Two state-space models, one for the US health care system and one for the US economy, were developed and estimated for the period 1950-1999. The output from the US economy model was then used as a reference input to control the growth of the health care system model. The counterfactual history produced by simulating the controlled model shows that a reduction in investment and volume-based services would have been needed to bring the growth of the health care system in line with the US economy. Specifically, a 13% reduction in capital expenditure, a 15% reduction in drug prices and a 32% reduction in prices for physician's services would have been needed over the late twentieth century. The methodology also suggests how universal health care programs might be designed using planning and economic incentives without either over-engineering plan provisions or using centralized, command-and-control approaches.

The absence of reliable access to clean energy and the services it provides imposes a large disease burden on low-income populations and impedes prospects for development. Furthermore, current patterns of fossil-fuel use cause substantial ill-health from air pollution and occupational hazards. Impending climate change, mainly driven by energy use, now also threatens health. Policies to promote access to non-polluting and sustainable sources of energy have great potential both to improve public health and to mitigate (prevent) climate disruption. There are several technological options, policy levers, and economic instruments for sectors such as power generation, transport, agriculture, and the built environment. However, barriers to change include vested interests, political inertia, inability to take meaningful action, profound global inequalities, weak technology-transfer mechanisms, and knowledge gaps that must be addressed to transform global markets. The need for policies that prevent dangerous anthropogenic interference with the climate while addressing the energy needs of disadvantaged people is a central challenge of the current era. A comprehensive programme for clean energy should optimise mitigation and, simultaneously, adaption to climate change while maximising co-benefits for health-eg, through improved air, water, and food quality. Intersectoral research and concerted action, both nationally and internationally, will be required.

We present a simple analysis of the global warming problem caused by the emissions of CO2 (a major greenhouse gas) into the atmosphere resulting from the burning of fossil fuels. We provide quantitative tools which enable policymakers and interested citizens to explore the following issues central to the global warming problem.(i) At what rate are we permitted to continue to emit CO2 after the global average atmospheric concentration has 'stabilized' at some chosen target level? The answer here provides the magnitude of the effort, measured by the necessary total reduction of today's global (annual) emissions rate to achieve stabilization. We shall see that stabilized emissions rates for all interesting stabilized concentration levels are much lower than the current emissions rate, but these small finite values are very important.(ii) Across how many years can we spread the total effort to reduce the annual CO2 emissions rate from its current high value to the above-mentioned low and stabilized target value? The answer here provides the time-scale of the total mitigation effort for any chosen atmospheric concentration target level. We confirm the common understanding that targets below a doubling of the pre-industrial concentration create great pressure to produce action immediately, while targets above double the pre-industrial level can tolerate longer periods of inaction.(iii) How much harder is the future mitigation effort, if we do not do our share of the job now? Is it a good idea to overshoot a stabilization target? The quantitative answers here provide the penalty of procrastination. For example, the mitigation task to avoid doubling the pre-industrial level is a problem that can be addressed gradually, over a period extending more than a century, if started immediately, but procrastination can turn the effort into a much more urgent task that extends over only a few decades. We also find that overshooting target levels is a bad idea.The quality of public discourse on this subject could be much enhanced if ball-park quantitative answers to these questions were more widely known.

