Subnational climate entrepreneurship: innovative climate action in California and São Paulo

The distinct role of subnational governments such as states and provinces in addressing climate change has been increasingly acknowledged. But while most studies investigate the causes and consequences of particular governments’ actions and networking activities, this article argues that subnational governments can develop climate action as a collective entrepreneurial activity. Addressing many elements explored in this special issue, it focuses on the second question and identifies climate entrepreneurship in two subnational governments—the states of California (USA) and São Paulo (Brazil). Examining internal action, as well as interaction with local authorities, national governments and the international regime, entrepreneurial activities are identified in the invention, diffusion and evaluation of subnational climate policy in each case. The article draws from the recent scholarship on policy innovation, entrepreneurship and climate governance. It contributes to the literature by exploring entrepreneurial subnational government activity in addressing climate change and expanding the understanding of the effects of policy innovation at the subnational level

Upper ocean oxygenation dynamics from I/Ca ratios during the Cenomanian-Turonian OAE 2

Author Posting. © American Geophysical Union, 2015. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Paleoceanography 30 (2015): 510–526, doi:10.1002/2014PA002741.Global warming lowers the solubility of gases in the ocean and drives an enhanced hydrological cycle with increased nutrient loads delivered to the oceans, leading to increases in organic production, the degradation of which causes a further decrease in dissolved oxygen. In extreme cases in the geological past, this trajectory has led to catastrophic marine oxygen depletion during the so-called oceanic anoxic events (OAEs). How the water column oscillated between generally oxic conditions and local/global anoxia remains a challenging question, exacerbated by a lack of sensitive redox proxies, especially for the suboxic window. To address this problem, we use bulk carbonate I/Ca to reconstruct subtle redox changes in the upper ocean water column at seven sites recording the Cretaceous OAE 2. In general, I/Ca ratios were relatively low preceding and during the OAE interval, indicating deep suboxic or anoxic waters exchanging directly with near-surface waters. However, individual sites display a wide range of initial values and excursions in I/Ca through the OAE interval, reflecting the importance of local controls and suggesting a high spatial variability in redox state. Both I/Ca and an Earth System Model suggest that the northeast proto-Atlantic had notably higher oxygen levels in the upper water column than the rest of the North Atlantic, indicating that anoxia was not global during OAE 2 and that important regional differences in redox conditions existed. A lack of correlation with calcium, lithium, and carbon isotope records suggests that neither enhanced global weathering nor carbon burial was a dominant control on the I/Ca proxy during OAE 2.Z.L. thanks NSF OCE 1232620. J.D.O. is supported by an Agouron Postdoctoral Fellowship. T.W.L. acknowledges support from the NSF-EAR and NASA-NAI. A.R. thanks the support of NERC via NE/J01043X/1.2015-11-1

The valanginian weissert oceanic anoxic event recorded in central-Eastern Sardinia (Italy)

Investigations on the S\u2019Ozzastru section from the northern part of the Mt Albo area (central-eastern Sardinia, Italy) for integrated litho- bio- and chemostratigraphy allowed the identification of the Valanginian Weissert Oceanic Anoxic Event (OAE), testified by a positive carbon isotope excursion (CIE). The section, which represents the deepest-water succession of the Valanginian in Sardinia, is composed of the Schiridd\ue8 Limestone followed by the Siniscola Marl, both proposed as new lithostratigraphic units. The presence among the ammonites of Busnardoites campylotoxus allows the attribution of the Schiridd\ue8 Limestone to the upper Lower Valanginian Inostranzewi Zone of Reboulet et al. 2014. Further characterization of this unit was not possible since it is barren/almost barren of nannofossils. The Siniscola Marl can be ascribed to the lower Upper Valanginian on the basis of the ammonite fauna indicating the Verrucosum Zone, and of the nannofossil content suggesting the Zone NK3. The carbon isotope record in the Siniscola Marl is characterized by a positive excursion with values up to 2.98 \u2030. In the nannofossil assemblages, nannoconids are not particularly abundant and are found, among others, together with C. oblongata, D. lehmanii, and pentaliths. The scarcity of nannoconids is regarded as a biostratigraphic support for the identification of the Weissert OAE, as it possibly reflects the \u201cnannoconid decline\u201d interval which characterizes this event. The end of the Weissert OAE CIE is not recorded probably because of suppression of the upper part of the succession for tectonic causes

