Monday, May 1, 2023

The varied landscape of universal health care


There’s more than one way for a nation to achieve universal coverage for its residents. Here are the systems of six different countries.

There is no single way to achieve universal health care — countries have done it in many different manners. Some have systems built on a foundation of public health coverage; others lean more heavily toward the private sector. Building largely on information from The Commonwealth Fund, we’ve compiled six examples.

Switzerland

Basic coverage: Residents must purchase basic health insurance from private, nonprofit insurers.

Basic coverage funding: Individuals must pay premiums. The government also contributes via general taxes and other funding.

Cost-sharing: Individuals pay out of pocket for services like primary care, specialty care, hospitalizations and prescriptions drugs, up to an annual deductible. After that’s met, patients pay coinsurance up to a cap. Hospitals also charge a small amount per day for stays.

Supplemental or alternate coverage: People can also purchase supplemental private insurance from for-profit insurers for services not covered by the basic plan, to get a greater choice of physicians, or to get better hospital rooms.

Notes: The government may help individuals with income-based premium subsidies.

The Netherlands

Basic coverage: Residents must purchase basic health insurance from private, nonprofit insurers.

Basic coverage funding: Individuals must pay premiums, and employers pay payroll taxes. The government also contributes via a central health insurance fund supplied by income taxes and government grants. 

Cost-sharing: Individuals pay out of pocket for things like hospital admissions, specialist services and prescription drugs, up to a deductible. After that, copayments, coinsurance or direct payments may be required for select services, like physiotherapy, medical devices and out-of-network care.   

Supplemental or alternate coverage: People can also purchase supplemental insurance for services not covered by the basic plan, like dental care and contraceptives, or brand name drugs.

Notes: The government may help individuals with income-based premium subsidies.

Germany

Basic coverage: Residents under a certain income are required to enroll in one of many private, nonprofit health insurance plans known as sickness funds.

Basic coverage funding: Most funding comes from income-dependent wage contributions for each individual (up to a ceiling). This cost is split between the individual and their employer. These contributions are pooled by the government in a central fund along with a tax subsidy, and then reallocated to individual sickness funds. Some individual sickness funds also charge income-dependent contributions on top of that, also split between employees and employers.

Cost-sharing: There is no deductible for basic coverage. Certain services, like prescription drugs, medical devices and hospital care, require copayments. There’s an annual out-of-pocket maximum based on income.

Supplemental or alternate coverage: Individuals above a certain income can opt out of buying into a sickness fund and instead purchase private health insurance. People in sickness funds can also purchase supplemental insurance to help with payments for things like dental care or private hospital rooms.

Notes: Individuals in certain fields, like civil servants, may also be able to opt for private health insurance or be insured through a different government program.

Canada

Basic coverage: As part of the nation’s overall health care program, residents are automatically enrolled in the health insurance program of their home territory or province.

Basic coverage funding: Provincial and territorial taxes and federal funding.

Cost-sharing: Applies only to non-covered benefits, such as outpatient prescription drugs or dental care.

Supplemental or alternate coverage: People can buy private insurance or receive it through their employers to help pay for outpatient prescription drugs and other services. Provinces or territories also offer outpatient drug plans.

Notes: Individuals with significant out-of-pocket expenses can get tax credits. Private hospital rooms may charge a fee.

Australia

Basic coverage: Citizens are automatically enrolled in a universal public health insurance program. Non-citizens may be allowed access to the program or may be treated as private-pay patients.

Basic coverage funding: A government levy on individuals and other tax revenue. The government may also charge a tax penalty on higher-income households that do not buy private insurance.

Cost-sharing: There are no deductibles or out-of-pocket costs for care at public hospitals. Patients can incur cost-sharing for outpatient visits and outpatient pharmaceuticals, but the government generally caps out-of-pocket fees. Certain medicines may not be covered at all.

Supplemental or alternate coverage: About half of Australians buy private supplementary insurance to pay for such things as private hospital care and dental and vision care.

Notes: The government may help individuals with income-based premium rebates for private insurance.

England

Basic coverage: Residents are automatically enrolled in public health coverage.

Basic coverage funding: General taxation, plus a payroll tax paid by employers and employees.

Cost-sharing: Limited to certain services, like some travel vaccinations or dentistry, and out-patient prescription drugs. Individuals can purchase a yearly certificate that will cover all pharmaceuticals.

Supplemental or alternate coverage: Residents can purchase private insurance, primarily to gain faster access to elective care.

Notes: Each country inside the United Kingdom (England, Scotland, Wales and Northern Ireland) has its own National Health Service program providing universal health care, but there are differences between them. Private hospitals may not be covered by England’s National Health Service. Certain visitors to the country may have to pay a health surcharge.

This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews. 

Simple Kid-Friendly Sliders

For those busy nights plan, on this simple yet savory sliders recipe. Kids are almost certain to love the taste and you will enjoy how quick and easy they are to make.

For more recipes, visit culinary.net.

Watch video to see how to make this delicious recipe!

Pepperoni Pizza Sliders

  • 1          package slider rolls
  • 1/2       cup pizza sauce
  • 1/2       cup mini pepperoni
  • 1 1/2    cups shredded, low-moisture, part-skim mozzarella cheese
  • 1/4       cup butter, melted
  • 1          teaspoon parsley flakes
  • 1/2       teaspoon dried oregano
  • 1/2       teaspoon garlic powder
  • 1/2       cup shredded Parmesan cheese
  • nonstick cooking spray
  1. Heat oven 350ยบ F.
  2. Keeping rolls connected, cut sheet of rolls horizontally, separating tops from bottoms. Place bottom halves of rolls in baking dish.
  3. Spread pizza sauce evenly over bottom halves. Sprinkle pepperoni over sauce. Sprinkle mozzarella over pepperoni and cover with top halves of rolls.
  4. Mix melted butter with parsley flakes, dried oregano, garlic powder, and shredded Parmesan cheese. Spoon evenly over sliders.
  5. Cover baking dish with aluminum foil sprayed with nonstick cooking spray to keep cheese from sticking.
  6. Bake 20 minutes.
  7. Remove foil and bake additional 5-10 minutes or until Parmesan is melted and golden brown.
  8. Cut sliders and serve immediately.

