Novel use of social media to assess and improve coastal flood forecasts and hazard alerts.

Coastal communities and infrastructure need protection from flooding and wave overtopping events. Assessment of hazard prediction methods, used in sea defence design, defence performance inspections and forecasting services, requires observations at the land-sea interface but these are rarely collected. Here we show how a database of hindcast overtopping events, and the conditions that cause them, can be built using qualitative overtopping information obtained from social media. We develop a database for a case study site at Crosby in the Northwest of England, use it to test the standard methods applied in operational flood forecasting services and new defence design, and suggest improvements to these methods. This novel approach will become increasingly important to deliver long-term, cost-effective coastal management solutions as sea-levels rise and coastal populations grow. At sites with limited, or no, monitoring or forecasting services, this approach, especially if combined with citizen science initiatives, could underpin the development of simplified early warning systems.

Autoimmune progesterone dermatitis: a diagnosis easily missed.

Autoimmune progesterone dermatitis (AIPD) is a rare, poorly characterized dermatosis, with about 60 previously reported cases. It typically undergoes cyclical flares relating to the menstrual cycle, especially the luteal phase, when levels of progesterone are at their highest. We report the case of a 34-year-old woman with an 8-year history of a profoundly pruritic eruption, associated with her menstrual cycle, in whom the diagnosis had proved elusive. Buserelin nasal spray resulted in complete clearance. AIPD is a diagnosis to consider in intractable eruptions in women, particularly if there is cyclical variation.

Drug-induced subacute cutaneous lupus erythematosus associated with omeprazole.

Subacute cutaneous lupus erythematosus (SCLE) is characterized by annular scaly erythematous plaques in a photosensitive distribution, and the presence of anti-Ro (SSA) and/or anti-La (SSB) antibodies. Most cases of SCLE are idiopathic, but occasional cases may be drug-induced or associated with a hereditary deficiency of complement components. We report two cases of drug-induced SCLE precipitated by the proton pump inhibitor, omeprazole. Drug-induced disease should be considered in all atypical or extensive cases of SCLE, especially in elderly patients.

Trends in state health care expenditures and funding: 1980-1998.

Health care spending estimates constitute an important public policy tool, providing a broad look at historical trends in unique State health care systems. The State health expenditure estimates presented here detail spending for the 50 States and the District of Columbia for calendar years 1980-1998. They include expenditure estimates for specific service types as well as for two major sources of funding--Medicare and Medicaid. In this article, the authors address health care's role in State economies, trends in major service sectors and payers, and factors influencing these trends.

National health expenditures, 1999.

The health care spending share of gross domestic product (GDP) remained steady between 1993 and 1999 as moderate-to-strong economic growth coincided with a rapid shift to managed care. This shift, along with decelerating growth in Medicare spending, appears to have generated a mostly one-time saving that lowered aggregate health expenditure growth.

National health expenditures, 1998.

In 1998, national health care expenditures reached $1.1 trillion, an increase of 5.6 percent from the previous year. This marked the fifth consecutive year of spending growth under 6 percent. Underlying the stability of the overall growth, major changes began taking place within the Nation's health care system. Public payers felt the initial effects of the Balanced Budget Act of 1997 (BBA), and private payers experienced increased health care costs and increased premium growth.

National health expenditures, 1997.

In 1997 health spending in the United States increased just 4.8 percent to $1.1 trillion. As a share of gross domestic product (GDP), national health expenditures (NHE) absorbed 13.5 percent of the country's output in 1997--a share that has remained relatively constant for 5 years. Despite the relative stability in recent years, signs of changing trends are emerging.