Spacecraft launched to Mars can retain viable terrestrial microorganisms on board that may survive the interplanetary transit. Such biota might compromise the search for life beyond Earth if capable of propagating on Mars. The current study explored the survivability of Psychrobacter cryohalolentis K5, a psychrotolerant microorganism obtained from a Siberian permafrost cryopeg, under simulated martian surface conditions of high ultraviolet irradiation, high desiccation, low temperature, and low atmospheric pressure. First, a desiccation experiment compared the survival of P. cryohalolentis cells embedded, or not embedded, within a medium/salt matrix (MSM) maintained at 25 degrees C for 24 h within a laminar flow hood. Results indicate that the presence of the MSM enhanced survival of the bacterial cells by 1 to 3 orders of magnitude. Second, tests were conducted in a Mars Simulation Chamber to determine the UV tolerance of the microorganism. No viable vegetative cells of P. cryohalolentis were detected after 8 h of exposure to Mars-normal conditions of 4.55 W/m(2) UVC irradiation (200-280 nm),-12.5 degrees C, 7.1 mbar, and a Mars gas mix composed of CO(2)(95.3%), N(2)(2.7%), Ar (1.6%), O(2)(0.2%), and H(2)O (0.03%). Third, an experiment was conducted within the Mars chamber in which total atmospheric opacities were simulated at tau = 0.1 (dust-free CO(2) atmosphere at 7.1 mbar), 0.5 (normal clear sky with 0.4 = dust opacity and 0.1 = CO(2)-only opacity), and 3.5 (global dust storm) to determine the survivability of P. cryohalolentis to partially shielded UVC radiation. The survivability of the bacterium increased with the level of UVC attenuation, though population levels still declined several orders of magnitude compared to UVC-absent controls over an 8 h exposure period.

Predictions of forest succession, diversity and function require an understanding of how species differ in their growth, allocation patterns and susceptibility to mortality. These processes in turn are affected by allometric constraints and the physiological state of the tree, both of which are coupled to the tree's labile carbon status. Ultimately, insight into the hidden labile pools and the processes affecting the allocation of labile carbon to storage, maintenance and growth will improve our ability to predict tree growth, mortality and forest dynamics. We developed the 'Allometrically Constrained Growth and Carbon Allocation'(ACGCA) model that explicitly couples tree growth, mortality, allometries and labile carbon. This coupling results in (1) a semi-mechanistic basis for predicting tree death,(2) an allocation scheme that simultaneously satisfies allometric relationships and physiology-based carbon dynamics and (3) a range of physiological states that are consistent with tree behavior (e.g., healthy, static, shrinking, recovering, recovered and dead). We present the ACGCA model and illustrate aspects of its behavior by conducting simulations under different forest gap dynamics scenarios and with parameter values obtained for two ecologically dissimilar species: loblolly pine (Pinus taeda L.) and red maple (Acer rubrum L.). The model reproduces growth and mortality patterns of these species that are consistent with their shade-tolerance and succession status. The ACGCA framework provides an alternative, and potentially improved, approach for predicting tree growth, mortality and forest dynamics.

Abstract: Nutrient availability often limits primary production, yet the processes governing the dynamics of nutrient limitation are poorly understood. In particular, plant-available (e.g., nitrate) versus plant-unavailable (e.g., dissolved organic nitrogen) nutrient losses may have qualitatively different impacts on nutrient limitation. We examine processes controlling equilibrium and transient nutrient dynamics at three separate timescales in a model of a nutrient cycling through plants and soil. When the only losses are from the plant-available nutrient pool, nutrient limitation at a long-term equilibrium is impossible under a wide class of conditions. However, plant biomass will appear to level off on a timescale controlled by plant nutrient turnover (years in grasslands, decades to centuries in forests), even though it can grow slowly forever. Primary production can be nutrient limited in the long-term when there are losses of plant-unavailable nutrients or when the mineralization flux saturates with increasing detrital mass. The long timescale required for soil nutrient buildup is set by the plant-unavailable loss rate (centuries to millennia). The short timescale (hours to days) at which available nutrients in the soil equilibrate in the model is controlled by biotic uptake. These insights into processes controlling different timescales in terrestrial ecosystems can help guide empirical and experimental studies.

