Public health and the economy could be served by reallocating medical expenditures to social programs.

As much as 30% of US health care spending in the United States does not improve individual or population health. To a large extent this excess spending results from prices that are too high and from administrative waste. In the public sector, and particularly at the state level, where budget constraints are severe and reluctance to raise taxes high, this spending crowds out social, educational, and public-health investments. Over time, as spending on medical care increases, spending on improvements to the social determinants of health are starved. In California the fraction of General Fund expenditures spent on public health and social programs fell from 34.8% in fiscal year 1990 to 21.4% in fiscal year 2014, while health care increased from 14.1% to 21.3%. In spending more on healthcare and less on other efforts to improve health and health determinants, the state is missing important opportunities for health-promoting interventions with a strong financial return. Reallocating ineffective medical expenditures to proven and cost-effective public health and social programs would not be easy, but recognizing its potential for improving the public's health while saving taxpayers billions of dollars might provide political cover to those willing to engage in genuine reform. National estimates of the percent of medical spending that does not improve health suggest that approximately $5 billion of California's public budget for medical spending has no positive effect on health. Up to 10,500 premature deaths could be prevented annually by reallocating this portion of medical spending to public health. Alternatively, the same expenditure could help an additional 418,000 high school students to graduate

Validation of Satellite Rainfall Products for Western Uganda.

Central equatorial Africa is deficient in long-term, ground-based measurements of rainfall; therefore, the aim of this study is to assess the accuracy of three high-resolution, satellite-based rainfall products in western Uganda for the 2001–10 period. The three products are African Rainfall Climatology, version 2 (ARC2); African Rainfall Estimation Algorithm, version 2 (RFE2); and 3B42 from the Tropical Rainfall Measuring Mission, version 7 (i.e., 3B42v7). Daily rainfall totals from six gauges were used to assess the accuracy of satellite-based rainfall estimates of rainfall days, daily rainfall totals, 10-day rainfall totals, monthly rainfall totals, and seasonal rainfall totals. The northern stations had a mean annual rainfall total of 1390 mm, while the southern stations had a mean annual rainfall total of 900 mm. 3B42v7 was the only product that did not underestimate boreal-summer rainfall at the northern stations, which had ~3 times as much rainfall during boreal summer than did the southern stations. The three products tended to overestimate rainfall days at all stations and were borderline satisfactory at identifying rainfall days at the northern stations; the products did not perform satisfactorily at the southern stations. At the northern stations, 3B42v7 performed satisfactorily at estimating monthly and seasonal rainfall totals, ARC2 was only satisfactory at estimating seasonal rainfall totals, and RFE2 did not perform satisfactorily at any time step. The satellite products performed worst at the two stations located in rain shadows, and 3B42v7 had substantial overestimates at those stations

Liquid droplet radiator program at the NASA Lewis Research Center

The NASA Lewis Research Center and the Air Force Rocket Propulsion Laboratory (AFRPL) are jointly engaged in a program for technical assessment of the Liquid Droplet Radiator (LDR) concept as an advanced high performance heat ejection component for future space missions. NASA Lewis has responsibility for the technology needed for the droplet generator, for working fluid qualification, and for investigating the physics of droplets in space; NASA Lewis is also conducting systems/mission analyses for potential LDR applications with candidate space power systems. For the droplet generator technology task, both micro-orifice fabrication techniques and droplet stream formation processes have been experimentally investigated. High quality micro-orifices (to 50 micron diameter) are routinely fabricated with automated equipment. Droplet formation studies have established operating boundaries for the generation of controlled and uniform droplet streams. A test rig is currently being installed for the experimental verification, under simulated space conditions, of droplet radiation heat transfer performance analyses and the determination of the effect radiative emissivity of multiple droplet streams. Initial testing has begun in the NASA Lewis Zero-Gravity Facility for investigating droplet stream behavior in microgravity conditions. This includes the effect of orifice wetting on jet dynamics and droplet formation. Results for both Brayton and Stirling power cycles have identified favorable mass and size comparisons of the LDR with conventional radiator concepts

Population pressure and global markets drive a decade of forest cover change in Africa\u27s Albertine Rift

