Finite element analysis of moving contact in mechanically fastened joints

The Finite Element Method (FEM) has made a number of otherwise intractable problems solvable. An important aspect for achieving an economical and accurate solution through FEM is matching the formulation and the computational organisation to the problem. This was realised forcefully in the present case of the solution of a class of moving contact boundary value problems of fastener joints. This paper deals with the problem of changing contact at the pin-hole interface of a fastener joint. Due to moving contact, the stresses and displacements are nonlinear with load. This would, in general, need an interactive-incremental approach for solution. However, by posing the problem in an inverse way, a solution is sought for obtaining loads to suit given contact configuration. Numerical results are given for typical isotropic and composite plates with rigid pins. Two cases of loading are considered: (i) load applied only at the edges of the plate and (ii) load applied at the pin and reacted at a part of the edge of the plate. Load-contact relationships, compliance and stress-patterns are investigated. This paper clearly demonstrates the simplification achieved by a suitable formulation of the problem. The results are of significance to the design and analysis of fastener joints.

Interaction between production characteristics and postharvest performance and practices for fresh fruit

Significant interactions have been demonstrated between production factors and postharvest quality of fresh fruit. Accordingly, there is an attendant need for adaptive postharvest actions to modulate preharvest effects. The most significant preharvest effects appear to be mediated through mineral nutrition influences on the physical characteristics of fruit. Examples of specific influencers include fertilisers, water availability, rootstock, and crop load effects on fruit quality attributes such as skin colour, susceptibility to diseases and physiological disorders, and fruit nutritional composition. Also, rainfall before and during harvest can markedly affect fruit susceptibility to skin blemishes, physical damage, and diseases. Knowledge of preharvest-postharvest interactions can help determine the basis for variability in postharvest performance and thereby allow refinement of postharvest practices to minimise quality loss after harvest. This knowledge can be utilised in predictive management systems. Such systems can benefit from characterisation of fruit nutritional status, particularly minerals, several months before and/or at harvest to allow informed decisions on postharvest handling and marketing options. Other examples of proactive management practices include adjusting harvesting and packing systems to account for rainfall effects before and/or during harvest. Improved understanding of preharvest-postharvest interactions is contributing to the delivery of consistently higher quality of fruit to consumers. This paper focuses on the state of knowledge for sub-tropical and tropical fruits, in particular avocado and mango.

Finite element analysis of moving contact in mechanically fastened joints

The Finite Element Method (FEM) has made a number of otherwise intractable problems solvable. An important aspect for achieving an economical and accurate solution through FEM is matching the formulation and the computational organisation to the problem. This was realised forcefully in the present case of the solution of a class of moving contact boundary value problems of fastener joints. This paper deals with the problem of changing contact at the pin-hole interface of a fastener joint. Due to moving contact, the stresses and displacements are nonlinear with load. This would, in general, need an interactive-incremental approach for solution. However, by posing the problem in an inverse way, a solution is sought for obtaining loads to suit given contact configuration. Numerical results are given for typical isotropic and composite plates with rigid pins. Two cases of loading are considered: (i) load applied only at the edges of the plate and (ii) load applied at the pin and reacted at a part of the edge of the plate. Load-contact relationships, compliance and stress-patterns are investigated. This paper clearly demonstrates the simplification achieved by a suitable formulation of the problem. The results are of significance to the design and analysis of fastener joints.

Interaction between production characteristics and postharvest performance and practices for fresh fruit

Significant interactions have been demonstrated between production factors and postharvest quality of fresh fruit. Accordingly, there is an attendant need for adaptive postharvest actions to modulate preharvest effects. The most significant preharvest effects appear to be mediated through mineral nutrition influences on the physical characteristics of fruit. Examples of specific influencers include fertilisers, water availability, rootstock, and crop load effects on fruit quality attributes such as skin colour, susceptibility to diseases and physiological disorders, and fruit nutritional composition. Also, rainfall before and during harvest can markedly affect fruit susceptibility to skin blemishes, physical damage, and diseases. Knowledge of preharvest-postharvest interactions can help determine the basis for variability in postharvest performance and thereby allow refinement of postharvest practices to minimise quality loss after harvest. This knowledge can be utilised in predictive management systems. Such systems can benefit from characterisation of fruit nutritional status, particularly minerals, several months before and/or at harvest to allow informed decisions on postharvest handling and marketing options. Other examples of proactive management practices include adjusting harvesting and packing systems to account for rainfall effects before and/or during harvest. Improved understanding of preharvest-postharvest interactions is contributing to the delivery of consistently higher quality of fruit to consumers. This paper focuses on the state of knowledge for sub-tropical and tropical fruits, in particular avocado and mango.

