A cost-benefit analysis of risk-reduction strategies targeted at older drivers

OBJECTIVE: The risk of motor-vehicle collisions increases as driving-related functional abilities decline. These declines can accompany normal or pathological aging and can be identified through driving-related functional screening exams upon license renewal. The objective of this cost-benefit analysis was to determine the utility of four functional screening procedures used to identify drivers at risk for motor-vehicle collisions, as well as an intervention designed to maintain or improve functional abilities. Additionally, this study sought to determine the expected cost per driver if an intervention was designed to target only those drivers who failed the functional ability-based driving screen, versus the expected cost per driver if the intervention was distributed en masse to all drivers 75 years and older. Improving functional abilities in older adults has potential far-reaching health and financial impacts which are broader than their impact of maintaining mobility. METHODS: A decision tree was constructed to evaluate the expected costs and benefits of (a) screening all drivers and intervening when indicated (several screening batteries of varying length were considered), (b) no screening, but intervening with all drivers of older age, or (c) neither screening nor intervening (i.e., re-licensing per usual). Test characteristics and risk probabilities were based on a cohort of drivers aged 75 and older from a previous study (Ball et al., 2006). Relevant sensitivity analyses were conducted. RESULTS: Providing all drivers with the speed-of-processing intervention is the most cost-beneficial option (expected cost per driver = $493.30), even if the cost of the intervention doubles. Sensitivity analysis indicated the effectiveness of the intervention could drop from 86% to 25% and the preventative approach of intervening with all drivers remains the most cost-beneficial strategy. The least cost-beneficial option is almost always re-licensing per usual (expected cost per driver = $1,562.84). CONCLUSION: Screening drivers upon license renewal is not currently beneficial because the available technology cannot consistently identify drivers at risk for a collision. However, the speed-of-processing intervention has demonstrated efficacy in improving driving competence (Roenker et al., 2003) and is a non-invasive, moderate-cost intervention that has the potential to protect the safety and mobility, as well as the financial interests, of older drivers and the community at large.     

Short- and long-term outcomes of gestational diabetes and its treatment on fetal development

Globally the prevalence of gestational diabetes mellitus (GDM) is rising mainly due to the increase in maternal obesity. A number of different methods to screen for and diagnose GDM have been described although consensus on the preferred methods does not yet exist. GDM has significant short- and long-term health risks for the mother, developing fetus and the children born to mothers with GDM. Short-term risks for the fetus include macrosomia (excessive birthweight), shoulder dystocia, birth trauma, and hypoglycaemia in the immediate postpartum period. Long-term risks for offspring born to mothers with GDM include increased rates of childhood and adulthood obesity and an increased cardiometabolic risk. A number of pharmacological treatments for GDM have been identified, these include insulin and oral glucose-lowering drugs metformin and glibenclamide. Whilst these oral glucose-lowering drugs show similar short-term childhood outcomes to insulin there is increasing evidence that these drugs may have adverse long-term outcomes on children and adults exposed to the drugs in utero. Future research on treatments for GDM should include long-term follow- up of children exposed to glucose lowering medication in utero to determine the long-term cardiometabolic risk in the offspring born to mothers with GDM.     

Contesting neoliberal knowledge politics in restoration governance: the restorationist’s dilemma

ABSTRACT

The success of ecological restoration efforts is tightly coupled with the effectiveness of many U.S. environmental policies. Yet scholars have raised questions about the ability of restoration to produce intended results. We use a case study of tidal wetland restoration planning in Oregon to examine how neoliberal environmental governance exercises influence through a set of knowledge politics that produces subpar outcomes. We present three main findings: (1) restoration policies produce a restoration economy based on a conception of wetland as commodity (2) practitioners in this restoration economy exhibit competitive behavior resulting in a piecemeal rather than a landscape approach to restoration; and (3) limited monitoring prevents changes to existing policies. Practitioners offer insight into the challenge of treating wetlands as a commodity and call for more monitoring to challenge the assumptions of hegemonic knowledge practices that reinforce a neoliberal environmental governance regime. The divergent ideas of reflexive practitioners, though not yet manifest as action, show where changes to restoration governance might be possible.     

Economic and employment impacts of offshore wind for Ireland: A value chain analysis

ABSTRACT

The imminent development of a number of offshore wind farms in the Republic of Ireland presents a sizable opportunity to stimulate the Irish economy through the growth of an indigenous and globally competitive offshore wind supply chain. This study uses a value chain analysis to evaluate the economic and employment potential of the offshore wind sector for Ireland. The analysis is based on the expenditure on products and services required to develop an offshore wind farm, the planned capacity of projects in the pipeline, and the ability of Irish companies to supply the sector. Results suggest that by 2030, 2.5–4.5GW of domestic offshore wind development could create between 11,424 and 20,563 supply chain jobs and generate between €763 m and €1.4bn in gross value added. This is the first study to estimate domestic GVA potential for the sector.     

REVIVING URBAN STREAMS: LAND USE,HYDROLOGY, BIOLOGY,AND HUMAN BEHAVIOR1

ABSTRACT: Successful stream rehabilitation requires a shift from narrow analysis and management to integrated understanding of the links between human actions and changing river health. At study sites in the Puget Sound lowlands of western Washington State, landscape, hydrological, and biological conditions were evaluated for streams flowing through watersheds with varying levels of urban development. At all spatial scales, stream biological condition measured by the benthic index of biological integrity (B‐IBI) declined as impervious area increased. Impervious area alone, however, is a flawed surrogate of river health. Hydrologic metrics that reflect chronic altered streamflows, for example, provide a direct mechanistic link between the changes associated with urban development and declines in stream biological condition. These measures provide a more sensitive understanding of stream basin response to urban development than do treatment of each increment of impervious area equally. Land use in residential backyards adjacent to streams also heavily influences stream condition. Successful stream rehabilitation thus requires coordinated diagnosis of the causes of degradation and integrative management to treat the range of ecological stressors within each urban area, and it depends on remedies appropriate at scales from backyards to regional storm water systems.