Do Employees From Less-Healthy Communities Use More Care and Cost More? Seeking to Establish a Business Case for Investment in Community Health.

INTRODUCTION: Few studies have examined the impact of community health on employers. We explored whether employed adults and their adult dependents living in less-healthy communities in the greater Philadelphia region used more care and incurred higher costs to employers than employees from healthier communities. METHODS: We used a multi-employer database to identify adult employees and dependents with continuous employment and mapped them to 31 zip code regions. We calculated community health scores at the regional level, by using metrics similar to the Robert Wood Johnson Foundation (RWJF) County Health Rankings but with local data. We used descriptive analyses and multilevel linear modeling to explore relationships between community health and 3 outcome variables: emergency department (ED) use, hospital use, and paid claims. Business leaders reviewed findings and offered insights on preparedness to invest in community health improvement. RESULTS: Poorer community health was associated with high use of ED services, after controlling for age and sex. After including a summary measure of racial composition at the zip code region level, the relationship between community health and ED use became nonsignificant. No significant relationships between community health and hospitalizations or paid claims were identified. Business leaders expressed interest in further understanding health needs of communities where their employees live. CONCLUSION: The health of communities in which adult employees and dependents live was associated with ED use, but similar relationships were not seen for hospitalizations or paid claims. This finding suggests a need for more primary care access. Despite limited quantitative evidence, business leaders expressed interest in guidance on investing in community health improvement

Seismic Loss and Downtime Assessment of Existing Tall Steel-Framed Buildings and Strategies for Increased Resilience

In areas of high seismicity in the United States, the design of many existing tall buildings followed guidelines that do not provide an explicit understanding of performance during major earthquakes. This paper presents an assessment of the seismic performance of existing tall buildings and strategies for increased resilience for a case study city, San Francisco, where an archetype tall building is designed based on an inventory of the existing tall building stock. A 40-story moment-resisting frame system is selected as a representative tall building. The archetype building is rectangular in plan and represents the state of design and construction practice from the mid-1970s to the mid-1980s. Nonlinear response history analysis (NLRHA) are conducted with ground motions representative of the design earthquake hazard level defined in current building codes, with explicit consideration of near-fault directivity effects. Mean transient interstory drifts and story accelerations under the 10% in 50-year ground motion hazard range from 0.19 to 1.14% and 0.15 to 0.81 g, respectively. In order to influence decision making, performance is reported as the expected consequences in terms of direct economic losses and downtime. Furthermore, to achieve increased levels of resilience, a number of strategies are proposed including seismic improvements to structural and nonstructural systems as well as mitigation measures to minimize impeding factors. Expected direct economic losses for the archetype building are in the order of 34% of building cost and downtime estimates for functional recovery are 87 weeks. The strategies presented in this paper enable up to a 92% reduction in losses and minimize downtime for functional recovery to 1 day or less

Seismic Loss and Downtime Estimates of Existing Tall Buildings and Strategies for Increased Resilience

Tall buildings play an important role in the socio-economic activity of major metropolitan areas. The resilience of these structures is critical to ensure a successful recovery after major disasters. Events such as the Canterbury earthquake in 2011 have highlighted the impact of poor performing buildings on the business continuity of downtown districts, where tall buildings are typically clustered together. Following the 2011 earthquake, Christchurch’s Central Business District (CBD) red zone covered a significant area of the city and more than 60% of the businesses were displaced (CERC 2012). Until the introduction of Performance Based Seismic Design (PBSD) in the 1990s, buildings were designed using conventional building codes, which follow a prescriptive force-based approach based on the first mode translational response of the structure (FEMA 2006). Researchers and engineers have raised concerns that the prescriptive approach of building codes is not suitable for tall building design due to the significant contribution of higher mode effects (PEER 2010a). As a result of these shortcomings, several jurisdictions in areas of high seismicity throughout the Unites States (e.g. Los Angeles and San Francisco) have adopted a PBSD approach for the design of new tall buildings. While new designs follow a more adequate approach, little is known about the seismic performance of older existing tall buildings that were designed prior to the adoption of PBSD (Almufti et al. 2012). This paper presents an assessment of the seismic performance of existing tall buildings in a case study city, San Francisco, where an archetype tall building is designed based on an inventory of the existing tall building stock. Non-Linear Response History Analysis (NLRHA) are conducted with ground motions representative of the design earthquake hazard level defined in current building codes, with explicit consideration of near-fault directivity effects. In order to influence decision making, performance is reported as the expected consequences in terms of direct economic losses and downtime. Once the performance of the archetype building is assessed, a range of structural and nonstructural enhancements are explored for enhanced performance as well as mitigation measures for increased resilience. Expected direct economic losses for the archetype building are in the order of 34% of building cost and downtime estimates for functional recovery are 87 weeks. The strategies presented in this paper enable up to a 92% reduction in losses and minimize downtime for functional recovery to 1 day

Risk-based seismic performance assessment of existing tall steel-framed buildings in San Francisco

