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The intrinsic L1 metallo- and L2 serine-β-lactamases in Stenotrophomonas maltophilia make it naturally multidrug resistant and difficult to treat. There is a need to identify novel treatment strategies for this pathogen, especially against isolates resistant to first line agents. Aztreonam in combination with avibactam has demonstrated potential, although data on other aztreonam-β-lactamase inhibitor (BLI) combinations are lacking. Additionally, molecular mechanisms for reduced susceptibility to these combinations have not been explored. The objectives of this study were to evaluate and compare the in vitro activity and understand the mechanisms of resistance to aztreonam in combination with avibactam, clavulanate, relebactam, and vaborbactam against S. maltophilia. A panel of 47 clinical S. maltophilia strains non-susceptible to levofloxacin and/or trimethoprim-sulfamethoxazole were tested against each aztreonam-BLI combination via broth microdilution and 6 isolates were then evaluated in time-kill analyses. Three isolates with varying aztreonam-BLI MICs were subjected to whole-genome sequencing and quantitative reverse transcriptase polymerase chain reaction. Avibactam restored aztreonam susceptibility in 98% of aztreonam-resistant isolates, compared to 61%, 71%, and 15% with clavulanate, relebactam, and vaborbactam, respectively. The addition of avibactam to aztreonam resulted in a ≥2 log10 CFU/mL decrease at 24 hours vs. aztreonam alone against 5/6 isolates compared to 1/6 with clavulanate, 4/6 with relebactam, and 2/6 with vaborbactam. Molecular analyses revealed that decreased susceptibility to aztreonam-avibactam was associated with increased expression of genes encoding for L1, L2, and the efflux pump smeABC. Aztreonam-avibactam is the most promising BLI-combination against multidrug resistant S. maltophilia. Decreased susceptibility may be due to the combination of overexpressed β-lactamases and efflux pumps. Further studies evaluating this combination against S. maltophilia are warranted.

We analyse the spectrum of the Hamiltonian of a photon propagating in a strong magnetic field B ∼ Bcr, where Bcr=m2e≃4.4×1013" role="presentation">Bcr=m2e≃4.4×1013 G is the Schwinger critical field. We show that the anomalous magnetic moment of a photon in the one-loop approximation is a non-decreasing function of the magnetic field B in the range 0 ≤ B ≤ 30 Bcr. We provide a numerical representation of the expression for the anomalous magnetic moment in terms of special functions. We find that the anomalous magnetic moment μγ of a photon for B = 30 Bcr is 8/3 of the anomalous magnetic moment of a photon for B = 1/2Bcr. Based on the recent observational evidence for vacuum birefringence from the neutron star RX J1856.5−3764 by Mignani et al., we suggest vacuum birefringence, the anomalous magnetic moment of the photon and the Faraday rotation angle as key observables for future experiments and measurements.

Arteries often demonstrate geometric variations such as elliptic and eccentric cross sections, stenosis, and tapering along the longitudinal axis. Effects of these variations on the mechanical stability of the arterial wall have not been investigated. The objective of this study was to determine the buckling behavior of arteries with elliptic, eccentric, stenotic, and tapered cross sections. The arterial wall was modeled as a homogeneous anisotropic nonlinear material. Finite element analysis was used to simulate the buckling process of these arteries under lumen pressure and axial stretch. Our results demonstrated that arteries with an oval cross section buckled in the short axis direction at lower critical pressures as compared to circular arteries. Eccentric cross sections, stenosis, and tapering also decreased the critical pressure. Stenosis led to dramatic pressure variations along the vessel and reduced the buckling pressure. In addition, tapering shifted the buckling deformation profile of the artery towards the distal end. We conclude that geometric variations reduce the critical pressure of arteries and thus make the arteries more prone to mechanical instability than circular cylindrical arteries. These results improve our understanding of the mechanical behavior of arteries.

