The Fiscal, Social and Economic Dividends of Feeling Better and Living Longer

While Canada has socialized most of the costs of treating illness, Canada has maintained a reliance on individuals interacting through private markets to invest in upstream health promotion and disease prevention. The failure of the market to provide the efficient level of upstream investment in health is leading to large and avoidable increases in the need for downstream medical treatment. The way to reduce the future deadweight loss of illness and disease is for provincial governments to address the upstream market failures through an expansion of the scope of public payment for health care to include upstream services for health promotion and disease prevention. Perhaps somewhat counterintuitively, spending public health-care dollars across a broader range of health and wellness services can result in spending less in total, because of the efficiency gains that will come from better health in the population. That is certainly what the evidence from a unique Albertan pilot project leads us to conclude. The Pure North S’Energy Foundation is a philanthropic initiative that pays for and provides preventative health-care services for Albertans drawn from groups that are vulnerable to poor health. This includes homeless people, people suffering from addiction, people with low incomes, people in isolated areas and susceptible seniors. The health improvements observed in those participating in the Pure North program have been significant. Effective health-promotion and disease-prevention services obviously benefit patients. But there are also substantial benefits to society as well. The annual health-care bill for a Canadian in poor health is estimated to be more than $10,000 higher than for someone in good health, meaning that keeping people in good health can be an important means for controlling public health-care budgets, and can free up scarce acutecare hospital resources. If the Pure North program were scaled-up province-wide to cover the nearly quartermillion Albertans in poor health, the resulting health improvement seen in Pure North participants could translate into a nearly 25-per-cent reduction in hospital days used by Alberta patients every year and a net savings of$500 million on hospital and physician costs. That does not even include the economic benefits of keeping workers in better health and productive, while spending fewer days ill or hospitalized. To date, Canada’s approach to health care has largely left it to patients to choose whether to seek healthpromotion and disease-prevention services on their own, suggesting an implicit deference to an individual’s rights and responsibilities. But for many low-income, isolated, addicted or aboriginal Canadians, there often is no choice: These services, when delivered privately, are often too expensive or may be otherwise inaccessible. The initial spirit behind Canadian medicare was to correct a health-market failure, so that no patient would face barriers to accessing necessary treatments. That same philosophy also recommends extending universal coverage for health-promotion and disease-prevention to vulnerable Canadians who today face similar barriers to access. If the Alberta government wants to show both foresight and fairness, the benefits from this kind of program, economically and societally, are simply too attractive to disregard

Servomotor and Controller Having Large Dynamic Range

A recently developed micro-commanding rotational-position-control system offers advantages of less mechanical complexity, less susceptibility to mechanical resonances, less power demand, less bulk, less weight, and lower cost, relative to prior rotational-position-control systems based on stepping motors and gear drives. This system includes a digital-signal- processor (DSP)-based electronic controller, plus a shaft-angle resolver and a servomotor mounted on the same shaft. Heretofore, micro-stepping has usually been associated with stepping motors, but in this system, the servomotor is micro-commanded in response to rotational-position feedback from the shaft-angle resolver. The shaft-angle resolver is of a four-speed type chosen because it affords four times the resolution of a single-speed resolver. A key innovative aspect of this system is its position-feedback signal- conditioning circuits, which condition the resolver output signal for multiple ranges of rotational speed. In the preferred version of the system, two rotational- speed ranges are included, but any number of ranges could be added to expand the speed range or increase resolution in particular ranges. In the preferred version, the resolver output is conditioned with two resolver-to-digital converters (RDCs). One RDC is used for speeds from 0.00012 to 2.5 rpm; the other RDC is used for speeds of 2.5 to 6,000 rpm. For the lower speed range, the number of discrete steps of RDC output per revolution was set at 262,144 (4 quadrants at 16 bits per quadrant). For the higher speed range, the number of discrete steps per revolution was set at 4,096 (4 quadrants at 10 bits per quadrant)

Developing an e-infrastructure for social science

We outline the aims and progress to date of the National Centre for e-Social Science e-Infrastructure project. We examine the challenges faced by the project, namely in ensuring outputs are appropriate to social scientists, managing the transition from research projects to service and embedding software and data within a wider infrastructural framework. We also provide pointers to related work where issues which have ramifications for this and similar initiatives are being addressed

The History of a Detection: A Most Unusual Volume and the Search for its Authorship

On General François Jarry, first Governor of the Royal Military College at High Wycombe, Jean-Baptiste Charles La Monnerie, of Port Macquarie, called Dr Fattorini, and the diary of Colonel Charles George Gray of the 75th Regiment of Foot, and the 95th Regiment (the Rifle Brigade known as the Green Jackets), and later of Port Macquarie

Qualification of Products Fabricated via Additive Manufacturing Using Nondestructive Evaluation

No abstract availabl

Ten-year mortality, disease progression, and treatment-related side effects in men with localised prostate cancer from the ProtecT randomised controlled trial according to treatment received