Managed Care for Elderly People: A Compendium of Findings

Although managed care seems to serve well the in terests of non-elderly enrollees and their payers, elderly people face more risks. Chronic conditions, multiple prob lems, and more limited resources make them more vul nerable, whereas multiple payer sources make them more complicated to cover. This synthesis of managed care de livered in Medicare and Medicaid demonstration projects serving elderly beneficiaries shows that managed care plans either select or attract enrollees who suffer fewer frailties than those served in fee-for-service settings, ex hibit reluctance to enter rural markets, provide a broad range of elderly-specific services, offer more compre hensive coverage and services, and result in greater per ceived access problems, particularly for vulnerable subgroups. Plans operate more cheaply by using fewer resources, even after adjusting for case mix differences. Managed care enrollees tend to be more satisfied with financial and coverage aspects, whereas fee-for-service enrollees report higher satisfaction on other dimensions. In acute care settings, process of care findings were mixed, whereas clinical and self-reported outcome indi cators were no better and in some instances worse in managed care. Long-term care enrollees, in the few stud ies reported, consistently faired worse in both the processes and outcomes of care. These findings suggest that further research on the effects of managed care in its rapidly changing incarnations is needed, particularly with respect to how to improve the quality of acute and long-term care delivered to elderly people and the proper role of government and other key actors in the health care system.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66514/2/10.1177_106286069801300304.pd

The Method for Assigning Priority Levels (MAPLe): A new decision-support system for allocating home care resources

<p>Abstract</p> <p>Background</p> <p>Home care plays a vital role in many health care systems, but there is evidence that appropriate targeting strategies must be used to allocate limited home care resources effectively. The aim of the present study was to develop and validate a methodology for prioritizing access to community and facility-based services for home care clients.</p> <p>Methods</p> <p>Canadian and international data based on the Resident Assessment Instrument – Home Care (RAI-HC) were analyzed to identify predictors for nursing home placement, caregiver distress and for being rated as requiring alternative placement to improve outlook.</p> <p>Results</p> <p>The Method for Assigning Priority Levels (MAPLe) algorithm was a strong predictor of all three outcomes in the derivation sample. The algorithm was validated with additional data from five other countries, three other provinces, and an Ontario sample obtained after the use of the RAI-HC was mandated.</p> <p>Conclusion</p> <p>The MAPLe algorithm provides a psychometrically sound decision-support tool that may be used to inform choices related to allocation of home care resources and prioritization of clients needing community or facility-based services.</p

Environmental consequences of Ontong Java Plateau and Kerguelen Plateau Volcanism

The mid-Cretaceous was marked by emplacement of large igneous provinces (LIPs) that formed gigantic oceanic plateaus, affecting ecosystems on a global scale, with biota forced to face excess CO2 resulting in climate and ocean perturbations. Volcanic phases of the Ontong Java Plateau (OJP) and the southern Kerguelen Plateau (SKP) are radiometrically dated and correlate with paleoenvironmental changes, suggesting causal links between LIPs and ecosystem responses. Aptian biocalcifi cation crises and recoveries are broadly coeval with C, Pb, and Os isotopic anomalies, trace metal infl uxes, global anoxia, and climate changes. Early Aptian greenhouse or supergreenhouse conditions were followed by prolonged cooling during the late Aptian, when OJP and SKP developed, respectively. Massive volcanism occurring at equatorial versus high paleolatitudes and submarine versus subaerial settings triggered very different climate responses but similar disruptions in the marine carbonate system. Excess CO2 arguably induced episodic ocean acidifi cation that was detrimental to marine calcifi ers, regardless of hot or cool conditions. Global anoxia was reached only under extreme warming, whereas cold conditions kept the oceans well oxygenated even at times of intensifi ed fertility. The environmental disruptions attributed to the OJP did not trigger a mass extinction: rock-forming nannoconids and benthic communities underwent a signifi cant decline during Oceanic Anoxic Event (OAE) 1a, but recovered when paroxysmal volcanism fi nished. Extinction of many planktonic foraminiferal and nannoplankton taxa, including most nannoconids, and most aragonitic rudists in latest Aptian time was likely triggered by severe ocean acidifi cation. Upgraded dating of paleoceanographic events, improved radiometric ages of the OJP and SKP, and time-scale revision are needed to substantiate the links between magmatism and paleoenvironmental perturbations