The objective was to quantify the incidence of tarsal lesions and level of hygiene by stall bed type. Cows were scored on 100 dairies from Wisconsin, Minnesota, Indiana, Iowa, and New York in the fall and winter. Thirty-eight dairies used rubber-filled mattresses (RFM), 27 had sand beds, 29 had waterbeds, and 6 used compost packs (CPk). Stocking density, stall dimensions, bedding amount, bedding frequency, and type of bedding were recorded. One pen of early-lactation multiparous cows on each dairy was scored based on injury of the tarsal joints at the lateral and medial surfaces and tuber calcis at the dorsal, lateral, and medial surfaces. A tarsal score of 1 represented hair loss, 2 was moderate, and 3 indicated severe swelling. Differences between bed types in the percentages of cows with lesions were tested with one-way ANOVA by lesion severity and incidence, with farm as the experimental unit. Cows on sand beds or waterbeds had fewer lesion scores of 1, 2, and 3 than those on RFM. The percentages of score 1 were 54.6 +/- 4.4 (RFM), 22.5 +/- 4.7 (sand), and 29.8 +/- 4.3 (waterbed), whereas the percentages of score 2 were 14.0 +/- 1.4, 2.3 +/- 1.5, and 5.0 +/- 1.4, and of score 3 were 3.0 +/- 0.4, 0.2 +/- 0.4, and 0.4 +/- 0.4. Cows on CPk had no lesions. Hygiene scores ranged from 1 to 5, with 1 being clean and 5 soiled. The percentages of hygiene score 1 were 0 (compost), 0.4 (RFM), 0.4 (sand), and 0.4 (waterbeds); those with score 2 were 79.0, 84.0 +/- 0.01, 73.2 +/- 0.01, and 80.4 +/- 0.01; with score 3 were 20.3, 15.2 +/- 0.01, 23.8 +/- 0.01, and 18.6 +/- 0.01; with score 4 were 0.8, 0.005 +/- 0.001, 0.006 +/- 0.001, and 0.025 +/- 0.003; and with score 5 was 0 for all bed types. Cows on RFM and waterbeds had improved hygiene compared with cows on sand beds. There was no difference in somatic cell count (SCC) by bed type. The percentage of cows in fourth lactation or greater on waterbeds (19.8 +/- 1.8) was greater than those on RFM (13.3 +/- 1.6) or on sand (13.5 +/- 1.8). The percentage culled was lower for cows on waterbeds than on RFM (22.8 +/- 1.5 vs. 29.4 +/- 1.4). Score 3 tarsal lesions were correlated (r = 0.60) with SCC. The length of the sand bed was correlated with a greater percentage of mature cows. The SCC was correlated with the percentage of cows reported lame on the day of the visit (r = 0.45) and with neck rail height (r = -0.26). On dairies with RFM, severe lesions (r = 0.60), death losses (r = 0.52), and percentage of the herd reported lame on the day of the visit (r = 0.52) were all correlated with the SCC. Dairies with higher percentages of lesions had higher SCC, death losses, lameness, and culling rates. Adding bedding several times per week may reduce the incidence of lesions.

