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Discriminating Archean Au deposit types and related ore-forming processes is challenging but paramount for increasing Au exploration success. This study tests the validity of applying geochemical data generated from conventional bulk versus modern in situ methods as discriminants for classifying Au deposits in the Archean Swayze greenstone belt with further comparison to other deposits in the contiguous Abitibi greenstone belt and Red Lake area (Superior Province, Canada). The study used five well-characterized Au settings, based on new mapping, as a basis for evaluating in situ (δ18Oquartz, δ33, 34Ssulfide, laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS) analysis of pyrite, electron microprobe analysis of gold), and whole-rock geochemical datasets to resolve whether intrusion-related Au deposits can be discriminated from orogenic-type Au deposits. Results show that the in situ methods provide insight into processes related to Au mineralization, both primary and subsequent remobilization and upgrading, and define elemental and isotopic correlations that cannot be resolved using conventional bulk methods. For example, when comparing the whole-rock to laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS) trace metal data, only Ag, Te, and Hg show a consistent positive correlation with Au across deposit types in both data sets. Furthermore, the wholerock datasets combined with in situ isotopic analysis suggest the Archean sanukitoid-associated Au deposits represent a distinct group of intrusion-related deposits with mineralization characterized by low δ34Spyrite (

The gold-endowed Larder Lake Cadillac deformation zone (LLCDZ) in the Abitibi greenstone belt of the Archean Superior Province generally trends east but swings to the southeast along the Malartic segment in Quebec. Immediately north of the LLCDZ along this segment, deformation of the less than ca. 2687 Ma metasedimentary Cadillac Group began with the formation of isoclinal F1 folds, which are overprinted by post-2676 ± 2.0 Ma regional F2 folds with an axial planar S2 cleavage oriented parallel to the trend of the Malartic segment. Auriferous quartz veins strike east–west (085°) anticlockwise to bedding and S2. They are folded into sigmoidal S-shaped folds due to sinistral shear parallel to bedding. Later dextral shearing segmented the veins and folded the F2 folds into Z-shaped F3 folds. The veins are similar in structural chronology, fluid isotopic composition (calculated [Formula: see text] value between –9.5‰ and –3.4‰ and [Formula: see text] values of 12‰), and isotopic re-equilibration temperatures (469 and 498 °C, quartz–biotite oxygen thermometer) to the veins at the nearby Canadian Malartic deposit to the east. They possess comparable Au–As–Sb association and sericite-arsenopyrite alteration halo, as other Cadillac-Group-hosted veins at the Lapa mine to the west. Collectively, they constitute a vein field that extends across the entire length of the Malartic segment. Contrary to recent interpretations of the Malartic segment as an early accretionary structure that controlled the emplacement of gold deposits, its southeast trend is interpreted as the short limb of a broad Z-shaped flexure that formed during later F3 folding of the LLCDZ.

ImportanceBeyond traditional race and ethnicity demographic characteristics, additional discrete data variables are needed for informed health interventions in the US.ObjectiveTo examine whether COVID-19 vaccine uptake patterns and associated disease outcomes differ among language preference groups.Design, Setting, and ParticipantsA cohort study of 851 410 individuals aged 18 years or older in a large multispecialty health system in Minnesota and western Wisconsin was conducted between December 15, 2020, and March 31, 2022.ExposureSelf-identified language preference and limited English proficiency (LEP) as measured by interpreter need were used to create subgroups using US census categories and attention to capture languages known to represent refugee groups.Main Outcomes and MeasuresThe primary outcome was COVID-19 vaccination uptake rates and time to first vaccine. Secondary outcomes were rates of COVID-19–associated hospitalization and death.ResultsMost of the 851 410 participants (women, 493 910 [58.0%]; median age, 29 [IQR, 35-64] years) were US-born English speakers; 7.5% were born in other countries, 4.0% had a language preference other than English (LPOE), and 3.0% indicated LEP as measured by interpreter need. Marked temporal clusters were observed for COVID-19 vaccination uptake, hospitalizations, and deaths associated with primary series vaccine eligibility, booster availability, and COVID-19 variants. Delayed first-dose vaccine was observed with LPOE (hazard ratio [HR], 0.83; 95% CI, 0.82-0.84) and interpreter need (HR, 0.81; 95% CI, 0.80-0.82) compared with those with English language preference and proficiency. Patients with LPOE were approximately twice as likely to be hospitalized (rate ratio [RR], 1.85; 95% CI, 1.63-2.08) or die (RR, 2.13; 95% CI, 1.65-2.69). Patients with LEP experienced even higher rates of hospitalization (RR, 1.98; 95% CI, 1.73-2.25) and COVID-19–associated death (RR, 2.32; 95% CI, 1.79-2.95). Outcomes varied for individual language preference groups.Conclusions and RelevanceIn this study, delayed time to first-dose vaccine was associated with increased COVID-19 hospitalization and death rates for specific LPOE and LEP groups. The findings suggest that data collection of language preference and interpreter need provides actionable health intervention information. Standardized system-level data collection, including at a national level, may improve efficient identification of social groups with disproportionate health disparities and provide key information on improving health equity in the US.

