Search

The southwest monsoon delivers over 70% of India’s annual rainfall and is crucial to the success of agriculture across much of South Asia. Monsoon precipitation is known to be sensitive to sea surface temperature (SST) in the Bay of Bengal (BoB). Here, we use a configuration of the Unified Model of the UK Met Office coupled to an ocean mixed layer model to investigate the role of upper-ocean features in the BoB on southwest monsoon precipitation. We focus on the pronounced zonal and meridional SST gradients characteristic of the BoB; the zonal gradient in particular has an as-yet unknown effect on monsoon rainfall. We find that the zonal SST gradient is responsible for a local decrease in rainfall over the southern BoB of approximately 5 mm day−1, and an increase in rainfall over Bangladesh and northern India of approximately 1 mm day−1. This increase is remotely forced by a strengthening of the monsoon Hadley circulation. The meridional SST gradient acts to decrease precipitation over the BoB itself, similarly to the zonal SST gradient, but does not have comparable effects over land. The impacts of barrier layers and high-salinity sub-surface water are also investigated, but neither has significant effects on monsoon precipitation in this model; the influence of barrier layers on precipitation is felt in the months after the southwest monsoon. Models should accurately represent oceanic processes that directly influence BoB SST, such as the BoB cold pool, in order to faithfully represent monsoon rainfall.

The circulation of the Bellingshausen Sea has not attracted as much attention as that of its neighbours, the Amundsen Sea and the West Antarctic Peninsula. Like them, it hosts a wide variety of vulnerable ice shelves, and exhibits inflows of warm deep water onto the continental shelf, and outflows of resulting ice shelf meltwater. Quantifying heat and freshwater transport, and understanding their temporal and spatial variability, is important for understanding the impact of a warming, melting Antarctica on ocean circulation. First, we identify processes influencing interannual variability in warm deep water on the southern Bellingshausen Sea continental shelf using the GLORYS12V1 1/12° reanalysis from 1993 to 2018. EOFs of potential temperature below 300 m allow separation into warm and cold regimes. The Amundsen Sea Low is more intense and extends further to the east during warm regimes than during cold regimes. Increased Ekman transport results in a stronger frontal jet and Antarctic Coastal Current (AACC) in the cold regime. The warm and cold regimes are also linked to different temperature tendencies. In the warm regime, a wind-induced reduction of sea ice results in increased heat loss to the atmosphere, convection, and formation of cold dense water in winter associated with a cooling of the southern Bellingshausen Sea and a net northward heat transport. In contrast, conditions of the cold regime favour a gradual warming of the southern Bellingshausen, consistent with a net southward heat transport.Second, we use high-resolution sections collected from two ocean gliders deployed in the Bellingshausen Sea between January and March 2020 to quantify the distribution of meltwater. We observe a cyclonic circulation in Belgica Trough, whose western limb transports a meltwater flux of 0.46 mSv northwards and whose eastern limb transports a newly-identified meltwater re-circulation (0.88 mSv) southwards. Peak meltwater concentration is located into two layers (~150 m and ~200 m) associated with different density surfaces (27.4 and 27.6 kg m-3). The deeper layer is characterised by elevated turbidity. The shallower layer is less turbid, and is more prominent closer to the shelf break and in the eastern part of Belgica Trough. We hypothesise that these different meltwater layers emanate from different ice shelves that abut the Bellingshausen Sea.To test the hypothesis of multiple source regions, we perform experiments using a regional set-up of MITgcm (approx. 3 km resolution), in which tracers released beneath ice shelves are used as a proxy for meltwater to diagnose transport pathways. Meltwater at the glider study site originates from ice shelves in the eastern Bellingshausen, particularly from George VI. Meltwater is primarily transported westward in the AACC; a small proportion detaches from the AACC via eddies and lateral mixing and, from the west, enters the cyclonic circulation within Belgica Trough, consistent with the glider-observed northward meltwater flow in the west and the southward re-circulation in the east. Very little meltwater from ice shelves immediately south of Belgica Trough enters this in-trough circulation.

Ocean gliders enable us to collect the ocean microstructure observations necessary to calculate the dissipation rate of turbulent kinetic energy, ε, on timescales of weeks to months: far longer than is normally possible using traditional ship-based platforms. Slocum gliders have previously been used to this end; here, we report the first detailed estimates of ε calculated using observations collected by a Seaglider. Seaglider 620 was deployed in the western tropical Atlantic in early 2020 and was equipped with a FP07 fast thermistor. We use these same fast thermistor observations to calculate ε following the Thorpe scale method. We find very good agreement between estimates of ε calculated following the two methods. The Thorpe scale method yields the larger values of ε, but the average difference, less than an order of magnitude, is smaller than reported elsewhere. The spatio-temporal distribution of ε is comparable for both methods. Maximum values of ε (10-7 W kg-1) are observed in the surface mixed layer; relatively high values (10-9 W kg-1) are also observed between approximately 200 and 500 m depth. These two layers are separated by a 100 m thick layer of low ε (10-10 W kg-1), which is co-located with a high-salinity layer of Subtropical Underwater and a peak in the strength of stratification (i.e. in N2). We calculate the turbulent heat and salt fluxes associated with the observed turbulence that act to ventilate deeper layer of the ocean. Between 200 and 500 m, ε induces downward (i.e. negative) fluxes of both properties that, if typical of the annual average, would have a very small influence on the heat and salt content of the salinity-maximum layer above. We compare these turbulent fluxes with estimates of fluxes due to double diffusion, having objectively identified those regions of the water column where double diffusion is likely to occur. While the downward heat flux due to double diffusive mixing is lower than that due to mechanical mixing, the downward salt flux due to double diffusive mixing is six times greater.