There is a general perception that too much money is being spent on health care, and that costs are rising too rapidly. One source of the problem is believed by some to be the widespread use of expensive technologies, and this logically leads to a potential solution: get physicians to stop using such technologies. Obvious targets are cardiothoracic surgeons who have access to a substantial number of expensive technologies and a substantial number of patients to use them on. To highlight some of the issues underlying the question of whether utilizing such technologies is justified, a case was constructed to illustrate the use of an expensive technology in a marginal clinical situation: a left ventricular assist device (LVAD) implanted in an older man with leukemia and an uncertain prognosis. To argue the question of whether or not the procedure was warranted, we recruited two outstanding proponents of differing views: Dr Patrick McCarthy, a cardiac surgeon who has broad experience with LVADs, and former Governor Richard Lamm of Colorado, one of the few public figures audacious enough to use the word “rationing” publicly. They presented their viewpoints at the Forty-first Annual Meeting of The Society of Thoracic Surgeons. The case that served as the focal point of their discussion is detailed as follows. A 62-year-old male carpenter, Mr I. Sandy Wood, noticed that he was tiring much earlier in the day than he had just a few weeks before, and that the frequent small cuts he received at work bled much longer than in the past. His family doctor ordered a battery of laboratory tests that revealed acute myelogenous leukemia. Echocardiogram at that time was normal, with a left ventricular ejection fraction of 63%. He was told that the chance of ultimately curing his acute myelogenous leukemia with appropriate chemotherapy was about 40%, and that nearly all relapses occur within 2 years of treatment. He underwent a full course of chemotherapy, including both cytosine arabinoside and idarubicin for induction, later followed at 3 and 5 months by consolidation courses of high-dose cytosine arabinoside. Aside from nausea and fatigue during chemotherapy, he did well. Five months after the end of chemotherapy, Mr Wood noticed increasing shortness of breath, generalized weakness, and ankle edema. An echocardiogram demonstrated a left ventricular ejection fraction of 19% and cardiac catheterization showed mild obstruction (25%) of the left anterior descending artery. Endomyocardial biopsy showed damage consistent with idarubicin-induced cardiomyopathy. Medical management included appropriate doses of an ACE inhibitor, beta-blocker, loop diuretic, spironolactone, and digoxin. Despite intensive outpatient management, his dyspnea and edema continued to worsen, and he became dyspneic at rest. He was hospitalized 3 times during a 4-month period, requiring intravenous inotropic support and highdose intravenous diuretics. During his third hospitalization, he failed to respond to intravenous drug therapy, and a repeat echocardiogram demonstrated an ejection fraction of 10%. He was deemed not to be a candidate for heart transplantation because of his recently active leukemia. Because he appeared unlikely to survive for more than a few weeks, he was evaluated as a candidate for support with a left ventricular assist device (LVAD) as destination therapy, was found to meet the criteria for support, and underwent placement of a HeartMate LVAD.

Can democracy resolve the new set of survival problems we face? Our greatest challenge is to modify or perhaps even reverse what has worked well. Our economic system must adapt to our ecological system. Genetic values that allowed Homo sapiens to prosper may be counterproductive today. Four preconceptions that hinder the United States in facing challenges: 1) It has a divine destiny; 2) Problem solving machinery and institutions are equal to the challenges; (the influence of money on politics undermines this); 3) Our political system and democracy are sustainable; 4) Population and economic growth are good. Nations must ask: How many people can we support? We cannot be growth maximizers and ecological realists at the same time. Both the Rio Declaration and the Brundtland Commission set utopian but unachievable goals.

PREFACE: The word “system” suggests a set of activities that come together in a reasonable fashion. If not seamless, they are at least end to end—the interstate highway system, the air traffic control system. The absence of a national health care system in the United States has produced a landscape replete with inconsistencies, redundancies, and—most problematic—gaps. Health care in this country, however, is not without systems. Multiple subsystems exist, governed by public laws and private insurance arrangements. These contending and competing systems collectively determine the size of the health care pie in the country and, effectively, divide it up. Any efforts to reform or coordinate these systems must start with the logic that created them rather than with the sometimes irrational results they generate. Richard Lamm, former governor of Colorado, sat atop a state system for twelve years. The systematized inequities he encountered during his tenure have made him an articulate campaigner for distributio...

In Christian theology, there is the story of Saint Martin of Tours. In the late thirteenth century, late one night outside an ancient city, Saint Martin of Tours was riding his horse down this ancient byway. Right outside the city gates, he comes across a cold and starving beggar. In an act of charity which got him sainted a couple hundred years later, he took his cloak and cut it in half. He took half of his dinner and gave it to the cold and starving beggar. Now, Bertold Brecht, in one of his plays, raises this question: What if instead of one cold and starving beggar, there were 50, or 60, or 100? What is the ethical choice now? What does the ethical person do? It is for asking these hard, but important, questions that you charge me, here and now, in 2007 A.D., with heresy. You charge me with heresy for changing "Love thy neighbor," to "Love thy nearest neighbor/ My answer to you is that this is the new bio-spiritual ethics. This is the new ethical reality. I wish with all my heart it were not, but my mind and soul tell me (tragically) that it is the new reality. Charity must begin at home. The Bible states (Timothy 5:8), "If any provide not for his own house, he hath denied the faith and is worse than an infidel.1" Painfully, but inevitably, mankind must fit itself into its ecosys tem. At some point?we can argue endlessly when that takes place?but at some point, infinite growth in a finite world comes to an end. At that point?whenever it happens?a new ethics must be formu lated.

