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This Special Communication reviews data about associations between maternal mortality and perinatal mental conditions, social determinants of health, suicide and addictive disorders, access limitations, and prenatal stress and describes efforts involving cross-disciplinary education and intervention sites and models. Importance: The rate of maternal mortality in the United States is 2-fold to 3-fold greater than that in other high-income countries. While many national initiatives have been developed to combat maternal mortality, these efforts often fail to include mental illness. Objective: To highlight the underrecognized contribution of mental illness to maternal mortality, which is nearly double that of postpartum hemorrhage. Evidence Review: A topic outline was developed to include challenges in measuring perinatal mental conditions and mortality rates; contributions of social determinants of health to mental conditions and mortality; perinatal psychiatric disorder characterization; mechanisms by which maternal mental illness increases mortality, specifically, suicide and addictive disorders; access limitations and care "deserts"; prenatal stress and its impact on reproductive outcomes; increasing clinician expertise through cross-disciplinary education; intervention sites and models; and asserting that mental health is fundamental to maternal health. Publications in the last 3 years were prioritized, particularly those relating to policy. References were selected through consensus. Sources were PubMed, Ovid, direct data published on government websites, and health policy sources such as the Policy Center for Maternal Mental Health. Findings: Priority was given to recent sources. Citations from 2022-2023 numbered 26; within the last 5 years, 14; and historical references, 15. Recommendations to address each topic area serve as concluding statements for each section. To mitigate the contributions of mental illness to the maternal mortality risk, a coordinated effort is required across professional and governmental organizations. Conclusions and Relevance: Concrete programmatic and policy changes are needed to reduce perinatal stress and address trauma, standardize the collection of social determinant of health data among perinatal patients, increase access to reproductive psychiatry curricula among prescribers, reduce perinatal mental health and obstetrical deserts, institute paid parental leave, and support seamless integration of perinatal and behavioral health care. Moreover, instead of focusing on a relatively minor portion of the contributors to health that current medical practice targets, fortifying the social foundation strengthens the prospects for the health of families for our current and future generations. [ABSTRACT FROM AUTHOR]

Purpose: Adolescent and young adult cancer survivors (AYAs) experience early-onset chronic conditions and disrupted psychosocial development. We report prevalence of disruptions in care delivery and social support during the early wave of the pandemic in a national sample of AYAs in the United States. Materials and Methods: We used data from the population-based National Health Interview Survey (NHIS; July–December 2020), which allows for nationally representative estimates, and included questions related to COVID-19. We identified 61 AYAs diagnosed with cancer between ages 15 and 39 years and not currently receiving cancer treatment and 244 age- and sex-matched controls. We compared the proportion of AYAs and controls reporting delayed care due to the pandemic, not getting needed care due to the pandemic, and changes in social and emotional support. Results: AYAs were predominantly non-Hispanic White (61.3%) and female (58.8%), with a median age at diagnosis of 28 years (interquartile range [IQR] 21–31 years). Fewer AYAs were employed (52.1% vs. 71.5%), and more lived in poverty (32.0% vs. 12.4%) and felt depressed daily (9.9% vs. 3.0%, all p < 0.05). The proportion of AYAs reporting delayed care (39.8% vs. 15.3%) and not getting needed care (31.7% vs. 10.4%) due to the pandemic was more than double that of controls (both p < 0.01). One in five AYAs experienced less social and emotional support compared to the prior year, although not significantly different from controls (21.6% vs. 12.4%, p = 0.10). Conclusions: The pandemic disrupted AYAs' care and exacerbated their psychosocial challenges. Providers and health systems should prioritize reconnecting AYAs to affordable and comprehensive care. [ABSTRACT FROM AUTHOR]