Sustainable grazing management for temporal and spatial variability in north Australian rangelands – a synthesis of the latest evidence and recommendations

Rainfall variability is a major challenge to sustainable grazing management in northern Australia, with management often complicated further by large, spatially-heterogeneous paddocks. This paper presents the latest grazing research and associated bio-economic modelling from northern Australia and assesses the extent to which current recommendations to manage for these issues are supported. Overall, stocking around the safe long-term carrying capacity will maintain land condition and maximise long-term profitability. However, stocking rates should be varied in a risk-averse manner as pasture availability varies between years. Periodic wet-season spelling is also essential to maintain pasture condition and allow recovery of overgrazed areas. Uneven grazing distributions can be partially managed through fencing, providing additional water-points and in some cases patch-burning, although the economics of infrastructure development are extremely context-dependent. Overall, complex multi-paddock grazing systems do not appear justified in northern Australia. Provided the key management principles outlined above are applied in an active, adaptive manner, acceptable economic and environmental outcomes will be achieved irrespective of the grazing system applied.

Experimental and numerical investigation of the behaviour of CFRP strengthened CHS beams subjected to bending

This paper presents the results of an experimental and numerical program to investigate the circular hollow section (CHS) beams, strengthened using Carbon Fibre Reinforced Polymer (CFRP) sheets. The circular hollow shaped steel beams bonded with different CFRP layer orientations were tested under four-point bending. The mid-span deflection, service load and failure load were recorded. The LHL (where L, first inner longitudinal layer, H, second hoop layer and L, third outer longitudinal layer) and LLH (where L, first inner longitudinal layer, L, second longitudinal layer and H, third outer hoop layer) layer oriented strengthened beams perform slightly better than HHL (where H, first inner hoop layer, H, second hoop layer and L, third outer longitudinal layer) layer oriented strengthened beams. The LHL and LLH layer oriented treated beams showed very similar structural behaviour. Numerical analyses were then conducted on the CFRP strengthened steel CHS beams. The validity of the models has been assessed by comparing the failure loads and mid-span deflections. The effects of various parameters such as bond length, section types, tensile modulus of CFRP, adhesive layer thickness and adhesive types have been studied.

Convex-transitive Banach spaces and their hyperplanes

The topic of this dissertation is the geometric and isometric theory of Banach spaces. This work is motivated by the known Banach-Mazur rotation problem, which asks whether each transitive separable Banach space is isometrically a Hilbert space. A Banach space X is said to be transitive if the isometry group of X acts transitively on the unit sphere of X. In fact, some weaker symmetry conditions than transitivity are studied in the dissertation. One such condition is an almost isometric version of transitivity. Another investigated condition is convex-transitivity, which requires that the closed convex hull of the orbit of any point of the unit sphere under the rotation group is the whole unit ball. Following the tradition developed around the rotation problem, some contemporary problems are studied. Namely, we attempt to characterize Hilbert spaces by using convex-transitivity together with the existence of a 1-dimensional bicontractive projection on the space, and some mild geometric assumptions. The convex-transitivity of some vector-valued function spaces is studied as well. The thesis also touches convex-transitivity of Banach lattices and resembling geometric cases.

Turing and the Trans-Pacific Partnership: Intellectual Property, Public Health, and Access to Essential Medicines