Recipe adapted from MilkMeansMore.org

SOURCE:
Culinary.net

Historic flooding in Fort Lauderdale was a sign of things to come – a look at who is most at risk and how to prepare

The hardest-hit homes in Florida’s mid-April flooding were in modest neighborhoods in low-lying areas. Chandan Khanna/AFP via Getty Images
Smitha Rao, The Ohio State University

When a powerful storm flooded neighborhoods in Fort Lauderdale, Florida, in April with what preliminary reports show was 25 inches of rain in 24 hours, few people were prepared. Even hurricanes rarely drop that much rain in one area that fast. Residents could do little to stop the floodwater as it spread over their yards and into their homes.

Studies show that as global temperatures rise, more people will be at risk from such destructive flooding – including in areas far from the coasts that rarely faced extreme flooding in the past.

In many of these communities, the people at greatest risk of harm from flash flooding are low-wage workers, older adults and other vulnerable residents who live in low-lying areas and who have few resources to protect their properties and themselves.

I study the impact of extreme weather on vulnerable communities as an assistant professor of social work. To limit the damage, communities need to know who is at risk and how they can be better prepared.

More extreme downpours in a warming world

The Fort Lauderdale storm on April 12-13, 2023, offered a view into the risks ahead as temperatures rise.

A warmer atmosphere can hold more moisture, leading to stronger downpours. The resulting deluges can be devastating. These events are expected to increase in frequency and intensity in many regions as greenhouse gas emissions from human activities continue to heat up the planet.

Four maps show how risk of extreme precipitation increased in some regions, particularly the Northeast, and projections of increasing rainfall in the East in the coming decades.
Where extreme precipitation events are forecast to increase under a low-emissions scenario and a high one. National Climate Assessment 2018

Recent disasters, including several in 2022 and in 2023 already, show how the risk of flash flooding is expanding beyond areas traditionally considered at risk.

Knowing who is most at risk

To plan for extreme weather, it’s crucial for community leaders and residents to know where the risks are highest and who might not be prepared.

Low-lying areas with poorly planned development, lack of investment in protective infrastructure and the lingering effects of historic disinvestment and discrimination are often at higher risk. So are low-income communities with tight budgets that can’t afford protective measures like upgraded levees or stormwater systems and can’t recover from damage quickly.

When older adults live in these flood-prone areas, they are at even higher risk. Older adults have a higher likelihood of having health needs or some form of disability that could affect their ability to leave quickly during a disaster. They are also more likely to be socially isolated, which may mean they don’t hear timely information or have help to evacuate or quick access to resources for recovering.

An older man carries a small fuzzy dog while walking through floodwater with a woman waring a backpack.
Residents walk out of a flooded neighborhood in Fort Lauderdale on April 13, 2023. Joe Raedle/Getty Images

Renters and the impact of housing insecurity

In a recent study, my colleagues and I looked at how prepared people were for disasters of any kind across the U.S. – flooding, tornadoes, hurricanes and others – and how housing security played a role. The numbers were sobering.

Overall, we found 57% of the population, among 29,070 housing units surveyed nationwide, reported they were not prepared with food, water, emergency funds and transportation in case disaster struck. We found that households facing housing insecurity – those behind on their payments for rent, mortgage or utilities – were less prepared for disasters than others, even when the occupants had similar incomes and educations.

A woman standing in floodwater in boots looks in the door of a flooded home. A sign reading 'beware of dog' is in the window. Floodwater is up to  her shins.
For residents with low incomes and without flood insurance, cleanup costs from flooding can be overwhelming. Joe Raedle/Getty Images

People who are struggling to meet day-to-day needs often don’t have the ability and resources to plan for everyday events, let alone for disasters. Our research has shown that households with children, households led by women, and low-income households were less prepared than others for disasters.

Renting adds additional challenges. In the U.S., lower-income families often depend on the rental market. They tend to move more frequently, and since they don’t own the property, they often can’t make upgrades for safety. And landlords might not prioritize those risks that seem rare but carry costs.

How to help communities stay safe

The most effective way to address these challenges is through solutions that are tailored to the community.

That can involve investing in infrastructure, including state-funded priorities like drainage systems and large-scale flood prevention measures, as well as ensuring that people have access to safe and affordable housing. Some communities and federal agencies have bought out properties that frequently flood and changed zoning rules to prevent more people from moving into harm’s way.

Raising community awareness about climate change and extreme weather risks is also crucial, especially among those most at risk, such as older adults. If people understand the risks, know how to prepare their homes, know how to plan for emergencies and know where to find assistance, they’re more likely to be prepared when disasters strikes.

Scientists explain why warming can lead to heavier downpours and flash flooding.

I believe the most successful efforts are those that bring at-risk communities into planning discussions.

For example, in Columbus, Ohio, the city is working with the Central Ohio Area Agency on Aging, Age Friendly Innovation Center and my team to improve disaster preparedness among older residents. We hope to learn from older adults in affordable housing communities who have experienced extreme weather in recent years to help design action plans for communities with special needs. The goal is to ensure residents are better prepared for climate- and weather-related emergencies in the future.

Smitha Rao, Assistant Professor of Social Work, The Ohio State University

This article is republished from The Conversation under a Creative Commons license. 

How Climate Change Impacts Birds, Their Feeding Habits and How to Help from Home

(Joan Casanova) Bird feeding is a common practice in the United States, with more than 59 million Americans participating, according to the U.S. Fish & Wildlife Service. In addition to providing aesthetic and recreational benefits, bird feeding can have positive impacts on bird populations.

