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In the United States, tornadoes are the third leading cause of fatalities from natural disasters1. To aid prevention and mitigation of tornado-related morbidity and mortality, improvement in standardizing tornado specific threat analysis terminology was assessed. The largest number of tornado-related fatalities has occurred in the state of Texas for over a hundred years. The occurrence of tornadic clusters or “outbreaks” has not been formally standardized. The concept of “tornado outbreaks” is better defined and its role in fatality mitigation is addressed in this Institutional Review Board (IRB) approved study.
To understand the role of “tornado outbreaks” related clusters in Texas in relationship to morbidity and mortality.
This IRB approved (IRB2017- 0507) research study utilized GIS tools and statistical analysis of historical data to examine the relationship between tornado severity (based on the Fujita Scale), the number of tornadoes, and the trends in morbidity and mortality. This study was funded in part from The National Science Foundation grant (NSF Grant #1560106) in support of the CyberHealthGIS Research Experience for Undergraduates (REU).
A statistically significant difference was demonstrated between the severity of a tornado and related morbidity and mortality during “tornado outbreaks” in Texas during a defined 30-year period.
Understanding the role and discerning the impacts of “tornado outbreaks” as related to tornado severity has critical implications to disaster preparedness. Applications of this conclusion may improve shelter planning/preparation, timely warning, and educating the at-risk public. Subsequently, examining the likelihood and improved descriptions of “tornado outbreaks” may aid in reducing the number of tornado-related injuries and fatalities nationally.
As with any policy area, social assistance in China does not develop in a historical vacuum. The weight of precedent, established vested interests and the emergence of particular policy paths are all consequences of a policy's history. In addition, how a policy's story is told and later relayed can go a long way to shaping how it is responded to and the extent to which it is deemed successful. The MLG system in China has been heavily influenced by its own history as well as the preceding history of social assistance. A final point to consider is the way in which the problem that a particular policy is addressing is defined or measured and the ways in which this has developed over time. The following discussion has three main aims. First, the chapter will introduce the historical background to social assistance in China. This will not be a comprehensive history of social assistance in China before the 1990s, but it will provide readers with a background to developments which have, to varying degrees, influenced the more contemporary developments of dibao. Second, the chapter will provide a review of the development of dibao from 1992 to approximately 2014. The intention of this part of the chapter is to provide readers with a broad understanding of the developmental events which occurred during this period regarding both urban and rural dibao but not to provide the details and argument which subsequent chapters will explore. Instead, this section will provide readers with the context in which to situate the subsequent discussion. The third and final part of the chapter takes a different tack and will discuss the ways that poverty is defined and the ways in which the problem has developed during the period that dibao has been practised. The chapter therefore follows a straightforward structure addressing, first, the history of social assistance prior to the reform era, which is then followed by a more detailed discussion of the development of the dibao from 1992 through to 2014. Third, and finally, the chapter will discuss how poverty has changed in China during the reform era.
The People's Republic of China's (China or PRC hereafter) transformation since 1978 has been dramatic and far reaching. The headline grabbing growth achieved under the leadership of the Chinese Communist Party (CCP) has transformed people's lives, but it has not been without consequence. The introduction of market principles has seen the re-emergence of poverty as a policy problem in urban and rural areas. The size of China means that the scale of the challenge presented by poverty was and continues to be enormous. While the reforms have lifted hundreds of millions of Chinese out of poverty there are tens of millions who have been left behind (ADB 2004; Gustafsson and Zhong 2000; Hussain 2003; Khan and Riskin 2001, 2005; Tang 2003). One response to the issue has been the introduction of new policies to expand the scope and provision of social assistance for those most in need. The Minimum Livelihood Guarantee (MLG or dibao hereafter) system emerged during the 1990s initially providing a means tested benefit to urban residents who applied for assistance. First appearing in Shanghai in 1993, the MLG was a radical departure from traditional urban social assistance and went on to spread to a small number of cities before being officially marked for national implementation in 1997. Since 1997 the MLG has undergone significant expansion in the number of people receiving the benefit as well as large increases in scope and expenditure, and, in 2007, a rural MLG system was implemented nationally. It is a means tested, locally-administered and -financed policy which provides a household with a top-up to their income providing a minimum income guarantee. The MLG was originally designed to provide the absolute minimum that a household might require to survive and as such should not necessarily be thought of as a poverty alleviation measure. Rather the MLG was a continuation of traditional Chinese social assistance which provided those most in need with the means to survive and served the state's political aims of governing a stable society.