A recent controversy in the United States over drug pricing by Turing Pharmaceuticals AG has raised larger issues in respect of intellectual property, access to medicines, and the Trans-Pacific Partnership (TPP). In August 2015, Turing Pharmaceuticals AG – a private biopharmaceutical company with offices in New York, the United States, and Zug, Switzerland - acquired the exclusive marketing rights to Daraprim in the United States from Impax Laboratories Incorporated. Martin Shkreli, Turing’s Founder and Chief Executive Officer, maintained: “The acquisition of Daraprim and our toxoplasmosis research program are significant steps along Turing’s path of bringing novel medications to patients with serious disorders, some of whom often go undiagnosed and untreated.” He emphasised: “We intend to invest in the development of new drug candidates that we hope will yield an even better clinical profile, and also plan to launch an educational effort to help raise awareness and improve diagnosis for patients with toxoplasmosis.” In September 2015, there was much public controversy over the decision of Martin Shkreli to raise the price of a 62 year old drug, Daraprim, from $US13.50 to $US750 a pill. The drug is particularly useful in respect to the treatment and prevention of malaria, and in the treatment of infections in individuals with HIV/AIDS. Daraprim is listed on the World Health Organization’s (WHO) List of Essential Medicines. In the face of much criticism, Martin Shkreli has said that he will reduce the price of Daraprim. He observed: “We've agreed to lower the price on Daraprim to a point that is more affordable and is able to allow the company to make a profit, but a very small profit.” He maintained: “We think these changes will be welcomed.” However, he has been vague and ambiguous about the nature of the commitment. Notably, the lobby group, Pharmaceutical Research and Manufacturers of America (PhARMA), disassociated itself from the claims of Turing Pharmaceuticals. The group said: “PhRMA members have a long history of drug discovery and innovation that has led to increased longevity and improved lives for millions of patients.” The group noted: “Turing Pharmaceutical is not a member of PhRMA and we do not embrace either their recent actions or the conduct of their CEO.” The biotechnology peak body Biotechnology Industry Organization also sought to distance itself from Turing Pharmaceuticals. A hot topic: United States political debate about access to affordable medicines This controversy over Daraprim is unusual – given the age of drug concerned. Daraprim is not subject to patent protection. Nonetheless, there remains a monopoly in respect of the marketplace. Drug pricing is not an isolated problem. There have been many concerns about drug pricing – particularly in respect of essential medicines for HIV/AIDS, tuberculosis, and malaria. This recent controversy is part of a larger debate about access to affordable medicines. The dispute raises larger issues about healthcare, consumer rights, competition policy, and trade. The Daraprim controversy has provided impetus for law reform in the US. US Presidential Candidate Hillary Clinton commented: “Price gouging like this in this specialty drug market is outrageous.” In response to her comments, the Nasdaq Biotechnology Index fell sharply. Hillary Clinton has announced a prescription drug reform plan to protect consumers and promote innovation – while putting an end to profiteering. On her campaign site, she has emphasised that “affordable healthcare is a basic human right.” Her rival progressive candidate, Bernie Sanders, was also concerned about the price hike. He wrote a letter to Martin Shkreli, complaining about the price increase for the drug Daraprim. Sanders said: “The enormous, overnight price increase for Daraprim is just the latest in a long list of skyrocketing price increases for certain critical medications.” He has pushed for reforms to intellectual property to make medicines affordable. The TPP and intellectual property The Daraprim controversy and political debate raises further issues about the design of the TPP. The dispute highlights the dangers of extending the rights of pharmaceutical drug companies under intellectual property, investor-state dispute settlement, and drug administration. Recently, the civil society group Knowledge Ecology International published a leaked draft of the Intellectual Property Chapter of the TPP. Knowledge Ecology International Director, James Love, was concerned the text revealed that the US “continues to be the most aggressive supporter of expanded intellectual property rights for drug companies.” He was concerned that “the proposals contained in the TPP will harm consumers and in some cases block innovation.” James Love feared: “In countless ways, the Obama Administration has sought to expand and extend drug monopolies and raise drug prices.” He maintained: “The astonishing collection of proposals pandering to big drug companies make more difficult the task of ensuring access to drugs for the treatment of cancer and other diseases and conditions.” Love called for a different approach to intellectual property and trade: “Rather than focusing on more intellectual property rights for drug companies, and a death-inducing spiral of higher prices and access barriers, the trade agreement could seek new norms to expand the funding of medical research and development (R&D) as a public good, an area where the US has an admirable track record, such as the public funding of research at the National Institutes of Health (NIH) and other federal agencies.” In addition, there has been much concern about the Investment Chapter of the TPP. The investor-state dispute settlement regime would enable foreign investors to challenge government policy making, which affected their investments. In the context of healthcare, there is a worry that pharmaceutical drug companies will deploy their investor rights to challenge public health measures – such as, for instance, initiatives to curb drug pricing and profiteering. Such concerns are not merely theoretical. Eli Lilly has brought an investor action against the Canadian Government over the rejection of its drug patents under the investor-state dispute settlement regime of the North American Free Trade Agreement (NAFTA). The Health Annex to the TPP also raises worries that pharmaceutical drug companies will able to object to regulatory procedures in respect of healthcare. It is disappointing that the TPP – in the leaks that we have seen – has only limited recognition of the importance of access to essential medicines. There is a need to ensure that there are proper safeguards to provide access to essential medicines – particularly in respect of HIV/AIDs, malaria, and tuberculosis. Moreover, there must be protection against drug profiteering and price gouging in any trade agreement. There should be strong measures against the abuse of intellectual property rights. The dispute over Turing Pharmaceuticals AG and Daraprim is an important cautionary warning in respect of some of the dangers present in the secret negotiations in respect of the TPP. There is a need to preserve consumer rights, competition policy, and public health in trade negotiations over an agreement covering the Pacific Rim.

