...estimates of risk factor prevalence and effect were combined to estimate impacts (population attributable risks)-the fraction of all deaths that could potentially be prevented if exposure of the ...population to the risk factor of interest was reduced to the minimum risk level. ...intervening on social rank will itself partially address the challenge of unhealthy lifestyles. ...upstream interventions (eg, earned income tax credits, universal early childhood education) are likely to be pro-equity, whereas more downstream interventions (eg, smoking cessation assistance, dietary advice) typically favour the privileged (who generally find it easier to access material and social support for behaviour change).7 Yet are not all modern societies hierarchical? ...the strength of evidence for the effect of social rank on mortality, as exemplified by the study by Stringhini and colleagues, is now impossible to ignore. ...the UN Sustainable Development Goals,10 which have replaced the MDGs and will run from 2016 to 2030, provide a timely opportunity to go beyond the WHO 25 x 25 goal and place social determinants squarely at the centre of sustainable development.
Summary In high-income countries, life expectancy at age 60 years has increased in recent decades. Falling tobacco use (for men only) and cardiovascular disease mortality (for both men and women) are ...the main factors contributing to this rise. In high-income countries, avoidable male mortality has fallen since 1980 because of decreases in avoidable cardiovascular deaths. For men in Latin America, the Caribbean, Europe, and central Asia, and for women in all regions, avoidable mortality has changed little or increased since 1980. As yet, no evidence exists that the rate of improvement in older age mortality (60 years and older) is slowing down or that older age deaths are being compressed into a narrow age band as they approach a hypothesised upper limit to longevity.
IMPORTANCE: US health care spending has continued to increase, and now accounts for more than 17% of the US economy. Despite the size and growth of this spending, little is known about how spending ...on each condition varies by age and across time. OBJECTIVE: To systematically and comprehensively estimate US spending on personal health care and public health, according to condition, age and sex group, and type of care. DESIGN AND SETTING: Government budgets, insurance claims, facility surveys, household surveys, and official US records from 1996 through 2013 were collected and combined. In total, 183 sources of data were used to estimate spending for 155 conditions (including cancer, which was disaggregated into 29 conditions). For each record, spending was extracted, along with the age and sex of the patient, and the type of care. Spending was adjusted to reflect the health condition treated, rather than the primary diagnosis. EXPOSURES: Encounter with US health care system. MAIN OUTCOMES AND MEASURES: National spending estimates stratified by condition, age and sex group, and type of care. RESULTS: From 1996 through 2013, $30.1 trillion of personal health care spending was disaggregated by 155 conditions, age and sex group, and type of care. Among these 155 conditions, diabetes had the highest health care spending in 2013, with an estimated $101.4 billion (uncertainty interval UI, $96.7 billion-$106.5 billion) in spending, including 57.6% (UI, 53.8%-62.1%) spent on pharmaceuticals and 23.5% (UI, 21.7%-25.7%) spent on ambulatory care. Ischemic heart disease accounted for the second-highest amount of health care spending in 2013, with estimated spending of $88.1 billion (UI, $82.7 billion-$92.9 billion), and low back and neck pain accounted for the third-highest amount, with estimated health care spending of $87.6 billion (UI, $67.5 billion-$94.1 billion). The conditions with the highest spending levels varied by age, sex, type of care, and year. Personal health care spending increased for 143 of the 155 conditions from 1996 through 2013. Spending on low back and neck pain and on diabetes increased the most over the 18 years, by an estimated $57.2 billion (UI, $47.4 billion-$64.4 billion) and $64.4 billion (UI, $57.8 billion-$70.7 billion), respectively. From 1996 through 2013, spending on emergency care and retail pharmaceuticals increased at the fastest rates (6.4% UI, 6.4%-6.4% and 5.6% UI, 5.6%-5.6% annual growth rate, respectively), which were higher than annual rates for spending on inpatient care (2.8% UI, 2.8%–2.8% and nursing facility care (2.5% UI, 2.5%-2.5%). CONCLUSIONS AND RELEVANCE: Modeled estimates of US spending on personal health care and public health showed substantial increases from 1996 through 2013; with spending on diabetes, ischemic heart disease, and low back and neck pain accounting for the highest amounts of spending by disease category. The rate of change in annual spending varied considerably among different conditions and types of care. This information may have implications for efforts to control US health care spending.