Purpose The purpose of this article was to identify effective interventions to reduce secondary school dropout rates, increase the quality of learning in secondary schools in developing countries, and estimate the cost and educational impact of a sustained program to implement a selection of these interventions. Methods Dropout risk is analyzed by multivariable regression using micro-datasets for 44 developing countries for which Demographic and Health Surveys are available. The analysis of interventions accesses recent meta-analyses of educational interventions in developing countries. We incorporate these results into a model of progression in secondary school—by grade, age, and gender, augmented by learning measures and by a facility to allow interventions to reduce dropout rates and improve learning—to estimate the impact and cost of a package of interventions out to 2030. Results Poverty, female gender, and rural location are key risk factors for secondary school dropout. In terms of interventions, school proximity for rural students is critical. Better teaching both reduces dropout and improves learning, whereas instruction in the mother tongue improves also improves learning. Systematic implementation of nine interventions in the 44 countries, 1 costing US$10.5 per capita per annum, would increase secondary completion rates by about 25% and more than double the index of learning achieved by 2030, with the effects being more pronounced in low-income countries. Conclusions Powerful interventions are available to change the trajectory of schooling in developing countries but the costs are substantial, and a coordinated funding effort will be required.

Purpose Deaths and serious injuries from road accidents remain a serious issue in developing countries, including for young people, for whom they are the largest cause of death. This article provides an assessment of interventions to reduce these deaths and injuries for adolescents in 75 developing countries. Methods We draw on new data on deaths and injuries by age, gender, and accident type for the 75 countries and on the road safety experience of developed and, more recently, developing countries. Critical tasks are to identify key interventions in road safety and estimate their impact and cost. We incorporate these impact and cost estimates in a modeling framework to calculate the reduction in deaths and serious injuries achieved out to 2030, relative to the base case. Finally, established methods are used to value the economic and social benefits arising from these reductions, and hence to calculate benefit-cost ratios. Results For the unchanged policy case, we estimate that there will be about 3 million deaths and 7.4 million serious injuries from road accidents for persons aged 10–24 years in the 75 countries to 2030. The preferred interventions avert one million of these deaths and 3 million serious injuries, at a cost of $6.5 billion per annum over 2016–2030, or $1.2 per capita across the total population of these countries. After valuing the benefits of the deaths and serious injuries averted, we find a benefit-cost ratio of 7.6 for 2016–2030, but of 9.9 if the interventions continue to 2050. Conclusions Proven methods, suitably adjusted to local conditions, are available to reduce the tragic toll of road accidents in developing countries. These initiatives are likely to have strong economic and social returns, and should be given high priority.

The Southwest Monsoon Current (SMC) flows eastward from the Arabian Sea into the Bay of Bengal (BoB) during summer, advecting a core of high salinity water. This high salinity core has been linked with Arabian Sea High Salinity Water that is presumed to enter the BoB directly from the Arabian Sea via the SMC. Here we show that the high salinity core originates primarily from the western equatorial Indian Ocean, reaching the BoB via the Somali Current, the Equatorial Undercurrent and the SMC. Years with anomalously saline high salinity cores are linked with the East Africa Coastal Current and the Somali Current winter convergence, and an anomalously strong Equatorial Undercurrent. Seasonal reversals that occur at the Somali Current and SMC junctions act as ‘railroad switches’ diverting water masses to different basins in the northern Indian Ocean. Interannual fluctuations of the Equatorial Undercurrent are linked to wind stress and El Niño.

Background This paper estimates the costs and benefits of investing in education interventions and specific child marriage programs to reduce child marriage in India. Child marriage in India remains highly prevalent despite considerable progress in the last decade or more, associated, in particular, with a decline in poverty. The economic consequences of the COVID 19 pandemic are likely to reverse these gains, meaning that the interventions to reduce child marriage evaluated in this paper assume even greater importance. Methods A literature search to identify interventions with costs and estimates of impact on reduction in child marriage for India, and other low and middle income countries was conducted. The costs and effectiveness of the interventions were modelled for India, and economic benefits of reducing school dropout rates and increasing secondary school completions were estimated. The ratio of the economic benefits to the intervention costs estimated gave the benefit-cost ratio. Results The interventions resulted in an average benefit-cost ratio of 16.8. The interventions are projected to decrease the estimated marriage rate for girls aged 15–17 years for India from an estimated rate of 16.4% in 2020 by 7.5 percentage points by 2050, with education interventions targeting increased attendance being the larger factor. By 2030, the proportion of girls completing school is estimated to increase by 13 percentage points and productivity to have increased by 16.4%. Conclusions The results indicate substantial economic and social gains to reducing child marriage by interventions that decrease school dropout rates, increase secondary school completions for girls, and address some of the broader social and cultural disadvantages they face in India. This has significant implications not only for their health, but also for the quality of the available economic opportunities and the possibility of attaining Sustainable Development Goal 5.