Africa\u27s Albertine Rift region faces a juxtaposition of rapid human population growth and protected areas, making it one of the world\u27s most vulnerable biodiversity hotspots. Using satellite-derived estimates of forest cover change, we examined national socioeconomic, demographic, agricultural production, and local demographic and geographic variables, to assess multilevel forces driving local forest cover loss and gain outside protected areas during the first decade of this century. Because the processes that drive forest cover loss and gain are expected to be different, and both are of interest, we constructed models of significant change in each direction. Although rates of forest cover change varied by country, national population change was the strongest driver of forest loss for all countries – with a population doubling predicted to cause 2.06% annual cover loss, while doubling tea production predicted to cause 1.90%. The rate of forest cover gain was associated positively with increased production of the local staple crop cassava, but negatively with local population density and meat production, suggesting production drivers at multiple levels affect reforestation. We found a small but significant decrease in loss rate as distance from protected areas increased, supporting studies suggesting higher rates of landscape change near protected areas. While local population density mitigated the rate of forest cover gain, loss was also correlated with lower local population density, an apparent paradox, but consistent with findings that larger scale forces outweigh local drivers of deforestation. This implicates demographic and market forces at national and international scales as critical drivers of change, calling into question the necessary scales of forest protection policy in this biodiversity hotspot. Using a satellite derived estimate of forest cover change for both loss and gain added a dynamic component to more traditionally static and unidirectional studies, significantly improving our understanding of landscape processes and drivers at work

Kontrollierbares Infektionsrisiko?:Eine Intensivstation unter dem Mikroskop

In der vorliegenden Arbeit wurden Katheter- und Infusionssysteme einer chirurgischen Intensivstation an verschiedenen Lokalisationen des Systems auf Keimkontaminationen untersucht. Hierbei wurden eine medikamentenabhängige Kontaminationshäufung und die Konsequenz der Kontamination für den Patienten geprüft. 6,67% der getesteten Systeme waren mit potentiell humanpathogenen Erregern kolonisiert. Eine medikamentenabhängige Kontaminationshäufung konnte nicht nachgewiesen werden. Anhand der Lokalisation und dem Bakteriennachweis im Patienten liegt es nahe in 75% der Fälle von einer exogenen Kontamination der Infusionssysteme auszugehen. Eine Ursache hierfür kann in mangelhafter Einhaltung der hygienischen Richtlinien gesehen werden. Eine Verkürzung von Wechselintervallen für Infusionssysteme ist nicht geeignet, um die Inzidenz nosokomialer Infektionen zu reduzieren. Zusammenfassend konnte gezeigt werden, dass die bakterielle Kontamination von Infusionssystemen durch fehlerhafte Hygienemaßnahmen ein relevantes Problem im intensivmedizinischen Alltag darstellt

Effects of alcohol consumption on mortality in patients with Type 2 diabetes mellitus

Aims/hypothesis: Moderate alcohol intake has been associated with increased life expectancy due to reduced mortality from cardiovascular disease. We prospectively examined the effects of alcohol consumption on mortality in Type 2 diabetic patients in Switzerland. Methods: A total of 287 patients with Type 2 diabetes mellitus (125 women, 162 men), recruited in Switzerland for the WHO Multinational Study of Vascular Disease in Diabetes, were included in this study. After a follow-up period of 12.6±0.6 years (means ± SD), mortality from CHD and from all causes was assessed. Results: During the follow-up, 70 deaths occurred (21 from CHD, 49 from other causes). Compared with non-drinkers, alcohol consumers who drank alcohol 1 to 15g, 16 to 30g and 30g or more per day had the following risk rates of death from CHD: 0.87 (95% CI: 0.25 to 2.51, NS), 0.00 (95% CI: 0.00 to 0.92, p less than 0.05) and 0.37 (95% CI, 0.01 to 2.42, NS), respectively. The corresponding risk rates of death from all causes were 1.27 (95% CI: 0.68 to 2.28, NS), 0.36 (95% CI: 0.09 to 0.99, p less than 0.05) and 1.66 (95% CI: 0.76 to 3.33, NS). Conclusions/interpretation: In Swiss Type 2 diabetic patients moderate alcohol consumption of 16 to 30g per day was associated with reduced mortality from CHD and from all causes. Alcohol intake above 30g per day was associated with a tendency towards increased all-cause mortalit