Maximizing the utilization of variable renewable energy (VRE) resources will be critical for cost-effective energy transition. Hybrid VRE systems offer potential reliability benefits with stochastic wind and solar. Here, we conduct a comprehensive assessment of temporal complementarity for co-located wind-PV hybrid systems at greater than 1.7 million locations across the contiguous United States. We model hourly variation in potential wind and solar generation for a period spanning 2007–2013 and evaluate robust evidence for complementarity using multiple metrics to assess correlations and stabilization benefits achieved via hybridization. We further explore regional case studies to investigate whether complementarity is an indicator of value, using price taker analysis to quantify the current and expected future value factor for hybrid systems. We find most locations in the U.S. (except for mountainous regions) offer complementarity of hourly wind and PV generation annually with modest seasonal variation. The stability coefficient is a better indicator of value in regions with large variation in wind potential and significant PV penetrations whereas the correlation metrics more clearly indicate value in regions where wind and PV both provide significant shares of generation. Overall, we find broad support for wind-PV hybrid systems to exploit resource synergies with economic benefits. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Pancreatic cancer is projected to become the second leading cause of cancer‐related deaths by 2030. Endoscopic retrograde cholangiopancreatography (ERCP) is recommended as first‐line therapy for biliary decompression in pancreatic cancer. The aim of our study was to characterize geographic and racial/ethnic disparities in ERCP utilization among patients with pancreatic cancer. Methods: Retrospective cohort study using the US Surveillance, Epidemiology, and End Results (SEER)‐Medicare database to identify patients diagnosed with pancreatic cancer from 2003‐2013. The primary outcome was receipt of ERCP, with or without stent placement, vs any non‐ERCP biliary intervention. Results: Of the 36 619 patients with pancreatic cancer, 37.5% (n = 13 719) underwent an ERCP, percutaneous drainage, or surgical biliary bypass. The most common biliary intervention (82.6%) was ERCP. After adjusting for tumor location and stage, Blacks were significantly less likely to receive ERCP than Whites (aOR 0.84, 95% CI 0.72, 0.97) and more likely to receive percutaneous transhepatic biliary drainage (PTBD) (aOR 1.38, 95% CI 1.14, 1.66). Patients in the Southeast and the West were more likely to receive ERCP than those in the Northeast (Southeast aOR 1.21, 95% CI 1.04, 1.40; West aOR 1.16, 95% CI 1.01, 1.32). Conclusion: Racial/ethnic and geographic disparities in access to biliary interventions including ERCP exist for patients with pancreatic cancer in the United States. Our results highlight the need for further research and policies to improve access to appropriate biliary intervention for all patients. [ABSTRACT FROM AUTHOR]

Objective: Despite benefits of adjuvant hormonal therapy (AHT), many eligible breast cancer patients do not complete therapy as recommended. Patterns of AHT use have not been well studied among uninsured breast cancer patients who fall into coverage gaps or are ineligible for public insurance programs. Methods: We identified 291 patients newly diagnosed with stages I-III hormone receptor-positive breast cancer from January 2008 to December 2012. All patients were treated at a safety-net healthcare system and enrolled in an income-based medical assistance program that fills AHT prescriptions at low cost. We extracted and linked cancer registry, pharmacy claims, and medical record data to assess AHT initiation (defined as a new AHT prescription ≤18 months since diagnosis) and sociodemographic and healthcare utilization variables. Log-binomial regression was used to identify correlates of initiation. Results: Overall, 239 (82%) patients initiated AHT. Tamoxifen (42%) and anastrozole (55%) were most commonly prescribed. The mean copay was $4.90 for tamoxifen and $6.00 for anastrozole. Although crude analyses revealed small, statistically significant prevalence ratios for race/ethnicity (Hispanic vs. white, other vs. white), year of diagnosis (2008 vs. 2012), primary care visit before diagnosis (any vs. none), and smoking status (current vs. never), there were no significant correlates of initiation in the adjusted model. Conclusion: Safety-net healthcare systems providing access to AHT ( i.e., through reduced copays) could improve the number of eligible patients initiating therapy. Continuity and integration of care in these settings may reduce disparities frequently observed in uninsured, low-income breast cancer populations. [ABSTRACT FROM AUTHOR]

The United States is affected by an average of almost seven severe weather events a year, often resulting in billions of dollars in physical and economic damages, a subset of which are related to grid outages. There is a need for power and energy system stakeholders to better understand and implement the strategies that help reduce net-economic and societal consequences associated with grid outages by improving the resilience of their systems. In addition, there are incentives to reduce emissions and meet climate goals, several pathways of which include resilient technologies. Including resilience constraints and metrics in energy system planning models may help inform the design of more resilient systems that are also more renewable and sustainable. This paper reviews qualitative definitions of resilience, quantitative approaches to resilience, recent examples of the inclusion of resilience in energy system models with respect to acute climatological threats, and the gaps in fully articulating resilience in current modeling tools. We then outline steps to effectively improve resilience considerations against such threats into energy sector modeling tools. Based on the findings, the authors propose a novel framework for energy system resilience assessment and future areas of research to bridge the current modeling gaps. • To date, resilience concerns have been lacking in energy systems optimization models. • Research is needed to better understand how renewables can contribute to resilience. • Resilience concerns should include uncertainty and translate to economic costs. • Future modeling efforts of co-optimizing renewable and resilience goals should be applied to common and validated models. [ABSTRACT FROM AUTHOR]