Arteries are often subjected to torsion due to body movement and surgical procedures. While it is essential that arteries remain stable and patent under twisting loads, the stability of arteries under torsion is poorly understood. The goal of this work was to experimentally investigate the buckling behavior of arteries under torsion and to determine the critical buckling torque, the critical buckling twist angle, and the buckling shape. Porcine common carotid arteries were slowly twisted in vitro until buckling occurred while subjected to a constant axial stretch ratio (1.1, 1.3, 1.5 (in vivo level) and 1.7) and lumen pressure (20, 40, 70 and 100 mmHg). Upon buckling, the arteries snapped to form a kink. For a group of six arteries, the axial stretch ratio significantly affected the critical buckling torque ( $$p

President Clinton, already facing formidable obstacles in reforming the health care system, denies that it will involve any rationing. This is politically understandable, but wrong. Infinite needs are rapidly overtaking finite resources. Most health providers recognize that the genius of modern medicine has outpaced our ability to pay. But the public still has unlimited expectations and a blind faith that everything can be provided to everyone by simply eliminating "waste, fraud, and abuse." Rationing is inherent in any health care system. As government undertakes to define what is "medically necessary or appropriate," it will unavoidably undertake a series of rationing decisions. Health care is being transformed from a private good to a public good. Government, when it reforms the health care system, must inevitably ask: How do we buy the most health for the public?

The spin observable D NN ′ ( θ ) was measured for ( p , n ) at 135 MeV on 16 O, 40 Ca, 48 Ca, and 208 Pb. Data for 16 O and 40 Ca are compared with distorted-wave impulse approximation (DWIA) calculations with Tamm-Dancoff (TDA) wave functions; the D NN ′ data generally agree with the J π distribution (O − , 1 − , 2 − ) predicted for the “spin-dipole” resonance.

The single greatest challenge facing managers in the developed countries of the world is to raise the productivity of knowledge and service workers. This challenge, which will dominate the management agenda for the next several decades, will ultimately determine the competitive performance of companies. Even more important, it will determine the very fabric of society and the quality of life of every industrialized nation. … Unless this challenge is met, the developed world will face increasing social tensions, increasing polarization, increasing radicalization, possibly even class war.

I end with another parable, but it is also a true story. Harvey Cushing, the famous surgeon after whom the Cushing Lectures are named, made an international reputation in his allegiance to quality. He badgered his profession to a higher standard of self-effacement and railed against the debasement of clinical skills and overemphasis on research and pursuit of personal gain. We honor him to this day because those were, and remain, important points. Yet, Harvey Cushing served as a surgeon during World War I and at Ypres. Although the Allied mortality was as much as 50,000 soldiers a day, not counting the wounded, Cushing refused to operate on any more than two patients each day, arguing that to do so would have lowered his standard of care for his patients--a standard that made sense in one time but that became strikingly insensitive, and I suggest even unethical, in another when confronted with a different reality. The ethical claims for professional autonomy based on such standards of professional ethics has had the effect of supporting widespread distributional inequities. These inequities are clearly a form of rationing that have been condoned implicitly by the professional ethics in the name of professional autonomy. Many of the condemnations we hear today of prospective payment systems and how they will "ration" medicine contain a similar sense of unreality. The high standards are laudatory, but they should not be used as an excuse to not meet other pressing needs. High standards should never be used to make a problem worse.(ABSTRACT TRUNCATED AT 250 WORDS)