Longitudinal changes in choroidal thickness and eye growth in childhood

PURPOSE To examine longitudinal changes in choroidal thickness and axial length in a population of children with a range of refractive errors. METHODS One hundred and one children (41 myopes and 60 nonmyopes) aged 10 to 15 years participated in this prospective, observational longitudinal study. For each child, 6-month measures of choroidal thickness (using enhanced depth imaging optical coherence tomography) and axial ocular biometry were collected four times over an 18-month period. Linear mixed-models were used to examine the longitudinal changes in choroidal thickness and the relationship between changes in choroidal thickness and axial eye growth over the study period. RESULTS A significant group mean increase in subfoveal choroidal thickness was observed over 18 months (mean increase 13 6 22 lm, P < 0.001). Myopic children exhibited significantly thinner choroids compared with nonmyopic children (P < 0.001), although there was no significant time by refractive group interaction (P ¼ 0.46), indicating similar changes in choroidal thickness over time in myopes and nonmyopes. However, a significant association between the change in choroidal thickness and the change in axial length over time was found (P < 0.001, β = −0.14). Children showing faster axial eye growth exhibited significantly less choroidal thickening over time compared with children showing slower axial eye growth. CONCLUSIONS A significant increase in choroidal thickness occurs over an 18-month period in normal 10- to 15-year-old children. Children undergoing faster axial eye growth exhibited less thickening and, in some cases, a thinning of the choroid. These findings support a potential role for the choroid in the mechanisms regulating eye growth in childhood.

Youth master plans as potential roadmaps to creating child- and youth-friendly cities

Communities across the globe are focusing on the needs of young people and their families in an effort to create child- and youth-friendly cities. In an attempt to become more child and youth friendly, over 40 communities in the United States have developed youth master plans (YMPs), as of 2009; however, our understanding of these plans is limited. To broaden this understanding, this research employed a multiple-methods approach, including an online questionnaire, plan analysis and semi-structured interviews with key community informants. Findings show that YMPs often focus on collaboration among community entities and youth participation, yet include only general normative statements regarding the physical environment. Furthermore, urban planners do not typically take the lead in development of YMPs, and, in some cases, are not involved at all. To inform and improve future YMPs, this paper recommends greater focus on the physical environment, particularly in relation to safety, access to nature and sustainable transportation.

Company taxation and tax spillovers: Separate accounting versus formula apportionment

It is observed in the real world that taxes matter for location decisions and that multinationals shift profits by transfer pricing. The US and Canada use so-called formula apportionment (FA) to tax corporate income, and the EU is debating a switch from separate accounting (SA) to FA. This paper develops a theoretical model that compares basic properties of FA to SA. The focal point of the analysis is how changes in tax rates affect capital formation, input choice, and transfer pricing, as well as on spillovers on tax revenue in other countries. The analysis shows that a move from SA to FA will not eliminate such spillovers and will, in cases identified in the paper, actually aggravate them.

The effects of habitat edges and trampling intensity on vegetation in urban forests