According to the National Audubon Society, birds provide important ecosystem services, such as pollination, pest control and seed dispersal. In fact, around 87% of flowering plants rely on animal pollinators, including birds, to reproduce and grow, according to a study published in “Science.” Birds also consume fruits and berries then spread the seeds, which helps maintain biodiversity and promotes the growth of new plants.

Considered good indicators of the health of the ecosystem, changes in bird populations and behaviors can signal changes in the environment, such as pollution, habitat loss and climate change. As temperatures, weather patterns and ecosystems change, it can affect the availability of food for birds, which may alter their behavior.

Feeding birds can be a beneficial practice that helps them cope with climate change. Consider these benefits:

  • Supplemental Food: Bird feeders provide a supplemental source of food for birds when natural food sources may be scarce due to prolonged droughts or severe storms. Bird feeding can help birds maintain energy levels, especially during breeding or migration when nutritional needs are higher.
  • Range Shifts: Climate change can cause shifts in the distribution and abundance of bird species. Feeders can serve as “refuges” for birds, providing reliable food sources as they move in search of suitable habitats.
  • Behavioral Adaptations: Some species may alter their feeding behaviors due to changes in timing of insects hatching or plants flowering, which can affect the availability of natural food sources. Bird feeders can help bridge these gaps, providing a stable source of food when traditional sources are disrupted.

Feeders
To attract more birds this season, it’s important to offer quality feed in a variety of bird feeder types placed at different heights.

Traditional tube feeders are basic, all-purpose, must-have feeders that work well for finches, nuthatches and other small birds that cling. Made with state-of- the-art materials to prevent warping and discoloration, Cole’s Terrific Tube Feeder features a quick-clean removable base.

Simply push a button and the bottom of the feeder comes off for easy access. Rinse well with soapy water, submerge in a 9-1 water-bleach solution, rinse and dry. Then reattach the bottom; there’s no disassembly or assembly of multiple parts necessary. Regular cleaning of feeders is essential, preventing mold, germs and disease.

Another option, bowl feeders, can serve not only seeds, but also dried mealworms, fruit and suet in cake or kibble form. For example, Cole’s Bountiful Bowl Feeder comes with an adjustable dome cover you can raise or lower to protect from rain and prevent larger birds and squirrels from getting to the food.

Popular Foods
In addition to feeders, offering a variety of foods is vital for inviting different species to your backyard.

  • Birdseed: Not all birdseed is created equal. Look for quality blends without filler seeds like red millet and oats. All-natural seed, containing no chemicals or mineral oil, is safe and more appealing to birds. Consider researched, specially formulated options like all-natural black oil sunflower, Cole’s “Hot Meats” (sunflower meats infused with habanero chile peppers) or Special Feeder blend, which is packed with black oil sunflower, sunflower meats, black striped sunflower, raw peanuts, safflower and pecans.
  • Dried Mealworms: Full of energy, essential nutrients, fats and proteins, mealworms are a preferred food for adult songbirds. Dried mealworms are easy to feed, less messy and lack the “ick” factor of live worms.
  • Fresh Fruit: Apple and orange halves and chunks of banana are favorites for orioles and tanagers.  
  • No-Melt Suet: Perfect for insect-eating birds, high-fat food provides abundant calories and rich nutrition. 

Don’t forget, birds need water just as much as humans. Drinking water helps regulate body processes, improves metabolism and maintains health. Birds also use water for preening and bathing, and on hot days, standing in cool water or taking a quick splash can help them keep cool.

Find more solutions to bring birds to your backyard at ColesWildBird.com

SOURCE:
Cole’s Wild Bird Products

How Wrexham’s football fairy tale is fuelled by Disney and Hollywood glamour


Simon Chadwick, SKEMA Business School and Paul Widdop, Manchester Metropolitan University

For one of the oldest football clubs in the world, this has been a season to remember. Wrexham’s men’s team have won the National League title and promotion to League Two, the fourth tier of English football.

And while it’s still a long way from the dizzy heights of the Premier League, success has been joyfully embraced by Wrexham’s fans and the club’s celebrity owners, actors Ryan Reynolds and Rob McElhenney.

The Hollywood-based pair bought Wrexham Association Football Club (AFC) in 2021, bringing £2 million to the table, and plenty of Californian glamour to their adopted corner of north Wales, which is now the subject of a documentary series streaming on Disney+.

But it was another of Disney’s famous productions which came to our minds when we considered this modern football fairytale: the popular cartoon Cars, in which a big star finds himself living in a small provincial town.

The star, Lightning McQueen, eventually falls in love with the town of Radiator Springs, and inspires his new neighbours to dream big. Cars tells the story of the great American dream, that anyone can make it to the top, and highlights the importance of a place and its people.

The real life version playing out in north Wales has Reynolds in the starring role, and Wrexham as Radiator Springs. But their story also illustrates some of the profound changes that are taking place across professional football – where kicking a ball around a pitch has become a lucrative industry involving marketing strategies, media partnerships and commercial opportunities.

Wrexham AFC has a long history and a loyal fan base. But of late, it has fallen upon hard times and languished in the lower reaches of the English professional leagues. At one stage in the 2000s, the club spent almost two years in administration, and in 2011 it was served with a winding-up order for not paying its taxes.

Big players

The club’s Hollywood saviour, Ryan Reynolds, arrived at a time when he was needed. And he has also proved himself to be no slouch when it comes to the business world. If his plan was to extract commercial and financial value from football through shrewd management and experience in entertainment, his record already looks pretty impressive.

Wrexham has secured promotion, attracting global attention, and new sponsorship deals. Reynolds is now even talking about building a sport franchise network and has gone from being an impassive observer of football to someone who has developed a love for the game and for Wrexham.

He and McElhenney are the stars of Welcome to Wrexham, the Disney+ series which claims the actors are “bringing some serious hope and change to a community that needs it”. Each episode is estimated to have generated around £430,000 for the club and its owners.