This study presents the results of a risk-based seismic performance assessment of an archetype tall building representative of the existing tall building stock in San Francisco, CA. The archetype tall building, selected based on an inventory of existing tall buildings, is a 40- storey Moment Resisting Frame (MRF) representative of design and construction practice from the 1970-s to the mid-1980s. A Multiple Stripe Analysis (MSA) was conducted at 8 different intensity levels ranging from frequent to very rare seismic events, i.e. from 85% to 1% probability of exceedance in 50 years. Non-Linear Response History Analyses (NLRHA) were conducted with ground motions representative of each intensity level considered. The results of the NLRHA results were used to assess the probability of earthquake losses, considering collapse potential and the probability of the building deemed irreparable due to permanent residual drifts in the structure. Based on the MSA results, the collapse fragility of the structure, assumed to follow a lognormal cumulative distribution expressed as a function of spectral acceleration at the fundamental period of the structure (T=5 seconds), has an estimated median of 0.15g and a dispersion of 0.30. A number of loss metrics were developed for the archetype building including: a loss function, which provides the annual frequency of exceeding a certain value of loss, e.g. the expected 500 year loss equals $53M or 39$0.6M or 0.46% of the building replacement cost; and loss exceedance rates, e.g. a loss of 10% building replacement cost or $13.5M has an exceedance rate of 95 years. The use of these results to benchmark the performance of the archetype tall building against the design intent in current building codes and to assess the impact of structural retrofit or other building enhancements is discussed

Kernel reconstruction for delayed neural field equations

Understanding the neural field activity for realistic living systems is a challenging task in contemporary neuroscience. Neural fields have been studied and developed theoretically and numerically with considerable success over the past four decades. However, to make effective use of such models, we need to identify their constituents in practical systems. This includes the determination of model parameters and in particular the reconstruction of the underlying effective connectivity in biological tissues. In this work, we provide an integral equation approach to the reconstruction of the neural connectivity in the case where the neural activity is governed by a delay neural field equation. As preparation, we study the solution of the direct problem based on the Banach fixed point theorem. Then we reformulate the inverse problem into a family of integral equations of the first kind. This equation will be vector valued when several neural activity trajectories are taken as input for the inverse problem. We employ spectral regularization techniques for its stable solution. A sensitivity analysis of the regularized kernel reconstruction with respect to the input signal u is carried out, investigating the Frechet differentiability of the kernel with respect to the signal. Finally, we use numerical examples to show the feasibility of the approach for kernel reconstruction, including numerical sensitivity tests, which show that the integral equation approach is a very stable and promising approach for practical computational neuroscience

A neural population model of the bi-phasic EEG-power spectrum during general anaesthesia

International audienceThe neuronal mechanisms of general anaesthesia are still poorly understood, though the induction of analgesia, amnesia, immobility and loss of consciousness by anaesthetic agents is well-established in hospital practice. To shed some light onto these mysterious effects, the chapter analyzes mathematically a neural field model describing the neural population dynamics by an integro-differential equation. The power spectrum is derived and compared to experimental results

Computer-assisted mammographic imaging

Computer-assisted mammography imaging comprises computer-based analysis of digitized images resulting in prompts aiding mammographic interpretation and computerized stereotactic localization devices which improve location accuracy. The commercial prompting systems available are designed to draw attention to mammographic abnormalities detected by algorithms based on symptomatic practise in North America. High sensitivity rates are important commercially but result in increased false prompt rates, which are known to distract radiologists. A national shortage of breast radiologists in the UK necessitates evaluation of such systems in a population breast screening programme to determine effectiveness in increasing cancer detection and feasibility of implementation

The roles of specialist provision for children with specific speech and language difficulties in England and Wales: a model for inclusion?

Children with specific speech and language difficulties pose a challenge to the education and health systems. In addition to their language difficulties they are also at risk of literacy and social, emotional and behavioural difficulties. The main support for children with more severe difficulties has been enhanced provision in mainstream schools (language units or integrated resources) and special schools. The move to an inclusive education system challenges this tradition. The present paper reports the results of interviews with heads of language units/integrated resources and headteachers of special schools (n=57) as part of a larger study within England and Wales. Their views are considered with reference to criteria for entry to specialist provision, the development of collaborative practice between teachers, teaching assistants and speech and language therapists, and the implications for inclusive education

Anesthetic action on the transmission delay between cortex and thalamus explains the beta-buzz observed under propofol anesthesia

In recent years, more and more surgeries under general anesthesia have been performed with the assistance of electroencephalogram (EEG) monitors. An increase in anesthetic concentration leads to characteristic changes in the power spectra of the EEG. Although tracking the anesthetic-induced changes in EEG rhythms can be employed to estimate the depth of anesthesia, their precise underlying mechanisms are still unknown. A prominent feature in the EEG of some patients is the emergence of a strong power peak in the β–frequency band, which moves to the α–frequency band while increasing the anesthetic concentration. This feature is called the beta-buzz. In the present study, we use a thalamo-cortical neural population feedback model to reproduce observed characteristic features in frontal EEG power obtained experimentally during propofol general anesthesia, such as this beta-buzz. First, we find that the spectral power peak in the α– and δ–frequency ranges depend on the decay rate constant of excitatory and inhibitory synapses, but the anesthetic action on synapses does not explain the beta-buzz. Moreover, considering the action of propofol on the transmission delay between cortex and thalamus, the model reveals that the beta-buzz may result from a prolongation of the transmission delay by increasing propofol concentration. A corresponding relationship between transmission delay and anesthetic blood concentration is derived. Finally, an analytical stability study demonstrates that increasing propofol concentration moves the systems resting state towards its stability threshold

Total synthesis and evaluation of 22-(3-azidobenzoyloxy)methyl epothilone C for photoaffinity labeling of β-tubulin

The total synthesis of 22-(3-azidobenzoyloxy)methyl epothilone C is described as a potential photoaffinity probe to elucidate the β-tubulin binding site. A sequential Suzuki-aldol-Yamaguchi macrolactonization strategy was utilized employing a novel derivatized C1–C6 fragment. The C22-functionalized analog exhibited good activity in microtubule assembly assays, but cytotoxicity was significantly reduced. Molecular modeling simulations indicated that excessive steric bulk in the C22 position is accommodated by the large hydrophobic pocket of the binding site. Photoaffinity labeling studies were inconclusive suggesting non-specific labeling