Lithium (Li)-metal batteries using solid-state electrolytes (SSEs) have attracted extensive attention owing to their high energy density. However, the interface issues arising from the Li ...stripping/plating cycles pose a major challenge for the applications of these batteries. This paper reports a three-dimensional (3D) time-dependent electrokinetic model, built based on the Nernst–Planck equation with electroneutrality assumption, to quantify the effects of interface conformity, external pressure, electrolyte Young's modulus, and ionic conductivity on the electrochemical behaviors of symmetric solid-state lithium cells. The evolution of interface morphology is related to the surface roughness, elastoplastic deformation, creep, and plating of the Li metal. The Laplace-Fourier domain solution is analytically derived, and the numerical solution is solved by implementing Talbot's Laplace transform method and the continuous convolution-Fourier transform (CC-FT) algorithm. A number of cases are analyzed, and the results reveal that a non-conformal interface with imperfect contact can induce uneven field distributions and that the nonuniformity increases with contact loss, and that the impact of external pressure on the reduction in ionic conductivity of SSE is similar to its effect on the potential drop. The results also suggest that the external pressure of 12.5 MPa can lead to relatively uniform deposition in a ceramic electrolyte system, while only 2 MPa is required in a polymer electrolyte system. In addition, A pressure of at least 2 MPa is needed to maintain the high ionic conductivity level for polymer composite SSEs of 14–16% volume LLZO particles.
•Analytical solution for electrolyte fields in the Fourier-Laplace domain is derived.•The correlation between pressure, SSE type, and plating behavior is reported.•The external pressure for uniform Li deposition is identified.•The impact of external pressure on ionic conductivity of SSE is discussed.
Inequalities in health between different ethnic groups in New Zealand are most pronounced between Māori and Europeans. Our aim was to assess the effect of self-reported racial discrimination and ...deprivation on health inequalities in these two ethnic groups.
We used data from the 2002/03 New Zealand Health Survey to assess prevalence of experiences of self-reported racial discrimination in Māori (n=4108) and Europeans (n=6269) by analysing the responses to five questions about: verbal attacks, physical attacks, and unfair treatment by a health professional, at work, or when buying or renting housing. We did logistic regression analyses to assess the effect of adjustment for experience of racial discrimination and deprivation on ethnic inequalities for various health outcomes.
Māori were more likely to report experiences of self-reported racial discrimination in all instances assessed, and were almost ten times more likely to experience discrimination in three or more settings than were Europeans (4·5% 95% CI 3·2–5·8
vs 0·5% 0·3–0·7). After adjustment for discrimination and deprivation, odds ratios (95% CI) comparing Māori and European ethnic groups were reduced from 1·67 (1·35–2·08) to 1·18 (0·92–1·50) for poor or fair self-rated health, 1·70 (1·42–2·02) to 1·21 (1·00–1·47) for low physical functioning, 1·30 (1·11–1·54) to 1·02 (0·85–1·22) for low mental health, and 1·46 (1·12–1·91) to 1·11 (0·82–1·51) for cardiovascular disease.
Racism, both interpersonal and institutional, contributes to Māori health losses and leads to inequalities in health between Māori and Europeans in New Zealand. Interventions and policies to improve Māori health and address these inequalities should take into account the health effects of racism.
Accumulating research suggests that racism may be a major determinant of health. Here we report associations between self-reported experience of racial discrimination and health in New Zealand.
Data ...from the 2002/2003 New Zealand Health Survey, a cross-sectional survey involving face-to-face interviews with 12,500 people, were analysed. Five items were included to capture racial discrimination in two dimensions: experience of ethnically motivated attack (physical or verbal), or unfair treatment because of ethnicity (by a health professional, in work or when gaining housing). Ethnicity was classified using self-identification to one of four ethnic groups: Māori, Pacific, Asian and European/Other peoples. Logistic regression, accounting for the survey design, age, sex, ethnicity and deprivation, was used to estimate odds ratios (OR) and 95% confidence intervals (CI).
Māori reported the highest prevalence of “ever” experiencing any of the forms of racial discrimination (34%), followed by similar levels among Asian (28%) and Pacific peoples (25%). Māori were almost 10 times more likely to experience multiple types of discrimination compared to European/Others (4.5% vs. 0.5%).
Reported experience of racial discrimination was associated with each of the measures of health examined. Experience of any one of the five types of discrimination was significantly associated with poor or fair self-rated health; lower physical functioning; lower mental health; smoking; and cardiovascular disease. There was strong evidence of a dose–response relationship between the number of reported types of discrimination and each health measure. These results highlight the need for racism to be considered in efforts to eliminate ethnic inequalities in health.