In July 2016, a Seaglider equipped with a microstructure sensor system was deployed in the southern Bay of Bengal at 7° 54.0′ N, 89° 4.5′ E. 162 profiles (of which 146 were to 1000 m) of microstructure shear and temperature were collected as a time series at the same location. Dissipation is calculated independently from both shear and temperature. The time-average profile shows high dissipation (nearly 1×10-5 W kg-1) near the surface, dropping rapidly over the uppermost 50 m to ~1×10-7 W kg-1, followed by a more gradual decrease to ~5×10-10 W kg-1 at 300m. A band of slightly higher dissipation around 500 m (~8×10-10 W kg-1) could facilitate an increased vertical flux of nutrients, heat, salinity, etc at these depths. From 600 to 1000 m dissipation remains roughly constant at ~1×10-10 W kg-1. Variability of the near surface dissipation in response to atmospheric forcing is also discussed.

Quantifying meltwater content and describing transport pathways is important for understanding the impact of a warming, melting Antarctica on ocean circulation. Meltwater fluxes can affect density-driven, on-shelf flows around the continent, and the formation of the dense water masses that ventilate abyssal regions of the world ocean. We present observations collected from two ocean gliders that were deployed in the Bellingshausen Sea for a period of 10 weeks between January and March of 2020. Using multiple high-resolution sections, we quantify both the distribution of meltwater concentrations and lateral meltwater fluxes within the Belgica Trough in the Bellingshausen Sea. We observe a cyclonic circulation in the trough, in agreement with previous studies. A meltwater flux of 0.46 mSv is observed flowing northwards in the western limb of the cyclonic circulation. A newly identified meltwater re-circulation (0.88 mSv) is observed flowing back towards the ice front (i.e. southwards) with the eastern limb of the cyclonic circulation. In addition, 1.16 mSv of meltwater is observed flowing northeastward, parallel to the shelf break, with the northern limb of the cyclonic circulation. Peak meltwater is concentrated into two layers associated with different density surfaces: one approximately 150 m deep (27.4 kg m-3) and one approximately 200 m deep (27.6 kg m-3}). The deeper of these layers is characterised by an elevated optical backscatter, which indicates a more turbid water mass. The shallower layer is less turbid, and is more prominent closer to the shelf break and in the eastern part of the Belgica Trough. We hypothesise that the deeper, turbid meltwater layer originates locally from the Venables Ice Shelf, whereas the shallower, less turbid meltwater layer, comprises meltwater from ice shelves in the eastern Bellingshausen Sea. The broad distribution of meltwater from multiple sources suggests the potential for remote interactions and feedbacks between the various ice shelves that abut the Bellingshausen Sea.

Persian Gulf Water (PGW) is an oxygenated, high‐salinity water mass that has recently been detected in the Bay of Bengal (BoB). However, little is known about the transport pathways of PGW into the BoB. Ocean glider observations presented here demonstrate the presence of PGW in the southwestern BoB. Output from an ocean re‐analysis product shows that this PGW signal is associated with a northward‐flowing filament of high‐salinity water. Particle tracking experiments reveal two pathways: one in the eastern Arabian Sea that takes a minimum of two years, and another in the western Arabian Sea that takes a minimum of three years. The western pathway connects to the BoB via equatorial currents. The greatest influx of PGW occurs between 82 and 87°E during the southwest monsoon. We propose that injection of PGW to the BoB OMZ contributes to keeping oxygen concentrations in the BoB above the level at which de‐nitrification occurs. Plain‐language summary The Persian Gulf is a hot, shallow sea that acts like a vast salt pan. Consequently, water flowing out of the Gulf has a very high salt concentration; it also has a relatively high dissolved oxygen concentration. This high‐salt, high‐oxygen signal is distinct to Persian Gulf Water and is largely preserved as Persian Gulf Water spreads in the ocean's interior. In observations collected by an ocean glider, we identify the remnants of this high‐salt, high‐oxygen signal in the southwestern Bay of Bengal, a region that is notably lacking in dissolved oxygen. Using an ocean model, we identify two pathways taken by Persian Gulf Water between the northern Arabian Sea and the Bay of Bengal: one in the eastern Arabian Sea that takes a minimum of two years; and one in the western Arabian Sea that takes a minimum of three years. Persian Gulf Water arrives in the Bay of Bengal throughout the year, but particularly during the southwest monsoon (June to September). Persian Gulf Water brings oxygen to the Bay of Bengal and potentially plays a role in keeping dissolved oxygen levels in the Bay above the level at which its ecological functioning would be significantly altered.

Summary The global burden of non-communicable diseases (NCDs) is growing, and there is an urgent need to estimate the costs and benefits of an investment strategy to prevent and control NCDs. Results from an investment-case analysis can provide important new evidence to inform decision making by governments and donors. We propose a methodology for calculating the economic benefits of investing in NCDs during the Sustainable Development Goals (SDGs) era, and we applied this methodology to cardiovascular disease prevention in 20 countries with the highest NCD burden. For a limited set of prevention interventions, we estimated that US$120 billion must be invested in these countries between 2015 and 2030. This investment represents an additional $1·50 per capita per year and would avert 15 million deaths, 8 million incidents of ischaemic heart disease, and 13 million incidents of stroke in the 20 countries. Benefit–cost ratios varied between interventions and country-income levels, with an average ratio of 5·6 for economic returns but a ratio of 10·9 if social returns are included. Investing in cardiovascular disease prevention is integral to achieving SDG target 3.4 (reducing premature mortality from NCDs by a third) and to progress towards SDG target 3.8 (the realisation of universal health coverage). Many countries have implemented cost-effective interventions at low levels, so the potential to achieve these targets and strengthen national income by scaling up these interventions is enormous.

