at field stations with this long- term approach were important to the ecological sciences and to biological field stations across the country. My colleagues and I at the University of Wisconsin–Madison responded to NSF’s initial call for proposals; we were one of the first six sites to be funded for a proposal entitled “Long-Term Ecological Research on Lake Ecosystems.”

According to statistics from the China National Resources Recycling Association, only 31% of the approximately 62 million tons of waste plastic produced in China in 2021 was recycled. The reason is that the composition of domestic waste is complex, and the compatibility between plastics requires waste plastics to be classified before recycling. Relying only on waste pickers and staff at garbage drop-off points for sorting is inefficient and costly. The sorting problem in the recycling process needs to be solved urgently. Establish a more reasonable recycling system to increase the recycling rate of waste plastics and alleviate plastic pollution. First, in the pre-survey desktop research, reports released by authoritative organizations such as the China National Resources Recycling Association were studied, and 12 documents were selected for review based on timeliness and content relevance. From the data published in the documents, it is known that the proportion of waste plastics in campus domestic waste is higher than that of municipal domestic waste. The campus has more ample space and public facilities can be deployed flexibly. Therefore, the waste plastic recycling facilities in the campus scene were determined as the research object. The research will be conducted in two parts based on the impact of internal process factors and external situational factors on recycling and sorting behavior. Internal process factors are first based on stratified random sampling in the probability sampling method to sample different user groups on campus to obtain 20 samples, and record their behavioral processes through implicit observation. To prevent observer bias, standardized open-ended and in-depth interviews were added. Thus, the overall basic functions and the functional list of each behavioral stage required in the plastic recycling classification process are determined and described in the form of abstraction, quantification, and object-object structure. Then the KJ method is used to classify functions, and four types are summarized: physical function, cognitive function, symbolic function and aesthetic function. Research on external situational factors attempts to identify users’ willingness and operability to sort plastic waste in specific scenarios. Through focus groups and semi-structured interviews, we studied whether plastic sorting and recycling behavior habits can be formed and maintained from the perspectives of cognitive attitudes, facility convenience, and the correlation mechanism of short-term incentives and long-term incentives. Finally, several program ideas are proposed based on internal and external factors, and a conceptual program is selected from the perspectives of technology, economy, and implementation conditions. In the process of concretizing the plan, experiments were conducted on various permutations and combinations of each functional module. In the arrangement, there are four independent variables: the number of components, the unit arrangement, the geometric forming method and the size. Use this as a clue to produce the final product design. This study uses the above research to explore possible waste plastic sorting and recycling methods to improve the current low recycling rate of waste plastics. It’s also hoped that this design can provide ideas for other sustainable designs.

Abu Dhabi Emirate, United Arab Emirates has a unique tidal system. Understanding the tidal hydrodynamics in Abu Dhabi waters is very important for the design of the hydraulic structures and in the marine environmental studies. The objective of this study is to investigate the tidal water levels and tidal motion in Abu Dhabi, making use of the long-term water levels available. To achieve the aim of the study, the National Energy and Water Research Center (NEWRC) of Abu Dhabi Water and Electricity Authority installed tidal gauges at different locations in Abu Dhabi waters to obtain long-term water level measurements. At present, long-term water level measurements for at least 3 years period are available at different locations in Abu Dhabi waters. Tidal analysis was carried out on the available data to determine the characteristics of the tidal wave in Abu Dhabi Emirate and to get the main tidal constituents affecting the tidal motion. The obtained tidal constituents are used in updating and improving the boundary conditions of the numerical hydrodynamic models simulating the flow pattern in Abu Dhabi waters. The set up of the water level measurement program in Abu Dhabi waters and the results of the tidal analysis are presented and discussed in the paper.