Tortuous arteries are often associated with aging, hypertension, atherosclerosis, and degenerative vascular diseases, but the mechanisms are poorly understood. Our recent theoretical analysis suggested that mechanical instability (buckling) may lead to tortuous blood vessels. The objectives of this study were to determine the critical pressure of artery buckling and the effects of elastin degradation and surrounding matrix support on the mechanical stability of arteries. The mechanical properties and critical buckling pressures, at which arteries become unstable and deform into tortuous shapes, were determined for a group of five normal arteries using pressurized inflation and buckling tests. Another group of nine porcine arteries were treated with elastase (8 U/ml), and the mechanical stiffness and critical pressure were obtained before and after treatment. The effect of surrounding tissue support was simulated using a gelatin gel. The critical pressures of the five normal arteries were 9.52 kPa (SD 1.53) and 17.10 kPa (SD 5.11) at axial stretch ratios of 1.3 and 1.5, respectively, while model predicted critical pressures were 10.11 kPa (SD 3.12) and 17.86 kPa (SD 5.21), respectively. Elastase treatment significantly reduced the critical buckling pressure ( P < 0.01). Arteries with surrounding matrix support buckled into multiple waves at a higher critical pressure. We concluded that artery buckling under luminal pressure can be predicted by a buckling equation. Elastin degradation weakens the arterial wall and reduces the critical pressure, which thus leads to tortuous vessels. These results shed light on the mechanisms of the development of tortuous vessels due to elastin deficiency.

Arterial tortuosity is a phenomenon which is observed throughout the body and is associated with aging, diabetes, high blood pressure, and other vascular diseases [1]. Tortuous arteries significantly hinder blood flow which may lead to the development of atherosclerotic plaque buildup [2]. Blood vessels may also become twisted or demonstrate 3-D tortuous shapes when subject to large twist deformations such as during surgical implantation of vascular grafts, propeller flap procedures, stent-artery interactions, and sudden movements of the neck or limbs [4–6]. However, the twisting behavior of arteries is poorly understood.Copyright © 2011 by ASME

In terms of population growth and resource use, humankind is living on the upper slopes of some awesome geometric curves. Current growth rates have certain areas of the world doubling their population every 25 years. What is at risk is no less than the future of the whole globe. It will be hard for the world to avoid a demographic trauma. It is very difficult to motivate people when there is uncertainty and when the problem will manifest itself in the future. We really do not know what limits there are to population growth or resource use, and at what point ecological disaster takes over, but there are clearly limits on certain nonrenewables such as energy, land, and water. Additionally, humankind must decide how it will deal with a large number of environmental challenges: depletion of the protective ozone layer, global warming, deforestation, soil erosion, spreading deserts, and pollution of land, air, and water. To begin making the required changes, people must educate themselves and then educate each other.

Heifer (n = 72), bull (n = 22) and steer (n = 60) calves from matings of Hereford, Hereford x Angus and three-breed crossbred dams to Piedmontese (P), Gelbvieh (G) and Red Angus (RA) bulls were evaluated for growth and fertility traits. Birth weight, calving difficulty and adjusted 205-d weaning weight data were obtained from all calves. Pelvic dimensions, reproductive tract scores and pregnancy percentages were analyzed for heifers at 12 months of age. Breeding soundness examinations compared reproductive traits of bull calves at 12 and 13 months old. Steers were assigned to pens by breed of sire post-weaning to evaluate daily gain and adjusted feed efficiency for growing and finishing periods. Calves sired by P and G sires had heavier birth weights and higher calving difficulty scores (P

We are rapidly entering into a brave new world of health care. Infinite medical demands have run smack into finite resources. We can't pay for everything but we can spend our limited resources in a much more health-effective way. We have no other alternative but to devise systems that give us maximum health to our society with our limited resources. It is time to begin this process.