Cet article se penchera sur la manière dont Olivier Choinière (Québec) et le Wooster Group (États-Unis) font usage de la pop culture dans leurs spectacles pour concevoir des assemblages singuliers, leur posture de créateurs glisse vers celle d’agenceurs d’objets culturels hétéroclites. La notion d’auctorialité se brouille, car elle se trouve télescopée entre le geste d’instauration de l’oeuvre scénique, et celui qui renvoie à la multiplication de citations des références pop — elles-mêmes mettant à mal l’attribution à un auteur unique. Leur posture s’apparente alors à celle du prosumer, conjuguant les gestes de production et de réception des objets esthétiques. Les valeurs d’originalité et d’authenticité de leurs voix de créateurs se décèlent alors dans les mouvements de sélection et de recadrage., This article examines how Olivier Choinière (Québec) and the Wooster Group (United States) make use of pop culture in their staged performances to produce singular assemblies, their stance as creators shifting to that of designers of miscellaneous cultural objects. The notion of editorialization blurs, for it is trapped between the action of establishing the scenic work and that of referring to the multiplication of pop culture references—which itself adversely affects the attribution to a single author. Their stance then resembles that of the prosumer, combining the production and reception of aesthetic objects. As a result, the originality and authenticity of their creative voices are detected in the movement of selection and restructuring.

PURPOSE To help clinicians and care systems determine the priority for tobacco counseling in busy clinic schedules, we assessed the lifetime health and economic value of annually counseling youth to discourage smoking initiation and of annually counseling adults to encourage cessation. METHODS We conducted a microsimulation analysis to estimate the health impact and cost effectiveness of both types of tobacco counseling in a US birth cohort of 4,000,000. The model used for the analysis was constructed from nationally representative data sets and structured literature reviews. RESULTS Compared with no tobacco counseling, the model predicts that annual counseling for youth would reduce the average prevalence of smoking cigarettes during adult years by 2.0 percentage points, whereas annual counseling for adults will reduce prevalence by 3.8 percentage points. Youth counseling would prevent 42,686 smoking-attributable fatalities and increase quality-adjusted life years (QALYs) by 756,601 over the lifetime of the cohort. Adult counseling would prevent 69,901 smoking-attributable fatalities and increase QALYs by 1,044,392. Youth and adult counseling would yield net savings of $225 and $580 per person, respectively. If annual tobacco counseling was provided to the cohort during both youth and adult years, then adult smoking prevalence would be 5.5 percentage points lower compared with no counseling, and there would be 105,917 fewer smoking-attributable fatalities over their lifetimes. Only one-third of the potential health and economic benefits of counseling are being realized at current counseling rates. CONCLUSIONS Brief tobacco counseling provides substantial health benefits while producing cost savings. Both youth and adult intervention are high-priority uses of limited clinician time.

Introduction This study estimates the health, economic, and budgetary impact resulting from graduated sodium reductions in the commercially produced food supply of the U.S., which are consistent with draft U.S. Food and Drug Administration voluntary guidance and correspond to Healthy People 2020 objectives and the 2015–2020 Dietary Guidelines for Americans. Methods Reduction in mean U.S. dietary sodium consumption to 2,300 mg/day was implemented in a microsimulation model designed to evaluate prospective cardiovascular disease–related policies in the U.S. population. The analysis was conducted in 2018–2020, and the microsimulation model was constructed using various data sources from 1948 to 2018. Modeled outcomes over 10 years included prevalence of systolic blood pressure ≥140 mmHg; incident myocardial infarction, stroke, cardiovascular disease events, and cardiovascular disease–related mortality; averted medical costs by payer in 2017 U.S. dollars; and productivity. Results Reducing sodium consumption is expected to reduce the number of people with systolic blood pressure ≥140 mmHg by about 22% and prevent approximately 895.2 thousand cardiovascular disease events (including 218.9 thousand myocardial infarctions and 284.5 thousand strokes) and 252.5 thousand cardiovascular disease–related deaths over 10 years in the U.S. Savings from averted disease costs are expected to total almost $37 billion—most of which would be attributed to Medicare ($18.4 billion) and private insurers ($13.4 billion)—and increased productivity from reduced disease burden and premature mortality would account for another $18.2 billion in gains. Conclusions Systemic sodium reductions in the U.S. food supply can be expected to produce substantial health and economic benefits over a 10-year period, particularly for Medicare and private insurers.

BackgroundThe benefits to adults who quit smoking increase over time as former smokers live longer, healthier lives. Youth who never smoke will benefit for decades. Thus, the long-term population effects of tobacco prevention and control policies may be substantial. Yet they are rarely quantified in evaluations of state tobacco control programmes.MethodsUsing a microsimulation model, we predicted the benefits to Minnesotans from 2018 to 2037 of having reduced cigarette smoking prevalence from 1998 to 2017. We first simulated the health and economic harms of tobacco that would have occurred had smoking prevalence stayed at 1997 levels. The harms produced by that scenario were then compared with harms in scenarios with smoking declining at observed rates from 1998 to 2017 and either expected declines from 2018 to 2037 or a greater decline to 5% prevalence in 2037.ResultsWith expected smoking prevalence decreases from 2018 to 2037, Minnesotans will experience 12 298 fewer cancers, 72 208 fewer hospitalisations for cardiovascular disease and diabetes, 31 913 fewer respiratory disease hospitalisations, 14 063 fewer smoking-attributable deaths, $10.2 billion less in smoking-attributable medical expenditures and $9.4 billion in productivity gains than if prevalence had stayed at 1997 levels. These gains are two to four times greater than for the previous 20 years, and would be about 15% higher if Minnesota achieves a 5% adult prevalence rate by 2037.ConclusionsThe tobacco control measures implemented from 1998 to 2017 will produce accelerated benefits during 2018–2037 if modest progress in tobacco prevalence rates is maintained.