Summary Investment in the capabilities of the world's 1·2 billion adolescents is vital to the UN's Sustainable Development Agenda. We examined investments in countries of low income, lower-middle income, and upper-middle income covering the majority of these adolescents globally to derive estimates of investment returns given existing knowledge. The costs and effects of the interventions were estimated by adapting existing models and by extending methods to create new modelling tools. Benefits were valued in terms of increased gross domestic product and averted social costs. The initial analysis showed high returns for the modelled interventions, with substantial variation between countries and with returns generally higher in low-income countries than in countries of lower-middle and upper-middle income. For interventions targeting physical, mental, and sexual health (including a human papilloma virus programme), an investment of US$4·6 per capita each year from 2015 to 2030 had an unweighted mean benefit to cost ratio (BCR) of more than 10·0, whereas, for interventions targeting road traffic injuries, a BCR of 5·9 (95% CI 5·8–6·0) was achieved on investment of $0·6 per capita each year. Interventions to reduce child marriage ($3·8 per capita each year) had a mean BCR of 5·7 (95% CI 5·3–6·1), with the effect high in low-income countries. Investment to increase the extent and quality of secondary schooling is vital but will be more expensive than other interventions—investment of $22·6 per capita each year from 2015 to 2030 generated a mean BCR of 11·8 (95% CI 11·6–12·0). Investments in health and education will not only transform the lives of adolescents in resource-poor settings, but will also generate high economic and social returns. These returns were robust to substantial variation in assumptions. Although the knowledge base on the impacts of interventions is limited in many areas, and a major research effort is needed to build a more complete investment framework, these analyses suggest that comprehensive investments in adolescent health and wellbeing should be given high priority in national and international policy.

Quantifying the variability of North Sea inflows and understanding the temporal variability of their physical properties are essential for understanding, modelling and managing the ecosystems of the North Sea. The Joint North Sea Information System (JONSIS) line hydrographic section crosses the path of the main inflows of Atlantic water into the northwestern North Sea. We use observations from an autonomous underwater glider to observe the inflows at high spatial and temporal resolutions. The glider completed 10 partial sections of the JONSIS line in October and November of 2013. Key water masses of the inflow are identified; their spatial distribution varies greatly from section to section. This is not apparent from long-running ship surveys of the JONSIS line, which are generally several months apart. In particular, the distribution of water of most recent Atlantic origin varies as summer stratification decays throughout autumn: at the start of the deployment it is present as a thin layer beneath the thermocline; at the end of the deployment, it occupies the full depth of the water column. Thermohaline flow, i.e. that which is driven by horizontal density gradients, is focused into three or four jets (approximately 10 km wide). Jets as narrow as these have not previously been observed in the region. We also observe baroclinic eddies. The thermohaline transport of the inflows is compared with the absolute transport that is derived by referencing geostrophic shear to the glider's dive-average current. Thermohaline transport (approximately 0.2 Sv) is consistently smaller than absolute transport (approximately 0.5 Sv). The week-to-week variability in hydrography and flow structure identified in this study is relevant to on-going efforts to define a background state against which the nature of anthropogenic changes can be assessed, and future modelling efforts should represent the spatial and temporal variability that we have identified.

Purpose The aims of the study were to develop methods to estimate the impact of better secondary schooling in developing countries on the employment and productivity of adolescents and provide initial results through application to 72 developing countries. Methods We model two effects here: the impact of longer and better quality secondary schooling on productivity in given job types and of increased school completion rates on the type of job obtained. Model parameter values are derived from the existing literature, supplemented by new empirical work. The impact of better schooling is studied, for each country, through the effects on the 20–24 years cohort, with the employment paths of successive cohorts traced through to 2030. Results For the education scenario studied—an increase of 65% in secondary school completions and of 90% in school quality by 2030—strong employment outcomes are obtained. Productivity per employee in the 20–24 years cohort is up by 37% by 2030, and employment by 3%. Nearly half of the productivity gain comes from better school quality, with 30% from additional schooling and 20% from shifts in employment structure. Productivity gains are much stronger in low-income countries than in upper middle-income countries. Conclusions The model shows strong effects of better education through the various channels, especially for low-income countries, indicating the need for increased investment in secondary schooling, especially in school quality. Further work is required on the quality of education and on employment structure to enable derivation of parameter estimates with a stronger evidence base.

This chapter addresses briefly the concept of 'research culture' and then the relevance of quality. C. J. Bland and M. T. Ruffin argue that the factors affecting research cultures do not operate in research groups as isolated characteristics. They liken these factors to 'fine threads of a whole fabric, individual, yet while interwoven, providing a strong, supportive and stimulating backdrop for the researcher'. In 1979, A. M. Pettigrew extended the anthropological concept of 'culture' to the particular context of everyday working groups. He proposed that the need for people to function effectively together within a given social setting gave rise to a particular group culture. In writing an application for funding or a thesis, one must be aware first and foremost that the responsibility rests with the person writing to communicate the quality and significance of a research programme clearly and well.