Background The ProtecT trial reported intention-to-treat analysis of men with localised prostate cancer randomly allocated to active monitoring (AM), radical prostatectomy, and external beam radiotherapy. Objective To report outcomes according to treatment received in men in randomised and treatment choice cohorts. Design, setting, and participants This study focuses on secondary care. Men with clinically localised prostate cancer at one of nine UK centres were invited to participate in the treatment trial comparing AM, radical prostatectomy, and radiotherapy. Intervention Two cohorts included 1643 men who agreed to be randomised and 997 who declined randomisation and chose treatment. Outcome measurements and statistical analysis Analysis was carried out to assess mortality, metastasis and progression and health-related quality of life impacts on urinary, bowel, and sexual function using patient-reported outcome measures. Analysis was based on comparisons between groups defined by treatment received for both randomised and treatment choice cohorts in turn, with pooled estimates of intervention effect obtained using meta-analysis. Differences were estimated with adjustment for known prognostic factors using propensity scores. Results and limitations According to treatment received, more men receiving AM died of PCa (AM 1.85%, surgery 0.67%, radiotherapy 0.73%), whilst this difference remained consistent with chance in the randomised cohort (p = 0.08); stronger evidence was found in the exploratory analyses (randomised plus choice cohort) when AM was compared with the combined radical treatment group (p = 0.003). There was also strong evidence that metastasis (AM 5.6%, surgery 2.4%, radiotherapy 2.7%) and disease progression (AM 20.35%, surgery 5.87%, radiotherapy 6.62%) were more common in the AM group. Compared with AM, there were higher risks of sexual dysfunction (95% at 6 mo) and urinary incontinence (55% at 6 mo) after surgery, and of sexual dysfunction (88% at 6 mo) and bowel dysfunction (5% at 6 mo) after radiotherapy. The key limitations are the potential for bias when comparing groups defined by treatment received and changes in the protocol for AM during the lengthy follow-up required in trials of screen-detected PCa. Conclusions Analyses according to treatment received showed increased rates of disease-related events and lower rates of patient-reported harms in men managed by AM compared with men managed by radical treatment, and stronger evidence of greater PCa mortality in the AM group. Patient summary More than 95 out of every 100 men with low or intermediate risk localised prostate cancer do not die of prostate cancer within 10 yr, irrespective of whether treatment is by means of monitoring, surgery, or radiotherapy. Side effects on sexual and bladder function are better after active monitoring, but the risks of spreading of prostate cancer are more common

Whole-genome landscapes of major melanoma subtypes

Melanoma of the skin is a common cancer only in Europeans, whereas it arises in internal body surfaces (mucosal sites) and on the hands and feet (acral sites) in people throughout the world. Here we report analysis of whole-genome sequences from cutaneous, acral and mucosal subtypes of melanoma. The heavily mutated landscape of coding and non-coding mutations in cutaneous melanoma resolved novel signatures of mutagenesis attributable to ultraviolet radiation. However, acral and mucosal melanomas were dominated by structural changes and mutation signatures of unknown aetiology, not previously identified in melanoma. The number of genes affected by recurrent mutations disrupting non-coding sequences was similar to that affected by recurrent mutations to coding sequences. Significantly mutated genes included BRAF, CDKN2A, NRAS and TP53 in cutaneous melanoma, BRAF, NRAS and NF1 in acral melanoma and SF3B1 in mucosal melanoma. Mutations affecting the TERT promoter were the most frequent of all; however, neither they nor ATRX mutations, which correlate with alternative telomere lengthening, were associated with greater telomere length. Most melanomas had potentially actionable mutations, most in components of the mitogen-activated protein kinase and phosphoinositol kinase pathways. The whole-genome mutation landscape of melanoma reveals diverse carcinogenic processes across its subtypes, some unrelated to sun exposure, and extends potential involvement of the non-coding genome in its pathogenesis

Retrospective evaluation of whole exome and genome mutation calls in 746 cancer samples

Funder: NCI U24CA211006Abstract: The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC) curated consensus somatic mutation calls using whole exome sequencing (WES) and whole genome sequencing (WGS), respectively. Here, as part of the ICGC/TCGA Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium, which aggregated whole genome sequencing data from 2,658 cancers across 38 tumour types, we compare WES and WGS side-by-side from 746 TCGA samples, finding that ~80% of mutations overlap in covered exonic regions. We estimate that low variant allele fraction (VAF < 15%) and clonal heterogeneity contribute up to 68% of private WGS mutations and 71% of private WES mutations. We observe that ~30% of private WGS mutations trace to mutations identified by a single variant caller in WES consensus efforts. WGS captures both ~50% more variation in exonic regions and un-observed mutations in loci with variable GC-content. Together, our analysis highlights technological divergences between two reproducible somatic variant detection efforts

An investigation into the design and performance of an automatic shape control system for a sedzimir cold rolling mill

Shape (or flatness) control for rolled steel strip is becoming increasingly important as customer requirements become more stringent. Automatic shape control is now more or less mandatory on all new four-high cold mills, but no comprehensive scheme yet exists on a Sendzimir mill. This is due to the complexity of the control system design on such a mill, where many more degrees of freedom for control exist than is the case with the four-high mills. The objective of the current work is to develop, from first principles, such a system; including automatic control of the As-U-Roll and first intermediate roll actuators in response to the measured strip shape. This thesis concerns itself primarily with the As-U-Roll control system. The material presented is extremely wide-ranging. Areas covered include the development of original static and dynamic mathematical models of the mill systems, and testing of the plant by data-logging to tune these models. A basic control system philosophy proposed by other workers is modified and developed to suit the practical system requirements and the data provided by the models. The control strategy is tested by comprehensive multivariable simulation studies. Finally, details are given of the practical problems faced when installing the system on the plant. These include problems of manual control inter-action bumpless transfer and integral desaturation. At the time of presentation of the thesis, system commissioning is still in progress and production results are therefore not yet available. Nevertheless, the simulation studies predict a successful outcome, although performance is expected to be limited until the first intermediate roll actuators are eventually included in the scheme also