A multi-scale agent-based modelling framework for urban freight distribution

Comprehensive modelling of urban freight operations remains a challenge in transportation research. This is partly due to the diversity of commodities transported, shipment units, vehicle types used, stakeholders’ objectives (e.g. suppliers, carriers, receivers), and to the limited availability of data. Thus, existing modelling efforts require several assumptions yet have limited behavioral foundations and minimal interaction between agents. This paper proposes a new agent-based modelling framework, which considers the heterogeneity of urban freight agents and their interactions. Agents include establishments (suppliers, carriers, and receivers) and freight vehicle drivers. Agents’ decisions are structured in three temporal resolutions: strategic, tactical, and operational. A single set of agents is represented throughout all modelling levels ensuring a consistent and sequential flow of information. At the strategic level, establishments’ characteristics and strategic decisions are modelled. These include location choices, fleet constitution, annual production/consumption of commodities, and establishment-to-establishment commodity flows. At the tactical level, shipments are assigned to carriers, who in turn plan their operations in terms of vehicle-driver-route assignments. Finally, at the operational level, the interactions between daily operational demands and transportation network supply are simulated. The supply representation has two different resolution levels (micro or meso) allowing for either detailed or computational efficient simulation. The simulation platform is distinct from previous works, as it explicitly considers planning horizons, replicates agent decision makings/interactions and involves a structure that allows for the propagation of influences bottom-up (e.g., prior simulation travel times on future route choice). The paper describes the simulation platform, constituent models, and illustrates its capabilities using an application of the modelling framework to the city of Singapore. Keywords: freight transport; city logistics; commodity flow; freight tours; simulation; AB

Oxidation and emission of methane in a monomictic lake (Rotsee, Switzerland)

The build-up of methane in the hypolimnion of the eutrophic Lake Rotsee (Lucerne, Switzerland) was monitored over a full year. Sources and sinks of methane in the water column were characterized by measuring concentrations and carbon isotopic composition. In fall, high methane concentrations (up to 1mM) were measured in the anoxic water layer. In the oxic layer, methane concentrations were much lower and the isotopic composition shifted towards heavy carbon isotopes. Methane oxidation rates peaked at the interface between oxic and anoxic water layers at around 8-10m depth. The electron balance between the oxidants oxygen, sulphate, and nitrate, and the reductants methane, sulphide and ammonium, matched very well in the chemocline during the stratified season. The profile of carbon isotopic composition of methane showed strong indications for methane oxidation at the chemocline (including the oxycline). Aerobic methane oxidizing bacteria were detected at the interface using fluorescence in situ hybridization. Sequencing the responsible organisms from DGGE bands revealed that aerobic methanotrophs type I closely related to Methylomonas were present. Sulphate consumption occurred at the sediment surface and, only towards the end of the stagnation period, matched with a zone of methane consumption. In any case, the flux of sulphate below the chemocline was not sufficient to oxidize all the methane and other oxidants like nitrate, iron or manganese are necessary for the observed methane oxidation. Although most of the methane was oxidized either aerobically or anaerobically, Lake Rotsee was still a source of methane to the atmosphere with emission rates between 0.2mgCH4m−2day−1 in February and 7mgCH4m−2day−1 in Novembe

QTc interval and resting heart rate as long-term predictors of mortality in type 1 and type 2 diabetes mellitus: a 23-year follow-up

Aims/hypothesis: We evaluated the association of QT interval corrected for heart rate (QTc) and resting heart rate (rHR) with mortality (all-causes, cardiovascular, cardiac, and ischaemic heart disease) in subjects with type 1 and type 2 diabetes. Methods: We followed 523 diabetic patients (221 with type 1 diabetes, 302 with type 2 diabetes) who were recruited between 1974 and 1977 in Switzerland for the WHO Multinational Study of Vascular Disease in Diabetes. Duration of follow-up was 22.6 ± 0.6years. Causes of death were obtained from death certificates, hospital records, post-mortem reports, and additional information given by treating physicians. Results: In subjects with type 1 diabetes QTc, but not rHR, was associated with an increased risk of: (1) all-cause mortality (hazard ratio [HR] 1.10 per 10ms increase in QTc, 95% CI 1.02-1.20, p = 0.011); (2) mortality due to cardiovascular (HR 1.15, 1.02-1.31, p = 0.024); and (3) mortality due to cardiac disease (HR 1.19, 1.03-1.36, p = 0.016). Findings for subjects with type 2 diabetes were different: rHR, but not QTc was associated with mortality due to: (1) all causes (HR 1.31 per 10 beats per min, 95% CI 1.15-1.50, p < 0.001); (2) cardiovascular disease (HR 1.43, 1.18-1.73, p < 0.001); (3) cardiac disease (HR 1.45, 1.19-1.76, p < 0.001); and (4) ischaemic heart disease (HR 1.52, 1.21-1.90, p < 0.001). Effect modification of QTc by type 1 and rHR by type 2 diabetes was statistically significant (p < 0.05 for all terms of interaction). Conclusions/interpretation: QTc is associated with long-term mortality in subjects with type 1 diabetes, whereas rHR is related to increased mortality risk in subjects with type 2 diabete