Purpose This study argues that investments in the health of the world's 1.2 billion adolescents is a critical component of the overall investment case for adolescents and is vital for achieving the United Nation's Sustainable Development Agenda. We undertake a benefit cost analysis of a range of interventions to improve adolescent health. Methods We examined investments in intervention-specific costs, program costs, and health systems costs at a country level for 40 low- and middle-income countries that account for about 90% of adolescents in low- and middle-income countries. Intervention-specific costs and impacts were computed using the OneHealth Tool, whereas other published resources were used for the program and health systems costs. Interventions modeled include those addressing physical, sexual, and reproductive health; maternal and newborn health; and some noncommunicable diseases. Two coverage scenarios were simulated: an unchanged coverage scenario and one in which the coverage increases to achieve a high coverage by 2030. Results Key outcomes included estimates of the costs, health-related impacts, and benefit–cost ratios (BCRs). For the 66 adolescent health interventions modeled for 40 countries, the total cost for the period of 2015–2030 was $358.4 billion or an average of $4.5 per capita each year. From 2015 to 2030, there were 7.0 million deaths averted, and 1.5 million serious disabilities averted. At a 3% discount rate, the average BCR were 12.6, 9.9, and 6.4 for low-income, lower middle-income, and upper middle-income countries, respectively. Countries with adolescent mortality rates ≥200 per 100,000 had an average BCR of 14.8 compared with countries with adolescent mortality rates Conclusions The results show that there are substantial benefits from a program of interventions to improve adolescent health.

Purpose This study sets out to identify effective interventions to reduce child marriage, estimate their economic benefits achieved through enhanced productivity, and undertake a benefit-cost analysis of the interventions. Methods We model the effects of a set of identified child marriage and education interventions for 31 low- and middle-income countries, 1 focusing on the reduction in child marriage rates and increasing secondary school attendance and completions. These lead to higher productivity, which generates increased gross domestic product per capita. The comparison of these benefits with the costs of the interventions generates benefit-cost ratios. Results Both types of interventions have significant effects on marriage rates for girls aged 15–17 years, which fall from 13.2% in 2015 to 5.2% in 2050. Both interventions lead to sharp increases in school attendance and secondary completion, which is 19.3% points higher by 2030. The productivity improvement is 22.7% by 2030. The average benefit-cost ratio for the 31 countries is 7.4 (standard deviation of 1.0) at a 3% discount rate. Conclusions The results indicate that there are substantial economic gains to reducing child marriage by specific child marriage and education interventions.

A long-established, 127 km-long hydrographic section in the northern North Sea at 59.28°N that runs from the eastern coast of Orkney (2.23°W) to the central North Sea (0°) crosses the path of the main inflows of Atlantic water. Data from 122 occupations between 1989 and 2015 are examined to determine the annual cycle and long-term trends of temperature, salinity and depth-varying geostrophic flow across the section. In an average year, the geostrophic flow referenced to the seafloor is at its narrowest (40 km) in winter, during which time it is driven by the strong horizontal salinity gradient; the horizontal temperature gradient is very weak. Velocity exceeds 4 cm s−1, but transport is at a minimum (0.11 Sv). In the deeper water in the east of the section, thermal stratification develops throughout summer and persists until October, whereas the west is tidally mixed all year. The bottom temperature gradient becomes the primary driver of the geostrophic flow, which is fastest (9 cm s−1) in September and broadest (100 km) in October. Maximum transport (0.36 Sv) occurs in October. Throughout the summer, the horizontal salinity gradient weakens, as does its contribution to the flow. However, it nevertheless acts to broaden the flow west of the location of the strongest horizontal temperature gradient. Section-mean de-seasoned temperature is found to be positively correlated to the Atlantic Multidecadal Oscillation and negatively correlated to the North Atlantic Oscillation. These results refine our understanding of the thermohaline forcing of Atlantic inflow into the northern North Sea, particularly in relation to the salinity distribution. Understanding the variability of this inflow is important for understanding the dynamics of the North Sea ecosystem.

Faced with serious air pollution, China is aggressively reshaping its energy system, building on recent progress with renewables and on available supplies of gas. This should help contain global warming and provide new impetus to climate change negotiations.

A new Global Investment Framework for Women's and Children's Health demonstrates how investment in women's and children's health will secure high health, social, and economic returns. We costed health systems strengthening and six investment packages for: maternal and newborn health, child health, immunisation, family planning, HIV/AIDS, and malaria. Nutrition is a cross-cutting theme. We then used simulation modelling to estimate the health and socioeconomic returns of these investments. Increasing health expenditure by just $5 per person per year up to 2035 in 74 high-burden countries could yield up to nine times that value in economic and social benefits. These returns include greater gross domestic product (GDP) growth through improved productivity, and prevention of the needless deaths of 147 million children, 32 million stillbirths, and 5 million women by 2035. These gains could be achieved by an additional investment of $30 billion per year, equivalent to a 2% increase above current spending.

Australia's current resources boom has three elements: high terms of trade, strong investment and increased resource exports. For a decade, the net effect has been strongly positive: the boost to incomes and activity from the first two has more than offset the impact of the high Australian dollar. But, both resource investment and the terms of trade will fall in due course and the economy will face a major deflationary shock. A sustained policy response will be needed that recognises the limits of monetary policy and hence involves fiscal stimulus, together with innovative approaches to ensure that infrastructure investment rises rapidly.