Sleepiness and fatigue in multiple sclerosis - same same but different? A systematic review on the Epworth Sleepiness Scale as an assessment tool

Objectives: Fatigue is a frequent and distressing symptom in patients with multiple sclerosis (MS). In contrast, sleepiness, characterized by difficulties to stay awake and alert during the day, seems to be less prevalent in MS; however exact studies are lacking. In addition, there is a semantic confusion of the concepts of “fatigue” and “sleepiness”, which are often used interchangeably. Methods: We conducted a systematic review of studies using the Epworth Sleepiness Scale (ESS) for the assessment of daytime sleepiness in patients with MS. Results: The summarized results of 48 studies demonstrate that sleepiness, as indicated by elevated ESS scores, is less prevalent and less severe than fatigue but is present in a significant proportion of patients with MS. In most cross-sectional and longitudinal studies, there was a moderate association between ESS scores and various fatigue rating scales. Longitudinal studies on the effect of wakefulness- promoting agents failed to show a consistent improvement of sleepiness or fatigue as compared to placebo. It has also been shown that daytime sleepiness is frequently associated with comorbid sleep disorders that are often underrecognized and undertreated in MS. Conclusions: Sleepiness and potential sleep disorders may also precipitate and perpetuate fatigue in patients with MS and should be part of the differential diagnostic assessment. To support an appropriate decision-making process, we propose an algorithm for the evaluation of sleepiness as compared to fatigue in patients with MS. Disclosure: Nothing to disclose

Impact of tobacco industry and other corporations in the defeat of the 1994 Clinton health care plan

Abstract Background: The primary reason cited by many scholars for the defeat of the Clinton Administration’s 1994 health care reform bill has long been identified as Health Insurance Association of America and National Federation of Independent Businesses opposition to the bill. Given this predominant consensus combined with sizeable proposed funding for the bill by a large tobacco product tax, this manuscript examined what the tobacco industry’s role was in whole or part in defeating the Clinton health care bill. Methods: This research occurred through crosschecking internal tobacco industry documents and Clinton White House documents. Results: Prior to the passage of the bill, the tobacco industry accepted a compromise of 45 cents per pack increase phased in over five years. Due to this compromise, the industry or third party allies had no role in the ultimate defeat in the bill. Conclusions: The primary reason for the bill’s ultimate defeat was general business (but not tobacco industry and third party ally) opposition, the bill running out of time, and conflicting bills. Secondary reasons for the bill’s defeat included issues with: employer mandates, high taxes on insurance plans, impacts on medical research and education, Congressional attention to other issues, election year politics, and possible future excise tax possibilities.Ye

BurkDiff: A Real-Time PCR Allelic Discrimination Assay for Burkholderia Pseudomallei and B. mallei

A real-time PCR assay, BurkDiff, was designed to target a unique conserved region in the B. pseudomallei and B. mallei genomes containing a SNP that differentiates the two species. Sensitivity and specificity were assessed by screening BurkDiff across 469 isolates of B. pseudomallei, 49 isolates of B. mallei, and 390 isolates of clinically relevant non-target species. Concordance of results with traditional speciation methods and no cross-reactivity to non-target species show BurkDiff is a robust, highly validated assay for the detection and differentiation of B. pseudomallei and B. mallei