Urban land planning: The role of a Master Plan in influencing local temperatures

Land use planning (LUP) is central for managing issues related to climatic variation in urban environments. However, Master Plans (MPs) usually do not include climatic aspects, and few studies have addressed climate change at the urban scale, especially in developing countries. This paper proposes a framework with ten categories for assessment of climatic variation in urban LUP. Each category comprises attributes that describe a complex of relationships in influencing local temperature variations. They are analyzed for the case of the Master Plan of Porto Alegre (MPPA), the Southernmost metropolis of Brazil. It is concluded that the MPPA is strongly grounded in climate-related land and zoning coordination, but exhibits weaknesses in building, cartographical and social aspects considered synergistically relevant for tackling problems related to urban climate variation. Furthermore, the MPPA does not contain provisions related to monitoring of local climate and greenhouse gases (GHG) emissions and it is ineffective for improving energy efficiency. Specific MPPA failures stemming from these weaknesses include: an increase of 21.79% in the city's urbanized area from 1986 to 2011 to accommodate a similar increase in population, with significant horizontal sprawl; average temperature rise of 0.392. °C from 1991-2000 to 2001-2010, with statistically significant increases in temperature found since 1931; significant vehicle traffic increases, especially since 2007. From these findings, it is possible to conclude that the MPPA does not offer answers to all the imbalances related to land use, and therefore gives insufficient support to tackle the issue of rising temperatures

Reduced costs with bisoprolol treatment for heart failure - An economic analysis of the second Cardiac Insufficiency Bisoprolol Study (CIBIS-II)

Background Beta-blockers, used as an adjunctive to diuretics, digoxin and angiotensin converting enzyme inhibitors, improve survival in chronic heart failure. We report a prospectively planned economic analysis of the cost of adjunctive beta-blocker therapy in the second Cardiac Insufficiency BIsoprolol Study (CIBIS II). Methods Resource utilization data (drug therapy, number of hospital admissions, length of hospital stay, ward type) were collected prospectively in all patients in CIBIS . These data were used to determine the additional direct costs incurred, and savings made, with bisoprolol therapy. As well as the cost of the drug, additional costs related to bisoprolol therapy were added to cover the supervision of treatment initiation and titration (four outpatient clinic/office visits). Per them (hospital bed day) costings were carried out for France, Germany and the U.K. Diagnosis related group costings were performed for France and the U.K. Our analyses took the perspective of a third party payer in France and Germany and the National Health Service in the U.K. Results Overall, fewer patients were hospitalized in the bisoprolol group, there were fewer hospital admissions perpatient hospitalized, fewer hospital admissions overall, fewer days spent in hospital and fewer days spent in the most expensive type of ward. As a consequence the cost of care in the bisoprolol group was 5-10% less in all three countries, in the per them analysis, even taking into account the cost of bisoprolol and the extra initiation/up-titration visits. The cost per patient treated in the placebo and bisoprolol groups was FF35 009 vs FF31 762 in France, DM11 563 vs DM10 784 in Germany and pound 4987 vs pound 4722 in the U.K. The diagnosis related group analysis gave similar results. Interpretation Not only did bisoprolol increase survival and reduce hospital admissions in CIBIS II, it also cut the cost of care in so doing. This `win-win' situation of positive health benefits associated with cost savings is Favourable from the point of view of both the patient and health care systems. These findings add further support for the use of beta-blockers in chronic heart failure