A national survey of services for the prevention and management of falls in the UK

Background: The National Health Service (NHS) was tasked in 2001 with developing service provision to prevent falls in older people. We carried out a national survey to provide a description of health and social care funded UK fallers services, and to benchmark progress against current practice guidelines. Methods: Cascade approach to sampling, followed by telephone survey with senior member of the fall service. Characteristics of the service were assessed using an internationally agreed taxonomy. Reported service provision was compared against benchmarks set by the National Institute for Health and Clinical Excellence (NICE). Results: We identified 303 clinics across the UK. 231 (76%) were willing to participate. The majority of services were based in acute or community hospitals, with only a few in primary care or emergency departments. Access to services was, in the majority of cases, by health professional referral. Most services undertook a multi-factorial assessment. The content and quality of these assessments varied substantially. Services varied extensively in the way that interventions were delivered, and particular concern is raised about interventions for vision, home hazard modification, medication review and bone health. Conclusion: The most common type of service provision was a multi-factorial assessment and intervention. There were a wide range of service models, but for a substantial number of services, delivery appears to fall below recommended NICE guidance

Constraining emissions of volatile organic compounds from western US wildfires with WE-CAN and FIREX-AQ airborne observations

The impact of biomass burning (BB) on the atmospheric burden of volatile organic compounds (VOCs) is highly uncertain. Here we apply the GEOS-Chem chemical transport model (CTM) to constrain BB emissions in the western US at ~25 km resolution. Across three BB emission inventories widely used in CTMs, the total of 14 modeled BB VOC emissions in the western US agree with each other within 30&ndash;40 %. However, emissions for individual VOC differ by up to a factor of 5 (i.e., lumped &ge; C4 alkanes), driven by the regionally averaged emission ratios (ERs) among inventories. We further evaluate GEOS-Chem simulations with aircraft observations made during WE-CAN (Western Wildfire Experiment for Cloud Chemistry, Aerosol Absorption, and Nitrogen) and FIREX-AQ (Fire Influence on Regional to Global Environments and Air Quality) field campaigns. Despite being driven by different global BB inventories or applying various injection height assumptions, GEOS-Chem simulations underpredict observed vertical profiles by a factor of 3&ndash;7. The model shows small-to-no bias for most species in low/no smoke conditions. We thus attribute the negative model biases mostly to underestimated BB emissions in these inventories. Tripling BB emissions in the model reproduces observed vertical profiles for primary compounds, i.e., CO, propane, benzene, and toluene. However, it shows no-to-less significant improvements for oxygenated VOCs, particularly formaldehyde, formic acid, acetic acid, and lumped &ge; C3 aldehydes, suggesting the model is missing secondary sources of these compounds in BB-impacted environments. The underestimation of primary BB emissions in inventories is likely attributable to underpredicted amounts of effective dry matter burned, rather than errors in fire detection, injection height, or ERs. We cannot rule out potential sub-grid uncertainties (i.e., not being able to fully resolve fire plumes) in the nested GEOS-Chem which could explain the model negative bias partially, though the back-of-the-envelope calculation and evaluation using longer-term ground measurements help increase the argument of the dry matter burned underestimation. The ERs of the 14 BB VOCs implemented in GEOS-Chem account for about half of the total 161 measured VOCs (~75 versus 150 ppb ppm-1). This reveals a significant amount of missing reactive organic carbon in widely-used BB emission inventories. Considering both uncertainties in effective dry matter burned and unmodeled VOCs, we infer that BB contributed up to 10 % in 2019 and 45 % in 2018 (240 and 2040 GgC) of the total VOC primary emission flux in the western US during these two fire seasons, compared to only 1&ndash;10 % in the standard GEOS-Chem.</p

Diffusion of New Technologies for Patients With Prostate Cancer

Background/Aims: Prostate cancer is the most common and costly cancer among U.S. men and offers a portfolio of case studies and clinical problems. Among these, the documented increases in use of robotic radical prostatectomy (RRP) and intensity-modulated radiotherapy (IMRT) are illustrative of rapid diffusion of costly, unproven technological innovations. Evidence of these case studies has been limited to the traditional Medicare fee-for-service (FFS) aged population and may provide a potentially biased view of the universe of cancer care in the U.S. To address this issue, we examine treatment patterns among prostate cancer patients enrolled in two integrated health care delivery systems. Methods: The sample included a retrospective cohort of patients diagnosed with nonmetastatic prostate cancer between 2000 and 2008 at the Northwest and Colorado regions of Kaiser Permanente. Choice of radiation therapy was defined as the receipt of external beam radiotherapy (three-dimensional [3D] conformal radiation therapy vs. IMRT) as primary treatment within one year of diagnosis. Choice of prostatectomy was defined as the receipt of surgery as primary treatment (open radical prostatectomy vs. minimally-invasive/robotic radical prostatectomy). A pooled time-series cross-section design was used to analyze the medical care resource use for treating prostate cancer. Results: Both RRP and IMRT were introduced in the two health systems in 2003, and their use has been steadily increasing since then. Use of traditional treatments has either remained stable: open radical prostatectomy; or decreased: 3D conformal radiation therapy. Discussion: We hypothesize that diffusion rates of RRP and IMRT have been slower among HMO enrollees compared with FFS patients. This study improves our understanding of patterns of prostate cancer care in the U.S. by using a large sample of managed care enrollees across the age spectrum, including men younger than 65 relative to men older than 65 years