We present programmable two-dimensional arrays of microscopic atomic ensembles consisting of more than 400 sites with nearly uniform filling and small atom number fluctuations. Our approach involves ...direct projection of light patterns from a digital micromirror device with high spatial resolution onto an optical pancake trap acting as a reservoir. This makes it possible to load large arrays of tweezers in a single step with high occupation numbers and low power requirements per tweezer. Each atomic ensemble is confined to ~1 μm3 with a controllable occupation from 20 to 200 atoms and with (sub)-Poissonian atom number fluctuations. Thus, they are ideally suited for quantum simulation and for realizing large arrays of collectively encoded Rydberg-atom qubits for quantum information processing.
Insufficient data exist on population-based trends in morbidity and mortality to determine the success of prevention strategies and improvements in health care delivery in stroke. The aim of this ...study was to determine trends in incidence and outcome (1-year mortality, 28-day case-fatality) in relation to management and risk factors for stroke in the multi-ethnic population of Auckland, New Zealand (NZ) over 30-years.
Four stroke incidence population-based register studies were undertaken in adult residents (aged ≥15 years) of Auckland NZ in 1981-1982, 1991-1992, 2002-2003 and 2011-2012. All used standard World Health Organization (WHO) diagnostic criteria and multiple overlapping sources of case-ascertainment for hospitalised and non-hospitalised, fatal and non-fatal, new stroke events. Ethnicity was consistently self-identified into four major groups. Crude and age-adjusted (WHO world population standard) annual incidence and mortality with corresponding 95% confidence intervals (CI) were calculated per 100,000 people, assuming a Poisson distribution.
5400 new stroke patients were registered in four 12 month recruitment phases over the 30-year study period; 79% were NZ/European, 6% Māori, 8% Pacific people, and 7% were of Asian or other origin. Overall stroke incidence and 1-year mortality decreased by 23% (95% CI 5%-31%) and 62% (95% CI 36%-86%), respectively, from 1981 to 2012. Whilst stroke incidence and mortality declined across all groups in NZ from 1991, Māori and Pacific groups had the slowest rate of decline and continue to experience stroke at a significantly younger age (mean ages 60 and 62 years, respectively) compared with NZ/Europeans (mean age 75 years). There was also a decline in 28-day stroke case fatality (overall by 14%, 95% CI 11%-17%) across all ethnic groups from 1981 to 2012. However, there were significant increases in the frequencies of pre-morbid hypertension, myocardial infarction, and diabetes mellitus, but a reduction in frequency of current smoking among stroke patients.
In this unique temporal series of studies spanning 30 years, stroke incidence, early case-fatality and 1-year mortality have declined, but ethnic disparities in risk and outcome for stroke persisted suggesting that primary stroke prevention remains crucial to reducing the burden of this disease.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
La0.6Sr0.4CoO3−δ thin films grown on YSZ single crystals were investigated directly in the stage of deposition by means of in situ impedance spectroscopy during pulsed laser deposition (IPLD). This ...method allows the observation of dense thin films unaltered by degradation and provides information about the oxygen exchange kinetics as well as the defect chemistry of pristine LSC thin films. These measurements revealed remarkably low surface resistance values (1.3 Ω cm2 at 600 °C and 0.04 mbar O2) compared to films measured outside the PLD chamber (∼20 Ω cm2 at 600 °C and 0.04 mbar O2). Also the activation energy of the surface exchange resistance at 0.04 mbar p(O2) is significantly lower than at ambient conditions (∼1 eV vs. ∼1.3 eV) and degradation happens considerably slower. Furthermore, the grain size of the LSC thin film does not affect its initial surface resistance directly after deposition. The chemical capacitance of LSC thin films was linked to the concentration of oxygen vacancies and shows that LSC thin films exhibit lower oxygen vacancy concentrations than the corresponding bulk material.
During the operation of moored, floating devices in the renewable energy sector, the tight coupling between the mooring system and floater motion results in snap load conditions. Before snap events ...occur, the mooring line is typically slack. Here, the mechanism of energy propagation changes from axial to bending dominant, and the correct modelling of the rotational deformation of the lines becomes important. In this paper, a new numerical solution for modelling the mooring dynamics that includes bending and shearing effects is proposed for this purpose. The approach is based on a geometrically exact beam model and quaternion representations for the rotational deformations. Further, the model is coupled to a two-phase numerical wave tank to simulate the motion of a moored, floating offshore wind platform in waves. A good agreement between the proposed numerical model and reference solutions was found. The influence of the bending stiffness on the motion of the structure was studied subsequently. We found that increased stiffness increased the amplitudes of the heave and surge motion, whereas the motion frequencies were less altered.
PDF
