Spatial patterns of natural hazards mortality in the United States

<p>Abstract</p> <p>Background</p> <p>Studies on natural hazard mortality are most often hazard-specific (e.g. floods, earthquakes, heat), event specific (e.g. Hurricane Katrina), or lack adequate temporal or geographic coverage. This makes it difficult to assess mortality from natural hazards in any systematic way. This paper examines the spatial patterns of natural hazard mortality at the county-level for the U.S. from 1970–2004 using a combination of geographical and epidemiological methods.</p> <p>Results</p> <p>Chronic everyday hazards such as severe weather (summer and winter) and heat account for the majority of natural hazard fatalities. The regions most prone to deaths from natural hazards are the South and intermountain west, but sub-regional county-level mortality patterns show more variability. There is a distinct urban/rural component to the county patterns as well as a coastal trend. Significant clusters of high mortality are in the lower Mississippi Valley, upper Great Plains, and Mountain West, with additional areas in west Texas, and the panhandle of Florida, Significant clusters of low mortality are in the Midwest and urbanized Northeast.</p> <p>Conclusion</p> <p>There is no consistent source of hazard mortality data, yet improvements in existing databases can produce quality data that can be incorporated into spatial epidemiological studies as demonstrated in this paper. It is important to view natural hazard mortality through a geographic lens so as to better inform the public living in such hazard prone areas, but more importantly to inform local emergency practitioners who must plan for and respond to disasters in their community.</p

Assessing variation in utilization for acute myocardial infarction in New York State

a b s t r a c t Background: Wide variations exist in healthcare expenditures, though most prior studies have assessed aggregate utilization. We sought to examine healthcare utilization variation in New York State by assessing hospitals in peer groups of similar capabilities. Methods: Using charge data in New York State from the 2008 Statewide Planning and Research Cooperative System (SPARCS) and cost-to-charge ratios at the cost-center level drawn from Institutional Cost Reports, we calculated total, routine, and ancillary costs for patients discharged with an acute myocardial infarction (AMI) diagnosis in 2008. We assessed the correlation of these cost data to Hospital Referral Region (HRR) Medicare reimbursement data from the 2007 Dartmouth Atlas of Health Care. After describing hospital level cost variability, we examined characteristics associated with higher costs within peer groups of similar cardiac care capabilities. Results: We found greater costs in hospitals providing the highest level of cardiovascular services, with cardiac surgery capable hospitals and non-invasive hospitals having total costs of $21,166 and$9268 per AMI discharge, and ancillary costs of $12,006 and$4167 per AMI discharge, respectively. Substantial variability in utilization existed in all levels of hospitals and across individual departmental cost centers. The two factors most frequently associated with higher total and ancillary costs across peer groups were patient case mix index and major or minor teaching status. Conclusions: Significant variation in cost per AMI discharge exists even within peer groups of hospitals with similar cardiac care capabilities. Implications: These findings support measurement and analysis at the hospital level to further understand the reasons for variation in utilization

Glucosyltransferase-dependent and independent effects of Clostridioides difficile toxins during infection

Clostridioides difficile infection (CDI) is the leading cause of nosocomial diarrhea and pseudomembranous colitis in the USA. In addition to these symptoms, patients with CDI can develop severe inflammation and tissue damage, resulting in life-threatening toxic megacolon. CDI is mediated by two large homologous protein toxins, TcdA and TcdB, that bind and hijack receptors to enter host cells where they use glucosyltransferase (GT) enzymes to inactivate Rho family GTPases. GT-dependent intoxication elicits cytopathic changes, cytokine production, and apoptosis. At higher concentrations TcdB induces GT-independent necrosis in cells and tissue by stimulating production of reactive oxygen species via recruitment of the NADPH oxidase complex. Although GT-independent necrosis has been observed in vitro, the relevance of this mechanism during CDI has remained an outstanding question in the field. In this study we generated novel C. difficile toxin mutants in the hypervirulent BI/NAP1/PCR-ribotype 027 R20291 strain to test the hypothesis that GT-independent epithelial damage occurs during CDI. Using the mouse model of CDI, we observed that epithelial damage occurs through a GT-independent process that does not involve immune cell influx. The GT-activity of either toxin was sufficient to cause severe edema and inflammation, yet GT activity of both toxins was necessary to produce severe watery diarrhea. These results demonstrate that both TcdA and TcdB contribute to disease pathogenesis when present. Further, while inactivating GT activity of C. difficile toxins may suppress diarrhea and deleterious GT-dependent immune responses, the potential of severe GT-independent epithelial damage merits consideration when developing toxin-based therapeutics against CDI

