Wasteful Spending in Health Care: A US and UK international comparison

In health care, greater attention in the United States and the United Kingdom is being given to maximize the benefit of dollars and pounds spent. With the persistent increase in health care prices and demographic changes, evidence-based high-value care has become essential. This paper examines the nature of wasteful uses of health dollars. The United States wastes money in its unnecessarily high use of testing and procedures and through its volatile prices that affect how health services are managed. Administrative costs in the US are also high, due to its relatively unregulated system. This comparative analysis shows that the UK, on the other hand, spends less per-capita on health with verifiably better outcomes; nonetheless, the UK too has sources of low-value spending. More analysis of this problem could help to produce sound public policy, which would reduce waste and release resources for the improvement of services.Dans le secteur de la santé, les États-Unis et le Royaume-Uni accordent une plus grande attention à l'optimisation des dépenses. Avec la hausse des prix et les changements démographiques, les soins de qualité fondés sur des recherches scientifiques sont devenus essentiels. Cet article examine la nature de l’utilisation inutile des dépenses consacrées à la santé. Les États-Unis gaspillent de l'argent en utilisant inutilement des tests et des procédures et en raison de la volatilité de leurs prix, qui influent sur la gestion des services de santé. Les coûts administratifs aux États-Unis sont également élevés en raison de son système relativement non réglementé. Cette analyse comparative montre que le Royaume-Uni, en revanche, dépense moins par habitant avec de bien meilleurs résultats. Malgré cela, le Royaume-Uni possède également des sources de dépenses à faible valeur ajoutée. Une analyse plus poussée de ce problème pourrait aider à élaborer une politique publique judicieuse, qui réduirait le gaspillage et dégagerait des ressources pour l'amélioration des services

Health, Wellness and Wellbeing

A population’s health is contributed to by many factors outside of the clinical setting. American literature and research are asserting the Social Determinants of Health, while terms like wellness and wellbeing are also important. The discourse between wellness and wellbeing show they are both components of health, but wellbeing relates to subjective happiness. The United States health care system spends a lot of money, compared to other countries, showing a skewed allocation of resources. As the United States recognizes a broader definition of health to include wellness and wellbeing, national health promotion and legislation represent this. Policies concerning wellness and health prevention are of particular importance in legislation of the Patient Protection and Affordable Care Act of 2010, for example. The focus of American health policy cannot, however, turn away from the more fundamental problem that there are many Americans without health insurance who are unable to get or pay for the clinical care they need. In moving policy forward, more quantitative information and political dedication would help wellness and wellbeing along with health care come onto the health policy agenda.La santé d’une population est influencée par de nombreux facteurs extérieurs au milieu clinique. La littérature ainsi que la recherche américaine mettent en avant les déterminants sociaux de la santé, tandis que des termes comme « Wellness » et Bien-être sont également importants. Le discours entre « Wellness » et Bien-être montre que tous les deux sont des composants de la santé, mais que le Bien-être est lié au bonheur subjectif. Le système de santé des États-Unis est très coûteux, par rapport à ceux d'autres pays, ce qui se traduit par une allocation asymétrique des ressources. Les États-Unis définissent de manière plus large la santé pour inclure « Wellness » et Bien-être et cela se reflète dans la promotion de la santé et la législation nationale. Par exemple, les politiques concernant « Wellness » et la prévention de la santé sont importantes pour la législation de la loi Patient Protection and Affordable Care Act of 2010. La politique de santé américaine ne peut cependant pas faire l’économie de se pencher sur le problème le plus fondamental, à savoir, le grand nombre d'Américains sans assurance maladie, incapables d'obtenir ou de payer les soins cliniques dont ils ont besoin. En faisant avancer les politiques, plus d'informations quantitatives et de dévouement politique pourraient contribuer à améliorer « Wellness » et Bien-être de même que les soins de santé qui viennent d’être inscrits au programme de la politique de santé

Alice in the Crosscurrents: An Update on Financial Hardship in Mississippi

The report Alice in the Crosscurrents: An Update on Financial Hardship in Mississippi highlights that financial hardship remains a significant issue in Mississippi, with 52% of households below the ALICE (Asset Limited, Income Constrained, Employed) Threshold in 2022. While the number of households in poverty decreased slightly, the number of ALICE households increased, indicating that many working families struggle to meet basic needs. Key factors include rising costs of living, the expiration of pandemic-related assistance, and wage increases that have not kept pace with inflation. Certain groups, including single-parent families, elderly households, and communities of color, face disproportionately high levels of financial hardship. The report emphasizes the need for systemic policy changes and cross-sector collaboration to address financial instability