BackgroundHigh-intensity antitobacco media campaigns are a proven strategy to reduce the harms of cigarette smoking. While buy-in from multiple stakeholders is needed to launch meaningful health policy, the budgetary impact of sustained media campaigns from multiple payer perspectives is unknown.MethodsWe estimated the budgetary impact and time to breakeven from societal, all-payer, Medicare, Medicaid and private insurer perspectives of national antitobacco media campaigns in the USA. Campaigns of 1, 5 and 10 years of durations were assessed in a microsimulation model to estimate the 10 and 20-year health and budgetary impact. Simulation model inputs were obtained from literature and both pubic use and proprietary data sets.ResultsThe microsimulation predicts that a 10-year national smoking cessation campaign would produce net savings of $10.4, $5.1, $1.4, $3.6 and $0.2 billion from the societal, all-payer, Medicare, Medicaid and private insurer perspectives, respectively. National antitobacco media campaigns of 1, 5 and 10-year durations could produce net savings for Medicaid and Medicare within 2 years, and for private insurers within 6–9 years. A 10-year campaign would reduce adult cigarette smoking prevalence by 1.2 percentage points, prevent 23 500 smoking-attributable deaths over the first 10 years. In sensitivity analysis, media campaign costs would be offset by reductions in medical care spending of smoking among all payers combined within 6 years in all tested scenarios.Conclusions1, 5 and 10-year antitobacco media campaigns all yield net savings within 10 years from all perspectives. Multiyear campaigns yield substantially higher savings than a 1-year campaign.

Le metteur en scène italien Romeo Castellucci fait un usage tout à fait singulier des matériaux scéniques, parmi lesquels l’environnement sonore occupe une fonction centrale et atypique. Le spectacle Inferno marque en ce sens une nouvelle appropriation par la scène des possibilités du sonore. S’affranchissant de sa fonction de bruitage et dépassant le registre musical, le son se mêle aux actions scéniques de manière dynamique. Cette création témoigne d’un processus de « dé-référentialisation » de la dimension sonore. Ne renvoyant plus qu’à elles-mêmes, les présences sonores peuvent entrer en dialogue avec les autres matières en scène. Cette écologie renouvelée de la scène place le spectateur face à lui-même et à son écoute. Cet article explore comment l’oeuvre de Castellucci peut nous éclairer sur la notion d’écoute comprise « non comme un déchiffrage, mais comme un événement » (Antoine Hennion)., This article analyzes the inscription of sound in Romeo Castellucci’s staging of Inferno. It aims to describe how the use of sound in this work differs markedly from its traditional use in theatre, and how its integration into the stage action creates a new type of dramaturgy. We examine how, in this performance, sound becomes an element in its own right. Sound is no longer mimetic: its purpose is not to echo the absence of something. When it affirms and expresses its own qualities, sound can “interact” with other scenic elements in an innovative manner. The interactions of both visible and audible components create dramaturgical tensions, leading us to examine the issue of listening and its modalities in a theatrical context.

Three-dimensional geologic modeling by integrated analysis and interpretation of drill core, 2-D and 3-D seismic, mine survey, and geologic map data provides new insights into the structural setting of the 85.5 million tonne (Mt) Flin Flon-Callinan-777 volcanogenic massive sulfide (VMS) ore system hosted in the Paleoproterozoic Flin Flon belt of Manitoba and Saskatchewan, Canada. The resultant camp-scale 3-D geologic model was, in addition to the densely drill intersected VMS-hosting mine horizon, constrained by lithostratigraphic reference drill holes intersecting the footwall and hanging-wall rock successions of the ore system, which were established by relogging 52 drill holes and systematically reconciling the lithofacies classes in their log descriptions with the lithofacies units of the 1:10,000-scale Flin Flon mining district geologic map. The lateral persistence and large stratigraphic range of these drill hole markers supported seismic interpretation and allowed tracing lithostratigraphic horizons and structures in areas with low drill hole density, expanding 3-D subsurface insight from the local to the more regional structural setting of the ore system. The overall 3-D modeled geometry and topological relationships between lithostratigraphic surfaces and multiple generations of thrust faults suggest that the Flin Flon mining district is underlain by an E-dipping stack of W-vergent thrust imbricates that formed during precollisional and collisional stages of the 1.9 to 1.8 Ga Trans-Hudson orogeny. The imbricate stack was subsequently deformed by E-trending ductile thrust faults that internally imbricated the Flin Flon arc assemblage and the molasse cover rocks of the Missi Group and brought up rocks of the former over the latter in a northerly direction. The VMS-hosting Millrock Member has been stacked on at least four structural levels, enhancing the VMS potential in the footwall and hanging wall of the known ore deposits where both thrust systems intersect.