"In every age," writes Bronowski (1973), in The Ascent of Man, ''there is a turning point, a new way of seeing and asserting the coherence of the world." Similarly, Abraham Lincoln (1862) said, "As our case is new, we must think and act anew. We must disenthrall ourselves . . ." It seems clear that the great forward leaps of human progress have been made by people who "disenthrall" themselves and develop "a new way of seeing and asserting the coherence of the world." We see this in Galileo and Copernicus, who had the audacity to claim the earth was not the center of the universe. We see this in Charles Darwin, who took on the religious establishment with the heretical idea that man was a product of evolution. We see it in political systems where Locke and Jefferson had the revolutionary ideas that humankind could govern themselves. We see it in Freud with his upsetting idea that man was not always a rational animal. All of these people challenged the current ordained wisdom of the time and all of them proved correct. These people were labeled heretics. Their ideas were aired amidst great controversy. Huxley once observed that, "All great truths begin as heresy." Humankind falls into a routine way of viewing the world and then, breaking the continuity, someone observes that the current orthodoxy is at variance with reality. A great debate ensues. New ideas are upsetting. Attempts are made to shout down new opinion. If the idea is grounded in

The objective was to conduct a broad survey of dairy management practices that have an effect on animal well-being. Dairies were visited during the fall and winter of 2005 and 2006 in Wisconsin, Minnesota, Indiana, Iowa, and New York. Data were collected on 113 dairies on colostrum feeding, dehorning, tail-docking, euthanasia methods, producer statements about welfare, use of specialized calf-raising farms (custom), level of satisfaction with calf-raising by producers, and cow behavior. Calves were raised by the owner on 50.4% of dairies; 30.1% were raised on custom farms during the milk-feeding period, 18.6% were custom raised after weaning, and 1% sold calves with the option to buy them back as first-lactation heifers. A total of 51.8% of producers were very satisfied with their current calf-raising methods. Three feedings of colostrum were fed to the calves on 23.9% of dairies, 2 feedings on 39.8% of farms, 1 feeding on 31.0% of farms, and colostrum replacement products were fed on 5.3% of farms. Many farms (61.9%) provided 3.8 L at first feeding. Calves were dehorned at different ages by various methods. By 8 wk, 34.5% of calves were dehorned. By 12 wk, 78.8% of calves were dehorned. The majority of calves were dehorned by hot iron (67.3%). The remainder were dehorned by gouging (8.8%), paste (9.7%), saw (3.5%), or unknown by calf owner (10.6%). Anesthetic use was reported by 12.4% of dairy owners and analgesia use by 1.8%. Tail-docking was observed on 82.3% of dairies. The most common reported docking time was pre- or postcalving (35.2%). The second most commonly reported time was d 1 (15.4%). Rubber band was the most common method (92.5%), followed by amputation (7.5%). Three dairies amputated precalving, 1 at 2 mo and 3 at d 1 or 2. Cow hygiene was the most common reason given to dock (73.5%), followed by parlor worker comfort (17.4%) and udder health (1.0%). Producers reported 2.0% of cows obviously lame. Gun was the preferred euthanasia method (85.7%), followed by i.v. euthanasia (8.0%), live pick-up (1.8%), and nondisclosure (3.5%). Most producers (77.9%) stated that cows were in an improved environment as compared with 20 yr ago, whereas 8.0% stated conditions were worse, and 14.2% were undecided. Dairies with higher percentages of cows that either approached or touched the observer had lower somatic cell counts. The survey results showed management practices that were important for animal welfare.

Forty-five steers produced by matings of Piedmontese (P), Gelbvieh (G) and Red Angus (RA) sires to British (B) and Continental crossbred (Cx) dams were started on a finishing diet at an average of 291 d. Five steers from each sire-breed group were slaughtered after 124, 166 or 208 d of finishing. Age-constant values for slaughter weight and estimated degree of maturity did not differ for the three sire breed groups. Carcasses produced by P steers had the least fat thickness, the largest longissimus muscle (LM) areas, the lowest numerical yield grades, the highest yields of separable muscle and the highest muscle-to-bone ratios. Additionally, LM samples from P-sired steers had the highest percentage of white muscle fibers, the lowest percentage of intermediate muscle fibers and the smallest cross-sectional area of red muscle fibers. Marbling scores and intramuscular lipid content were highest for RA steers; P and G steers had similar values for marbling and intramuscular lipid content. Longissimus steaks from G steers received the lowest ratings for tenderness, flavor intensity and amount of connective tissue. Steaks from P and RA steers received similar sensory panel ratings. No differences were observed among the three sire-breed groups for amount and solubility of intramuscular collagen or for partitioning of separable carcass fat.

