内华达大学雷诺分校

Introduction As the population of older adults continues to grow, addressing social determinants of health that influence access to basic needs is increasingly important for supporting healthy aging. Transportation and food insecurity represent interconnected challenges that may limit older adults' ability to live independently and access essential resources. The purpose of this study was to determine the association between transportation insecurity and food insecurity among older adults aged 60 and older residing in Clark County, NV. Methods A quantitative, cross-sectional survey was administered via telephone (n = 1,001) between November 2022 and February 2023 using random-digit dialing, yielding a 24.58% cooperation rate. Transportation insecurity was assessed using the Sixteen-Item Transportation Security Index, and food insecurity was measured using the USDA 6-item short form Food Security Survey Module. Demographic and socioeconomic variables were included as covariates. Multivariable logistic regression analyses were conducted to evaluate associations. Results Food insecurity was reported by 18.2% of participants, while 25.3% experienced transportation insecurity. A logistic regression model (chi(2) = 263.509, df = 19, n = 789, p < 0.001) indicated that transportation insecurity was significantly associated with food insecurity, with individuals experiencing transportation insecurity having 4.26 times the odds of being food insecure. Having a disability and lower income were positively associated with food insecurity, while older age (85+) was negatively associated with food insecurity. Conclusions Transportation barriers and food access challenges frequently overlap among older adults and should be addressed in tandem. Integrating transportation solutions into food access interventions may strengthen public health efforts to reduce disparities and support aging populations.

This paper presents a discrete-time multi-rate frequency control scheme for a single-bus system comprising a synchronous generator (SG) and an inverter-based resource (IBR). The proposed method coordinates the fast IBR response with the slower SG dynamics using a discrete-time signal derived from the frequency evolution, which captures the required rate of active power variation for frequency regulation. The IBR reference is defined as a combination of frequency-deviation feedback and a rate-dependent term modulated by a smooth activation function, while the SG is governed by a ramp-limited integral control law updated at a slower sampling rate. The resulting control architecture is implemented in a multi-rate framework with distinct fast and slow update loops. A discrete-time model of the closed-loop system is derived and formulated as a singularly perturbed system, in which the IBR tracking dynamics form a contractive fast subsystem and the SG-frequency dynamics evolve on the slow time scale. Practical stability is established by combining a contraction property of the fast subsystem with an input-to-state stability characterization of the slow sampled dynamics. The analysis characterizes the influence of IBR tracking bandwidth, sampling-rate separation, and SG ramp-rate constraints on the closed-loop frequency response.

To address the growing public concerns regarding ethics, fairness, and the protective nature of digital transformation, hospitality organizations are incorporating corporate digital responsibility (CDR) practices, including enhanced data security measures. This study draws upon the deontic model of justice to examine the impact of CDR practices directed toward customers on employees’ perceived organizational justice and subsequent organizational outcomes. A total of 281 responses from U.S. hospitality employees were collected using a time-lagged design with a two-wave data collection approach. The proposed model is tested using PLS-SEM in SmartPLS 4.0. Findings indicate that CDR practices related to digital ethics and data privacy and protection positively affect employees’ perceived organizational justice. Similarly, perceived organizational justice has a positive influence on job satisfaction, perceived job performance, and organizational trust. The study highlights the critical role of CDR practices in enhancing employees' perceptions and influencing their attitudes and behaviors in the workplace.

Climate adaptation decisions are often made locally, yet evidence remains limited on how rural residents in inland, natural-resource-dependent regions perceive and respond to multiple climate hazards. This study examines multidimensional perceptions of drought, heat, and wildfire and their association with self-reported adaptation among residents of Nevada's Humboldt River Basin. Using an in-person survey of adults across the Upper, Middle, and Lower sub-basins, we measure perceived changes in hazard magnitude, frequency, timing, and duration; classify adaptation responses into ordered categories; and estimate survey-weighted descriptive models and generalized ordered logit models. Results show that residents generally perceive worsening conditions across all three hazards, particularly greater drought and wildfire magnitude and increased hazard frequency. Perceptions vary spatially, with Lower Basin residents reporting stronger perceived worsening than Middle and Upper Basin residents. Adaptation responses are practical and hazard-specific: wildfire responses emphasize property protection, heat responses emphasize cooling and energy efficiency, and drought responses emphasize water and vegetation management strategies. Generalized ordered logit estimates show that higher perceived climate risk, greater hazard salience, and stronger institutional trust are associated with more intensive adaptation. The findings suggest that locally grounded climate information, trusted institutions, and hazard-specific outreach can support adaptation planning in rural river basins, whereas persistent non-adaptation may reflect capacity constraints that information alone cannot overcome.

Purpose Despite advances in treatments, nearly half of the patients with head and neck squamous cell carcinoma (HNSCC) experience recurrence. Early recurrence detection is critical for enabling timely curative interventions and improving survival outcomes. Here, we evaluated circulating tumor DNA (ctDNA) testing post-definitive treatment to detect molecular residual disease (MRD) and predict outcomes in patients with HNSCC. Methods and Materials This retrospective study included a real-world cohort of 97 patients with stage I to IV HNSCC undergoing ctDNA testing using a personalized, tumor-informed assay (Signatera, Natera, Inc). Longitudinal plasma samples (n = 500) were collected pretreatment, in the early postdefinitive local treatment setting (within 3 months of completing definitive local treatment, before adjuvant treatment), and during postdefinitive treatment surveillance (after adjuvant therapy [if given] or postcompletion of definitive local treatment until recurrence). Results Median patient follow-up was 22 (2-56) months. ctDNA-based MRD positivity in the early postdefinitive local treatment setting was significantly associated with inferior progression-free survival (PFS) (hazard ratio [HR], 6.39; P = .0002) and overall survival (OS) (HR, 25.72; P = .003). Longitudinally, MRD positivity during the postdefinitive treatment surveillance window was associated with significantly shorter PFS (HR, 38.87; P < .0001) and OS (HR, 14.37; P = .014) and preceded radiographic progression by a median of 4.3 (0.62-21.91) months. The increased risk of recurrence for patients who were MRD-positive was observed across all pathologic stages, regardless of p16 status. In multivariate analysis, MRD positivity postdefinitive treatment was the only clinicopathologic factor significantly associated with PFS (HR, 38.29; P < .001). Conclusions In patients with stage I to IV HNSCC, ctDNA-based MRD positivity after definitive local therapy and adjuvant treatment is associated with disease recurrence and poor survival outcomes.