Suchergebnisse

Oftmals zeitintensive Betreuung durch eine Vielzahl hochqualifizierter Leitungserbringer mit ständig fortentwickelten Stoffen und Geräten - das Gesundheitswesen vereint alle Faktoren, die ein System teuer machen. Die Ökonomie hat dies schon lange erkannt und die 'Gesundheitsökonomie' als Subdisziplin herausgebildet. Finanzielle Belange - oder vielleicht besser: ökonomische Zwänge - spielen aber auch für das Recht eine Rolle: Um möglichst hohe Gewinne zu erzielen (so die Kritik der einen) oder um zumindest ökonomisch überleben zu können (so die Verteidigung der anderen), muss permanent geprüft werden, wie Leistungen günstiger angeboten werden können. Dass das nicht spurlos an der Qualität der medizinischen Leistung vorbeigehen und damit Haftungsfragen aufwerfen kann, liegt auf der Hand. Als Besonderheit tritt hierbei hinzu, dass die Vorgaben für eine 'sparsame Medizin' dabei nicht immer nur von den (patientennahen) Behandlern, sondern auch von patientenfernen Entscheidern kommen können.

Time-intensive care by a multitude of highly qualified conductors with constantly evolving substances and devices - the health care system unites all the factors that make a system expensive. The economy has recognized this for many years and has developed the "health economy" as a subdiscipline. But financial concerns - or perhaps better: economic constraints – are also important in the field of law: In order to achieve the highest possible profits (so the criticism of the one) or at least to survive economically (so the defense of the others) there must be permanently checked to see how services can be offered less expensivly. It is obvious that this must trace to the quality of the medical performance and thus can raise liability issues. A peculiarity is the fact that the guidelines for a "thrifty medicine" do not always only come from those who directly treat the patients, but also from remote decision makers.

Abstract
In the hazards literature, a near-miss is defined as an event that had a nontrivial probability of causing loss of life or property but did not due to chance. Frequent near-misses can desensitize the public to tornado risk and reduce responses to warnings. Violent tornadoes rarely hit densely populated areas, but when they do they can cause substantial loss of life. It is unknown how frequently violent tornadoes narrowly miss a populated area. To address this question, this study looks at the spatial distribution of possible exposures of people to violent tornadoes in the United States. We collected and replicated tornado footprints for all reported U.S. violent tornadoes between 1995 and 2016, across a uniform circular grid, with a radius of 40 km and a resolution of 0.5 km, surrounding the centroid of the original footprint. We then estimated the number of people exposed to each tornado footprint using proportional allocation. We found that violent tornadoes tended to touch down in less populated areas with only 33.1% potentially impacting 5000 persons or more. Hits and near-misses were most common in the Southern Plains and Southeast United States with the highest risk in central Oklahoma and northern Alabama. Knowledge about the location of frequent near-misses can help emergency managers and risk communicators target communities that might be more vulnerable, due to an underestimation of tornado risk, for educational campaigns. By increasing educational efforts in these high-risk areas, it might be possible to improve local knowledge and reduce casualties when violent tornadoes do hit.

Integrative research on water resources requires a wide range of socio-environmental datasets to better understand human-water interactions and inform decision-making. However, in transboundary watersheds, integrating cross-disciplinary and multinational datasets is a daunting task due to the disparity of data sources and the inconsistencies in data format, content, resolution, and language. This paper introduces a socio-environmental geodatabase that transcends political and disciplinary boundaries in the Rio Grande/Río Bravo basin (RGB). The geodatabase aggregates 145 GIS data layers on five main themes: (i) Water & Land Governance, (ii) Hydrology, (iii) Water Use & Hydraulic Infrastructures, (iv) Socio-Economics, and (v) Biophysical Environment. Datasets were primarily collected from public open-access data sources, processed with ArcGIS, and documented through the FGCD metadata standard. By synthesizing a broad array of datasets and mapping public and private water governance, we expect to advance interdisciplinary research in the RGB, provide a replicable approach to dataset compilation for transboundary watersheds, and ultimately foster transboundary collaboration for sustainable resource management.

International audience ; The Rio Grande/Bravo is an arid river basin shared by the United States and Mexico, the fifth-longest river in NorthAmerica, and home to more than 10.4 million people. By crossing landscapes and political boundaries, the Rio Grande/Bravo bringstogether cultures, societies, ecosystems, and economies, thereby forming a complex social-ecological system. The Rio Grande/Bravosupplies water for the human activities that take place within its territory. While there have been efforts to implement environmentalflows (flows necessary to sustain riparian and aquatic ecosystems and human activities), a systematic and whole-basin analysis of theseefforts that conceptualizes the Rio Grande/Bravo as a single, complex social-ecological system is missing. Our objective is to addressthis research and policy gap and shed light on challenges, opportunities, and success stories for implementing environmental flows inthe Rio Grande/Bravo. We introduce the physical characteristics of the basin and summarize the environmental flows studies alreadydone. We also describe its water governance framework and argue it is a distributed and nested governance system across multiplepolitical jurisdictions and spatial scales. We describe the environmental flows legal framework and argue that the authority over differentaspects of environmental flows is divided across different agencies and institutions. We discuss the prioritization of agricultural usewithin the governance structure without significant provisions for environmental flows. We introduce success stories for implementingenvironmental flows that include leasing of water rights or voluntary releases for environmental flow purposes, municipal ordinancesto secure water for environmental flows, nongovernmental organizations representing the environment in decision-making processes,and acquiring water rights for environmental flows, among others initiatives. We conclude that environmental flows are possible andhave been implemented but their implementation has not ...

International audience ; The Rio Grande/Bravo is an arid river basin shared by the United States and Mexico, the fifth-longest river in NorthAmerica, and home to more than 10.4 million people. By crossing landscapes and political boundaries, the Rio Grande/Bravo bringstogether cultures, societies, ecosystems, and economies, thereby forming a complex social-ecological system. The Rio Grande/Bravosupplies water for the human activities that take place within its territory. While there have been efforts to implement environmentalflows (flows necessary to sustain riparian and aquatic ecosystems and human activities), a systematic and whole-basin analysis of theseefforts that conceptualizes the Rio Grande/Bravo as a single, complex social-ecological system is missing. Our objective is to addressthis research and policy gap and shed light on challenges, opportunities, and success stories for implementing environmental flows inthe Rio Grande/Bravo. We introduce the physical characteristics of the basin and summarize the environmental flows studies alreadydone. We also describe its water governance framework and argue it is a distributed and nested governance system across multiplepolitical jurisdictions and spatial scales. We describe the environmental flows legal framework and argue that the authority over differentaspects of environmental flows is divided across different agencies and institutions. We discuss the prioritization of agricultural usewithin the governance structure without significant provisions for environmental flows. We introduce success stories for implementingenvironmental flows that include leasing of water rights or voluntary releases for environmental flow purposes, municipal ordinancesto secure water for environmental flows, nongovernmental organizations representing the environment in decision-making processes,and acquiring water rights for environmental flows, among others initiatives. We conclude that environmental flows are possible andhave been implemented but their implementation has not ...