Addressing liver disease in the UK: A blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis

This paper will explore how the financial regulatory structure propelled three credit rating agencies -- Moody's, Standard & Poor's (S&P), and Fitch -- to the center of the U.S. bond markets -- and thereby virtually guaranteed that when these rating agencies did make mistakes, these mistakes would have serious consequences for the financial sector. We begin by looking at some relevant history of the industry, including the series of events that led financial regulators to outsource their judgments to the credit rating agencies (by requiring financial institutions to use the specific bond creditworthiness information that was provided by the major rating agencies) and when the credit rating agencies shifted their business model from "investor pays" to "issuer pays." We then look at how the credit rating industry evolved and how its interaction with regulatory authorities served as a barrier to entry. We then show how these ingredients combined to contribute to the subprime mortgage debacle and associated financial crisis. Finally, we consider two possible routes for public policy with respect to the credit rating industry: One route would tighten the regulation of the rating agencies, while the other route would reduce the required centrality of the rating agencies and thereby open up the bond information process in a way that has not been possible since the 1930s.

/pdf/markets-the-credit-rating-agencies-2we1ac10em.pdf

Markets: The Credit Rating Agencies

Electric vehicles (EVs) have no tailpipe emissions, but the production of their batteries leads to environmental burdens. In order to avoid problem shifting, a life cycle perspective should be applied in the environmental assessment of traction batteries. The aim of this study was to provide a transparent inventory for a lithium-ion nickel-cobalt-manganese traction battery based on primary data and to report its cradle-to-gate impacts. The study was carried out as a process-based attributional life cycle assessment. The environmental impacts were analyzed using midpoint indicators. The global warming potential of the 26.6 kilowatt-hour (kWh), 253-kilogram battery pack was found to be 4.6 tonnes of carbon dioxide equivalents. Regardless of impact category, the production impacts of the battery were caused mainly by the production chains of battery cell manufacture, positive electrode paste, and negative current collector. The robustness of the study was tested through sensitivity analysis, and results were compared with preceding studies. Sensitivity analysis indicated that the most effective approach to reducing climate change emissions would be to produce the battery cells with electricity from a cleaner energy mix. On a per-kWh basis, cradle-to-gate greenhouse gas emissions of the battery were within the range of those reported in preceding studies. Contribution and structural path analysis allowed for identification of the most impact-intensive processes and value chains. This article provides an inventory based mainly on primary data, which can easily be adapted to subsequent EV studies, and offers an improved understanding of environmental burdens pertaining to lithium-ion traction batteries.

/pdf/life-cycle-assessment-of-a-lithium-ion-battery-vehicle-pack-4pasojh8qn.pdf

Life Cycle Assessment of a Lithium-Ion Battery Vehicle Pack

This analysis of the Spanish health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Overall health status continues to improve in Spain, and life expectancy is the highest in the European Union. Inequalities in self-reported health have also declined in the last decade, although long-standing disability and chronic conditions are increasing due to an ageing population. The macroeconomic context in the last decade in the country has been characterized by the global economic recession, which resulted in the implementation of health system-specific measures addressed to maintain the sustainability of the system. New legislation was issued to regulate coverage conditions, the benefits package and the participation of patients in the National Health System funding. Despite the budget constraints linked to the economic downturn, the health system remains almost universal, covering 99.1% of the population. Public expenditure in health prevails, with public sources accounting for over 71.1% of total health financing. General taxes are the main source of public funds, with regions (known as Autonomous Communities) managing most of those public health resources. Private spending, mainly related to out-of-pocket payments, has increased over time, and it is now above the EU average. Health care provision continues to be characterized by the strength of primary care, which is the core element of the health system; however, the increasing financing gap as compared with secondary care may challenge primary care in the long-term. Public health efforts over the last decade have focused on increasing health system coordination and providing guidance on addressing chronic conditions and lifestyle factors such as obesity. The underlying principles and goals of the national health system continue to focus on universality, free access, equity and fairness of financing. The evolution of performance measures over the last decade shows the resilience of the health system in the aftermath of the economic crisis, although some structural reforms may be required to improve chronic care management and the reallocation of resources to high-value interventions.

Spain: Health system review

Summary Background Patients admitted to intensive-care units are at high risk of health-care-associated infections, and many are caused by antimicrobial-resistant pathogens. We aimed to assess excess mortality and length of stay in intensive-care units from bloodstream infections and pneumonia. Methods We analysed data collected prospectively from intensive-care units that reported according to the European standard protocol for surveillance of health-care-associated infections. We focused on the most frequent causative microorganisms. Resistance was defined as resistance to ceftazidime ( Acinetobacter baumannii or Pseudomonas aeruginosa ), third-generation cephalosporins ( Escherichia coli ), and oxacillin ( Staphylococcus aureus ). We defined 20 different exposures according to infection site, microorganism, and resistance status. For every exposure, we compared outcomes between patients exposed and unexposed by use of time-dependent regression modelling. We adjusted results for patients' characteristics and time-dependency of the exposure. Findings We obtained data for 119 699 patients who were admitted for more than 2 days to 537 intensive-care units in ten countries between Jan 1, 2005, and Dec 31, 2008. Excess risk of death (hazard ratio) for pneumonia in the fully adjusted model ranged from 1·7 (95% CI 1·4–1·9) for drug-sensitive S aureus to 3·5 (2·9–4·2) for drug-resistant P aeruginosa . For bloodstream infections, the excess risk ranged from 2·1 (1·6–2·6) for drug-sensitive S aureus to 4·0 (2·7–5·8) for drug-resistant P aeruginosa . Risk of death associated with antimicrobial resistance (ie, additional risk of death to that of the infection) was 1·2 (1·1–1·4) for pneumonia and 1·2 (0·9–1·5) for bloodstream infections for a combination of all four microorganisms, and was highest for S aureus (pneumonia 1·3 [1·0–1·6], bloodstream infections 1·6 [1·1–2·3]). Antimicrobial resistance did not significantly increase length of stay; the hazard ratio for discharge, dead or alive, for sensitive microorganisms compared with resistant microorganisms (all four combined) was 1·05 (0·97–1·13) for pneumonia and 1·02 (0·98–1·17) for bloodstream infections. P aeruginosa had the highest burden of health-care-acquired infections because of its high prevalence and pathogenicity of both its drug-sensitive and drug-resistant strains. Interpretation Health-care-associated bloodstream infections and pneumonia greatly increase mortality and pneumonia increase length of stay in intensive-care units; the additional effect of the most common antimicrobial resistance patterns is comparatively low. Funding European Commission (DG Sanco).

https://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(10)70258-9.pdf

Clinical outcomes of health-care-associated infections and antimicrobial resistance in patients admitted to European intensive-care units: a cohort study

International Input–Output Association (IIOA) PO Box 202, A-1031 Vienna, Austria; Fax: +43-2244-30210 Website: http://www.iioa.org; Email: office@iioa.org Dear Friends and Colleagues, The Associati...

Christof Paparella

Papers

Annual Report 2008