Twinkle -- a small satellite spectroscopy mission for the next phase of exoplanet science

With a focus on off-the-shelf components, Twinkle is the first in a series of cost competitive small satellites managed and financed by Blue Skies Space Ltd. The satellite is based on a high-heritage Airbus platform that will carry a 0.45 m telescope and a spectrometer which will provide simultaneous wavelength coverage from 0.5-4.5 $\rm{\mu m}$. The spacecraft prime is Airbus Stevenage while the telescope is being developed by Airbus Toulouse and the spectrometer by ABB Canada. Scheduled to begin scientific operations in 2025, Twinkle will sit in a thermally-stable, sun-synchronous, low-Earth orbit. The mission has a designed operation lifetime of at least seven years and, during the first three years of operation, will conduct two large-scale survey programmes: one focused on Solar System objects and the other dedicated to extrasolar targets. Here we present an overview of the architecture of the mission, refinements in the design approach, and some of the key science themes of the extrasolar survey.Comment: Presented at SPIE Astronomical Telescopes & Instrumentation 202

The genesis of gold mineralisation hosted by orogenic belts: A lead isotope investigation of Irish gold deposits

Lead isotope analyses have been performed on 109 gold and 23 sulphide samples from 34 Irish gold occurrences, including 27 placers, and used to shed light on the sources of mineralising fluids and metals associated with gold mineralisation hosted by orogenic belts. The Pb isotope ratios of lode and placer gold range from 206Pb/204Pb=17.287-18.679, 207Pb/204Pb=15.382-15.661, and 208Pb/204Pb=37.517-38.635, consistent with the Pb isotopic data on previously reported Irish sulphide mineralisation. There is no evidence that gold mineralisation is associated with distinctive source regions, and it appears to have been derived from similar sources to those responsible for the widespread sulphide mineralisation in Ireland. It is inferred that the principal controls on the Au mineralisation are structural and not related to the distribution of Au in their source rocks. The range of Pb isotope ratios favours the interaction of multiple source reservoirs predominantly during the Caledonian Orogeny (c. 475-380Ma). Underlying basement was the primary control on two key sources of Pb. Gold occurrences located to the south-east of the Iapetus Suture are characterised by Pb compositions that derive predominantly from the Late Proterozoic crustal basement or overlying Lower Palaeozoic sediments, whilst those located north-west of the Iapetus Suture are characterised by less radiogenic Pb signatures derived predominantly from Late Proterozoic or older crustal basement. A third source, relatively enriched in radiogenic Pb, also played a role in the formation of a number of Irish gold occurrences, and may have been associated with syn- to post-orogenic intrusives. Magmatic processes may therefore have played an important role in the formation of some orogenic gold occurrences

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

Association between alcohol taxes and health harms: a UK framework

Yanich, DaniloBackground: Alcohol use is prevalent in the United States and is related to preventable injuries, deaths and health care and other costs. With the use of the Sheffield Alcohol Policy Model, this study concentrates on the policy intervention of the taxation of alcohol and how it can reduce health harms attributable to alcohol. ☐ Methods: A major acute health harm attributable to alcohol is road traffic accidents. With the use of the Fatality Analysis Reporting System (FARS) database, I analyzed monthly data on injuries and fatalities from drinking-related accidents. I looked at the State of Connecticut for its policy implementation of a 20 percent increase on the per-gallon excise tax on all types of alcohol in July 2011. The analysis used the autoregressive integrated moving average model to examine 2000 to 2016 FARS data for any association among the higher tax and health harms by drinking-relating accidents. In addition, a model on underage drivers was run to examine any possible difference in the effect of the tax increase by age. ☐ Results: The tax increase was associated with 1.8 fewer injuries and fatalities per month by alcohol-related crashes, a reduction of 15.7 percent. For alcohol-related crashes of underage drivers, the tax increase was associated with a larger monthly decline of 44.4 percent. The results were found after using controls. ☐ Conclusion: Intervention of alcohol taxation has the potential to reduce the harms related to alcohol use. Public policy should consider the different forms of taxation and consult evidence-based taxation scenarios, such as this study and the Sheffield Alcohol Policy Model, when forming policy.University of Delaware, School of Public Policy and AdministrationM.A