As a result, some of Wrexham’s success carries the hallmarks of what is termed “Disneyfication”, the creation of sentimentally compelling entertainment for mass audiences in everything from sport to nature and children’s stories. Disneyfication is often seen as being synonymous with globalisation, commercialisation and commodification, and research suggests it has some key characteristics.

The first, known as “theming” involves an institution being placed into a narrative that is mostly unrelated to its original purpose. Wrexham AFC was formed in 1864 and for most of its existence was never the subject of heart-rending digital content for a US entertainment business and two Hollywood actors. Players have gone from kicking a ball in a stadium to becoming performers in a drama that is streamed around the world.

Another component of Disneyfication is “hybrid consumption” – attracting fans and potential consumers through various commercial means. In Wrexham’s case, that started with owning a fairly large stadium with room for 10,000 spectators, and continues with more than 319,000 people watching the first episode of Welcome to Wrexham, and over 1 million followers of the club’s TikTok account.

Disneyfication also requires a focus on selling things. To that end, TikTok’s logo has appeared on Wrexham’s shirts which are a cornerstone of Wrexham’s rapidly proliferating merchandise portfolio. Visit Wrexham’s online store and you’ll even see shirts carrying the logo of Aviation Gin, an alcohol business in which Reynolds has a stake.

Football traditionalists may despair at the influence Wrexham’s owners are having on the sport and on the club, and worry that Disneyfication may now be reaching the lower leagues as well as the very pinnacle of English football. Some will worry that the Racecourse Ground is becoming more like a theme park attraction than a football stadium.

Even so, the Disneyfication of Wrexham is changing the town, in a way not dissimilar to Lightening McQueen’s influence on Radiator Springs. Visitor numbers have soared and the football club’s success is beginning to have a tangible local economic impact, adding to hotel room bookings and beer sales.

Like Disney attractions around the world, a small football club is proving capable of generating financial returns and a hint of fantasy. There is clearly a Disney version of the American dream to be had – and enjoyed – in this provincial town of north Wales.

Simon Chadwick, Professor of Sport and Geopolitical Economy, SKEMA Business School and Paul Widdop, Reader of Sport Business, Manchester Metropolitan University

This article is republished from The Conversation under a Creative Commons license. 

Zooming in on the brains of babies

New tools are helping neuroscientists investigate why early life is such a crucial time for neural development

Many of our defining traits — including the languages we speak and how we connect with others — can be traced back at least in part to our earliest experiences. Although our brains remain malleable throughout our lives, most neuroscientists agree that the changes that occur in the womb and in the first few years of life are among the most consequential, with an outsize effect on our risk of developmental and psychiatric conditions.

“Early on in life, the brain is still forming itself,” says Claudia Lugo-Candelas, a clinical psychologist at Columbia University and coauthor of an overview of the prenatal origins of psychiatric illness in the Annual Review of Clinical Psychology. Starting from a tiny cluster of stem cells, the brain develops into a complex organ of roughly 100 billion neurons and trillions of connections in just nine months. Compared to the more subtle brain changes that occur later in life, Lugo-Candelas says, what happens in utero and shortly after birth “is like building the house, versus finishing the deck.”

But just how this process unfolds, and why it sometimes goes awry, has been a hard mystery to crack, largely because so many of the key events are difficult to observe. The first magnetic resonance imaging (MRI) scans of baby and fetal brains were taken back in the early 1980s, and doctors seized on the tool to diagnose major malformations in brain structure. But neuroimaging tools that can capture the baby brain’s inner workings in detail and spy on fetal brain activity in pregnant moms are much newer developments. Today, this research, coupled with long-term studies that follow thousands of individual children for years, is giving scientists new insights into how the brain develops.

These advances have propelled researchers to a different stage than they were in even five years ago, says Damien Fair, a neuroscientist at the University of Minnesota who studies developmental conditions like autism and attention deficit hyperactivity disorder (ADHD).

Until recently, a major challenge has been that, unlike an adult, a fetus or newborn baby won’t lie still inside a brain scanner. Buoyed by amniotic fluid, a fetus constantly shifts position, and newborn babies love to wriggle around, checking out their environment. In the past, researchers and clinicians often had to do multiple time-consuming, expensive scans to get a good image. They sometimes sedated children and pregnant moms to reduce movement, an approach that alters brain function and may have health risks.

But new imaging and computational techniques that reduce distortions caused by fidgeting — including software developed by a company cofounded by Fair — have made it easier to collect data from babies and fetuses. And that has invigorated the field.

Peering into prenatal brain development

The new work is starting to reveal what typical brain development looks like and hint at how atypical conditions like autism and ADHD may arise. In a first-of-its kind study in 2017, for example, a team of researchers led by pediatric neuroscientist Moriah Thomason, now at New York University, used functional magnetic resonance imaging (fMRI) to investigate patterns of neural communication among brain regions in 32 fetuses. Half of the pregnant women were at high risk of early delivery and 14 of the babies ultimately were born prematurely.

Premature birth is a known risk factor for cognitive and emotional issues later on. But it has been difficult for scientists to determine whether this is due to the trauma of premature delivery, which often involves brain injury and oxygen deprivation, or to preexisting brain differences that start in the womb.

Thomason’s study provided the first evidence that the problems start in utero.

As fetuses, the preemies-to-be that were scanned by her team had brain activity that suggested weaker communication between various brain regions compared with fetuses that ended up being carried to term. Most strikingly, the scientists found altered neural communication in networks that eventually support language, including a language center on the left side of the brain.

Researchers have since found more evidence for prenatal brain disruption in preemies. In 2021, for example, another group found that 24 prematurely delivered infants had lower brain volumes and less cerebrospinal fluid while still in utero, compared with a group of infants carried to term. And a variety of studies have found that women who delivered prematurely had high levels of inflammation caused by bacterial or viral infections in the amniotic fluid and placental tissues.

The findings add to growing evidence that inflammatory events during pregnancy can alter fetal brain development. Large-population studies, for example, have shown that mothers who have had a severe infection during pregnancy are at a slightly elevated risk of having an autistic child, although it’s not yet clear that prenatal infection alone can actually cause autism.