Introduction Tobacco control programs and policies reduce tobacco use and prevent health and economic harms. The majority of tobacco control programs and policies in the United States are implemented at local and state levels. Yet the literature on state-level initiatives reports a limited set of outcomes. To facilitate decision-making that is increasingly focused on costs, we provide estimates of a broader set of measures of the impact of tobacco control policy, including smoking prevalence, disease events, deaths, medical costs, productivity and tobacco tax revenues, using the experience of Minnesota as an example. Methods Using the HealthPartners Institute’s ModelHealth™: Tobacco MN microsimulation, we assessed the impact of the stream of tobacco control expenditures and cigarette price increases from 1998 to 2017. We simulated 1.3 million individuals representative of the Minnesota population. Results The simulation estimated that increased expenditures on tobacco control above 1997 levels prevented 38,400 cancer, cardiovascular, diabetes and respiratory disease events and 4,100 deaths over 20 years. Increased prices prevented 14,600 additional events and 1,700 additional deaths. Both the net increase in tax revenues and the reduction in medical costs were greater than the additional investments in tobacco control. Conclusion Combined, the policies address both short-term and long-term goals to reduce the harms of tobacco by helping adults who wish to quit smoking and deterring youth from starting to smoke. States can pay for initial investments in tobacco control through tax increases and recoup those investments through reduced expenditures on medical care.

PURPOSE Our aim was to update estimates of the health and economic impact of clinical services recommended for the primary prevention of cardiovascular disease (CVD) for the comparative rankings of the National Commission on Prevention Priorities, and to explore differences in outcomes by sex and race/ethnicity. METHODS We used a single, integrated, microsimulation model to generate comparable results for 3 services recommended by the US Preventive Services Task Force: aspirin counseling for the primary prevention of CVD and colorectal cancer, screening and treatment for lipid disorders (usually high cholesterol), and screening and treatment for hypertension. Analyses compare lifetime outcomes from the societal perspective for a US-representative birth cohort of 100,000 persons with and without access to each clinical preventive service. Primary outcomes are health impact, measured by the net difference in lifetime quality-adjusted life years (QALYs), and cost-effectiveness, measured in incremental cost per QALY or cost savings per person in 2012 dollars. Results are also presented for population subgroups defined by sex and race/ethnicity. RESULTS Health impact is highest for hypertension screening and treatment (15,600 QALYs), but is closely followed by cholesterol screening and treatment (14,300 QALYs). Aspirin counseling has a lower health impact (2,200 QALYs) but is found to be cost saving ($31 saved per person). Cost-effectiveness for cholesterol and hypertension screening and treatment is $33,800 per QALY and $48,500 per QALY, respectively. Findings favor hypertension over cholesterol screening and treatment for women, and opportunities to reduce disease burden across all services are greatest for the non-Hispanic black population. CONCLUSIONS All 3 CVD preventive services continue to rank highly among other recommended preventive services for US adults, but individual priorities can be tailored in practice by taking a patient’s demographic characteristics and clinical objectives into account.

BackgroundAdult smoking prevalence in Minnesota fell from 21.8% in 1997 to 15.2% in 2016. This reduction improved heart and lung health, prevented cancers, extended life and reduced healthcare costs, but quantifying these benefits is difficult.Methods1.3 million individuals were simulated in a tobacco policy model to estimate the gains to Minnesotans from 1998 to 2017 in health, medical spending reductions and productivity gains due to reduced cigarette smoking. A constant prevalence scenario was created to simulate the tobacco harms that would have occurred had smoking prevalence stayed at 1997 levels. Those harms were compared with tobacco harms from a scenario of actual smoking prevalence in Minnesota from 1998 to 2017.ResultsThe simulation model predicts that reducing cigarette smoking from 1998 to 2017 has prevented 4560 cancers, 31 691 hospitalisations for cardiovascular disease and diabetes, 12 881 respiratory disease hospitalisations and 4118 smoking-attributable deaths. Minnesotans spent an estimated $2.7 billion less in medical care and gained $2.4 billion in paid and unpaid productivity, inflation adjusted to 2017 US$. In sensitivity analysis, medical care savings ranged from $1.7 to $3.6 billion.ConclusionsMinnesota’s investment in comprehensive tobacco control measures has driven down smoking rates, saved billions in medical care and productivity costs and prevented tobacco related diseases of its residents. The simulation method employed in this study can be adapted to other geographies and time periods to bring to light the invisible gains of tobacco control.