Purpose To determine whether a combination of L-methylfolate, methylcobalamin, and pyridoxal-5′-phosphate (LMF-MC-PLP [Metanx; Pamlab LLC, Covington, La]) improves sensory neuropathy. Research Design and Methods This multicenter, randomized, double-blind, placebo-controlled trial involved 214 patients with type 2 diabetes and neuropathy (baseline vibration perception threshold [VPT]: 25-45 volts), who were randomly assigned to 24 weeks of treatment with either L-methylfolate calcium 3 mg, methylcobalamin 2 mg, and pyridoxal-5′-phosphate 35 mg or placebo. The primary end point was effect on VPT. Secondary end points included Neuropathy Total Symptom Score (NTSS-6) and Short Form 36 (SF-36), as well as plasma levels of folate, vitamins B 6 and B 12 , methylmalonic acid (MMA), and homocysteine. Results There was no significant effect on VPT. However, patients receiving LMF-MC-PLP consistently reported symptomatic relief, with clinically significant improvement in NTSS-6 scores at week 16 ( P =.013 vs placebo) and week 24 ( P =.033). Improvement in NTSS scores was related to baseline MMA and inversely related to baseline PLP and metformin use. Quality-of-life measures also improved. Homocysteine decreased by 2.7±3.0 μmol/L with LMF-MC-PLP versus an increase of 0.5±2.4 μmol/L with placebo ( P =.0001). Adverse events were infrequent, with no single event occurring in ≥2% of subjects. Conclusions LMF-MC-PLP appears to be a safe and effective therapy for alleviation of peripheral neuropathy symptoms, at least in the short term. Additional long-term studies should be conducted, as the trial duration may have been too short to show an effect on VPT. In addition, further research on the effects in patients with cobalamin deficiency would be useful.

The continuum of care for reproductive, maternal, newborn, and child health (RMNCH) addresses three key dimensions of service delivery across time, space, and type of care (Kerber and others 2007): Access to needed services throughout the life cycle, including adolescence, pregnancy, childbirth, the postnatal period, and childhood Access to interventions with functional linkages among levels of care in the health system provided by families and communities, outpatient and outreach services, and health facilities Access to different types of health services and activities, including prevention, promotion, and curative and palliative care (World Health Assembly 2009). Assessing the returns on investments in the continuum of care for RMNCH requires specification of a package of interventions and an estimate of the full costs incurred in the health system to deliver those interventions. On the benefits side, the outcome of the continuum of care is evidenced in the many dimensions of the health benefits arising from an integrated care program. These benefits are not only lives saved; they also include the improved health and welfare of mothers and children, and the benefits that arise from expanding the ability of women to plan their pregnancies. These diverse health gains will have a wide range of economic and social benefits. Thus, assessing the returns on investment in the continuum of care for RMNCH also requires a comprehensive attempt to measure the various benefits that accrue to communities, at different stages of the life-cycle, as a result of the interventions. The overall analysis compares costs and benefits, taking into consideration their varying patterns over time, to generate benefit-cost ratios and rates of return on investment.This chapter assesses the costs and benefits of delivering a set of integrated RMNCH interventions across the continuum of care in countries with high child and maternal mortality. The purpose is twofold: To demonstrate that very high returns can be achieved by strengthening investments in the delivery of a suite of high-impact interventions To underscore the importance of an accurate assessment of those returns, including the full range of costs involved in delivering integrated care across the continuum and the full range of benefits that flow from the interventions. This chapter is based on the first attempt, to our knowledge, to undertake such a comprehensive analysis of the returns on investment in the continuum of care for RMNCH (Stenberg and others 2014).

Summary Background Depression and anxiety disorders are highly prevalent and disabling disorders, which result not only in an enormous amount of human misery and lost health, but also lost economic output. Here we propose a global investment case for a scaled-up response to the public health and economic burden of depression and anxiety disorders. Methods In this global return on investment analysis, we used the mental health module of the OneHealth tool to calculate treatment costs and health outcomes in 36 countries between 2016 and 2030. We assumed a linear increase in treatment coverage. We factored in a modest improvement of 5% in both the ability to work and productivity at work as a result of treatment, subsequently mapped to the prevailing rates of labour participation and gross domestic product (GDP) per worker in each country. Findings The net present value of investment needed over the period 2016–30 to substantially scale up effective treatment coverage for depression and anxiety disorders is estimated to be US$147 billion. The expected returns to this investment are also substantial. In terms of health impact, scaled-up treatment leads to 43 million extra years of healthy life over the scale-up period. Placing an economic value on these healthy life-years produces a net present value of $310 billion. As well as these intrinsic benefits associated with improved health, scaled-up treatment of common mental disorders also leads to large economic productivity gains (a net present value of $230 billion for scaled-up depression treatment and $169 billion for anxiety disorders). Across country income groups, resulting benefit to cost ratios amount to 2·3–3·0 to 1 when economic benefits only are considered, and 3·3–5·7 to 1 when the value of health returns is also included. Interpretation Return on investment analysis of the kind reported here can contribute strongly to a balanced investment case for enhanced action to address the large and growing burden of common mental disorders worldwide. Funding Grand Challenges Canada.