BackgroundCare recipients in care and welfare are increasingly presenting themselves with complex needs (Huber et al., 2016). An answer to this is the integrated organization of care and welfare in a way that personalized care is the measure (Topol, 2016). The reality, however, is that care and welfare are still mainly offered in a standardized, specialized and fragmented way. This imbalance between the need for care and the supply of care not only leads to under-treatment and over-treatment and thus to less (experienced) quality, but also entails the risk of mis-treatment, which means that patient safety is at stake (Berwick, 2005). It also leads to a reduction in the functioning of citizens and unnecessary healthcare cost (Olsson et al, 2009).Integrated CareIntegrated care is the by fellow human beings experienced smooth process of effective help, care and service provided by various disciplines in the zero line, the first line, the second line and the third line in healthcare and welfare, as close as possible (Ettema et al, 2018; Goodwin et al, 2015). Integrated care starts with an extensive assessment with the care recipient. Then the required care and services in the zero line, the first line, the second line and / or the third line are coordinated between different care providers. The care is then delivered to the person (fellow human) at home or as close as possible (Bruce and Parry, 2015; Evers and Paulus, 2015; Lewis, 2015; Spicer, 2015; Cringles, 2002).AimSupport societal participation, quality of live and reduce care demand and costs in people with complex care demands, through integration of healthcare and welfare servicesMethods (overview)1. Create best healthcare and welfare practices in Slovenia, Poland, Austria, Norway, UK, Finland, The Netherlands: three integrated best care practices per involved country 2. Get insight in working mechanisms of favourable outcomes (by studying the contexts, mechanisms and outcomes) to enable personalised integrated care for meeting the complex care demand of people focussed on societal participation in all integrated care best practices.3. Disclose program design features and requirements regarding finance, governance, accountability and management for European policymakers, national policy makers, regional policymakers, national umbrella organisations for healthcare and welfare, funding organisations, and managers of healthcare and welfare organisations.4. Identify needs of healthcare and welfare deliverers for creating and supporting dynamic partnerships for integrating these care services for meeting complex care demands in a personalised way for the client.5. Studying desired behaviours of healthcare and welfare professionals, managers of healthcare and welfare organisations, members of involved funding organisations and national umbrella organisations for healthcare and welfare, regional policymakers, national policy makers and European policymakersInvolved partiesAlma Mater Europaea Maribor Slovenia, Jagiellonian University Krakow Poland, University Graz Austria, Kristiania University Oslo Norway, Salford University Manchester UK, University of Applied Sciences Turku Finland, University of Applied Sciences Utrecht The Netherlands (secretary), Rotterdam Stroke Service The Netherlands, Vilans National Centre of Expertise for Long-term Care The Netherlands, NIVEL Netherlands Institute for Health Services Research, International Foundation of Integrated Care IFIC.References1. Berwick DM. The John Eisenberg Lecture: Health Services Research as a Citizen in Improvement. Health Serv Res. 2005 Apr; 40(2): 317–336.2. Bruce D, Parry B. Integrated care: a Scottish perspective. London J Prim Care (Abingdon). 2015; 7(3): 44–48.3. Cringles MC. Developing an integrated care pathway to manage cancer pain across primary, secondary and tertiary care. International Journal of Palliative Nursing. 2002 May 8;247279.4. Ettema RGA, Eastwood JG, Schrijvers G. Towards Evidence Based Integrated Care. International journal of integrated care 2018;18(s2):293. DOI: 10.5334/ijic.s22935. Evers SM, Paulus AT. Health economics and integrated care: a growing and challenging relationship. Int J Integr Care. 2015 Jun 17;15:e024.6. Goodwin N, Dixon A, Anderson G, Wodchis W. Providing integrated care for older people with complex needs: lessons from seven international case studies. King’s Fund London; 2014.7. Huber M, van Vliet M, Giezenberg M, Winkens B, Heerkens Y, Dagnelie PC, Knottnerus JA. Towards a 'patient-centred' operationalisation of the new dynamic concept of health: a mixed methods study. BMJ Open. 2016 Jan 12;6(1):e010091. doi: 10.1136/bmjopen-2015-0100918. Lewis M. Integrated care in Wales: a summary position. London J Prim Care (Abingdon). 2015; 7(3): 49–54.9. Olsson EL, Hansson E, Ekman I, Karlsson J. A cost-effectiveness study of a patient-centred integrated care pathway. 2009 65;1626–1635.10. Spicer J. Integrated care in the UK: variations on a theme? London J Prim Care (Abingdon). 2015; 7(3): 41–43.11. Topol E. (2016) The Patient Will See You Now. The Future of Medicine Is in Your Hands. New York: Basic Books.