The MLG is important for two reasons. First, it is a radical departure in the mechanics of social assistance provision in China.
The list of interviewees is anonymised in line with ethical agreements and checklists secured before fieldwork was conducted. The number of the interview listed here corresponds with the number in the text, so (Interview 1) in text refers to the first interview on the list below. Interviews were conducted between 2006 and 2016.
The previous chapter noted how the emergence, spread and implementation of the urban MLG could be explained through the FA framework. It was shown that the space provided by the structure of the Chinese state facilitated innovation in social assistance policy in Shanghai when there were policy actors willing to exploit it. It was also shown that the structure of the state could serve to shape and constrain the choices available to particular actors, whereas those who wielded additional authority were in a position to force through decisions. In this chapter the development of the urban MLG in the period 1999 to 2003 will be discussed. This period is significant because, as noted in Chapter 1, there was significant expansion in the scope and spending on the urban MLG but the reasons for this go undiscussed. What is notable about this period is that it demonstrated that even during a period when the policy-making environment in China was changing the power of elite leaders was undiminished and could still be used to force through significant changes in policy. What is also notable is that the expansion of the urban MLG shows the MCA taking advantage of the situation in order to resolve a number of problems it was facing and also to expand its own capabilities.
The chapter will first discuss some of the challenges that the urban MLG was facing after national implementation was achieved – primarily a problem of variation although it manifested in different ways. It will be argued that the reasons for this variation are partly due to the design of the policy but also due to the process through which it came to be implemented nationally. The chapter then goes on to show how the intervention of a powerful policy actor, Premier Zhu Rongji, brought about a situation where various issues facing the MLG were temporarily resolved. This intervention demonstrates the key elements of the FA framework in action, namely the interaction of values, state structure and the relative authority of different actors in the system. The chapter will end with a discussion of how the MCA exploited both Zhu's intervention and the fragmented nature of the system in order to pursue its own agenda.
As the historical description of the development of dibao in the previous chapter has shown, the emergence and implementation of the urban MLG was a process that does not necessarily fit with the established discourse on social assistance policy in China. Rather the process was messy and involved numerous actors at central and local levels who interacted over an extended period of time, seeking particular outcomes and being enabled or frustrated by the structure of the state. The process of the urban MLG's national implementation was not just the announcement of the 1997 Circular or the 1999 Regulations but also the process leading up to these documents being published and enforced. This took place in the context of China's fragmented authoritarian political structure and this, together with the actions of certain key actors, had a profound impact on the shape of the MLG as well as establishing a number of problems that subsequently would need to be dealt with. Two processes need to be addressed in order to understand the problems which developed later. These are the spread of the MLG between 1994 and 1997 and the implementation of the MLG between 1997 and 1999. Both these processes were subject to the FA of China's politics and exhibited outcomes that would be expected for a policy that emerged in a bureaucratic structure lacking in political authority and fiscal resources.
This chapter sets out the case that in order to understand what the MLG is now it is essential to understand where it came from, what political values it was attached to and that underpin it, and how its implementation was brought about. Initially, when it emerged in Shanghai the urban MLG was a product of the space that exists within the Chinese system to innovate and experiment when the higher levels of authority allow it. As it moved from being a local innovation to a national policy the way the MLG was discussed changed, and the state structure that had fostered its development became a challenge to its spread. The explicit linking of the MLG to the cause of reform and social stability suggest that the policy had different goals to alleviating poverty.