The synvolcanic Mooshla Intrusive Complex intrudes coeval ~2699 to 2696 Ma volcanic rocks of the Blake River Group within the southern margin of the Archean Abitibi greenstone belt. The upper Blake River Group is host to the Doyon-Bousquet-LaRonde mining camp that contains Au-rich volcanogenic massive sulfide (VMS) deposits, possible subsea-floor epithermal-style deposits, and orogenic Au deposits. In total, the camp contains to date in excess of 28 million ounces (Moz) Au, making it a world-class example of Au-rich paleosea-floor environments. The Mooshla Intrusive Complex is spatially, temporally, and most probably genetically associated with all of the above types of mineralization. It is host to parts of the Doyon (5.5 Moz Au), Mouska (0.8 Moz Au), and Mic Mac (0.11 Moz Au) Au deposits and host to the smaller Mooshla A and B Au occurrences. Host volcanic units to the Mooshla Intrusive Complex are intensely deformed, metamorphosed, altered, and mineralized, as is the intrusion itself. The Mooshla Intrusive Complex was formed by nine distinctive phases of subvolcanic dikes, sills, and stocks. These were emplaced in two stages to form a shallow, multiphase synvolcanic intrusion along the contact between the Hebecourt and Bousquet volcanic formations. The Mouska stage is represented by a preliminary swarm of thin diabase sills, intruded by a well-layered gabbroic sill, a more crudely layered quartz diorite, and tonalite. A period of devolatilization accompanied crystallization of the xenolith-rich top of the tonalite magma chamber, as evidenced by the presence of an aplite dike swarm and associated extensive alteration zones and miarolitic cavities. The younger Doyon stage comprises a series of fine-grained aphyric to porphyritic, tonalite and trondhjemite dikes and sills, which also contain evidence of in situ devolatilization. The geochemical signatures of the Mooshla Intrusive Complex indicate emplacement during formation of an evolved, extensional oceanic island arc-style succession. Primitive mantle-normalized spider plots suggest a common origin for this island-arc intrusive suite that is similar to that of the volcanic succession of the upper member of the Bousquet Formation. Various element ratio plots used to further define magma origin and emplacement history suggest that whereas the Mouska-stage magmatic phases have a relatively straightforward, coexisting fractionation history, the Doyon-stage tonalite-trondhjemite has a more complex interplay of assimilation-fractionation-contamination, suggesting midcrustal partitioning and interaction with both earlier formed, partially hydrated ~2720 Ma oceanic crust and upper Blake River host strata (~2699-2696 Ma). The protracted and mulitphased magmatic evolution of the Mooshla Intrusive Complex led to the generation of volatile-rich phases that contributed to the development of a submarine magmatic-hydrothermal system that is thought to be responsible for the formation of the Doyon Au-Cu deposit. Geologic and timing relationships suggest that this magmatic-hydrothermal system might also have contributed to the generation of Au-rich VMS deposits higher in the host volcanic succession as part of a large Archean magmatic and hydrothermal center.

The Lemoine auriferous volcanogenic massive sulfide deposit (0.76 Mt at 4.6 g/t Au, 4.2 wt % Cu, and 9.5 wt % Zn) is part of the Chibougamau camp located in the northeastern part of the Abitibi greenstone belt. The deposit is hosted by a steeply dipping, S-facing homoclinal volcanic succession (~2729–2726 Ma Waconichi Formation, Lemoine Member) composed of effusive and intrusive tholeiitic rhyolites and andesites cut by comagmatic diorite and gabbro dikes and overlain by transitional to mildly calc-alkaline basalts, andesites, and rhyolites. Seven predominant synvolcanic alteration assemblages, now intensely deformed and metamorphosed to upper greenschist facies, were defined based on their mineralogy and position relative to ore. Albite-quartz, sericite-carbonate, sericite-chlorite, sericite-chlorite-(Zn), and chlorite-sericite-epidote-carbonate assemblages define semiconcordant zones that are stacked from the paleoseafloor to the deep footwall. In contrast, chlorite and chlorite-sericite-chloritoid assemblages overprint the other alteration zones and form subconcordant to now transposed discordant zones in the deposit footwall. Most alteration assemblages are characterized by relative SiO2, CaO, and Na2O mass losses and relative FeO, MgO, K2O, and CO2 mass gains. Whole-rock oxygen isotopes indicate that the temperatures of alteration ranged from ~100° to 150°C (sericite-carbonate assemblage) to ≥350°C (sericite-chlorite, chlorite-sericite-chloritoid, and chlorite assemblages). The chlorite-sericite-chloritoid assemblage, and to some extent the sericite-chlorite assemblage, are associated with strong to near total depletion of light rare earth elements possibly due to reaction with Cl-bearing, mildly acidic fluids at depth in the ore-forming hydrothermal system. The sulfide lens was formed in part on the seafloor and in part by subseafloor replacement. The massive sulfides are particularly rich in Bi, suggesting a possible magmatic input into the Lemoine ore-forming hydrothermal system. High Bi concentrations in the mineralizing system are likely to have enhanced Au precipitation by scavenging the precious metal from the hydrothermal fluids. The Au-rich nature of the Lemoine auriferous volcanogenic massive sulfide deposit can be explained by a combination of very efficient metal transport, highly effective capture of metals at or near the seafloor, and a possible magmatic contribution to the hydrothermal system.