The aim of the study is to evaluate carbon stock in litter and organic forest soils in Latvia as well as to characterize accumulation of carbon in litter in afforested lands. The study is providing empirically valid information about soil and litter carbon changes for the National greenhouse gas (GHG) inventory by using data from National forest inventory (NFI), forest soil monitoring demonstration project BioSoil and other studies. The study proves significance of organic forest soil carbon pool in Latvia and demonstrates necessity to extend NFI incorporated forest soil monitoring program to improve data on soil density in wet organic soils, as well as to integrate data characterizing water regime in forests. The acquired data also proves that the conservative approach of calculation of carbon stock changes in litter in afforested lands applied in the Latvia’s National GHG inventory avoids overestimation of CO2 removals. The data on litter carbon stock collected in this study is sufficient to estimate total carbon stock for stands dominated by most common tree species and long term impact of changes of species composition. Measurements of organic soil and litter thickness should be continued by NFI and integrated with more detailed soil monitoring to increase accuracy of carbon stock estimates and gather data necessary for verification of modelling data, particularly in afforested lands and due to change of dominant species.

"Introduction. The rapid spread of coronavirus disease 2019 (COVID-19) has created unprecedent global challenges for health systems. National Healthcare Systems Hospitals adopted protective measures and medical equipment resources, exposing healthcare workers at risk for stress syndromes, subclinical mental health symptoms, and long-term occupational burnout. Health workers have had to deal with the most severe clinical cases in intensive care specialized operative division. Since the first months of the epidemic spread, some studies have established shown that nurses have shown symptoms of severe anxiety associated with peritraumatic dissociative experiences. Most of the studies examined the emotional impact of COVID 19 on health professionals but did not focus on different consider professionals roles and hospital departments workload. Objective. The aim of our study was to analyze the emotional characteristics of health workers during the II wave of coronavirus (November-December 2020), comparing the frontline (COVID 19) and second line (chronic diseases) hospital divisions and analyzing the differences between the health roles. Methods. We conduct a pilot study among health-workers. A sample of 28 healthcare workers (aged 23-62 years) were recruited from frontline and secondline hospital departments (L’Aquila, IT). The administered psychological battery was composed of n. 4 self-reports evaluating emotional variables (depression, anxiety, and stress) (DASS-21), personality traits (BFI-10), burnout risk (MBI), and perceived stress (PSS). Results. The results highlighted significant differences: older health workers were found to be more vulnerable than those who younger health workers; another interesting point was that healthcare workers serving in frontline wards showed symptoms of depersonalization. No significant difference for the type of role held. Conclusions. A prevention program should be activated to preserve frontline and older workers mental health. Earlier support could mitigate the effect of the pandemic experience, reducing the risk for emotional health workers' fragility."

On December 1991, the French National Assembly passed the French Waste Management Research Act, authorizing a 15 year research program of three options for HLW: separation and/or transmutation, long-term storage, and geologic disposal. On June 2006, the “Planning Act on the sustainable management of radioactive materials and waste” sets a new framework and new aims to the above mentioned options. This paper deals only with the geologic disposal research program. In a step by step approach, this program has been broken down into three phases having intermediate goals (objectives): site selection for an Underground research Laboratory (URL), potential disposal feasibility, potential reversible disposal design. The first step of the research program aimed at URL site selection. From 1994 to 1996, Andra carried out geological-characterization work in four districts. This enabled to make the Request for Licensing and Operation of the laboratory facility on three sites. During this phase, wells, 2D seismic campaigns and land studies of geologic outcrops were the essential activities. The result was the selection of the most suitable site for the implementation of an underground laboratory. Main results on Bure URL will be presented in the paper. In the second phase the research program targeted the safety and technical feasibility of a potential reversible disposal somewhere in Meuse and Haute Marne districts site, chosen by the government in 1998. Andra conducted geologic survey during the URL shaft construction and experiments in drifts at depths of 445 and 490 m. This program allowed consolidating the knowledge already acquired: geological environment, stability of the rock, containment properties and it confirms that the rock will maintain its qualities. The 2005 Progress Report presents the results of this phase. The main conclusion is that a potential disposal facility may be safely constructed over a zone around the URL, called transposition zone (about 250 km2). The paper will present the most important results in this phase. From 2006, the third phase of the program, the activities were oriented, inside the transposition zone, to determine a smaller zone in which a potential disposal facility could be designed. In 2009, Andra issued a proposal describing such a zone to the French authorities. In this paper, the main results of this phase will be presented. Finally, the next steps towards a final implementation will be given.