Although changes in urban forest vegetation have been documented in previous Finnish studies, the reasons for these changes have not been studied explicitly. Especially, the consequences of forest fragmentation, i.e. the fact that forest edges receive more solar radiation, wind and air-borne nutrients than interiors have been ignored. In order to limit the change in urban forest vegetation we need to know why it occurs. Therefore, the effects of edges and recreational use of urban forests on vegetation were investigated together in this thesis to reveal the relative strengths of these effects and to provide recommendations for forest management. Data were collected in the greater Helsinki area (in the cities of Helsinki, Vantaa and Espoo, and in the municipalities of Sipoo and Tuusula) and in the Lahti region (in the city of Lahti and in the municipality of Hollola) by means of systematic and randomized vegetation and soil sampling and tree measurements. Sample plots were placed from the forest edges to the interiors to investigate the effects of forest edges, and on paths of different levels of wear and off these paths to investigate the effects of trampling. The natural vegetation of mesic and sub-xeric forest site types studied was sensitive both to the effects of the edge and to trampling. The abundances of dwarf shrubs and bryophytes decreased, while light- and nitrogen-demanding herbs and grasses - and especially Sorbus aucuparia – were favoured at the edges and next to the paths. Results indicated that typical forest site types at the edges are changing toward more nitrophilic vegetation communities. Covers of the most abundant forest species decreased considerably – even tens of percentages – from interiors to the edges indicating strong edge effects. These effects penetrated at least up to 50 m from the forest edges into the interiors, especially at south to west facing open edges. The effects of trampling were pronounced on paths and even low levels of trampling decreased the abundances of certain species considerably. The effects of trampling extended up to 8 m from path edges. Results showed that the fragmentation of urban forest remnants into small and narrow patches should be avoided in order to maintain natural forest understorey vegetation in the urban setting. Thus, urban forest fragments left within urban development should be at least 3 ha in size, and as circular as possible. Where the preservation of representative original forest interior vegetation is a management aim, closed edges with conifers can act as an effective barrier against solar radiation, wind and urban load, thereby restricting the effects of the edge. Tree volume at the edge should be at least 225-250 m3 ha-1 and the proportion of conifers (especially spruce) 80% or more of the tree species composition. Closed, spruce-dominated edges may also prevent the excessive growth of S. aucuparia saplings at urban forest edges. In addition, closed edges may guide people’s movements to the maintained paths, thus preventing the spontaneous creation of dense path networks. In urban areas the effects of edges and trampling on biodiversity may be considerable, and are important to consider when the aim of management is to prevent the development of homogeneous herb-grass dominated vegetation communities, as was observed at the investigated edges.

Health-Related Quality of Life, Costs and Treatment of Inflammatory Rheumatic Diseases in Routine Practice : With special emphasis on biological drugs

Rheumatoid arthritis (RA) and other chronic inflammatory joint diseases already begin to affect patients health-related quality of life (HRQoL) in the earliest phases of these diseases. In treatment of inflammatory joint diseases, the last two decades have seen new strategies and treatment options introduced. Treatment is started at an earlier phase; combinations of disease-modifying anti-rheumatic drugs (DMARDs) and corticosteroids are used; and in refractory cases new drugs such as tumour necrosis factor (TNF) inhibitors or other biologicals can be started. In patients with new referrals to the Department of Rheumatology of the Helsinki University Central Hospital, we evaluated the 15D and the Stanford Health Assessment Questionnaire (HAQ) results at baseline and approximately 8 months after their first visit. Altogether the analysis included 295 patients with various rheumatic diseases. The mean baseline 15D score (0.822, SD 0.114) was significantly lower than for the age-matched general population (0.903, SD 0.098). Patients with osteoarthritis (OA) and spondyloarthropathies (SPA) reported the poorest HRQoL. In patients with RA and reactive arthritis (ReA) the HRQoL improved in a statistically significant manner during the 8-month follow-up. In addition, a clinically important change appeared in patients with systemic rheumatic diseases. HAQ score improved significantly in patients with RA, arthralgia and fibromyalgia, and ReA. In a study of 97 RA patients treated either with etanercept or adalimumab, we assessed their HRQoL with the RAND 36-Item Health Survey 1.0 (RAND-36) questionnaire. We also analysed changes in clinical parameters and the HAQ. With etanercept and adalimumab, the values of all domains in the RAND-36 questionnaire increased during the first 3 months. The efficacy of each in improving HRQoL was statistically significant, and the drug effects were comparable. Compared to Finnish age- and sex-matched general population values, the HRQoL of the RA patients was significantly lower at baseline and, despite the improvement, remained lower also at follow-up. Our RA patients had long-standing and severe disease that can explain the low HRQoL also at follow-up. In a pharmacoeconomic study of patients treated with infliximab we evaluated medical and work disability costs for patients with chronic inflammatory joint disease during one year before and one year after institution of infliximab treatment. Clinical and economic data for 96 patients with different arthritis diagnoses showed, in all patients, significantly improved clinical and laboratory variables. However, the medical costs increased significantly during the second period by 12 015 (95% confidence interval, 6 496 to 18 076). Only a minimal decrease in work disability costs occurred mean decrease 130 (-1 268 to 1 072). In a study involving a switch from infliximab to etanercept, we investigated the clinical outcome in 49 patients with RA. Reasons for switching were in 42% failure to respond by American College of Rheumatology (ACR) 50% criteria; in 12% adverse event; and in 46% non-medical reasons although the patients had responded to infliximab. The Disease Activity Score with 28 joints examined (DAS28) allowed us to measure patients disease activity and compare outcome between groups based on the reason for switching. In the patients in whom infliximab was switched to etanercept for nonmedical reasons, etanercept continued to suppress disease activity effectively, and 1-year drug survival for etanercept was 77% (95% CI, 62 to 97). In patients in the infliximab failure and adverse event groups, DAS28 values improved significantly during etanercept therapy. However, the 1-year drug survival of etanercept was only 43% (95% CI, 26 to 70) and 50% (95% CI, 33 to 100), respectively. Although the HRQoL of patients with inflammatory joint diseases is significantly lower than that of the general population, use of early and aggressive treatment strategies including TNF-inhibitors can improve patients HRQoL effectively. Further research is needed in finding new treatment strategies for those patients who fail to respond or lose their response to TNF-inhibitors.