The objective of this field study was to compare effect of stall base on herd health, stall maintenance, bedding cost, and producer satisfaction. Ninety-one dairies visited during a 4-mo period starting October 14, 2005 included 33 rubber-filled mattress (RFM), 27 sand, and 31 waterbed (WB) stall bases. In this study, percent culled was higher for RFM (P = 0.001) and sand (P = 0.06) than WB dairies. Percent of cows in fourth lactation or greater was higher on WB than either RFM (P = 0.01) or sand (P = 0.02) dairies. There was no difference between base types for production or somatic cell count. Bedding cost per bed per week was WB ($0.73), RFM ($0.89), and sand ($0.97). Sand beds were bedded less frequently (P = 0.01). Comparisons between RFM and sand indicate higher satisfaction for RFM regarding manure management (P < 0.0001) and higher satisfaction with sand for cow comfort (P < 0.0001). Producers with WB were more satisfied with base life (P < 0.0001) and cow comfort (P < 0.0001) than those with RFM. Producers with WB were more satisfied with cow longevity (P < 0.0001) as compared to RFM. Length of sand stall was correlated with longevity (0.56, P = 0.01) while percent of mature cows was greater on dairies that provided waterbeds (P = 0.02). This data indicates that WB may be a viable option for cows and producers, when good quality sand is unavailable or handling sand-laden manure is not feasible.

There is an elephant in the living room of the House of Health Care that is not going away. The Ethical Force Program authors of Wynia et al. (2004) recognize early on that their report “does not a...

With resources becoming scarcer, providers, payers, and governments alike are grappling with how to best use these resources to serve the American people. Should the focus be on caring for individual patients (microallocation)? Or should the focus be on how to best serve a group of people (macroallocation)? Whether tax monies or health insurance premiums, pooled resources are always limited resources. Macroallocation involves trade-offs and setting priorities, but in the end, rationing is an obligation.

A real–time robotic weed control system was developed and tested in commercial cotton fields. The precision weed control system was capable of distinguishing grass–like weeds from cotton plants and applying a chemical spray only to targeted weeds while traveling at a continuous speed of 0.45 m/s. The robot consisted of a real–time machine vision system, a controlled illumination chamber, and a precision chemical applicator. In commercial cotton fields, the system correctly sprayed 88.8% of the weeds while correctly identifying and not spraying 78.7% of the cotton plants while traveling at 0.45 m/s.

Unplanned pregnancies are still common in developed societies. Although the medical-technical methods are mainly in use for family planning, other methods - not provided by the medical care system - have an important impact on the occurrence of unplanned pregnancies. Moreover the frequency of their use is not accurately recorded in usual study-protocols. The spread of methods based on the knowledge of physiologic infertility in woman's cycle (further: fertility awareness) and their relation to unplanned pregnancies is to be investigated.A survey by way of self-administered questionnaire was conducted between September 1997 and March 1998 on women in a maternity ward in a hospital in Berlin (former East-Berlin, n = 220). The use of family planning methods (with a special focus on fertility awareness) and the planning state of pregnancies were recorded.33 % of delivered pregnancies were unplanned. In the last year before conception occurred the part of the use of fertility awareness grew from 12 % to 30 % and correspondingly 25 % to 32 % of unplanned pregnancies were connected with these methods.The blanking-out of fertility awareness in the framework of medical care system leads to a constellation where a considerable part of unplanned pregnancies occurs beyond its range. The adequate solution for this problem should be an incorporation of fertility awareness into the mainstream of family planning.

American expectations for health care over the last 30 years have been developed during the most massive transfer of wealth into one sector that history has ever seen. American expenditures for health have been growing for the last 40 years at two and one half times the rate of inflation, which defies the law of economic gravity. Health care has grown from 6 percent of our gross domestic product (GDP) to almost 14 percent in 40 years and now accounts for one dollar out of every seven dollars spent in America. Americans pay 50 percent more per capita for health care than the average of the rest of the developed world. If US health care were a separate nation, it would have one of the largest economies in the world.