As countries around the world are racing towards realizing the common dream of humans creating long-term habitats in space, emerging space countries like Jordan, with no established space agency, are struggling to participate in the development of research and projects in the field. Additionally, due to the deteriorating economical situation in Jordan, students now seek professions with higher market demands and payment rates to ensure a safe career path. This led Jordanian students to overlook emerging fields of study like space. From here arises the need to conduct proper outreach to spread awareness on space research and its benefits, and to incorporate space studies in the Jordanian educational system in order to build a strong base of human resources in the field. Since Jordan is lacking in both educational and theoretical, as well as professional and practical sides, students mostly turn to completing their studies and gaining professional experience in the space field abroad. Therefore, before establishing Jordanian-targeted education programs and initiatives for space studies, there is the need for the establishment of local space institutes, projects, and programs which ensure that students will have access to training programs and practical experience as well as securing future job opportunities, thereby making space careers a viable option. In 2020, under the Moon Village Association's Participation of Emerging Space Countries program, a roadmap for Jordan’s contribution to lunar exploration and the Jordan Space Research Initiative (JSRI) were created. This 20-year roadmap focuses on establishing an analog R&D facility in Jordan’s Wadi Rum desert, aiming to support the emerging space field in Jordan, while contributing to its national priorities and sustainable development goals. Beginning with the outreach element to foster space education, JSRI launched two space design competitions in 2021 to engage students and professionals interested in the field. These competitions allowed the participants to learn about spacesuit and rover design, as well as develop their own prototypes in a hands-on educational exercise. By providing funding and expert support, JSRI ensured that a diverse group of Jordanians was able to participate, regardless of their backgrounds. This approach proved to be successful in enabling the participation of various segments of the Jordanian society, and has shown that people with a passion for space can thrive through educational initiatives such as these competitions. Building on this success, future partnerships and educational initiatives are being established, aiding in the formation of a space network in Jordan

Small modular reactors (SMRs) offer potential for addressing the nation’s long-term energy needs. However, the project design cycle for new reactor concepts is lengthy. As part of the Department of Energy’s Advanced SMR research and development program, Oak Ridge National Laboratory (ORNL) is developing a Dynamic System Modeling Tool (MoDSIM) to facilitate rapid instrumentation and controls studies of SMR concepts. Traditional nuclear reactor design makes use of verified and validated codes to meet the strict quality assurance requirements of the licensing process for the Nuclear Regulatory Commission. However, there are significant engineering analyses and high-level decisions required prior to the rigorous design phase. These analyses typically do not require high-fidelity codes. Different organizations and researchers may examine various plant configuration options prior to formal design activities. Engineers and managers must continuously make down-selection decisions regarding potential reactor architectures and subsystems. Traditionally, the modeling of these complex systems has been based on legacy models. Considerable time and effort are necessary to understand and manipulate these legacy models. For trade-space studies, two developments in the model-based systems engineering space represent a significant advancement in the ability of engineering tools to meet these demands. The first is Modelica: a nonproprietary, equation-based, object-oriented modeling language for cyber-physical systems. The second is the Functional Mockup Interface: a standardized, open interface for model exchange, simulation, and deployment. ORNL’s MoDSIM tool makes use of these developments and is intended to provide a flexible and robust dynamic system-modeling environment for SMRs. This includes single or multiple reactors, perhaps sharing common resources, or producing both electricity and process heat for local consumption or feeding a regional grid. MoDSIM uses the open-source modeling language (Modelica) and incorporates a user interface, coupled dynamic models, and analysis capabilities that will enable non-expert modelers to perform sophisticated end-to-end system simulations of both neutronic and thermal-hydraulic models. This approach enables open-source and crowd-source-type collaborations for model development of SMRs in an approach similar to open-source and open-design techniques currently used for software production and complex system design. As part of the tool development, an example SMR was chosen (advanced liquid metal reactor [ALMR]) and the ALMR models developed and interface tools demonstrated. For initial verification purposes, the results from these Modelica simulations are compared with the results documented for the earlier ALMR power-reactor innovative small-module concept. These results, as well as initial demonstrations of the tool for different control strategies, are presented in this paper.

