An uncertain future, deep uncertainty, scenarios, robustness and adaptation: How do they fit together?

A highly uncertain future due to changes in climate, technology and socio-economics has led to the realisation that identification of “best-guess” future conditions might no longer be appropriate. Instead, multiple plausible futures need to be considered, which requires (i) uncertainties to be described with the aid of scenarios that represent coherent future pathways based on different sets of assumptions, (ii) system performance to be represented by metrics that measure insensitivity (i.e. robustness) to changes in future conditions, and (iii) adaptive strategies to be considered alongside their more commonly used static counterparts. However, while these factors have been considered in isolation previously, there has been a lack of discussion of the way they are connected. In order to address this shortcoming, this paper presents a multidisciplinary perspective on how the above factors fit together to facilitate the devel- opment of strategies that are best suited to dealing with a deeply uncertain future

Uncertainty, sensitivity and scenario analysis: how do they fit together?

Session J5. Advances and applications in decision making in the face of multiple plausible futuresDealing with uncertainty is becoming increasingly important in model-based decision support. Various methods have been developed in order to do this, including uncertainty, sensitivity and scenario analysis. Although these different methods serve their purpose, the availability of a large number of methods can make it difficult for practitioners to understand the similarities and differences between them and when the use of one is more suitable than another, resulting in confusion. In addition, researchers often identify with belonging to a group dealing with a particular approach, which can lead to a lack of crossfertilisation and understanding. In order to assist with bridging the gap between researchers working on different approaches to dealing with uncertainty and eliminate confusion for practitioners, the objective of this paper is to examine the relationship between uncertainty, sensitivity and scenario analysis in the context of model-based decision support, and to take the first steps towards establishing common ground between these methods and assess the contexts under which they are most suitable. This is achieved by conceptualising the various methods as different approaches to “sampling” the hyperspace of model inputs, although this is done from different perspectives and for different ends (Figure 1). It is therefore also necessary to think about the assumptions each method is making about the space being explored, and there are benefits to be gained in thinking about how best to sample the space for each purpose. The approaches identified in this conference paper provide a first level of coarse characterisations. Further refinements in categorisation is possible (with the differentiation between narrative and stress testing scenarios as a first example), and likely to be useful. There are connections to be made to other disciplines, such as philosophy and decision theory, regarding the assumptions each method makes.H.R. Maier, J.H.A. Guillaume, C. McPhail, S. Westra, J.H. Kwakkel, S. Razavi, H. van Delden, M.A. Thyer, S.A. Culley and A.J. Jakema

Psychosocial outcomes in long-term Dutch adult survivors of childhood cancer:The DCCSS-LATER 2 psycho-oncology study

Background: This study compares a comprehensive range of psychosocial outcomes of adult childhood cancer survivors (CCS) to general population-based references and identifies sociodemographic and medical risk factors.Methods: CCS from the Dutch Childhood Cancer Survivor Study (DCCSS)-LATER cohort (diagnosed 1963–2001) part 2 (attained age ≥18 years, diagnosed &lt;18 years, ≥5 years since diagnosis) completed the Rosenberg Self-Esteem Scale, Hospital Anxiety and Depression Scale, Distress Thermometer, Self-Rating Scale for Post-Traumatic Stress Disorder, and the Short Form-36 (Health Related Quality of Life). CCS’ scores were compared with references using analysis of variances and logistic regression analysis, controlling for age and sex (p &lt;.05). Risk factors for worse psychosocial outcomes were assessed with regression analyses (p &lt;.05).Results: CCS, N = 1797, mean age 35.4 years, 49.0% female, all ≥15 years since diagnosis, participated. Three percent reported posttraumatic stress disorder because of childhood cancer and 36.6% experienced clinical distress. CCS did not differ from references on self-esteem and anxiety but were less depressed (d = −.25), and scored poorer on all health-related quality of life scales, except for bodily pain (.01 ≤ d ≥ −.36). Female sex, lower educational attainment, not being in a relationship, and being unemployed were negatively associated with almost all psychosocial outcomes. Except for a central nervous system tumor diagnosis, few medical characteristics were associated with psychosocial outcomes.Conclusion: CCS appear resilient regarding mental health but have slightly poorer health-related quality of life than references. Sociodemographic characteristics and central nervous system tumors were related to most psychosocial outcomes, but no clear pattern was observed for other medical factors. Future studies should address additional factors in explaining CCS’ psychosocial functioning, such as coping, social support, and physical late effects.</p

Consensus Statement on Public Involvement and Engagement with Data-Intensive Health Research.