• Need for firm capacity will drive future adoption of higher battery power capacity. • Higher battery power capacity enables ILRs of 2.0 and above. • Net energy value increases at a decreasing rate with ILR. • Future PV cost declines will likely compete with declining value. In this study, we explore how the energy and capacity values of coupled systems comprising solar photovoltaic arrays and battery storage (PV-plus-battery systems) could evolve over time based on the evolution of the bulk power system. Using a price-taker model with simulated hourly energy and capacity prices projected from the present to 2050, we simulate the revenue-maximizing dispatch of a range of DC-coupled PV-plus-battery configurations in three locations in the United States. These configurations are defined by the inverter loading ratio (ILR, the ratio of the PV array capacity to the inverter capacity, which we vary from 1.4 to 2.6) and the battery-inverter ratio (BIR, the ratio of the battery power capacity to the inverter capacity, which we vary from 0.25 to 1.0). Based on each configuration's total value, we estimate the breakeven costs needed to justify each incremental increase in ILR (holding BIR constant) or BIR (holding ILR constant). We find that, in a future with low-cost renewable energy technologies, PV-plus-battery system ILRs can be economically increased to around 2.0–2.4 at a BIR of 1.0, depending on solar resource. Our results indicate that a likely evolution of PV-plus-battery system design will be increasingly greater battery power capacity to mitigate the declining PV capacity value, which will, in turn, enable increasingly higher ILRs to further increase energy value. The extent to which PV-plus-systems will be deployed with increasingly higher ILRs depends primarily on whether PV cost declines outpace declining value and increasing curtailment over time. [ABSTRACT FROM AUTHOR]

• End-use electrification could accelerate and increase generation capacity additions. • Electrification could support greater cost-effective integration of renewables. • Costs per incremental unit of electricity grow modestly with electrification. • Electrification reduces energy sector emissions and primary energy consumption. Electrification of end-use technologies could have important implications for bulk power sector planning, operations, and impacts. By combining previously-defined electrification scenarios with capacity expansion modeling, we evaluate the potential challenges and opportunities associated with electrification. Our scenario analysis reveals that electrification reduces energy consumption and air emissions from across the energy sector, and its impacts on energy system costs are modest due, in part, to the abundance of low-cost resources in the United States. [ABSTRACT FROM AUTHOR]

Hybridization of solar photovoltaic (PV) and wind installations has the potential to reduce transmission costs through sharing of spur-line capacity and other interconnection cost components. Many studies have assessed hybridization opportunities on a site-by-site basis but have not captured the impact of PV-wind hybridization on overall power system evolution and system costs. Here, we use a high-resolution national-scale capacity-expansion model to explore electricity-system-cost-minimizing deployment of PV-wind hybrid systems across the United States (U.S.) in scenarios that achieve a zero-carbon electricity mix in 2040. While overall system cost savings resulting from hybridization are relatively small—roughly 0.8% for baseline interconnection cost assumptions and <2% for sensitivity cases with high interconnection costs—there are notable shifts in deployment patterns when hybridization is allowed. PV capacity is often relocated to sites where wind capacity and associated interconnection capacity is already deployed, and "overbuilding" of nameplate PV and wind capacity relative to point-of-interconnection capacity is observed to increase with rising interconnection costs. Roughly 300 gigawatts (GW) of point-of-interconnection capacity (over 500 GW of nameplate PV and wind capacity) are deployed at hybrid installations with PV:wind capacity ratios between 1:3 and 3:1 in modeled zero-carbon power systems across the U.S. • PV-wind hybrid deployment is modeled at ∼50,000 sites across the contiguous U.S. • Hundreds of gigawatts of PV-wind hybrids are deployed in modeled zero-carbon systems. • With hybridization, PV capacity often relocates to sites with installed wind capacity. • Overall electricity system costs are reduced by roughly 1–2% with hybridization. • "Overbuilding" generation vs interconnection capacity offsets high transmission costs. [ABSTRACT FROM AUTHOR]