Ongoing experimental work has been underway at selected nuclear sites in the Russian State Atomic Energy Corporation (ROSATOM) during the past two years to determine the effectiveness, reliability, application and acceptability of high technology polymers for liquid radioactive waste solidification. The long term project is funded by the U.S. Department of Energy’s Initiatives for Proliferation Prevention (IPP) program. IPP was established in 1994 as a non-proliferation program of DOE / National Nuclear Security Administration and receives its funding each year through Congressional appropriation. The objectives of IPP are: • To engage former Soviet nuclear weapons scientists, engineers and technicians, currently or formerly involved with weapons of mass destruction, in peaceful and sustainable commercial activities. • To identify non-military, commercial applications for former Soviet institute technologies through cooperative projects among former Soviet weapons scientists, U.S. national laboratories and U.S. industry. • To create new technology sources and to provide business opportunities for U.S. companies, while offering commercial opportunities and meaningful employment for former weapons scientists. Argonne National Laboratory provides management oversight for this project. More than 60 former weapons scientists are engaged in this project. With the project moving toward its conclusion in 2012, the emphasis is now on expanding the experimental work to include the sub-sites of Seversk (SCC), Zheleznogorsk (MCC) located in Siberia and Gatchyna (KRI) and applying the polymer technology to actual problematic waste streams as well as to evaluate the prospects for new applications, beyond their current use in the nuclear waste treatment field. Work to date includes over the solidification of over 80 waste streams for the purpose of evaluating all aspects of the polymer’s effectiveness with LLW and ILW complex waste. Waste stream compositions include oil, aqueous, acidic and basic solutions with heavy metals, oil sludge, spent extractants, decontamination solutions, salt sludge, TBP and other complex waste streams. Extensive irradiation evaluation (up to 270 million rad), stability and leach studies, evaporation and absorption capacity tests and gas generation experimentation on tri-butyl phosphate (TBP) waste have been examined. The extensive evaluation of the polymer technology by the lead group, V.G. Khlopin Radium Institute, has resulted in significant discussion about its possible use within the ROSATOM network. At present the focus of work is with its application to legacy LLW and ILW waste streams that exist in a variety of sectors that include power plants, research institutes, weapons sites, submarine decommissioning and many others. As is the case in most countries, new waste treatment technologies first must be verified by the waste generator, and secondly, approved for use by the government regulators responsible for final storage. The polymer technology is the first foreign sorbent product to enter Russia for radioactive waste treatment so it must receive ROSATOM certification by undergoing irradiation, fire / safety and health / safety testing. Experimental work to date has validated the effectiveness of the polymer technology and today the project team is evaluating criteria for final acceptance of the waste form by ROSATOM. The paper will illustrate results of the various experiments that include irradiation of actual solidified samples, gas generation of irradiated samples, chemical stability (cesium leach rate) and thermal stability, oil and aqueous waste stream solidification examples, and volume reduction test data that will determine cost benefits to the waste generator. Throughout the course of this work, it is apparent that the polymer technology is selective in nature; however, it can have broad applicability to problematic waste streams. One such application is the separation and selective recovery of trans-plutonium elements and rare earth elements from standard solutions. Another application is the use of polymers at sites where radioactive liquids are accidently emitted from operations, thus causing the risk of environmental contamination.