The perfect-plasticity approximation (PPA) is an analytically tractable model of forest dynamics, defined in terms of parameters for individual trees, including allometry, growth, and mortality. We estimated these parameters for the eight most common species on each of four soil types in the US Lake states (Michigan, Wisconsin, and Minnesota) by using short-term (</=15-year) inventory data from individual trees. We implemented 100-year PPA simulations given these parameters and compared these predictions to chronosequences of stand development. Predictions for the timing and magnitude of basal area dynamics and ecological succession on each soil were accurate, and predictions for the diameter distribution of 100-year-old stands were correct in form and slope. For a given species, the PPA provides analytical metrics for early-successional performance (H(20), height of a 20-year-old open-grown tree) and late-successional performance (Z*, equilibrium canopy height in monoculture). These metrics predicted which species were early or late successional on each soil type. Decomposing Z* showed that (i) succession is driven both by superior understory performance and superior canopy performance of late-successional species, and (ii) performance differences primarily reflect differences in mortality rather than growth. The predicted late-successional dominants matched chronosequences on xeromesic (Quercus rubra) and mesic (codominance by Acer rubrum and Acer saccharum) soil. On hydromesic and hydric soils, the literature reports that the current dominant species in old stands (Thuja occidentalis) is now failing to regenerate. Consistent with this, the PPA predicted that, on these soils, stands are now succeeding to dominance by other late-successional species (e.g., Fraxinus nigra, A. rubrum).

We use a two-species model of plant competition to explore the effect of intraspecific variation on community dynamics. The competitive ability ("performance") of each individual is assigned by an independent random draw from a species-specific probability distribution. If the density of individuals competing for open space is high (e.g., because fecundity is high), species with high maximum (or large variance in) performance are favored, while if density is low, species with high typical (e.g., mean) performance are favored. If there is an interspecific mean-variance performance trade-off, stable coexistence can occur across a limited range of intermediate densities, but the stabilizing effect of this trade-off appears to be weak. In the absence of this trade-off, one species is superior. In this case, intraspecific variation can blur interspecific differences (i.e., shift the dynamics toward what would be expected in the neutral case), but the strength of this effect diminishes as competitor density increases. If density is sufficiently high, the inferior species is driven to extinction just as rapidly as in the case where there is no overlap in performance between species. Intraspecific variation can facilitate coexistence, but this may be relatively unimportant in maintaining diversity in most real communities.

BACKGROUND: Canopy structure, which can be defined as the sum of the sizes, shapes and relative placements of the tree crowns in a forest stand, is central to all aspects of forest ecology. But there is no accepted method for deriving canopy structure from the sizes, species and biomechanical properties of the individual trees in a stand. Any such method must capture the fact that trees are highly plastic in their growth, forming tessellating crown shapes that fill all or most of the canopy space. METHODOLOGY/PRINCIPAL FINDINGS: We introduce a new, simple and rapidly-implemented model-the Ideal Tree Distribution, ITD-with tree form (height allometry and crown shape), growth plasticity, and space-filling, at its core. The ITD predicts the canopy status (in or out of canopy), crown depth, and total and exposed crown area of the trees in a stand, given their species, sizes and potential crown shapes. We use maximum likelihood methods, in conjunction with data from over 100,000 trees taken from forests across the coterminous US, to estimate ITD model parameters for 250 North American tree species. With only two free parameters per species-one aggregate parameter to describe crown shape, and one parameter to set the so-called depth bias-the model captures between-species patterns in average canopy status, crown radius, and crown depth, and within-species means of these metrics vs stem diameter. The model also predicts much of the variation in these metrics for a tree of a given species and size, resulting solely from deterministic responses to variation in stand structure. CONCLUSIONS/SIGNIFICANCE: This new model, with parameters for US tree species, opens up new possibilities for understanding and modeling forest dynamics at local and regional scales, and may provide a new way to interpret remote sensing data of forest canopies, including LIDAR and aerial photography.

The scientific and policy worlds have different goals, which can lead to different standards for what constitutes "proof" of a change or phenomena, and different approaches for characterizing and conveying uncertainty and risk. These differences can compromise effective communication among scientists, policymakers, and the public, and constrain the types of socially compelling questions scientists are willing to address. In this paper, we review a set of approaches for dealing with uncertainty, and illustrate some of the errors that arise when science and policy fail to coordinate correctly. We offer a set of recommendations, including restructuring of science curricula and establishment of science-policy forums populated by leaders in both arenas, and specifically constituted to address problems of uncertainty.