PURPOSE The Patient Protection and Affordable Care Act’s provisions for first-dollar coverage of evidence-based preventive services have reduced an important barrier to receipt of preventive care. Safety-net providers, however, still serve a substantial uninsured population, and clinician and patient time remain limited in all primary care settings. As a consequence, decision makers continue to set priorities to help focus their efforts. This report updates estimates of relative health impact and cost-effectiveness for evidence-based preventive services. METHODS We assessed the potential impact of 28 evidence-based clinical preventive services in terms of their cost-effectiveness and clinically preventable burden, as measured by quality-adjusted life years (QALYs) saved. Each service received 1 to 5 points on each of the 2 measures—cost-effectiveness and clinically preventable burden—for a total score ranging from 2 to 10. New microsimulation models were used to provide updated estimates of 12 of these services. Priorities for improving delivery rates were established by comparing the ranking with what is known of current delivery rates nationally. RESULTS The 3 highest-ranking services, each with a total score of 10, are immunizing children, counseling to prevent tobacco initiation among youth, and tobacco-use screening and brief intervention to encourage cessation among adults. Greatest population health improvement could be obtained from increasing utilization of clinical preventive services that address tobacco use, obesity-related behaviors, and alcohol misuse, as well as colorectal cancer screening and influenza vaccinations. CONCLUSIONS This study identifies high-priority preventive services and should help decision makers select which services to emphasize in quality-improvement initiatives.

Evidence indicates that aspirin is effective for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) but also increases the risk for gastrointestinal (GI) and cerebral hemorrhages.To assess the net balance of benefits and harms from routine aspirin use across clinically relevant age, sex, and CVD risk groups.Decision analysis using a microsimulation model.3 systematic evidence reviews.Men and women aged 40 to 79 years with a 10-year CVD risk of 20% or less, and no history of CVD and without elevated risk for GI or cerebral hemorrhages that would contraindicate aspirin use.Lifetime, 20 years, and 10 years.Clinical.Low-dose aspirin (≤100 mg/d).Primary outcomes are length and quality of life measured in net life-years and quality-adjusted life-years. Benefits include reduced nonfatal myocardial infarction, nonfatal ischemic stroke, fatal CVD, CRC incidence, and CRC mortality. Harms include increased fatal and nonfatal GI bleeding and hemorrhagic stroke.Lifetime net quality-adjusted life-years are positive for most adults initiating aspirin at ages 40 to 69 years, and life expectancy gains are expected for most men and women initiating aspirin at ages 40 to 59 years and 60 to 69 years with higher CVD risk. Harms may exceed benefits for persons starting aspirin in their 70s and for many during the first 10 to 20 years of use.Results are most sensitive to the relative risk for hemorrhagic stroke and CVD mortality but are affected by all relative risk estimates, baseline GI bleeding incidence and case-fatality rates, and disutilities associated with aspirin use.Aspirin effects by age are uncertain. Stroke benefits are conservatively estimated. Gastrointestinal bleeding incidence and case-fatality rates account only for age and sex.Lifetime aspirin use for primary prevention initiated at younger ages (40 to 69 years) and in persons with higher CVD risk shows the greatest potential for positive net benefit.Agency for Healthcare Research and Quality.

The topic of safe fish consumption among women is complex both in its audience (women who are or could become pregnant) and its message (it is important to eat fish for its many nutritional benefits but because mercury levels vary by species, it is important to make informed choices about which species to eat). These complexities have led to confusion and fish avoidance in this population. Ideal messages about fish consumption have been suggested in the literature, but a more nuanced approach to message delivery that addresses subtleties, such as style and format of information, is needed for women to optimally use the materials. To explore how to package and deliver messages that describe and promote safe fish consumption, we conducted focus groups among women in our target population. Findings were used to design a visually appealing brochure and interactive, mobile-responsive website with recipes and a format that echoes and links to Pinterest. By delivering complex messages using a mode (easily accessible), style (photo-centric) and format (interactive, with recipes similar to Pinterest) desired by women, we have created an opportunity for repeated exposure to appealing fish images and recipes. Ideally, such exposure also piques curiosity and encourages women to seek out more complex fish information and consume safe fish during pregnancy.

Gold-rich volcanogenic massive sulfide (VMS) deposits are a subgroup of lode gold deposits, as defined by Poulsen et al. (2000). They are commonly defined by an average gold grade in grams per tonne greater than that of the combined base metals in weight percent (Au g/t > Cu + Zn + Pb wt percent: Poulsen et al., 2000). Five of the largest and best examples of Au-rich VMS deposits currently recognized in the world are located in the Blake River Group in the Abitibi greenstone belt, Quebec, Canada. The Horne (54.3 Mt at 6.1 g/t Au, 11.7 Moz Au) and Quemont (13.9 Mt at 4.7 g/t Au, 2.3 Moz Au) deposits occur in the Noranda camp (Fig. 1⇓), and the LaRonde Penna (59 Mt at 4.3 g/t Au, 8.1 Moz Au), Bousquet 2-Dumagami (15.5 Mt at 7.2 g/t Au, 3.6 Moz Au) and Bousquet 1 (7.5 Mt at 5.3 g/t Au, 1.3 Moz Au) deposits occur in the Doyon-Bousquet-LaRonde mining camp (Table 1⇓), 45 km east of Noranda (Fig. 1⇓). View this table: Table 1. Total Production, Reserves and Geologic Resources for the Doyon-Bousquet-LaRonde (DBL) Mining Camp Fig. 1. Geologic map of the Bousquet Formation in the Doyon-Bouquet-LaRonde mining camp area. This map is a synthesis of the Doyon-Bousquet-LaRonde mining camp and shows the location of the Au-rich VMS deposits (current and past producers) and main occurrences and the location of the intrusion-related Au-Cu vein systems (current and past producers) and main occurrences at surface. Adapted from Lafrance et al. (2003a, b, c). U-Pb ages from Lafrance et al. (2003a; 2005) and from Mercier-Langevin et al. (2004; 2007a). The LaRonde Penna Au-rich VMS deposit is a major Zn producer and one of the largest Canadian gold deposits, with 58.6 Mt of ore (production, reserves, and resources) at …