The previous two chapters focused on explaining the development of the urban dibao programme between 1992 and 2003. It was argued that a combination of the opportunities and limits of China's fragmented authoritarian system and the actions of particular actors had a profound impact on the form and function of the urban dibao system. While developments did not cease to occur in urban dibao – notably the introduction of a more comprehensive (quanmian) system which provided dibao recipients with relief for medical, housing and education costs – the major development during the period after 2003 was the introduction of the rural dibao system as a nationwide policy. This marked a significant change in the focus of social assistance in China which had previously been centred on urban areas and the problem of the new urban poverty, and saw the spread of ideas and practice from the cities into the countryside. Notably the promotion, spread and implementation of the rural dibao system also saw the emergence of similar practices and challenges that had characterised the urban programme. Not everything was the same, however, and the rural dibao system which was eventually implemented also shows slight differences which suggest that lessons may have been learned from the previous experiences implementing the MLG in China's cities.
This chapter will focus on explaining why the rural dibao system was implemented at the time, and in the way, it was. While interviews with Civil Affairs officials suggested that the MCA had learned from the experience of the urban dibao system this is not entirely borne out by a critical analysis of the documents and events leading up to implementation of the rural system and its aftermath. For example, implementation ran along similar lines, with a spread of implementation by local government which was encouraged by the MCA, but not wholeheartedly supported until a higher authority became involved and drove national implementation. Similarly, while some concessions based on the problems of the urban programme were worked into the design of rural dibao, such as guaranteed funding, other problematic areas were left alone, such as calculating the minimum income line for the MLG (the dibao xian).
The previous three chapters addressed issues which affected the urban and rural dibao systems during the initial emergence, development and implementation of the programmes. This highlighted the significant impact that China's fragmented policy-making system had on dibao, shaping not just how it emerged but also how it subsequently developed, the context of national implementation, and subsequent adaptations and expansion. The chapters also demonstrated that the significance of the actors who had an interest in dibao and where they were in the state hierarchy was significant in determining outcomes, especially with regard to the utilisation of resources (authority, financial, personnel or information). The preceding discussion also highlighted the various challenges that the dibao system has experienced during its implementation, including local government resistance to implementation and exclusion of those entitled, for example. This chapter will address how these issues might ultimately be addressed by discussing the question of whether or not both the urban and rural dibao systems have been institutionalised since the mid-2000s, and the implications of the answer. Overall it will argue that dibao has not been institutionalised and that the process of institutionalising was cut short in the late 2000s. This is primarily due to the purpose of the policy and the changing nature of China's development, but it is also indicative of certain aspects of China's FA and the impact this has on the policy-making process. Looking to the future this has implications for the policy long term in that it leaves the current system in a precarious state, but it also allows the Chinese state to respond to the changing nature of China's socio-economic context as well as more global developmental trends.
To this end the chapter is structured as follows. First, the concept of institutionalisation will be set out and discussed. This section will be broadly based on Fewsmith's study on the sustainability of experiments and reforms to local accountability in China, and Leung and Xiao's argument that social assistance in China has been institutionalised (Fewsmith 2013; Leung and Xiao 2016). The definition of institutionalisation set up in this section will go on to inform the rest of the discussion in the chapter.
An exploration of dibao – China's minimum income guaranteeEvery day in the People's Republic of China 70 million people receive help from the state through the minimum livelihood guarantee (dibao). What began as a reform in the city of Shanghai in the early 1990s is now a key component in the measures used by the Communist Party of China to maintain social stability and legitimacy. While scholars regularly discuss how effective dibao has been in alleviating poverty very little addresses what influenced its development. This book argues that in order to understand dibao we need to look at how the programme emerged and how it has developed in the years since. Drawing on newspaper articles, government reports and interviews with key officials and researchers, the book also addresses debate on the policy process in China as a whole.