Robert C. Hendel, MD, FACC, FAHA, Chair; Biykem Bozkurt, MD, PhD, FACC, FAHA; Gregg C. Fonarow, MD, FACC, FAHA; Jeffrey P. Jacobs, MD, FACC; Pamela N. Peterson, MD, FACC; Veronique L. Roger, MD, MPH, FACC, FAHA[∥∥∥][1]; Eric E. Smith, MD, MPH, FAHA; James E. Tcheng, MD, FACC, FSCAI; Tracy

Over the past decade, there has been an increasing awareness that the quality of medical care delivered in the United States is variable. In its seminal document dedicated to characterizing deficiencies in delivering effective, timely, safe, equitable, efficient, and patient-centered medical care, the Institute of Medicine described a quality “chasm”.1 Recognition of the magnitude of the gap between the care that is delivered and the care that ought to be provided has stimulated interest in the development of measures of quality of care and the use of such measures for the purposes of quality improvement and accountability. Consistent with this national focus on healthcare quality, the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) have taken a leadership role in developing measures of the quality of care for cardiovascular disease (CVD) in several clinical areas (Table 1). The ACCF/AHA Task Force on Performance Measures was formed in February 2000 and was charged with identifying the clinical topics appropriate for the development of performance measures and with assembling writing committees composed of clinical and methodological experts. When appropriate, these committees have included representation from other organizations involved in the care of patients with the condition of focus. The committees are informed about the methodology of performance measure development and are instructed to construct measures for use both prospectively and retrospectively, to rely upon easily documented clinical criteria, and where appropriate, to incorporate administrative data. The data elements required for the performance measures are linked to existing ACCF/AHA clinical data standards to encourage uniform measurements of cardiovascular care. The writing committees are also instructed to evaluate the extent to which existing nationally recognized performance measures conform to the attributes of performance measures described by the ACCF/AHA and to strive to create measures aligned with acceptable existing measures …

In Fig. 4a of this Analysis, owing to an error during the production process, the year in the header of the right column was '2016' rather than '2010'. In addition, in the HTML version of the Analysis, Table 1 was formatted incorrectly. These errors have been corrected online.

Advances in information and communication technologies are disrupting traditional models of scholarly publishing, radically changing our capacity to reproduce, distribute, control, and publish information. The key question is whether there are new opportunities and new models for scholarly publishing that would better serve researchers and better communicate and disseminate research findings. Identifying access and efficiency limitations under the subscription publishing model, this paper explores the potential impacts of enhanced access to research outputs using a modified Solow-Swan model, which introduces ‘accessibility’ and ‘efficiency’ parameters into calculating returns to R&D. Indicative impact ranges are presented for Government, Higher Education and Australian Research Council R&D expenditures. We conclude that there may be substantial benefits to be gained from more open access to research findings.

Cet article presente le developpement et l’application d’un modele permettant d’estimer les couts de la communication scientifique (c’est-a-dire de la publication scientifique et des activites associees) au sein du systeme d’enseignement superieur australien. Les auteurs ont adopte une perspective systemique en vue de structurer leur analyse des publications consacrees aux couts induits par l’integralite de la filiere de communication scientifique, et de disposer des donnees necessaires a l’elaboration d’un modele de couts applicable au systeme de communication scientifique. Cet article propose un certain nombre d’estimations des couts de communication scientifique supportes par les etablissements d’enseignement superieur australiens. Ces estimations ont ete formulees d’apres le modele elabore, mais aussi a l’issue d’un long processus de collecte de donnees et de consultations menees a l’echelon local. Aussi s’avereront-elles sans doute utiles dans le cadre de la gestion des budgets et des priorites des etablissements. Il s’agit du premier effort mene en Australie en vue de realiser une estimation systematique des couts des activites entourant la publication scientifique, et ce modele offrira probablement de vastes possibilites d’application dans d’autres pays.

The following article1 is the report of an American Diabetes Association task force that summarizes the recent literature on tests and measures to identify people at risk for foot ulceration and to recommend what should be included in the comprehensive foot exam for adult patients with diabetes. Although this information would be timely and pertinent for physical therapists at any time, its content is particularly complementary to the content of PTJ's Special Issue on Diabetes. This article has been reprinted with permission of the American Diabetes Association from Boulton AJM, Armstrong DG, Albert SF, et al. Comprehensive foot examination and risk assessment: a report of the Task Force of the Foot Care Interest Group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care . 2008;31:1679-1685. DOI: 10.2337/dc08-9021. Available online at: http://care.diabetesjournals.org. Copyright ©2008 American Diabetes Association. From Diabetes Care ®, Vol 31, 2008; 1679-1685. Reprinted with permission from The American Diabetes Association . Reference 1 Boulton AJM, Armstrong DG, Albert SF, et al. Comprehensive foot examination and risk assessment: a report of the Task Force of the Foot Care Interest Group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care. 2008;31:1679–1685. [OpenUrl][1][FREE Full Text][2] [1]: {openurl}?query=rft.jtitle%253DDiabetes%2BCare%26rft.stitle%253DDiabetes%2BCare%26rft.issn%253D0149-5992%26rft.aulast%253DBoulton%26rft.auinit1%253DA.%2BJ.M.%26rft.volume%253D31%26rft.issue%253D8%26rft.spage%253D1679%26rft.epage%253D1685%26rft.atitle%253DComprehensive%2BFoot%2BExamination%2Band%2BRisk%2BAssessment%253A%2BA%2Breport%2Bof%2Bthe%2BTask%2BForce%2Bof%2Bthe%2BFoot%2BCare%2BInterest%2BGroup%2Bof%2Bthe%2BAmerican%2BDiabetes%2BAssociation%252C%2Bwith%2Bendorsement%2Bby%2Bthe%2BAmerican%2BAssociation%2Bof%2BClinical%2BEndocrinologists%26rft_id%253Dinfo%253Adoi%252F10.2337%252Fdc08-9021%26rft_id%253Dinfo%253Apmid%252F18663232%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=FULL&journalCode=diacare&resid=31/8/1679&atom=%2Fptjournal%2F88%2F11%2F1436.atom