Gold-rich volcanogenic massive sulfide (VMS) deposits consist of synvolcanic banded and concordant massive sulfide lenses and adjacent stockwork feeder zones in which gold concentration in g/t Au exceeds the combined Cu, Pb, Zn grades in wt percent and thus constitutes the main commodity. The Agnico-Eagle LaRonde Penna deposit is a world-class Au-rich VMS (production, reserves and resources of 58.8 Mt at 4.31 g/t Au) located in the eastern part of the Blake River Group of the Abitibi greenstone belt. The deposit comprises four stacked massive sulfide lenses within the upper member of the Bousquet Formation (2698–2697 Ma). The two main ore zones, 20 North and 20 South, are sheetlike, massive to semimassive polymetallic sulfide lenses and stringer zones. Both lenses and sulfide stringers are deformed and transposed by the main foliation. The 20 North lens (Zn-Au-Ag-Cu-Pb) is the main orebody. It is subdivided into two zones: the 20N Au and 20N Zn zones. The 20N Au zone is a transposed and ribbon-textured gold- and copper-rich pyrite-chalcopyrite stringer zone overlain to the south by a 10- to 30-m-thick massive pyrite-sphalerite-galena lens (20N Zn zone). The 20 South lens is an 8- to 10-m-thick gold- and zinc-rich massive sulfide and stringer zone located about 10 to 15 m below the Cadillac Group sedimentary rocks (

The LaRonde Penna Au-rich volcanogenic massive sulfide (VMS) deposit is the largest Au deposit currently mined in Canada (58.8 Mt at 4.31 g/t, containing 8.1 Moz of Au). It is part of the Doyon-Bousquet-LaRonde mining camp located in the eastern part of the Blake River Group of the Abitibi greenstone belt which is host to several of the world’s most important, present and past, Au-rich VMS deposits (e.g., Horne, Quemont, Bousquet, Bousquet 2-Dumagami). The LaRonde Penna deposit consists of massive to semimassive sulfide lenses (Au-Zn-Ag-Cu-Pb), stacked in the upper part of a steeply dipping, south-facing homoclinal volcanic sequence composed of extensive tholeiitic basaltic flows (Hebecourt Formation) overlain by tholeiitic to transitional, mafic to intermediate, effusive and volcaniclastic units at the base (lower member of the Bousquet Formation) and transitional to calc-alkaline, intermediate to felsic, effusive and intrusive rocks on top (upper member of the Bousquet Formation). The mafic to felsic volcanism of the Hebecourt Formation and of the lower member of the Bousquet Formation formed an extensive submarine basement or platform on which the intermediate to felsic rocks of the upper member of the Bousquet Formation were emplaced at restricted submarine eruptive centers or as shallow composite intrusive complexes. The submarine felsic volcanic rocks of the upper member of the Bousquet Formation are characterized by dacitic to rhyodacitic autoclastic (flow breccia) deposits that are cut and overlain by rhyodacitic and rhyolitic domes and/or partly extrusive cryptodomes and by intermediate to mafic sills and dikes. This volcanic architecture is thought to have been responsible for internal variations in ore and alteration styles, not only from one lens to another, but also along a single mineralized horizon or lens. In the upper part of the mine, the 20 North lens comprises a transposed pyrite-chalcopyrite (Au-Cu) stockwork (20N Au zone) overlain by a pyrite-sphalerite-galena-chalcopyrite-pyrrhotite (Zn-Ag-Pb) massive sulfide lens (20N Zn zone). The latter was formed, at least in part, by replacement of footwall rhyodacitic autoclastic deposits emplaced within a subbasin located between two rhyolite domes or cryptodomes. The 20N Zn zone tapers with depth in the mine and gives way to the 20N Au zone. At depth in the mine, the 20N Au zone consists of semimassive sulfides (Au-rich pyrite and chalcopyrite) enclosed by a large aluminous alteration halo on the margin of a large rhyolitic dome or cryptodome. U-Pb zircon geochronology gives ages of 2698.3 ± 0.8 and 2697.8 ± 1 Ma for the footwall and hanging-wall units of the 20 North lens, respectively. Thus, the formation of the 20 North lens was coeval with other VMS deposits in the Bousquet Formation and in the uppermost units of the Blake River Group. Although deformation and metamorphism have affected the primary mineral assemblages and the original geometry of the deposit, these events were not responsible for the different auriferous ore zones and alteration at LaRonde Penna. Studies of the LaRonde Penna deposit show that the hydrothermal system evolved in time and space from near-neutral seawater-dominated hydrothermal fluids, responsible for Au-Cu-Zn-Ag-Pb mineralization, to highly acidic fluids with possible direct magmatic contributions, responsible for Au ± Cu-rich ore and aluminous alteration. The different ore types and alteration reflect the evolving local volcanic setting described in this study.