Long-Term Medical Care Costs of Breast, Prostate, Lung and Colorectal Cancer for HMO Members

Background/Aims: The rising economic burden of cancer in the United States has become a significant public policy issue. Current knowledge of cancer care costs is largely limited to Medicare fee-for-service patients age ≥ 65 years, based on linked Surveillance, Epidemiology, and End Results (SEER) Medicare data. Accordingly, estimates that reflect care costs across the cancer experience, from diagnosis to end-of-life and among individuals \u3c 65 years of age, are needed. This study estimated total and incremental long-term costs of care for individuals age ≥ 18 years diagnosed with breast, colorectal, lung and prostate cancer in integrated health care settings. Methods: We used administrative and electronic medical record data linked with tumor registry information for individuals who were enrolled in one of four nonprofit integrated health care systems and diagnosed with primary breast, colorectal, lung or prostate cancer between 1/1/2000–12/31/2008 (cases). We also identified age-/sex-matched cancer-free individuals (controls). Participating health systems included Group Health Cooperative, Henry Ford Health System, Kaiser Permanente Northwest and Kaiser Permanent Colorado. Long-term costs (at 5, 10 and 20 years) of care were based on the Phases-of-Care approach (Initial, Continuing and End-of-life phases) and measured using the Kaplan-Meier Sample Average estimator, incorporating cost data from the standardized relative resource cost algorithm and cancer site-, age- and stage-specific survival probabilities from SEER. Costs were calculated for both cases and controls to estimate total and incremental care costs, stratified by cancer site, age group (≥65 years) and stage at diagnosis (advanced vs. not advanced). Results: Total and incremental long-term costs of cancer care were significantly higher among individuals age \u3c 65 years at diagnosis compared to those ≥ 65 years. There was considerable variability in total and incremental long-term costs by cancer site and stage at diagnosis. Discussion: Estimates reported in this study improve our understanding of the magnitude of long-term economic resources needed to provide cancer care in the United States by describing cancer care costs among patients in integrated care settings and those age \u3c 65 years. Our results will be directly applicable to future analyses of cancer care costs, serving as a foundation for cost comparisons across different health care systems

Ocean biogeochemistry control on the marine emissions of brominated very short‐lived ozone‐depleting substances: A machine‐learning approach

Halogenated very short lived substances (VSLS) affect the ozone budget in the atmosphere. Brominated VSLS are naturally emitted from the ocean, and current oceanic emission inventories vary dramatically. We present a new global oceanic emission inventory of Br‐VSLS (bromoform and dibromomethane), considering the physical forcing in the ocean and the atmosphere, as well as the oceanbiogeochemistry control. A data‐oriented machine‐learning emulator was developed to couple the air‐sea exchange with the ocean biogeochemistry. The predicted surface seawater concentrations and the surface atmospheric mixing ratios of Br‐VSLS are evaluated with long‐term, global‐scale observations; and the predicted vertical distributions of Br‐VSLS are compared to the global airborne observations in both boreal summer and winter. The global marine emissions of bromoform and dibromomethane are estimated to be 385 and 54 Gg Br per year, respectively. The new oceanic emission inventory of Br‐VSLS is more skillful than the widely used top‐down approaches for representing the seasonal/spatial variations and theannual means of atmospheric concentrations. The new approach  improves the model predictability for the coupled Earth system model and can be used as a basis for investigating the past and future ocean emissions and feedbacks under climate change. This model framework can be used to calculate the bidirectional oceanic fluxes for other compounds of interest.Fil: Wang, Siyuan. National Center for Atmospheric Research; Estados UnidosFil: Kinnison, Douglas E.. National Center for Atmospheric Research; Estados UnidosFil: Montzka, Stephen A.. National Oceanic & Atmospheric Administration; Estados UnidosFil: Apel, Eric C.. University of California. Department of Chemistry; Estados UnidosFil: Hornbrook, Rebecca S.. National Center for Atmospheric Research; Estados UnidosFil: Hills, Alan J.. National Center for Atmospheric Research; Estados UnidosFil: Blake, Donald R.. University of California at Irvine; Estados UnidosFil: Barletta, Barbara. University of California at Irvine; Estados UnidosFil: Meinardi, Simone. University of California at Irvine; Estados UnidosFil: Sweeney, Colm. National Oceanic & Atmospheric Administration; Estados UnidosFil: Moore, Fred. National Oceanic & Atmospheric Administration; Estados UnidosFil: Long, Matthew. National Center for Atmospheric Research; Estados UnidosFil: Saiz-lopez, Alfonso. Instituteof Physical Chemistry Rocasolano. Department of Atmospheric Chemistry and Climate; EspañaFil: Fernandez, Rafael Pedro. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza; Argentina. Universidad Nacional de Cuyo. Facultad de Ciencias Exactas y Naturales; Argentina. Universidad Tecnológica Nacional. Facultad Regional Mendoza; ArgentinaFil: Tilmes, Simone. National Center for Atmospheric Research; Estados UnidosFil: Emmons, Louisa K.. National Center for Atmospheric Research; Estados UnidosFil: Lamarque, Jean-François. National Center for Atmospheric Research; Estados Unido