Engineering Corynebacterium glutamicum for isobutanol production

The production of isobutanol in microorganisms has recently been achieved by harnessing the highly active 2-keto acid pathways. Since these 2-keto acids are precursors of amino acids, we aimed to construct an isobutanol production platform in Corynebacterium glutamicum, a well-known amino-acid-producing microorganism. Analysis of this host’s sensitivity to isobutanol toxicity revealed that C. glutamicum shows an increased tolerance to isobutanol relative to Escherichia coli. Overexpression of alsS of Bacillus subtilis, ilvC and ilvD of C. glutamicum, kivd of Lactococcus lactis, and a native alcohol dehydrogenase, adhA, led to the production of 2.6 g/L isobutanol and 0.4 g/L 3-methyl-1-butanol in 48 h. In addition, other higher chain alcohols such as 1-propanol, 2-methyl-1-butanol, 1-butanol, and 2-phenylethanol were also detected as byproducts. Using longer-term batch cultures, isobutanol titers reached 4.0 g/L after 96 h with wild-type C. glutamicum as a host. Upon the inactivation of several genes to direct more carbon through the isobutanol pathway, we increased production by ∼25% to 4.9 g/L isobutanol in a ∆pyc∆ldh background. These results show promise in engineering C. glutamicum for higher chain alcohol production using the 2-keto acid pathways

The Public Playground Paradox: "Child’s Joy" or Heterotopia of Fear?

Literature depicts children of the Global North withdrawing from public space to“acceptable islands”. Driven by fears both of and for children, the publicplayground – one such island – provides clear-cut distinctions between childhoodand adulthood. Extending this argument, this paper takes the original approach oftheoretically framing the playground as a heterotopia of deviance, examining –for the first time – three Greek public playground sites in relation to adjacentpublic space. Drawing on an ethnographic study in Athens, findings show fear tounderpin surveillance, control and playground boundary porosity. Normativeclassification as “children’s space” discourages adult engagement. However, in anovel and significant finding, a paradoxical phenomenon sees the playground’spresence simultaneously legitimizing playful behaviour in adjacent public spacefor children and adults. Extended playground play creates alternate orderings andnegotiates norms and hierarchies, suggesting significant wider potential toreconceptualise playground-urban design for an intergenerational public realm

Correction: The Unsustainable Trend of Natural Hazard Losses in the United States, &lt;em&gt;Sustainability&lt;/em&gt; 2011, &lt;em&gt;3&lt;/em&gt;, 2157-2181

The authors wish to make the following correction to this paper. Due to mislabeling, replace: [...] &lt;strong&gt;&lt;/strong&gt

The Unsustainable Trend of Natural Hazard Losses in the United States

In the United States, direct losses from natural hazards are on the rise with hurricanes, flooding, and severe storms contributing about three quarters of the total damages. While losses from severe storms have been stable over the past fifty years, hurricane and flood losses have tripled. Per capita losses are also increasing showing that impacts outpace population growth with high per capita losses occurring largely in the Southeast and Midwest. If the loss escalation of the past two decades continues into the future, then direct losses of $300 to$400 billion within a single decade are possible. In order to reverse this trend, sustainable development, vulnerability reduction, and hazard mitigation must become priorities and current loss reduction efforts need to be evaluated and re-assessed in terms of their effectiveness. These conclusions are drawn from the analysis of spatial and temporal trends in direct losses from natural hazards using SHELDUSTM data from 1960 through 2009. Loss data are adjusted for inflation, population, and wealth to capture both trends in total losses and per capita losses. The loss data are then compared to disaster-related federal government and private insurance expenditures

The Unsustainable Trend of Natural Hazard Losses in the United States

In the United States, direct losses from natural hazards are on the rise with hurricanes, flooding, and severe storms contributing about three quarters of the total damages. While losses from severe storms have been stable over the past fifty years, hurricane and flood losses have tripled. Per capita losses are also increasing showing that impacts outpace population growth with high per capita losses occurring largely in the Southeast and Midwest. If the loss escalation of the past two decades continues into the future, then direct losses of $300 to$400 billion within a single decade are possible. In order to reverse this trend, sustainable development, vulnerability reduction, and hazard mitigation must become priorities and current loss reduction efforts need to be evaluated and re-assessed in terms of their effectiveness. These conclusions are drawn from the analysis of spatial and temporal trends in direct losses from natural hazards using SHELDUS TM data from 1960 through 2009. Loss data are adjusted for inflation, population, and wealth to capture both trends in total losses and per capita losses. The loss data are then compared to disaster-related federal government and private insurance expenditures.natural hazards; losses; hazard mitigation; United States; severe weather; climate change; resilience