Lugo-Candelas’s research focuses on how a pregnant woman’s perceived stress, life events, depression and anxiety may affect early brain development. A number of studies have found that high maternal anxiety and depression during pregnancy are associated with a twofold increase in the risk of the child developing a mental disorder later in life. If the risks start earlier in development, “that also means there’s a chance to intervene earlier than we thought,” she says. But, Lugo-Candelas adds, scientists are still working to untangle the mechanisms behind that increased risk, what stressors might have the most impact, and when and how to intervene.

Moreover, like many other risk factors in pregnancy, there’s no one thing that leads to psychiatric illness or developmental problems, says Lugo-Candelas. “It’s a collection of tiny risks.” She emphasizes that there’s nothing rigidly deterministic about any of these early exposures or experiences. “You can have children that are exposed prenatally to a bunch of the things that we think could increase risk for a psychiatric disease, and then have a child that doesn’t have a disorder at all and will never have it.”

That complexity speaks to one of the greatest challenges of studying the developing brain: the fact that similar outcomes, such as autism or schizophrenia, can have many underlying neurological causes. Some people with autism have increased connectivity between certain brain regions compared with the neurotypical population, for example — but others have less. There’s no single neural signature for the condition.

Brain connections as ‘neural fingerprints’

Fair’s approach to this problem has been to identify what he calls “functional fingerprints,” patterns — unique to each individual — in how different brain regions communicate with each other when a person is at rest inside an fMRI scanner.

He first observed these neural fingerprints in adults in 2014, and went on to show that children have them too. The patterns are surprisingly consistent within families, even across generations, he and his colleagues have found, suggesting that certain types of brain connectivity are at least partially inherited.

Last year, he published evidence that even eight-month-old babies have these neural fingerprints — and that certain elements of the fingerprint, such as the amount of crosstalk between regions involved in functions like attention and movement, can predict an infant’s precise age, down to a few months.

Meanwhile, Thomason’s fMRI studies of the fetal brain suggest that these distinct connectivity patterns emerge in the second and third trimester, including in neural circuits that eventually govern learning, memory and emotion. Thomason and others are now using neuroimaging to investigate how a variety of prenatal experiences — ranging from maternal Covid-19 infection to cannabis use — affect how these circuits develop.

The fact that scientists can detect these distinct brain activity patterns so early suggests to Fair and others that much of what makes us who we are is already in place by the time we’re born, even though we’ll continue to be shaped by our experiences and exposures throughout life. Because every baby’s brain is shaped by so many different factors, however, researchers are going to need long-term imaging data from thousands of children to get a robust understanding of what “typical” development looks like, Fair and colleagues argue in the 2021 Annual Review of Developmental Psychology.

Eventually, imaging tools could help clinicians and researchers monitor how a baby’s brain is developing, spot signs of future trouble and develop earlier personalized interventions and treatments for conditions like autism, Fair adds.

In the meantime, Lugo-Candelas thinks that we already know enough to take action. “I feel pretty confident that interventions that effectively minimize distress in pregnancy, like paid maternal leave, are going to be beneficial for the next generation,” she says. She notes that could lead to better outcomes in school and other areas, like mental health, that ripple across the lifespan. “I just don’t think we’ve done a really good job yet at measuring what those outcomes look like, or the mechanisms that lead to them.”

This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews. 

Shelby Podiatry

     Shelby Podiatry opened in May 1997. I graduated podiatry school, completed my surgical residency , then joined the Army as a podiatrist at Ft Leonard Wood, MO.  After completing my Army service I moved to Alabama and started working here.  Podiatry is a medical field for foot care specifically. 


Podiatrists treat different types of foot problems from skin and nails, to bone and joint issues in the foot. The most common foot problems I see are ingrown toenails and heel pain. Ingrown toenails can be treated in the office  as a same day procedure with immediate relief. Heel pain is oftentimes a chronic problem made worse with increased activity.  



     Our office accepts most every insurance or those patients without insurance. We have a friendly, caring staff who will happily book your appointment and answer your questions.  


We treat an assortment of foot problems, including common issues like broken bones and athlete’s foot. We also treat issues that may need surgical intervention, like bunions or rearfoot deformities. Whatever the problem may be, you can rest assured that we will take care of you.  
At Shelby Podiatry, we are with you every step of the way. We create a personalized foot care plan to meet your treatment goals starting from your first appointment. 


Your feet are your body’s foundation, and when your foundation starts to falter look to Shelby Podiatry. We can perform many surgical procedures in-office and get you back on your feet sooner.  For life-threatening situations, please call 911! 

Shelby Podiatry will make sure you get the medicine you need. Some acute and chronic foot conditions can be treated or managed with medication. We will advise you on the best pharmaceutical treatment options. Whatever you may need, our team is here to assist and make you as comfortable as possible.  

Shelby Podiatry is the best option for all of your foot care needs. Whether you are suffering from foot pain, bunions, or ingrown toenails, we offer the solutions you need! These can range from custom made orthotic inserts to in-office surgical procedures. Contact Shelby Podiatry today to help set you on the right foot.

  We offer advanced treatment for a variety of wounds, such as diabetic foot ulcers. Wound bed preparation, for example, is a vital first step to proper treatment, and our team is qualified to handle some of the most complex foot wounds our patients may encounter.


Our goal is to make your experience comfortable and friendly.













We love our customers, so feel free to visit during normal business hours.

Please send us a message, or call us for an appointment.

227 1st St N A, Alabaster, AL 35007




We Provide a Professional & Honest Approach to Podiatry



Sunday, April 30, 2023

The road to low-carbon concrete

For thousands of years, humanity has had a love affair with cement and concrete. But now, industry groups and researchers are seeking solutions to the huge amounts of carbon dioxide that cement-making generates.

