The effects of tides on the water mass mixing and sea ice in the Arctic Ocean

In this study, we use a novel pan-Arctic sea ice-ocean coupled model to examine the effects of tides on sea ice and the mixing of water masses. Two 30 year simulations were performed: one with explicitly resolved tides and the other without any tidal dynamics. We find that the tides are responsible for a ∼15% reduction in the volume of sea ice during the last decade and a redistribution of salinity, with surface salinity in the case with tides being on average ∼1.0–1.8 practical salinity units (PSU) higher than without tides. The ice volume trend in the two simulations also differs: −2.09 × 103 km3/decade without tides and −2.49 × 103 km3/decade with tides, the latter being closer to the trend of −2.58 × 103 km3/decade in the PIOMAS model, which assimilates SST and ice concentration. The three following mechanisms of tidal interaction appear to be significant: (a) strong shear stresses generated by the baroclinic clockwise rotating component of tidal currents in the interior waters; (b) thicker subsurface ice-ocean and bottom boundary layers; and (c) intensification of quasi-steady vertical motions of isopycnals (by ∼50%) through enhanced bottom Ekman pumping and stretching of relative vorticity over rough bottom topography. The combination of these effects leads to entrainment of warm Atlantic Waters into the colder and fresher surface waters, supporting the melting of the overlying ice

Hotspots of dense water cascading in the Arctic Ocean: Implications for the Pacific water pathways

We explore dense water cascading (DWC), a type of bottom‐trapped gravity current, on multidecadal time scales using a pan‐Arctic regional ocean‐ice model. DWC is particularly important in the Arctic Ocean as the main mechanism of ventilation of interior waters when open ocean convection is blocked by strong density stratification. We identify the locations where the most intense DWC events occur and evaluate the associated cross‐shelf mass, heat, and salt fluxes. We find that the modeled locations of cascading agree well with the sparse historical observations and that cascading is the dominant process responsible for cross‐shelf exchange in the boundary layers. Simulated DWC fluxes of 1.3 Sv (1 Sv = 106 m3/s) in the Central Arctic are comparable to Bering Strait inflow, with associated surface and benthic Ekman fluxes of 0.85 and 0.58 Sv. With ice decline, both surface Ekman flux and DWC fluxes are increasing at a rate of 0.023 and 0.0175 Sv/year, respectively. A detailed analysis of specific cascading sites around the Beaufort Gyre and adjacent regions shows that autumn upwelling of warm and saltier Atlantic waters on the shelf and subsequent cooling and mixing of uplifted waters trigger the cascading on the West Chukchi Sea shelf break. Lagrangian particle tracking of low salinity Pacific waters originating at the surface in the Bering Strait shows that these waters are modified by brine rejection and cooling, and through subsequent mixing become dense enough to reach depths of 160–200 m

Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3

Sustainable Development Goal (SDG) 3 aims to “ensure healthy lives and promote well-being for all at all ages”. While a substantial effort has been made to quantify progress towards SDG3, less research has focused on tracking spending towards this goal. We used spending estimates to measure progress in financing the priority areas of SDG3, examine the association between outcomes and financing, and identify where resource gains are most needed to achieve the SDG3 indicators for which data are available

Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3

Background: Sustainable Development Goal (SDG) 3 aims to “ensure healthy lives and promote well-being for all at all ages”. While a substantial effort has been made to quantify progress towards SDG3, less research has focused on tracking spending towards this goal. We used spending estimates to measure progress in financing the priority areas of SDG3, examine the association between outcomes and financing, and identify where resource gains are most needed to achieve the SDG3 indicators for which data are available. Methods: We estimated domestic health spending, disaggregated by source (government, out-of-pocket, and prepaid private) from 1995 to 2017 for 195 countries and territories. For disease-specific health spending, we estimated spending for HIV/AIDS and tuberculosis for 135 low-income and middle-income countries, and malaria in 106 malaria-endemic countries, from 2000 to 2017. We also estimated development assistance for health (DAH) from 1990 to 2019, by source, disbursing development agency, recipient, and health focus area, including DAH for pandemic preparedness. Finally, we estimated future health spending for 195 countries and territories from 2018 until 2030. We report all spending estimates in inflation-adjusted 2019 US$, unless otherwise stated. Findings: Since the development and implementation of the SDGs in 2015, global health spending has increased, reaching$7·9 trillion (95% uncertainty interval 7·8–8·0) in 2017 and is expected to increase to $11·0 trillion (10·7–11·2) by 2030. In 2017, in low-income and middle-income countries spending on HIV/AIDS was$20·2 billion (17·0–25·0) and on tuberculosis it was $10·9 billion (10·3–11·8), and in malaria-endemic countries spending on malaria was$5·1 billion (4·9–5·4). Development assistance for health was $40·6 billion in 2019 and HIV/AIDS has been the health focus area to receive the highest contribution since 2004. In 2019,$374 million of DAH was provided for pandemic preparedness, less than 1% of DAH. Although spending has increased across HIV/AIDS, tuberculosis, and malaria since 2015, spending has not increased in all countries, and outcomes in terms of prevalence, incidence, and per-capita spending have been mixed. The proportion of health spending from pooled sources is expected to increase from 81·6% (81·6–81·7) in 2015 to 83·1% (82·8–83·3) in 2030. Interpretation: Health spending on SDG3 priority areas has increased, but not in all countries, and progress towards meeting the SDG3 targets has been mixed and has varied by country and by target. The evidence on the scale-up of spending and improvements in health outcomes suggest a nuanced relationship, such that increases in spending do not always results in improvements in outcomes. Although countries will probably need more resources to achieve SDG3, other constraints in the broader health system such as inefficient allocation of resources across interventions and populations, weak governance systems, human resource shortages, and drug shortages, will also need to be addressed. Funding: The Bill & Melinda Gates Foundatio

Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3

Background Sustainable Development Goal (SDG) 3 aims to “ensure healthy lives and promote well-being for all at all ages”. While a substantial effort has been made to quantify progress towards SDG3, less research has focused on tracking spending towards this goal. We used spending estimates to measure progress in financing the priority areas of SDG3, examine the association between outcomes and financing, and identify where resource gains are most needed to achieve the SDG3 indicators for which data are available. Methods We estimated domestic health spending, disaggregated by source (government, out-of-pocket, and prepaid private) from 1995 to 2017 for 195 countries and territories. For disease-specific health spending, we estimated spending for HIV/AIDS and tuberculosis for 135 low-income and middle-income countries, and malaria in 106 malaria-endemic countries, from 2000 to 2017. We also estimated development assistance for health (DAH) from 1990 to 2019, by source, disbursing development agency, recipient, and health focus area, including DAH for pandemic preparedness. Finally, we estimated future health spending for 195 countries and territories from 2018 until 2030. We report all spending estimates in inflation-adjusted 2019 US$, unless otherwise stated. Findings Since the development and implementation of the SDGs in 2015, global health spending has increased, reaching$7·9 trillion (95% uncertainty interval 7·8–8·0) in 2017 and is expected to increase to $11·0 trillion (10·7–11·2) by 2030. In 2017, in low-income and middle-income countries spending on HIV/AIDS was$20·2 billion (17·0–25·0) and on tuberculosis it was $10·9 billion (10·3–11·8), and in malaria-endemic countries spending on malaria was$5·1 billion (4·9–5·4). Development assistance for health was $40·6 billion in 2019 and HIV/AIDS has been the health focus area to receive the highest contribution since 2004. In 2019,$374 million of DAH was provided for pandemic preparedness, less than 1% of DAH. Although spending has increased across HIV/AIDS, tuberculosis, and malaria since 2015, spending has not increased in all countries, and outcomes in terms of prevalence, incidence, and per-capita spending have been mixed. The proportion of health spending from pooled sources is expected to increase from 81·6% (81·6–81·7) in 2015 to 83·1% (82·8–83·3) in 2030. Interpretation Health spending on SDG3 priority areas has increased, but not in all countries, and progress towards meeting the SDG3 targets has been mixed and has varied by country and by target. The evidence on the scale-up of spending and improvements in health outcomes suggest a nuanced relationship, such that increases in spending do not always results in improvements in outcomes. Although countries will probably need more resources to achieve SDG3, other constraints in the broader health system such as inefficient allocation of resources across interventions and populations, weak governance systems, human resource shortages, and drug shortages, will also need to be addressed

Tracking development assistance for health and for COVID-19: a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990-2050

Background The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. Methods We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. Findings In 2019, health spending globally reached$8. 8 trillion (95% uncertainty interval UI] 8.7-8.8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total,$40.4 billion (0.5%, 95% UI 0.5-0.5) was development assistance for health provided to low-income and middle-income countries, which made up 24.6% (UI 24.0-25.1) of total spending in low-income countries. We estimate that $54.8 billion in development assistance for health was disbursed in 2020. Of this,$13.7 billion was targeted toward the COVID-19 health response. $12.3 billion was newly committed and$1.4 billion was repurposed from existing health projects. $3.1 billion (22.4$2.4 billion (17.9%) was for supply chain and logistics. Only $714.4 million (7.7$1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied. Interpretation Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd

Histological Findings from Controlled Application of a Thermal Plasma to Human Skin

Ionised gas or plasma is often described as the fourth state of matter since it can be produced from an electrically neutral gas which has been fully or partially ionised. The resulting mixture of free electrons, positively charged ions and un-ionized gas possess a rich chemistry and may be used to transport thermal energy. Plasma has thus found applications in such diverse fields as spacecraft propulsion, magnetic confinement fusion, silicon etching, and surface treatment and of course biomedicine. We have developed a plasma generating device that can deliver a controlled depth epidermal and dermal burn injury as a function of energy delivery over a unit area and time of exposure. This is important as a therapeutic tool for treating skin lesions; a device to create burn wound healing models, for medicolegal understanding of burn depth and for the development of new wound care products. In our study plasma is delivered onto a human skin model in an experiment approved by the local ethics committee. Fresh abdominoplasty skin was marked according to protocol and treated with a controlled energy dose per unit area using the new plasma delivery system developed at the Surrey Space Centre at Surrey University. Skin samples are biopsied and immediately placed in formal saline before sectioning and staining. The immediate histological changes of superficial burn injury in human skin can then be determined. The findings in this study show a reproducible depth of thermal injury as a function of energy delivery. Each 25 J/cm2 increment up to 100 J/cm2 causes a 0.5 mm depth of cutaneous thermal injury. In the 25 and 50 J/cm2 injury the epidermis remains intact and appears as a ‘first degree or superficial burn injury’. Histologically the basal epidermal cells show characteristic oedematous morphology which we have called ‘Frame Cells’ because the morphology after superficial injury has not been previously recognized. There is a clear line of demarcation within the superficial dermis where the zone of coagulation meets the zone of stasis. In the 75 and 100 J/cm2 the epidermis appears coagulated and has histologically separated from the dermis burn at the dermo-epidermoid junction. The line of dermal coagulative necrosis is clearly defined. Melanocytes are absent immediately after even the most superficial injury. Fibroblasts, vascular endothelial cells, epithelial cells, pigment cells, collagen and elastin are all examined using immunohistochemical stains

Effect of Tides on the Indonesian Seas Circulation and Their Role on the Volume, Heat and Salt Transports of the Indonesian Throughflow

The effect of tides on the Indonesian Throughflow (ITF) is explored in a regional ocean model of South East Asia. Our model simulations, with and without tidal forcing, reveal that tides drive only a modest increase in the ITF volume, heat and salt transports toward the Indian Ocean. However, tides drive large regional changes in these transports through Lombok Strait, Ombai Strait and the Timor Sea, and regulate the partitioning of the ITF amongst them. The effect of tidal mixing on the salinity and temperature profiles within the Indonesian Seas drives a small decrease in the heat and salt transports toward the Indian Ocean in all three exit passages. In contrast, the tidal residual circulation due to the interaction between the tides and the topography and stratification (including the effects of tidal mixing on the circulation) leads to a large decrease in the transports toward the Indian Ocean through the Lombok and Ombai straits, but a large increase through the Timor Sea. Hence, the small net contribution from tides to the ITF's volume, heat and salt transports is due to a compensation between large, but opposing tidal residual transports at the combined Lombok and Ombai straits and in the Timor Sea. Our results indicate that explicit representation of tides, often missing in Earth system models, is necessary to accurately capture the ITF's pathway and so the tracer transport from the Pacific into the Indian Ocean

Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3

Background: Sustainable Development Goal (SDG) 3 aims to “ensure healthy lives and promote well-being for all at all ages”. While a substantial effort has been made to quantify progress towards SDG3, less research has focused on tracking spending towards this goal. We used spending estimates to measure progress in financing the priority areas of SDG3, examine the association between outcomes and financing, and identify where resource gains are most needed to achieve the SDG3 indicators for which data are available. Methods: We estimated domestic health spending, disaggregated by source (government, out-of-pocket, and prepaid private) from 1995 to 2017 for 195 countries and territories. For disease-specific health spending, we estimated spending for HIV/AIDS and tuberculosis for 135 low-income and middle-income countries, and malaria in 106 malaria-endemic countries, from 2000 to 2017. We also estimated development assistance for health (DAH) from 1990 to 2019, by source, disbursing development agency, recipient, and health focus area, including DAH for pandemic preparedness. Finally, we estimated future health spending for 195 countries and territories from 2018 until 2030. We report all spending estimates in inflation-adjusted 2019 US$, unless otherwise stated. Findings: Since the development and implementation of the SDGs in 2015, global health spending has increased, reaching$7·9 trillion (95% uncertainty interval 7·8–8·0) in 2017 and is expected to increase to $11·0 trillion (10·7–11·2) by 2030. In 2017, in low-income and middle-income countries spending on HIV/AIDS was$20·2 billion (17·0–25·0) and on tuberculosis it was $10·9 billion (10·3–11·8), and in malaria-endemic countries spending on malaria was$5·1 billion (4·9–5·4). Development assistance for health was $40·6 billion in 2019 and HIV/AIDS has been the health focus area to receive the highest contribution since 2004. In 2019,$374 million of DAH was provided for pandemic preparedness, less than 1% of DAH. Although spending has increased across HIV/AIDS, tuberculosis, and malaria since 2015, spending has not increased in all countries, and outcomes in terms of prevalence, incidence, and per-capita spending have been mixed. The proportion of health spending from pooled sources is expected to increase from 81·6% (81·6–81·7) in 2015 to 83·1% (82·8–83·3) in 2030. Interpretation: Health spending on SDG3 priority areas has increased, but not in all countries, and progress towards meeting the SDG3 targets has been mixed and has varied by country and by target. The evidence on the scale-up of spending and improvements in health outcomes suggest a nuanced relationship, such that increases in spending do not always results in improvements in outcomes. Although countries will probably need more resources to achieve SDG3, other constraints in the broader health system such as inefficient allocation of resources across interventions and populations, weak governance systems, human resource shortages, and drug shortages, will also need to be addressed

Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3

Background: Sustainable Development Goal (SDG) 3 aims to “ensure healthy lives and promote well-being for all at all ages”. While a substantial effort has been made to quantify progress towards SDG3, less research has focused on tracking spending towards this goal. We used spending estimates to measure progress in financing the priority areas of SDG3, examine the association between outcomes and financing, and identify where resource gains are most needed to achieve the SDG3 indicators for which data are available. Methods: We estimated domestic health spending, disaggregated by source (government, out-of-pocket, and prepaid private) from 1995 to 2017 for 195 countries and territories. For disease-specific health spending, we estimated spending for HIV/AIDS and tuberculosis for 135 low-income and middle-income countries, and malaria in 106 malaria-endemic countries, from 2000 to 2017. We also estimated development assistance for health (DAH) from 1990 to 2019, by source, disbursing development agency, recipient, and health focus area, including DAH for pandemic preparedness. Finally, we estimated future health spending for 195 countries and territories from 2018 until 2030. We report all spending estimates in inflation-adjusted 2019 US$, unless otherwise stated. Findings: Since the development and implementation of the SDGs in 2015, global health spending has increased, reaching$7·9 trillion (95% uncertainty interval 7·8–8·0) in 2017 and is expected to increase to $11·0 trillion (10·7–11·2) by 2030. In 2017, in low-income and middle-income countries spending on HIV/AIDS was$20·2 billion (17·0–25·0) and on tuberculosis it was $10·9 billion (10·3–11·8), and in malaria-endemic countries spending on malaria was$5·1 billion (4·9–5·4). Development assistance for health was $40·6 billion in 2019 and HIV/AIDS has been the health focus area to receive the highest contribution since 2004. In 2019,$374 million of DAH was provided for pandemic preparedness, less than 1% of DAH. Although spending has increased across HIV/AIDS, tuberculosis, and malaria since 2015, spending has not increased in all countries, and outcomes in terms of prevalence, incidence, and per-capita spending have been mixed. The proportion of health spending from pooled sources is expected to increase from 81·6% (81·6–81·7) in 2015 to 83·1% (82·8–83·3) in 2030. Interpretation: Health spending on SDG3 priority areas has increased, but not in all countries, and progress towards meeting the SDG3 targets has been mixed and has varied by country and by target. The evidence on the scale-up of spending and improvements in health outcomes suggest a nuanced relationship, such that increases in spending do not always results in improvements in outcomes. Although countries will probably need more resources to achieve SDG3, other constraints in the broader health system such as inefficient allocation of resources across interventions and populations, weak governance systems, human resource shortages, and drug shortages, will also need to be addressed. Funding: The Bill & Melinda Gates Foundation