Thinking Like a River

Author(s):  
Donald Worster

When we drive by a modern farm, we still expect to see green plants sprouting from the earth, bearing the promise of food or cooking oil or a cotton shirt. Pulling up one of those plants, we are still prepared to find dirt clinging to its roots. Even in this age of high-tech euphoria, agriculture remains essentially a matter of plants growing in the soil. But another element besides soil has always been a part of the farmer’s life-water. Farming is not only growing crops on a piece of land, it is also growing crops in water. I don’t mean a hydroponics lab. I mean that the farmer and his plants inescapably are participants in the natural cycle of water on this planet. Water is a more volatile, uncertain element than soil in the agricultural equation. Soil naturally stays there on the farm, unless poor management intervenes, whereas water is by nature forever on the move, falling from the clouds, soaking down to roots, running off in streams to the sea. We must farm rivers and the flow of water as well as fields and pastures if we are to continue to thrive. But it has never been easy to extract a living from something so mobile and elusive, so relentless and yet so vulnerable as water. If there is to be a long-term, sustainable agriculture in the United States or elsewhere, farmers must think and act in accord with the flow of water over, under, through, and beyond their farms. Preserving the fertility of the soil resource is critical to sustaining it, of course, but not more so than maintaining the quality of water. In many ways, the two ideals are one. And their failure is one, as when rain erodes the topsoil and creeks and rivers suffer. But there are differences between those two resources, differences we must understand and respect. Unlike soil, water cannot be “built.” It can be lost to the farmer, or it can be diverted, polluted, misused, or over-appropriated, but it can never be deepened or enhanced as soil can be.

2020 ◽  
Vol 28 (3) ◽  
pp. 536-546
Author(s):  
Marina S. Reshetnikova

The rapid acceleration of scientific and technological progress, which started at the beginning of the 21st century, has become a decisive factor in influencing the global economy. Who will lead the global innovation race? This problem is especially relevant in the field of artificial intelligence (AI). At the moment, the United States and China are the main participants in the battle for dominance in this area. The author assesses Chinas innovative potential in the field of AI and identifies its achievements in this area. Based on the statistics provided, Chinas AI leadership has reached a critical point. China is confidently leading the new fundamental research of artificial intelligence, forming its theoretical base and applied research and development, which will contribute to the creation of new high-tech innovative products and services. However, in terms of the number and quality of AI specialists (AI Talents) and the number of companies engaged in AI, China is still lagging behind its main rival, namely the United States. The author proved that, despite the obvious successes of China, the United States still has an equal lead in the global innovation race.


1993 ◽  
Vol 9 (1) ◽  
pp. 37-41 ◽  
Author(s):  
David M. Dush

The hospice movement grew in part as a reaction to the perception that modern medical care had become too technological at the expense of being impersonal and insensitive to human psychological and spiritual concerns. In the United States, the institutionalization of hospice care under Medicare and other reimbursement systems has further established hospice as an alternative to high-technology, high-cost care. The present paper examines the question: What if hospice care becomes itself high-technology, aggressive, costly health care in order to remain true to its goal of maximizing quality of life? Implications for the goals and philosophical underpinnings of palliative care are discussed.


Stroke ◽  
2020 ◽  
Vol 51 (3) ◽  
pp. 899-907 ◽  
Author(s):  
Wolfgang G. Kunz ◽  
Mohammed A. Almekhlafi ◽  
Bijoy K. Menon ◽  
Jeffrey L. Saver ◽  
Myriam G. Hunink ◽  
...  

Background and Purpose— The benefit that endovascular thrombectomy offers to patients with stroke with large vessel occlusions depends strongly on reperfusion grade as defined by the expanded Thrombolysis in Cerebral Infarction (eTICI) scale. Our aim was to determine the lifetime health and cost consequences of the quality of reperfusion for patients, healthcare systems, and society. Methods— A Markov model estimated lifetime quality-adjusted life years (QALY) and lifetime costs of endovascular thrombectomy–treated patients with stroke based on eTICI grades. The analysis was performed over a lifetime horizon in a United States setting, adopting healthcare and societal perspectives. The reference case analysis was conducted for stroke at 65 years of age. National health and cost consequences of improved eTICI 2c/3 reperfusion rates were estimated. Input parameters were based on best available evidence. Results— Lifetime QALYs increased for every grade of improved reperfusion (median QALYs for eTICI 0/1: 2.62; eTICI 2a: 3.46; eTICI 2b: 5.42; eTICI 2c: 5.99; eTICI 3: 6.73). Achieving eTICI 3 over eTICI 2b reperfusion resulted on average in 1.31 incremental QALYs as well as healthcare and societal cost savings of $10 327 and $20 224 per patient. A 10% increase in the eTICI 2c/3 reperfusion rate of all annually endovascular thrombectomy–treated patients with stroke in the United States is estimated to yield additional 3656 QALYs and save $21.0 million and $36.8 million for the healthcare system and society, respectively. Conclusions— Improved reperfusion grants patients with stroke additional QALYs and leads to long-term cost savings. Procedural strategies to achieve complete reperfusion should be assessed for safety and feasibility, even when initial reperfusion seems to be adequate.


2020 ◽  
Vol 12 (2) ◽  
pp. 463
Author(s):  
Jenna Bryant ◽  
C. Jill Stowe

Yearling auctions constitute the most common means of trading prospective Thoroughbred racehorses. The main objective of many equine operations is to breed yearlings to sell at these auctions, and therefore, the ability of breeders to consistently realize positive returns is paramount to their long-term participation in the market. In this article, we investigate the estimated profitability of Thoroughbred yearlings sold in auctions from 2001–2018. According to our estimates, less than 50% of transactions were profitable, with negative median profit in all years under analysis but two. In addition, the likelihood of realizing a positive return diminishes as the quality of sire decreases. Our results suggest that the long-run sustainability for many breeders, especially breeders that may lack the capital to invest in high quality stallions, is questionable.


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