A variety of models have shown that spatial dynamics and small-scale endogenous heterogeneity (e.g., forest gaps or local resource depletion zones) can change the rate and outcome of competition in communities of plants or other sessile organisms. However, the theory appears complicated and hard to connect to real systems. We synthesize results from three different kinds of models: interacting particle systems, moment equations for spatial point processes, and metapopulation or patch models. Studies using all three frameworks agree that spatial dynamics need not enhance coexistence nor slow down dynamics; their effects depend on the underlying competitive interactions in the community. When similar species would coexist in a nonspatial habitat, endogenous spatial structure inhibits coexistence and slows dynamics. When a dominant species disperses poorly and the weaker species has higher fecundity or better dispersal, competition-colonization trade-offs enhance coexistence. Even when species have equal dispersal and per-generation fecundity, spatial successional niches where the weaker and faster-growing species can rapidly exploit ephemeral local resources can enhance coexistence. When interspecific competition is strong, spatial dynamics reduce founder control at large scales and short dispersal becomes advantageous. We describe a series of empirical tests to detect and distinguish among the suggested scenarios.

This prospective study was designed to have an insight into critical events occurring in the 13-bedded multidisciplinary intensive care unit (ICU) of our hospital and to report the critical events to evaluate the avoidable/iatrogenic problems so as to improve patient outcome and keep a self-check in the ICU. The errors reported were due to wrong mechanical or human performance. Repeated performance errors of the same kind pointed to the problem area, to which was paid proper attention in the required manner. Some malfunctioning equipments were abandoned and the need for adequate availability of staff was emphasized. Reporting of critical events was done keeping the patients' and doctor's identities anonymous through a proforma designed to report the event.

BACKGROUND: The objective of this study is to present cardiovascular results of a national study about the implementation of clinical guidelines and other instruments and practices for clinical care management among health plan operators in Brasil. METHODS: This was a cross-sectional study based on a representative sample of the 1,573 Brazilian health plan operators, stratified by macro region and market segment. Each stratum was subdivided in take-all and take-some strata by Hedlin's method, with equiprobability selection in each take-some stratum. The resulting sample size was of 90 health plan operators who were interviewed using a structured questionnaire. The study had a descriptive nature and, to obtain estimates for percents and total number of health plan operators relative to a population size of N=1572., sample weights were taken into account. RESULTS: Of the health plan operators, 61.2% considered that the implementation of clinical guidelines should be conducted by administrative and regulatory government organizations, involving a partnership with health plan operators, health service providers and medical societies. It was shown that only 32.3% of the health plan operators in the country enforce clinical guidelines. With regard to cardiovascular disease, the reported utilization of guidelines was one of the highest among all diseases analyzed. The percentages for acute myocardial infarction (87%), congestive heart failure (85%) and the use of invasive procedures (81.1%) were higher than for arterial hypertension (74.1%) and cerebrovascular disease (72.2%). CONCLUSION: This study indicated the incipient utilization of clinical guidelines among health plan operators in the Brazilian health system. In general, the cardiovascular area showed one of the highest rates of utilization reported in the study.

According to the reviews of some critical factors, such as incidence rate of oral maxillofacial neoplasm, influence factors of molecular-biology and pathology, and advancement of comprehensive treatments, a new treatment idea-balancing therapeutic idea (BTI) has been put forward to improve the patients' life quality, prolong their survival, and decrease their psychological and physiological pains. The key point of the BTJ is that the doctors should pay much attention to the patients' overall benefit and keep away from the risk of over-treatment based on the fact that it is impossible that cancer cells are killed out at the hiological level. It is important for doctors to let the residual tumor cells be monitored and restricted with body's immune defense system under the condition of normal physiological function and not being destroyed by improper treatment. This is the most important purpose of BTI that let oral cancer become chronic disease authentically and improve the therapeutic safety and efficiency.

