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

Prevention of osteoporotic refractures in regional Australia

Objective: Clinical guidelines recommend that patients who sustain a minimal trauma fracture (MTF) should receive a bone mineral density (BMD) scan and bisphosphonate (or equivalent) therapy if diagnosed with osteoporosis. A pilot fracture liaison service (FLS) was implemented in regional NSW to improve adherence to the guidelines. Design: Prospective cohort study with an historical control. Setting: Primary care. Participants: Control (n = 47) and cohort (n = 93) groups comprised patients consenting to interview who presented with a MTF to the major referral hospital 4 months before and 12 months after FLS implementation respectively. Main outcome measures: Primary outcome measures were the rates of BMD scans and anti-osteoporotic medication initiation/review after MTF. Hospital admission data were also examined to determine death and refracture rates for all patients presenting during the study period with a primary diagnosis of MTF within 3 years of their initial fracture. Results: Although there was no improvement in BMD scanning rates, the reported rate of medication initiation/review after fracture was significantly higher (P \u3c 0.05) in the FLS cohort. However, once adjusted for age, this association was not significant (P = 0.086). There was a lower refracture rate during the cohort period (P = 0.013), however, there were significantly more deaths (P = 0.035) within 3 years of initial fracture. When deaths were taken into account via competing risk regression, patients in the cohort period were significantly less likely to refracture than those in the control period (Hazard ratio = 0.576, P = 0.032). Conclusions: A rurally based nurse-led FLS was associated with modest improvement after MTF. Consideration should be given to ways to strengthen the model of care to improve outcomes

State criminal justice telecommunications (STACOM). Volume 3: Requirements analysis and design of Texas criminal Justice Telecommunications Network

For abstract, see N78-16218

Application of computer-aided dispatch in law enforcement: An introductory planning guide

A set of planning guidelines for the application of computer-aided dispatching (CAD) to law enforcement is presented. Some essential characteristics and applications of CAD are outlined; the results of a survey of systems in the operational or planning phases are summarized. Requirements analysis, system concept design, implementation planning, and performance and cost modeling are described and demonstrated with numerous examples. Detailed descriptions of typical law enforcement CAD systems, and a list of vendor sources, are given in appendixes

Diploma in Education? Rethinking the Curriculum.

For well over half a century the traditional end-on diploma year has been under fire from university departments, students, and the teaching profession. How is it possible in one year for students to reach adequate levels of knowledge and understanding in a large number of subjects, epistemologicalIy diverse and frequently outside their undergraduate experience? The answer of course, is that it is not possible to believe otherwise is to labour under gross delusion. A university department of education, acting with the best of intentions, cannot give more than cursory attention to even the most essential elements of a preservice programme within an abbreviated academic year

When are active Brownian particles and run-and-tumble particles equivalent? Consequences for motility-induced phase separation

Active Brownian particles (ABPs, such as self-phoretic colloids) swim at fixed speed $v$ along a body-axis ${\bf u}$ that rotates by slow angular diffusion. Run-and-tumble particles (RTPs, such as motile bacteria) swim with constant \u until a random tumble event suddenly decorrelates the orientation. We show that when the motility parameters depend on density $\rho$ but not on ${\bf u}$, the coarse-grained fluctuating hydrodynamics of interacting ABPs and RTPs can be mapped onto each other and are thus strictly equivalent. In both cases, a steeply enough decreasing $v(\rho)$ causes phase separation in dimensions $d=2,3$, even when no attractive forces act between the particles. This points to a generic role for motility-induced phase separation in active matter. However, we show that the ABP/RTP equivalence does not automatically extend to the more general case of \u-dependent motilities

Moderate influenza vaccine effectiveness in Victoria, Australia, 2011

We used a sentinel general practitioner (GP) network to conduct surveillance for laboratory-confirmed influenza amongst patients presenting with influenza-like illness (ILI) in Victoria, Australia in 2011. The test-negative variation of the case control study design was used to estimate effectiveness for seasonal trivalent influenza vaccine. Cases and controls were ILI patients that tested positive and negative for influenza, respectively. Vaccination status was recorded by GPs and vaccine effectiveness (VE) was calculated as (1-adjusted odds ratio)x100%. There were 529 patients included in the study, of which 29% were influenza-positive. Twelve percent of study participants were reported as vaccinated, 6% of cases and 15% of controls. Adjusted VE against all influenza was 56%, but not statistically significant. There was generally little variation in VE estimates when stratified by virus type and subtype, which is consistent with good matches between circulating strains and the vaccine strains. The VE was higher among adults of working age than among children

Modelling fish habitat preference with a genetic algorithm-optimized Takagi-Sugeno model based on pairwise comparisons

Species-environment relationships are used for evaluating the current status of target species and the potential impact of natural or anthropogenic changes of their habitat. Recent researches reported that the results are strongly affected by the quality of a data set used. The present study attempted to apply pairwise comparisons to modelling fish habitat preference with Takagi-Sugeno-type fuzzy habitat preference models (FHPMs) optimized by a genetic algorithm (GA). The model was compared with the result obtained from the FHPM optimized based on mean squared error (MSE). Three independent data sets were used for training and testing of these models. The FHPMs based on pairwise comparison produced variable habitat preference curves from 20 different initial conditions in the GA. This could be partially ascribed to the optimization process and the regulations assigned. This case study demonstrates applicability and limitations of pairwise comparison-based optimization in an FHPM. Future research should focus on a more flexible learning process to make a good use of the advantages of pairwise comparisons

PLM in design and engineering education: International perspectives

Technological advances in the last decade have influenced changes in the design and engineering industries on a global scale. Lean and collaborative product development are approaches increasingly adopted by the industry and seen as the core of product lifecycle management. These trends have created the need for new skilled professionals, and universities should adapt their curricula in response. There is an increased need for academia to work with industry in order to meet these challenges. This article reports on the Parametric Technology Corporation Academic Research Symposium held in April 2011. The topics were centred around understanding the essence of product lifecycle management and its impact on design and engineering education. Furthermore, examples of implementing product lifecycle management and collaborative practices in higher education were presented from the United States and France. This article concludes with a discussion of the recommendations made at the symposium for the future development and support of key skills across university curricula