The Nordic countries share many cross-sectoral targets at the national level to meet ambitious environmental, social, sustainable and innovative development goals and standards. When it comes to spatial planning, central governments in the Nordic countries often have limited power to influence local-level priorities, particularly with respect to regulating land use and adopting a range of policies that impact sustainable urban development. In parallel, various new planning approaches, as well as a range of nationwide support mechanisms have emerged in the Nordic countries, often with the aim of supporting and steering municipalities’ efforts to achieve sustainable urban development. Our report aims to better understand such initiatives and how they are connected to spatial planning efforts in Nordic municipalities by examining one national support initiative in each Nordic country, illustrated with learnings from municipal case studies. We examined FutureBuilt in Norway, the Partnership for Vibrant City Centres in Denmark, the Borgarlína project in Iceland, the Sustainable City programme in Finland and Visions: in the North in Sweden. As shown by the findings from our case studies, different perspectives on external governance – such as state intervention versus municipal self-governance in Nordic countries – highlight challenges in influencing local urban development due to limited state mandates. National support initiatives emerge as an alternative means to guide local development. They may serve to foster collaboration and inclusivity, particularly when inspiring local, strategic spatial planning, as seen in the Swedish case study. National support initiatives are viewed as complementary tools to spatial planning that support sustainable urban development processes and projects. Though they take various forms, their purpose and impact should be understood within the overall context. Collaboration and lessons learned from national support initiatives have the potential to enhance legislation or state intervention. However, an imbalance in municipalities’ access to support poses a challenge in each Nordic country. It is therefore crucial to assess the appropriateness and purpose of support, recognising that municipal pathways are influenced by the way in which support is designed. Striking a balance with respect to state-municipal governance is essential. In short, we can draw the following recommendations: A partnership-based approach with collaboration between various stakeholders enhances inclusivity. New ways of working that are agile and flexible and focus on the local context should be emphasised for effective outcomes. The importance of long-term commitments and policy coherence in the field of sustainable urban development should be emphasised at both national and municipal levels. Efforts should be made to ensure continuity in sustainable urban development initiatives beyond the duration of the given programme. A more formal and institutionalised way of obtaining government funding for sustainable urban development projects at the local level should be developed in some countries. That could level the playing field for municipalities with varying resources, knowledge and lobbying capabilities. In other countries, capacity building – including training and resources – can be provided to help municipalities navigate support options and apply for them. It is beneficial to create platforms providing information about support for sustainable urban development and to make municipalities aware of upcoming calls well in advance.

The goals of this work are to a) understand community perspectives related to public engagement with science and the Luquillo Long Term Ecological Research (LUQ-LTER) program, b) enhance existing relationships within these communities, and c) illuminate opportunities for establishing new relationships between the LUQ-LTER program and its surrounding community. We share results from our case study that includes three methods of data collection: interviews with natural resource managers, a community conversation activity with 12 local community organizations, and a survey given at a public outreach event at El Portal de El Yunque. From interviews with natural resource managers, we learned they are looking for collaborations which directly benefit the resources they manage (forests, water, etc.), and they are also hoping for more formal communication structures between them and the LUQ-LTER. Sixty percent of the organizations at the Community Conversation shared that the most valuable outcome was learning that LUQ-LTER existed .All participants expressed interest in collaborating with the LUQ-LTER and said that LUQ-LTER’s long term ecological data could be beneficial for them to use and LUQ-LTER could be a productive context to share data they gather to heighten utility in all directions. From a survey given at the International Day of Forests Celebration, we learned that most people present at the activity came to the El Yunque National Forest to learn about the forest, spend time with family, or enjoy the forest. We also learned that during previous visits to El Yunque, they most commonly either day hiked or visited a geographical feature (waterfall or observation tower). When asked about which activities they would like to have happen in the future in El Yunque, most people indicated high levels of interest in having educational activities (like festivals or flora and fauna workshops), workshops or training on environmental issues, and night tours. The volunteer opportunities for which the most people indicated highest levels of interest were trail, camp, and related maintenance as well as fish and wildlife opportunities. Overall, everyone we talked to was interested in more collaboration and working together in the future, giving the LUQ-LTER program an excellent starting point for building stronger relationships with the community surrounding their site.