Nobody knows who did it first, or when. But by the 2nd or 3rd century BCE, Roman engineers were routinely grinding up burnt limestone and volcanic ash to make caementum: a powder that would start to harden as soon as it was mixed with water.

They made extensive use of the still-wet slurry as mortar for their brick- and stoneworks. But they had also learned the value of stirring in pumice, pebbles or pot shards along with the water: Get the proportions right, and the cement would eventually bind it all into a strong, durable, rock-like conglomerate called opus caementicium or — in a later term derived from a Latin verb meaning “to bring together” —  concretum.

The Romans used this marvelous stuff throughout their empire — in viaducts, breakwaters, coliseums and even temples like the Pantheon, which still stands in central Rome and still boasts the largest unreinforced concrete dome in the world.

Two millennia later, we’re doing much the same, pouring concrete by the gigaton for roads, bridges, high-rises and all the other big chunks of modern civilization. Globally, in fact, the human race is now using an estimated 30 billion metric tons of concrete per year — more than any other material except water. And as fast-developing nations such as China and India continue their decades-long construction boom, that number is only headed up.

Unfortunately, our long love affair with concrete has also added to our climate problem. The variety of caementum that’s most commonly used to bind today’s concrete, a 19th-century innovation known as Portland cement, is made in energy-intensive kilns that generate more than half a ton of  carbon dioxide for every ton of product. Multiply that by gigaton global usage rates, and cement-making turns out to contribute about 8 percent of total CO 2 emissions.

Granted, that’s nowhere near the fractions attributed to transportation or energy production, both of which are well over 20 percent. But as the urgency of addressing climate change heightens public scrutiny of cement’s emissions, along with potential government regulatory pressures in both the United States and Europe, it’s become too big to ignore. “Now it’s recognized that we need to cut net global emissions to zero by 2050,” says Robbie Andrew, a senior researcher at the CICERO Center for International Climate Research in Oslo, Norway. “And the concrete industry doesn’t want to be the bad guy, so they’re looking for solutions.” 

Major industry groups like the London-based Global Cement and Concrete Association and the Illinois-based  Portland Cement Association have now released detailed road maps for reducing that 8 percent to zero by 2050. Many of their strategies rely on emerging technologies; even more are a matter of scaling up alternative materials and underutilized practices that have been around for decades. And all can be understood in terms of the three chemical reactions that characterize concrete’s life cycle: calcination, hydration and carbonation.

The direct approach: Eliminate emissions from the start

Portland cement is made in giant rotary kilns that carry out the calcination reaction:

calcium carbonate (limestone, chalk) + heat →  calcium oxide (quicklime) + carbon dioxide.

The carbonate-rich rock is ground up and placed in the kiln along with clay, which fuses with the quicklime and contributes minerals that will eventually help the concrete resist cracks and weathering. The end result is “clinker”: pale, grayish nodules that are ground to make cement powder.

About 40 percent of a kiln’s CO2 emissions arise from the “heat” term in this equation, and it’s been a tough fraction to cut. Clinker production requires peak temperatures of 1,450 degrees Celsius, hotter than molten lava, and kiln operators have long assumed that the only practical way to get there is to burn coal or natural gas. Biomass like wood doesn’t burn consistently hot enough. And standard electric heaters powered with renewable sources like wind or solar get their heat from electrical resistance in current-carrying wires. “You can’t get much out before the wire just falls apart,” Andrew says.

Yet the industry has now begun to explore all-electric options that can be powered by renewables. In May, for example, the Swedish green-tech firm  SaltX Technology demonstrated that it can produce clinker with its Electric Arc Calciner: a proprietary system similar to the plasma torches widely used by automakers and other manufacturers for cutting metal. Plasma torches pass an electric current through a jet of inert gas, typically nitrogen or argon, which ionizes the gas and heats it to temperatures over 20,000 degrees Celsius. In June, SaltX announced a partnership with the Swedish limestone supplier SMA Mineral to accelerate commercialization of its technology.

And in 2021, the German firm HeidelbergCement demonstrated that it could make clinker by replacing the fossil fuels with hydrogen, which burns at over 2,000 degrees Celsius. Hydrogen is mostly made from natural gas at the moment. But it can also be made via the electrolysis of water. So as clean energy prices fall and the generation of lots of hydrogen with green electricity becomes more plausible, Andrew says, the interest of cement companies is growing.

But even then, there’s work to be done before cement-makers around the country and the world can switch over to hydrogen wholesale, says Richard Bohan, who leads the Portland Cement Association’s sustainability efforts. The systems aren’t yet set up for it. “Hydrogen would be great — and right off the bat could reduce our carbon footprint by 40 percent,” he says. “Hydrogen, though, requires infrastructure — either pipelines or a very robust electric grid that in some areas of the country we don’t have yet.” It could help, experts say, if Congress passes proposed measures to expedite energy projects.

To tackle the other 60 percent of cement emissions — the CO2 that’s released on the right-hand side of the calcination reaction — the industry is beginning to revive some old alternatives for cement’s raw materials.

Simply by adding some powdered, unbaked limestone to its final product, for example, a kiln’s carbon footprint can be reduced as much as 10 percent. (Limestone alone is relatively inert but will help Portland cement harden when it’s mixed with water.) This Portland-limestone cement is already commonly used in Europe and is now taking off in the United States. “We’re seeing regions of the country where Portland-limestone cements are the predominant material and we’re hearing individual plants say that they’re only going to produce this type from now on,” Bohan says.

Kiln operators are also taking a fresh look at replacing some of their limestone-based cement with mineral-rich industrial waste products. One commonly used example is blast-furnace slag from steel mills, which is rich in calcium and hardens like standard cement when it’s mixed with water. Another is fly ash from coal-fired power plants, which doesn’t harden on its own, but does when it’s mixed with water and standard cement. Either way, the resulting cement yields concrete that is at least as strong and durable as the standard variety, if somewhat more abrasive and slower to cure, while potentially trimming emissions by another 15 or even 20 percent.