Because of the increasing number of cicatricial uteruses, uterine ruptures are likely to become more frequent. However, few cases discovered in the postpartum period are described in literature. Our case report describes a uterine rupture, which occurred during a quick vaginal delivery, in a patient with previous cesarian section. The diagnosis has been made few days after delivery, the patient presenting pelvic pain and fever. We do not disagree with the principle to check uterine scar only when suspicion of rupture, but we should keep in mind that in case of endometritis in the postpartum period, with cicatricial uterus, it would be necessary to research uterine rupture by fitted imaging.

Despite the cardiovascular risk attributable to the NSAIDs, these drugs are among the most prescribed treatments in the world. Recently to manage this risk during chronic inflammatory rheumatisms a surveillance plan has been developed based on a decision algorithm. Given that the arterial thrombotic risks (myocardial or cerebral) are observed essentially during long-term treatments, two types of situation have been envisaged, short-term treatments and long-term treatments. Before any short-term NSAID prescription (less than one month), the cardio-renal risk should be evaluated. A pre-therapeutic check-up should include the search for risk factors and the treatment surveillance should imply a clinical and biological check-up carried out after 2 to 3 weeks of treatment. Before any long-term NSAID prescription (more than one month), the arterial thrombotic risk (cardiac or cerebral) should be evaluated and the patient's history determined. Pre-therapeutic check-up and surveillance should be carried out and reconsidered at least every three months. In the case of high risk, the advice of a cardiologist should be obtained and drastic therapeutic measures taken. There are cases where the prescription of NSAIDs or coxibs is possibly not recommended.

A method based on measurements of dissolved molecular nitrogen, molecular oxygen, and argon can distingish biological from physical contributions to oxygen supersaturation in the ocean. The derived values of biological O(2) production can be used as a check on estimates of total organic productivity measured by instantaneous rates of carbon-14 assimilation. Application to the shallow summer O(2) maxima in the North Pacific gyres shows that about 72% of the O(2) supersaturation maximum at 28 degrees N and about 86% of the maximum at 40 degrees N are due to net photosynthetic production.

OBJECTIVE: To investigate whether the alterations of microtubule and microfilament expression are responsible for the neurotoxicity of carbon disulfide. METHODS: Wistar rats were administered with carbon disulfide by gavage at a dosage of 300 or 500 mg/kg for continuous 12 weeks (five times per week). Spinal cords of carbon disulfide-intoxicated rats and their age-matched controls were Triton-extracted and ultracentrifuged to yield a pellet and a corresponding supernatant fraction. Then, the contents of alpha-tubulin, beta-tubulin, and beta-actin in both fractions were determined by immunoblotting. In the meantime, their mRNA levels in spinal cords were quantified using reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS: In the supernatant fraction, the contents of beta-tubulin and beta-actin in both treated groups increased significantly (P < 0.01) the content of beta-tubulin increased by 141% and 158% respectively, and the content of beta-actin increased by 19% and 32% respectively. In the pellet fraction, the content of beta-tubulin in both groups increased by 107%(P < 0.01) and 118%(P < 0.01) respectively, and the others keep unaffected. In the meantime, the levels of of mRNA expression of beta-tubulin and beta-actin gene were elevated consistently in CS(2)-treated groups (P < 0.01) the levels of mRNA expression of beta-tubulin increased by 207% and 212% respectively, and the levels of mRNA expression of beta-actin increased by 94% and 91% respectively. CONCLUSION: Carbon disulfide intoxication results in alternations of microtubule and microfilament expression, and the alternations might be related to its neurotoxicity.

Helminths of the respiratory system make up an important part of the parasitic diseases found in domestic animals. Therefore, many studies have been carried out on these helminths in Turkey. In this article, a check list and the prevalence rates of helminths of respiratory system found in domestic animals in Turkey has been given.

A 55-year-old man was admitted to our hospital with a growing cystic lesion in the left middle field of the lung. After we diagnosed it as non-small cell lung cancer, we performed left upper lobectomy. A series of chest X-ray revealed that the cyst was formed by the check-valve mechanism due to the lung cancer, retrospectively. We should keep in mind the existence of lung cancer and other malignant tumors adjacent to cystic lesions.