This consensus statement reflects the deliberations of an international group of stakeholders with a range of expertise in public involvement and engagement (PI&E) relating to data-intensive health research. It sets out eight key principles to establish a secure role for PI&E in and with the research community internationally and ensure best practice in its execution. Our aim is to promote culture change and societal benefits through ensuring a socially responsible trajectory for innovations in this field.Peer reviewe

Biomedical and therapeutic applications of biosurfactants

During the last years, several applications of biosurfactants with medical purposes have been reported. Biosurfactants are considered relevant molecules for applications in combating many diseases and as therapeutic agents due to their antibacterial, antifungal and antiviral activities. Furthermore, their role as anti-adhesive agents against several pathogens illustrate their utility as suitable anti-adhesive coating agents for medical insertional materials leading to a reduction of a large number of hospital infections without the use of synthetic drugs and chemicals. Biomedical and therapeutic perspectives of biosurfactants applications are presented and discussed in this chapter

Photochemical And Thermal Isomerization Processes Of A Chiral Auxiliary Based Donor -acceptor Substituted Chiroptical Molecular Switch: Convergent Synthesis, improved Resolution And Switching Properties

A new type of chiroptical molecular switch is presented where irradiation employing different wave- lengths of light induces a reversible helix inversion of a sterically overcrowded alkene bearing a second chiral entity in the form of a stereogenic center present in a pyrrolidine unit.The additional stereogenic center in the chiral auxiliary group has a distinct influence on the switching selectivity of this system and greatly facilitates the resolution of the different diastereoisome s,which is a considerable improvement compared with previously reported systems.In addition,the pyrrolidine stereogenic center causes small energetic differences between the various states of the switch system resulting in a small but signifi- cant directional preference in the helix inversion steps.

Accounting for Multisectoral Dynamics in Supporting Equitable Adaptation Planning: A Case Study on the Rice Agriculture in the Vietnam Mekong Delta

The need for explicitly considering equity in climate change adaptation planning is increasingly being recognized. However, evaluations of adaptation often adopt an aggregated perspective, while disaggregation of results is important to learn about who benefits when and where. A typical example is adaptation of rice agriculture in the Vietnam Mekong Delta (VMD). Efforts focused on flood protection have mainly benefitted large-scale farmers while harming small-scale farmers. To investigate the distributional consequences of adaptation policies in the VMD, we assess both aggregate total output and equity indicators, as well as disaggregated impacts in terms of district-level farming profitability. Doing so requires an adequate representation of the multisectoral dynamics between the human and biophysical systems which influence farming profitability. We develop a spatially explicit integrated assessment model that couples inundation, sedimentation, soil fertility and nutrient dynamics, and behavioral land-use change and farming profitability calculation. We find that inter-district inequality responds in a non-linear way to climatic and socio-economic changes and choices of adaptation policies. The patterns of who wins and who loses could change substantially when a different policy is implemented or if a slightly different uncertain future materializes. We also find that there is no simple ranking of alternative adaptation policies, so one should make trade-offs based on agreed preferences. Accounting for equity implies exploring the distribution of outcomes over different groups over a range of uncertain futures. Only by accounting for multisectoral dynamics can planners anticipate the equity consequences of adaptation and prepare additional measures to aid the worse-off actors.Policy Analysi

Survival Benefit of Repeat Local Treatment in Patients Suffering From Early Recurrence of Colorectal Cancer Liver Metastases.