The Natural Resource Condition Assessment (NRCA) Program aims to provide documentation about the current conditions of important park natural resources through a spatially explicit, multi-disciplinary synthesis of existing scientific data and knowledge. Findings from the NRCA will help Salinas Pueblo Missions National Monument (SAPU) managers to develop near-term management priorities, engage in watershed or landscape scale partnership and education efforts, conduct park planning, and report program performance (e.g., Department of the Interior’s Strategic Plan “land health” goals, Government Performance and Results Act). The objectives of this assessment are to evaluate and report on current conditions of key park resources, to evaluate critical data and knowledge gaps, and to highlight selected existing stressors and emerging threats to resources or processes. For the purpose of this NRCA, staff from the National Park Service (NPS) and Saint Mary’s University of Minnesota – GeoSpatial Services (SMUMN GSS) identified key resources, referred to as “components” in the project. The selected components include natural resources and processes that are currently of the greatest concern to park management at SAPU. The final project framework contains nine resource components, each featuring discussions of measures, stressors, and reference conditions. This study involved reviewing existing literature and, where appropriate, analyzing data for each natural resource component in the framework to provide summaries of current condition and trends in selected resources. When possible, existing data for the established measures of each component were analyzed and compared to designated reference conditions. A weighted scoring system was applied to calculate the current condition of each component. Weighted Condition Scores, ranging from zero to one, were divided into three categories of condition: low concern, moderate concern, and significant concern. These scores help to determine the current overall condition of each resource. The discussions for each component, found in Chapter 4 of this report, represent a comprehensive summary of current available data and information for these resources, including unpublished park information and perspectives of park resource managers, and present a current condition designation when appropriate. Each component assessment was reviewed by SAPU resource managers, NPS Southern Colorado Plateau Network (SCPN) staff, or outside experts. Existing literature, short- and long-term datasets, and input from NPS and other outside agency scientists support condition designations for components in this assessment. However, in some cases, data were unavailable or insufficient for several of the measures of the featured components. In other instances, data establishing reference condition were limited or unavailable for components, making comparisons with current information inappropriate or invalid. In these cases, it was not possible to assign condition for the components. Current condition was not able to be determined for six of the ten components due to these data gaps. For those components with sufficient available data, the overall condition varied. Two components were determined to be in good condition: dark night skies and paleontological resources. However, both were at the edge of the good condition range, and any small decline in conditions could shift them into the moderate concern range. Of the components in good condition, a trend could not be assigned for paleontological resources and dark night skies is considered stable. Two components (wetland and riparian communities and viewshed) were of moderate concern, with no trend assigned for wetland and riparian communities and a stable trend for viewshed. Detailed discussion of these designations is presented in Chapters 4 and 5 of this report. Several park-wide threats and stressors influence the condition of priority resources in SAPU...

A shortcoming of the current empirical impact evaluation literature is the lack of studies that measure the effect of access to credit in the medium and long term, as well as the impact on interventions targeted at micro-, small-, and medium-sized enterprises (MSMEs). This study addresses both aspects by analyzing the average impact that the Lending Program for the Productive Development and Employment Generation of the San Juan Province has had on sales, employment, investment, and productivity of beneficiary MSMEs. The authors measured the abovementioned impacts using a lagged dependent variable (LDV) model that, beyond controlling for selection bias, also controls for the sequential entry of companies into the program. To conduct this analysis, the authors used a survey implemented by the National University of San Juan to 664 companies. The results of the study indicate a positive and statistically significant impact of 6.9 percent on the likelihood to invest, 9.7 percent on sales, 4.3 percent on employment, and 6.4 percent on labor productivity. The analysis allows for the identification of differentiated impacts by type of company, as classified by size and sector or type of economic activity.

This presentation was commissioned by the Environment Network of the Regional Policy Dialogue for the III Hemispheric Meeting celebrated on March 9th and 10th, 2004. Objective: Economic valuation of the Third Program of Air Quality 2000-2010 (PROAIRE). Focused on health benefits associated to reductions of PM10 and Ozone: 4 scenarios against a baseline 1995-99, but considers also social effects of environmental contingencies. Time Horizon: 2000-2010, results shown for 2010 Uses local and international studies to estimate the change in health effects (Many epidemiological studies have been conducted in México City). Uses one US Study to estimate the long-term exposure effects on premature mortality. Uses unit values derived in the US and transferred to México, and Human Capital to value mortality reductions Performed by the Environmental Studies Institute (IVM, The Netherlands) and The National Center for Environmental Health (CENSA) supported by many other institutions.

Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.