Granted, there was a lot of carbon dioxide emitted during the original creation of these wastes. But using them in cement doesn’t produce any new carbon. And two-plus centuries of industrialization have left a substantial backlog of slag and ash, even if we eventually phase out coal entirely. “It’s a win-win. If you have the waste, then replacing your clinker with it is cheaper than producing new clinker,” says Andrew. Indeed, this technique is already widely used in fast-growing countries like Brazil and China, which are producing mountains of slag and ash as they build up their industries.

By themselves, however, the kinds of substitutions just mentioned can’t cut more than about a fifth of that 60 percent of the total carbon dioxide released on the right side of the chemical reaction. So, with an eye on that 2050 zero-emission goal, industry researchers have been investigating at least half a dozen recipes for alternative cements that could minimize or eliminate the 60 percent — often by eliminating the Portland-cement ingredient that produces it, calcium carbonate.

This is definitely a long-term solution, cautions environmental scientist Jeffrey Rissman, who studies industrial greenhouse gas emissions at Energy Innovation, a climate policy think tank in San Francisco. “These newer technologies are at various stages of R&D and commercialization,” he says. “So they still need more technology refinements to help them scale up and drive down their costs.”

Still, some alternatives are considerably further along than others. Among the best-developed are geopolymers, which are hard materials that result when various oxides of silicon and aluminum are soaked in an alkaline solution such as lye (sodium hydroxide), and respond by linking themselves into long chains and networks. The need to use alkali solutions instead of plain water does make geopolymer cements trickier to handle at construction sites. Even so, they have been successfully used in a number of construction projects. And industry interest has been rising fast over the past decade: Not only do geopolymers have a total carbon footprint as much as 80 percent smaller than ordinary Portland cement, but they are also quite a bit stronger. They are also more resistant to water, fire, weathering and chemicals — which is why geopolymers have been commercially produced since the 1970s for encapsulating toxic wastes, sealing ordinary concrete against the elements, and a variety of other, non-cement applications.

And there is no shortage of raw materials: Silicon oxides and aluminum oxides are abundant in slag and fly ash, and they are found in clay, discarded glass and even agricultural by-products. (Burnt rice hulls are so rich in silica that they’re a respiratory danger to anyone who breathes them in.) So in addition to cutting carbon emissions, the widespread use of geopolymer cement could be a handy way to get rid of quite a few troublesome waste products. 

The indirect approach: Maximize concrete efficiency

Once it reaches the construction site, cement begins to fulfill its intended purpose in the hydration reaction:

cement (CaO and minerals) + water (H2O) + aggregate (sand or gravel) + air →  concrete.

The cement, water and aggregate are blended into a thick slurry (or delivered that way in a cement mixer truck), poured into a mold, and left untouched for days or weeks while water and cement react to form concrete. This process also locks in the aggregate, which is included for strength and bulk, along with any reinforcements like steel rebar.

Aside from the transportation required to truck materials to the site, there’s nothing here that generates any further CO2. But the hydration equation does highlight an indirect way of reducing a building’s cement usage, and thus its carbon footprint: Use concrete as sparingly as possible.

Careful attention to concrete efficiency could deliver nearly a quarter of the reductions required to meet the industry’s 2050 zero-emissions goal, according to estimates in the Global Cement and Concrete Association’s climate road map. But that’s not the norm yet, says Cรฉcile Faraud, who leads clean construction efforts at the international climate action group C40 Cities. “Business as usual is, ‘Oh, let’s pour a bit more concrete, just to be on the safe side.’”

That it is, agrees Bohan of Portland Cement — and for good reason: “Contractors, material suppliers, architects and engineers are naturally very risk-averse,” he says, as are the agencies that write building codes. “They want the built environment to last for a very long time” — decades, if not centuries. And, as demonstrated in 2021 in Surfside, Florida, when a 40-year-old high-rise condominium collapsed, killing 98 residents, the consequences of structural failure can be very high.

Still, adds Bohan, attitudes have begun to shift in the face of climate change. “The industry has begun to realize they can have safety, security and resilience, and have a sustainable built environment,” he says. They also have to work with  a growing number of climate-conscious cities that are legislating change: In 2016, for example, Vancouver targeted the emissions produced by concrete and other structural materials for a 40 percent reduction by 2030.

Builders and engineers are trying out a lot of ways to economize on concrete without compromising safety. One is through careful design. For example, says Rissman, higher-strength concrete mixes often have a higher cement content — and thus, a larger carbon footprint. “You can reserve those mixes for structural elements like support pillars and use a lower-strength mix for walkways or stairs that don’t need to support heavy weight,” he says.

A more high-tech way to achieve a similar result was demonstrated in May by researchers at the Graz University of Technology in Austria, who found that they could reduce a concrete building’s carbon footprint by as much as 50 percent through the use of construction-scale  3D printers. In these systems, which have been attracting worldwide interest in recent years as a fast, affordable way to build homes and other structures from local materials, robot-controlled nozzles extrude streams of wet concrete to build up walls and other elements, layer by layer. The Graz team achieved their savings by using this method to create intricate, void-filled walls and ceilings that placed concrete exactly where it was needed for strength and safety, but nowhere else. The team has also shown that the printers can extrude thin steel wires along with the wet slurry, thus reinforcing those parts of the structure where concrete alone isn’t strong enough — and without the need for conventional steel reinforcement rods, or rebar.

An even higher-tech approach is to use concrete made with water that contains suspended flakes of graphene: a super-strong form of carbon in which the atoms bind to one another in a hexagonal lattice one atom thick. In 2018, a team of researchers at the University of Exeter in the United Kingdom announced that they had used such a graphene suspension to produce concrete that was 146 percent stronger than the conventional variety. If ways can be found to mass-produce graphene at a low-enough price to make its use routine — and lots of groups are working to get those costs down — then the team’s calculations suggest that an entire building made of such concrete would need only about half as much cement as a conventionally built one to achieve the same structural strength. That could have a major impact on CO 2 emissions.