BACKGROUND: A uniform treatment strategy for patients suffering from early recurrence after local treatment of CRLM is currently lacking. The aim of this observational cohort study was to assess the potential survival benefit of repeat local treatment compared to systemic therapy in patients suffering from early recurrence of CRLM. PATIENTS AND METHODS: Patients who developed recurrent CRLM within 12 months after initial local treatment with curative intent were retrospectively identified in Amsterdam University Medical Centers between 2009-2019. Differences in overall and progression-free survival among treatment strategies were assessed using multivariable Cox regression analyses. RESULTS: A total of 135 patients were included. Median overall survival of 41 months [range 4-135] was observed in patients who received repeat local treatment, consisting of upfront or repeat local treatment after neoadjuvant systemic therapy, compared to 24 months [range 1-55] in patients subjected to systemic therapy alone (adjusted HR = 0.42 [95%-CI: 0.25-0.72]; P = .002). Prolonged progression-free survival was observed after neoadjuvant systemic therapy followed by repeat local treatment, as compared to upfront repeat local treatment in patients with recurrent CRLM within 4 months following initial local treatment of CRLM (adjusted HR = 0.36 [95%-CI: 0.15-0.86]; P = .021). CONCLUSION: Patients with early recurrence of CRLM should be considered for repeat local treatment strategies. A multimodality approach, consisting of neoadjuvant systemic therapy followed by repeat local treatment, appeared favorable in patients with recurrence within 4 months following initial local treatment of CRLM

Hang in There: A Novel Body-Centric Interactive Playground

Part 2: Key ApplicationsInternational audienceWe introduce and evaluate a first version of a novel body-centric playground that aims at increasing bodily exertion and immersion. The concept centers around the player, who is suspended from the ceiling using a rope and climbing harness and stands on a tilted platform. This caused players to assume a body posture that elicits the feeling of flying, which was further enhanced by the flying game that they played. We discuss the choices made in the type of body movements, and how these relate to different aspects such as movement mimicry and exertion. We performed a user study, in which the hanging position was compared to a setting where players stood on the ground. We found no significant differences in the amount of movement and perceived engagement between the two conditions. However, there was a tendency of favoring the hanging position. Moreover, we observed that the placement of game elements affected the movement patterns

Psychosocial functioning of parents of Dutch long-term survivors of childhood cancer

Objective: To describe health-related quality of life (HRQoL), post-traumatic stress and post-traumatic growth of parents of long-term survivors of childhood cancer (CCS) and study associated factors. Methods: Parents of survivors of the Dutch Childhood Cancer Survivor Study LATER cohort below 30 years and diagnosed 1986–2001 were invited to complete the TNO-AZL Questionnaire for Adult's HRQoL (e.g., sleep and aggressive emotions), Self-Rating Scale for Post-traumatic Stress Disorder, Post-traumatic Growth Inventory, and Illness Cognition Questionnaire. HRQoL domain scores were compared to references using Mann-Whitney U tests. Correlations between post-traumatic stress, growth and HRQoL were evaluated. Medical characteristics of their child and illness cognitions were studied as associated factors of HRQOL, post-traumatic stress and growth. p < 0.05 was considered statistically significant. Results: Parents (n = 661 of n = 448 survivors, 56% female, mean time since child's diagnosis: 21.3 [SD: 3.3] years) reported better HRQoL in social functioning and aggressive emotions than references (r =.08–0.17). Mothers additionally reported better HRQoL in pain, daily activities, sexuality, vitality, positive and depressive emotions (r =.07–0.14). Post-traumatic stress was symptomatic in 3%, and associated with worse HRQoL (r = −0.27–0.48). Post-traumatic growth was positively associated to post-traumatic stress and better HRQoL (r = 0.09–0.12). Cancer recurrence was associated to better HRQoL (β = 0.37–0.46). Acceptance illness cognitions were associated to better (β = 0.12–0.25), and helplessness to worse outcomes (β = 0.14–0.38). Conclusions: HRQoL of parents of young adult survivors of CCS is comparable to references or slightly better. Only a small proportion reports symptomatic post-traumatic stress. Improving acceptance and reducing feelings of helplessness may provide treatment targets for parents with psychosocial problems