International audience; The Polarization and Directionality of the Earth's Reflectance (POLDER) spatial polarimeter was onboard the Advanced Earth Observation Satellite (ADEOS) satellite that flew from August 1996 to June 30, 1997. POLDER measured both multidirectional reflectance and polarization in visible and near-infrared spectral bands with a very wide field of view. An accurate absolute radiometric calibration is essential for the scientific exploitation of radiance measurements of the Earth. POLDER inflight radiometric calibration has been performed at the Centre National d'Etudes Spatiales (CNES), French National Space Studies Center, from measurements taken only on well-characterized targets. This paper presents the results of the POLDER in-flight radiometric interband calibration over clouds for channels 443 and 490 nm. The method is based on the comparison of measurements to simulations. Selected measurements correspond to observations over oceans for high, thick convective cumulonimbus and for low, thick stratocumulus. Simulations are calculated using the discrete ordinate computing method. An error budget considers the sensitivity of this calibration method to cloud microphysics, to cloud top altitude, and to aerosols and gaseous loading. Calibration results are discussed for different simulated cloud models

Emplacement of the Proterozoic Gunnison annular complex, Colorado, involved brittle failure and both subhorizontal sheeting and steeply-dipping dyking. The annular complex consists of a central diorite body (1730 Ma), surrounded by a ring of metamorphosed supracrustal rocks, in turn ringed by tonalite and granodiorite (1721 Ma). The older central diorite was emplaced as sills parallel to bedding, prior to regional deformation of the Gunnison volcanic arc, ∼1730–1710 m.y. ago. This central body was deformed during regional shortening, into an upright bowl with inward-dipping walls. The surrounding country rocks were folded and locally transposed against the central body, forming an arcuate foliation, conforming roughly to the shape of the body. This foliation and bedding acted as mechanical planes of weakness, which localized the syn-deformational emplacement of the outer ring intrusions, as multiple magma sheets parallel to steeply dipping bedding and foliation. Portions of the outer rings were also injected along concentric, inward-dipping, shear fractures generated under high magma pressure, a process similar to cone sheet emplacement in volcanic ring-dyke complexes. Multiple mechanisms were therefore involved in the emplacement of this sheeted annular plutonic complex, which otherwise superficially resembles a subvolcanic ring-dyke complex.

INTRODUCTION My experience and reflections concerning tobacco litigation stem from representing the American Cancer Society in November of 1998,1 when the State of Oregon asked Judge Anna Brown of the Circuit Court of Multnomah County in Portland to approve the settlement agreement reached between Oregon and the major tobacco manufacturers.2 The American Cancer Society intervened in opposition.3 The agreement was a part of a multi-state settlement reached by forty-six state Attorneys Generals and the tobacco industry proposed to state courts during that same week and the ensuing weeks around the country. By October of 1999,4 the Master-Settlement Agreement (MSA) was approved by enough states that it was effectuated.5 Distributions pursuant to the agreement will begin in 2000 or 2001.6 Total disbursements over twenty years will exceed $240 billion, a huge amount of money by anyone's standards.7 The position advanced in opposition had basically four points: (1) the State was getting far too little; (2) it was giving up far too much; (3) the structured nature of the settlement meant that the State's future interests were aligned with, indeed dependent upon, future success in tobacco sales, an exact reversal of existing health policy; and (4) the kinds of determinations underlying the MSA were essentially legislative, and well beyond the adjudicative and enforcement capabilities of a single judge sitting in a lower court of general jurisdiction. All four of these points will be developed later,8 but the crucial point is the last: litigation is simply not an appropriate vehicle for setting health care policy within a state or across a nation. And yet, on several different fronts, litigation is the means by which we are setting that policy9 as it affects tobacco consumption, quite possibly the nation's leading health concern. Whether a comprehensive tobacco policy is possible may be in doubt; that it is disserved by litigation seems certain. The MSA was the result of nearly two years of litigation brought by forty-six state Attorneys General in what were called the "Medicaid" cases, wherein the states sued the tobacco companies for the health care injury inflicted by tobacco consumption. 10 The potential impact of these suits on public health and industry was huge. 11 But two other forms of litigation-private and federal-exist as well, and are potentially far more significant. For the past forty years, private individuals have brought private tort actions against tobacco companies, seeking redress for injuries such as cancer and death.12 Part II of this article examines these suits. Recently, this litigation has begun to show marked success. However, by its nature, private litigation does not adequately address public health concerns, and therefore will not create a comprehensive national tobacco policy. Part III discusses the State Medicaid actions in depth. These suits brought new legal theories, strong litigation resources and involved entities representing the public interest. However, the result of this litigation, the MSA, is far from satisfactory in addressing the wrongs committed by the tobacco industry and in providing sensible public health policy. Part IV examines the recent lawsuit by United States Attorney General, Janet Reno, against the tobacco companies.13 This action is based upon two federal statutes permitting the federal government to recover expenses resulting from tortious misconduct, including Medicare or veterans' benefits paid due to tobacco-related disease and death. Legal weakness in the government's case and tremendous political pressures will likely lead the government to settle on terms favorable to the industry. Altogether, these three areas of litigation-the state Medicaid litigation, the private litigation and the newly filed federal litigation-pose a real probability of extracting hundreds of billions of dollars from the tobacco industry, with the potential for changing its behavior, as well as compensating its victims. …