There is even a no-tech approach: Keep using the structures we’ve already built for as long as possible. After all, “the more durable your buildings are, the less concrete you will need for new buildings,” says Diana รœrge-Vorsatz, an environmental scientist at the Central European University in Vienna and coauthor of a look at ways to achieve a net-zero construction industry in the 2020 Annual Review of Environment and Resources.

In developed nations like the US, says รœrge-Vorsatz, who is also a vice chair of the emission-mitigation working group of the International Panel on Climate Change, this will require tax policies and other incentives that reward reuse instead of endlessly building what’s shiny and new. And in fast-growing countries like China and India, she says, increasing buildings’ longevity means shifting the focus from speed to quality. “When you just want to expand quickly then you do it the cheapest and fastest way,” she says. “Here in Eastern Europe, we had a big construction rush in the 1960s and ’70s and a lot of those buildings are already crumbling.”

And then there is the no-concrete approach: Completely replace the gray stuff with something more renewable. One emerging option is mass timber: the generic name for a variety of wood products that have been glued or otherwise bonded into giant structural elements that can equal or exceed the performance of concrete and steel. Since its development by Austrian researchers in the early 1990s, mass timber has been widely used in Europe and is drawing increased attention in the US — especially in states like Oregon and Washington that have extensive forests and many idled sawmills. The world’s tallest wood-frame building, an 87-meter apartment-retail tower completed in Milwaukee, Wisconsin, in July 2022, may not hold that distinction long: Taller mass-timber buildings have been proposed — including one that would rise 80 stories over the Chicago waterfront.

The cutting-edge approach: Exploit the carbonation reaction

Appearances to the contrary, concrete is not chemically inert. Even as it starts to harden, for example, it’s already participating in the carbonation reaction:

Ca(OH)2 (in concrete) + CO 2 (in air) → CaCO 3 + H 2O (water vapor)

In effect, says Andrew, this is a spontaneous reversal of the cement-making process: As soon as calcium compounds in the concrete are exposed to CO2 in the air, he says, “they will try to close the loop and form calcium carbonate again.”

This happens rapidly on a fresh concrete surface, adds Andrew, then slows as the carbon dioxide molecules have to diffuse deeper and deeper into the solid mass to find unreacted calcium. But it never stops completely — which means that all those concrete structures scattered around the planet are actually pulling CO2 out of the atmosphere and undoing some of the climate damage they caused. In its road map, the Portland Cement Association estimates that older concrete structures have already absorbed about 10 percent of the CO 2 produced to build them. But that’s a deliberately conservative number, says Bohan;  other estimates range as high as 43 percent.

For builders, it’s true, carbonation is often viewed as an enemy to be fought — especially in big, heavy structural elements like foundations, pillars and retaining walls, all of which have to be reinforced with steel rebar. In fresh concrete, which provides an alkaline environment, this steel is surrounded with a protective oxide layer. But in carbonated concrete, the chemistry shifts and dissolves the protective layer. This leaves the steel wide open to rust and corrosion, which can eventually lead to a structure’s collapse.

And yet at least half a dozen startup companies have been launched over the past decade with technologies intended to enhance the carbonation reaction — and thereby make concrete into a significant repository for atmospheric CO2.

One of the best-established of these startups is Nova Scotia-based CarbonCure, which has already sold more than 700 systems for installation at concrete plants worldwide to inject fresh, wet concrete mixes with CO 2 captured from industrial sources. The injected CO 2 immediately starts reacting with the slurry, filling it within minutes with a blizzard of solid calcium-carbonate nanocrystals. These nanocrystals, in turn, will enhance the strength of the concrete as it cures — meaning, says CarbonCure, that builders can use around 5 percent less Portland cement with no loss of safety margin. Furthermore, the company says that its concrete mix can be used with standard steel rebar, since the solid nanocrystals will not degrade that protective oxide layer the way that atmospheric CO 2 does.

In Los Gatos, California, Blue Planet Systems is hoping to achieve much more dramatic reductions by focusing not on the cement part of concrete but the aggregate: the inert filler of sand or gravel that makes up most of concrete’s volume. The company’s process is proprietary, but the basic idea is to start with any calcium-rich waste product, such as slag or concrete rubble from a demolition site, soak it in a “capture solution” and expose it to the raw flue gas coming out of a cement kiln, power plant, steel mill or any other emission source. The solution helps the calcium ions pull the CO directly out of the flue gas and bind it into calcium carbonate.

The end result, after the capture solution is recovered for reuse, is solid nodules that are 44 percent calcium carbonate. When used as aggregate, says Blue Planet, which is constructing its first demonstration plant in Pittsburg, California, these nodules yield a concrete that has bound as much or more carbon dioxide as went into making it — nearly 670 kilograms per cubic meter.

It remains to be seen whether innovations like these can really get the concrete industry to a place where it emits no net carbon dioxide. Yet industry observers and insiders alike find plenty of room for optimism, if only because the momentum for change has built so rapidly. Remember, says Andrew, that as recently as a decade ago there seemed to be no feasible, climate-friendly alternatives to Portland cement at all. The stuff was cheap, familiar and had a huge infrastructure already in place — hundreds of quarries, thousands of kilns, whole fleets of trucks fanning out to deliver pre-mixed concrete slurry to building sites. “So for a long time, decarbonizing cement production was in the ‘too hard’ basket,” he says.

Yet today, says Bohan, “because of this intense attention to the climate issue, people are now going back and saying, ‘Wow, we didn’t realize all these options were available.’”

Editor’s note: This article was updated on November 21, 2022, to clarify the number of systems sold by CarbonCure, and to what types of facilities. CarbonCure has sold more than 700 of its systems, for operation at hundreds of concrete plants worldwide. The article originally said that CarbonCure has equipped 418 Portland cement plants with its systems. A change was also made to clarify that the source of the carbon dioxide used by these systems comes from various industrial sources, not mostly power plants as implied.

This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews. Sign up for the newsletter.