This paper reports on the development and application of a model used to estimate the costs of scholarly communication (i.e. scholarly publishing and related activities) in Australian higher education. A systems perspective was used to frame a review of the literature on the costs involved in the entire scholarly communication value chain and inform the development of a scholarly communication system cost model. This paper presents estimated scholarly communication costs for higher education institutions in Australia, based upon the modelling, local data collections and stakeholder consultation, that may prove useful in the management of institutional budgets and priorities. It represents the first systematic attempt to estimate the costs of scholarly publishing related activities in Australia, and it could be easily applied elsewhere.

The world has recently moved to a new economic growth path, driven by the rapid growth of developing country economies. How this new path affects the vulnerability of key biophysical systems and its resulting policy implications are assessed using a risk-based approach. Greenhouse gas emissions based on current policies are projected to 2030, with aggressive reductions from 2030 to 2100. Probabilities for global mean temperature in 2100 are applied to damage functions for four key vulnerabilities. Five conclusions are reached. CO2 emissions grow by 3.1% per annum over 2004–2030. Atmospheric CO2 concentration levels 4900ppm CO2-e and warming of 2.2–4.7 1C are attained by 2100. The four key vulnerabilities face a very high risk of adverse outcomes. The current policy mix cannot adequately manage these risks, which can be reduced but not eliminated by early global action. Furthermore, the Intergovernmental on Panel Change’s (IPCC) Special Report for Emission Scenarios (SRES) no longer provide a reliable tool for medium-term analysis in the new economy. Measures to reduce global fossil fuel consumption, accelerate the diffusion of existing non-fossil fuel technologies and to hasten the development of new technologies are urgently needed.

In recent years the world has moved to a new path of rapid global growth, largely driven by the developing countries, which is energy intensive and heavily reliant on the use of coal—global coal use will rise by nearly 60% over the decade to 2010. It is likely that, without changes to the policies in place in 2006, global CO2 emissions from fuel combustion would nearly double their 2000 level by 2020 and would continue to rise beyond 2030. Neither the SRES marker scenarios nor the reference cases assembled in recent studies using integrated assessment models capture this abrupt shift to rapid growth based on fossil fuels, centred in key Asian countries. While policy changes must and will occur, the realism of the reference case is critical for analysis and policy formulation. Using such a reference path will have significant effects on impact and damage estimates, on the analysis of achievable stabilisation paths and on estimates of the costs of achieving stabilisation at a given GHG concentration level. Use of a realistic reference path is also essential for the international negotiations, arising out of the COP13 meeting in Bali, to achieve widely desired stabilisation goals: both the level of emission reductions to be achieved, and the preferred distribution of those reductions over countries and regions, will be heavily influenced by the reference case assumed.

1. Chaired this panel,2. University of Pittsburgh/UPMC, Pittsburgh, Pennsylvania,3. Georgetown University Hospital, Washington, DC,4. Columbia University College of Physicians and Surgeons, Department of Surgery, New York, New York,5. Colaizzi Pedorthic Center, Pittsburgh, Pennsylvania,6. HCA Richmond Retreat Hospital, Richmond, Virginia,7. University of Michigan Hospital, Ann Arbor, Michigan,8. University of Texas Health Science Center, San Antonio, Texas,9. Covance, Princeton, New Jersey,10. St. Joseph’s Hospital, Belleville, Illinois,11. University of South Florida, Tampa, Florida,12. Penn North Centers for Advanced Wound Care, Warren, Pennsylvania,13. Cabrini Medical Center, New York, New York,14. Beth Israel Deaconess Medical Center, Boston, Massachusetts, and15. Barnes-Jewish Hospital at Washington University Medical Center, St. Louis, Missouri

Diabetic foot ulcers (DFUs) are a leading cause of morbidity and hospitalisation among patients with diabetes. We analysed claims data for Medicare part B diabetic foot ulcer patients treated with Negative Pressure Wound Therapy at home (N = 1135) and diabetic foot ulcer patients from a published meta‐analysis of randomised controlled wet‐to‐moist therapy. The expected costs of care for the two treatments were also compared. A significantly greater proportion of wounds treated with NPWT achieved a successful treatment endpoint compared with wet‐to‐moist therapy at both 12 weeks (39·5% versus 23·9%; P < 0·001) and 20 weeks (46·3% versus 32·8%; P < 0·001). NPWT‐treated patients reached a successful wound treatment endpoint more rapidly, and the benefit was apparent in all wound sizes. Expected 20‐week treatment costs for NPWT were similar to those for wet‐to‐moist therapy if one nursing visit per day for the latter is assumed but 42% less if two nursing visits per day are made. Thus, NPWT may improve the proportion of DFUs that attain a successful wound treatment endpoint and decrease resource utilisation by a given health care system compared with standard wet‐to‐moist therapy.