A point which has been stated and restated at different points during this book has been the remarkable transformation that China has experienced in the almost four decades since the twin policies of reform and opening were implemented. It is almost a cliché nowadays to touch on how much the economy has grown year on year, how villages have been transformed into metropolises, or how historically great cities like Shanghai have re-entered the limelight. The shift from a poor but comparatively equal society, at least in material terms, to one of moderate wealth but greater inequality is a common thread to the narrative of China's transformation. Less frequently told outside of China studies is the story of how China's state-owned sector almost drowned in debt and how the social assistance, social security and social welfare systems all creaked under the contradictions of market reforms and ongoing obligations inherited from the planned economy. The emergence, implementation and subsequent development of dibao is part of this story although it has frequently been passed over to discuss seemingly more pressing concerns, such as China's rapidly ageing population or the difficulties in reforming the delivery of healthcare; and all are dwarfed by the mammoth poverty alleviation projects imposed on the countryside in the last few decades. Fundamentally, the MLG system, in both rural and urban areas, matters as it might not involve the same fiscal resources, nor might it cover as many people, but it tells us a great deal about how the policy process in China works, and day-to- day it affects a similar number of people to those living in the UK.
Goals of the study
While the importance of the dibao programme is now reflected in a growing literature produced by both Chinese and international scholars, the origins and development of the MLG have been treated relatively superficially. This has meant, as noted in the Introduction, that a dominant narrative has emerged regarding dibao which suggests that the system was implemented as a consequence of rational decision making by an omnipotent and benevolent governing system. The documentary and interview evidence suggested very early on when researching this topic that this narrative did not hold up and the reality of the policy process was much messier than subsequently presented or described.
National Institute for Health and Care Excellence have recommended faecal calprotectin (FC) testing as an option in adults with lower gastrointestinal symptoms for whom specialist investigations are being considered, if cancer is not suspected and it is used to support a diagnosis of inflammatory bowel disease (IBD) or irritable bowel syndrome. York Hospital and Vale of York Clinical Commissioning Group have developed an evidence-based care pathway to support this recommendation for use in primary care. It incorporates a higher FC cut-off value, a ‘traffic light’ system for risk and a clinical management pathway.
To evaluate this care pathway.
The care pathway was introduced into five primary care practices for a period of six months and the clinical outcomes of patients were evaluated. Negative and positive predictive values (NPV and PPV) were calculated. GP feedback of the care pathway was obtained by means of a web-based survey. Comparator gastroenterology activity in a neighbouring trust was obtained.
The care pathway for FC in primary care had a 97% NPV and a 40% PPV. This was better than GP clinical judgement alone and doubled the PPV compared with the standard FC cut-off (<50 mcg/g), without affecting the NPV. In total, 89% of patients with IBD had an FC>250 mcg/g and were diagnosed by ‘straight to test’ colonoscopy within three weeks. The care pathway was considered helpful by GPs and delivered a higher diagnostic yield after secondary care referral (21%) than the conventional comparator pathway (5%).
A care pathway for the use of FC that incorporates a higher cut-off value, a ‘traffic light’ system for risk and supports clinical decision making can be achieved safely and effectively. It maintains the balance between a high NPV and an acceptable PPV. A modified care pathway for the use of FC in primary care is proposed.
This paper explores the role of a designer's sense of engagement in early stage design. In the field of virtual reality, presence and immersion are standard measures of an individual's sense of engagement and involvement in an activity. High levels of presence might indicate that the designer is highly focused on the work. The central research question is the following: do designers who are more engaged in design activity, as measured by presence and immersive tendency questionnaires, produce better designs? An experiment was conducted to assess presence and immersive tendencies within the context of a hands-on, open-ended design-and-build activity. The results indicated that the designers' sense of immersion and presence ranged widely as well as their sense of frustration and calmness while performing the design activity. It was found that higher levels of presence correlated with either high design performance or low design performance. Lower levels of presence correlated with average design performance. No correlations were found between immersive tendency and design performance. This study suggests that some level of presence can be linked with better design, and it implies that level of presence might serve as an indicator of performance and learning in similar design-and-build activities.