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This is the largest nationally representative study to date of the toll taken by sepsis and pneumonia, two conditions often caused by deadly microbes, including the antibiotic-resistant bacteria MRSA. Such infections can lead to longer hospital stays, serious complications and even death. "In many cases, these conditions could have been avoided with better infection control in hospitals," said Ramanan Laxminarayan, Ph.D., principal investigator for Extending the Cure, a project examining antibiotic resistance based at the Washington, D.C. think-tank Resources for the Future. "Infections that are acquired during the course of a hospital stay cost the United States a staggering amount in terms of lives lost and health care costs," he said. "Hospitals and other health care providers must act now to protect patients from this growing menace." Laxminarayan and his colleagues analyzed 69 million discharge records from hospitals in 40 states and identified two conditions caused by health care-associated infections: sepsis, a potentially lethal systemic response to infection and pneumonia, an infection of the lungs and respiratory tract. The researchers looked at infections that developed after hospitalization. They zeroed in on infections that are often preventable, like a serious bloodstream infection that occurs because of a lapse in sterile technique during surgery, and discovered that the cost of such infections can be quite high: For example, people who developed sepsis after surgery stayed in the hospital 11 days longer and the infections cost an extra $33,000 to treat per person. Even worse, the team found that nearly 20 percent of people who developed sepsis after surgery died as a result of the infection. "That's the tragedy of such cases," said Anup Malani, a study co-author, investigator at Extending the Cure, and professor at the University of Chicago. "In some cases, relatively healthy people check into the hospital for routine surgery. They develop sepsis because of a lapse in infection control—and they can die." The team also looked at pneumonia, an infection that can set in if a disease-causing microbe gets into the lungs—in some cases when a dirty ventilator tube is used. They found that people who developed pneumonia after surgery, which is also thought to be preventable, stayed in the hospital an extra 14 days. Such cases cost an extra $46,000 per person to treat. In 11 percent of the cases, the patient died as a result of the pneumonia infection.

By combining a hurricane model and coupled ocean-atmosphere general circulation model to investigate the early Pliocene, Emanuel, Brierley and co-author Alexey Fedorov observed how vertical ocean mixing by hurricanes near the equator caused shallow parcels of water to heat up and later resurface in the eastern equatorial Pacific as part of the ocean wind-driven circulation. The researchers conclude from this pattern that frequent hurricanes in the central Pacific likely strengthened the warm pool in the eastern equatorial Pacific, which in turn increased hurricane frequency — an interaction described by Emanuel as a “two-way feedback process.”�The researchers believe that in addition to creating more hurricanes, the intense hurricane activity likely created a permanent El Nino like state in which very warm water in the eastern Pacific near the equator extended to higher latitudes. The El Nino weather pattern, which is caused when warm water replaces cold water in the Pacific, can impact the global climate by intermittently altering atmospheric circulation, temperature and precipitation patterns.The research suggests that Earth’s climate system may have at least two states — the one we currently live in that has relatively few tropical cyclones and relatively cold water, including in the eastern part of the Pacific, and the one during the Pliocene that featured warm sea surface temperatures, permanent El Nino conditions and high tropical cyclone activity.Although the paper does not suggest a direct link with current climate models, Fedorov said it is possible that future global warming could cause Earth to transition into a different equilibrium state that has more hurricanes and permanent El Nino conditions. “So far, there is no evidence in our simulations that this transition is going to occur at least in the next century. However, it’s still possible that the condition can occur in the future.”�Whether our future world is characterized by a mean state that is more El Nino-like remains one of the most important unanswered questions in climate dynamics, according to Matt Huber, a professor in Purdue University’s Department of Earth and Atmospheric Sciences. The Pliocene was a warmer time than now with high carbon dioxide levels. The present study found that hurricanes influenced by weakened atmospheric circulation — possibly related to high levels of carbon dioxide — contributed to very warm temperatures in the Pacific Ocean, which in turn led to more frequent and intense hurricanes. The research indicates that Earth’s climate may have multiple states based on this feedback cycle, meaning that the climate could change qualitatively in response to the effects of global warming.

No silver bullets. This is the simple premise of Diane Ravitch’s new book, “The Death and Life of the Great American School System,” which is being brought out this week by Basic Books. Written by one of our nation’s most respected scholars, it has been eagerly awaited. But it has also been, at least in some quarters, anticipated with a certain foreboding, because it was likely to debunk much of the conventional — and some not so conventional — wisdom surrounding education reform. Click Image to Enlarge

What of the once-great comprehensive high schools, institutions with history and in some cases a track record of success going back generations? As time moves on, it is fast becoming clear that the new small schools, many with inane themes (how about the School of Peace and Diversity?), can never substitute for a good neighborhood high school, which can become a center of communal life and pride. Ms. Ravitch’s report underscores the fact that the trick is to fix the neighborhood schools beset with problems, not destroy them.

It is not only the foundations that Ms. Ravitch blames for the current crisis: government has also failed in the attempt to reform the schools from above, lacking a clear perspective of how schools work on a day-to-day basis. Thus, the major federal initiative, No Child Left Behind, well intentioned as it may have been, ended up damaging the quality of education, not improving it. While the federal government declares schools as “failing” and prescribes sanctions for schools not meeting its goal of “annual yearly progress,” it is the states that are allowed to write and administer the tests. This has led to a culture of ever easier tests and more test preparation rather than real instruction. More ominously, it led to such scandals as the New York State Education Department lowering the “cut scores” that define the line between passing and failing. Ms. Ravitch suggests that the proper roles of the states and federal government have been reversed under NCLB. Maybe the standards for achievement should be set in Washington, which, after all, administers the National Assessment of Educational Progress , and the solutions found at the local level, using the accurate data provided by Washington. Instead of moving in a different direction from the failed NCLB model of the Bush Administration, the Obama administration has adopted and expanded on them.