Total Hip and Knee Arthoplasty for Osteoarthritis : Factors Related to the Early Outcome of Surgery

Some perioperative clinical factors related to the primary cemented arthroplasty operation for osteoarthritis of the hip or knee joint are studied and discussed in this thesis. In a randomized, double-blind study, 39 patients were divided into two groups: one receiving tranexamic acid and the other not receiving it. Tranexamic acid was given in a dose of 10 mg/kg before the operation and twice thereafter, at 8-hour intervals. Total blood loss was smaller in the tranexamic acid group than in the control group. No thromboembolic complications were noticed. In a prospective, randomized study, 58 patients with hip arthroplasty and 39 patients with knee arthroplasty were divided into groups with postoperative closed-suction drainage and without drainage. There was no difference in healing of the wounds, postoperative blood transfusions, complications or range of motion. As a result of this study, the use of drains is no longer recommended. In a randomised study the effectiveness of a femoral nerve block (25 patients) was compared with other methods of pain control (24 patients) on the first postoperative day after total knee arthroplasty. The femoral block consisted of a single injection administered at patients´ bedside during the surgeon´s hospital rounds. Femoral block patients reported less pain and required half of the amount of oxycodone. Additional femoral block or continued epidural analgesia was required more frequently by the control group patients. Pain management with femoral blocks resulted in less work for nursing staff. In a retrospective study of 422 total hip and knee arthroplasty cases the C-reactive protein levels and clinical course were examined. After hip and knee arthroplasty the maximal C-reactive protein values are seen on the second and third postoperative days, after which the level decreases rapidly. There is no difference between patients with cemented or uncemented prostheses. Major postoperative complications may cause a further increase in C-reactive protein levels at one and two weeks. In-hospital and outpatient postoperative control radiographs of 200 hip and knee arthroplasties were reviewed retrospectively. If postoperative radiographs are of good quality, there seems to be no need for early repetitive radiographs. The quality and safety of follow-up is not compromised by limiting follow-up radiographs to those with clinical indications. Exposure of the patients and the staff to radiation is reduced. Reading of the radiographs by only the treating orthopaedic surgeon is enough. These factors may seem separate from each other, but linking them together may help the treating orthopaedic surgeon to adequate patient care strategy. Notable savings can be achieved.

Disease control and management

Globally, the main contributors to morbidity and mortality are chronic conditions, including cardiovascular disease and diabetes. Chronic disease is costly and partially avoidable, with around 60% of deaths and nearly 50% of the global disease burden attributable to these conditions. By 2020, chronic illnesses will likely be the leading cause of disability worldwide. Existing healthcare systems that focus on acute episodic health conditions, both national and international, cannot address the worldwide transition to chronic illness; nor are they appropriate for the ongoing care and management of those already dealing with chronic diseases. As such, chronic disease management requires integrated approaches that incorporate interventions targeted at both individuals and populations, and emphasise the shared risk factors of different conditions. International and Australian strategic planning documents articulate similar elements to manage chronic disease, including the need for aligning sectoral policies for health, forming partnerships, and engaging communities in decision-making. Infectious diseases are also a common and significant contributor to ill health throughout the world. In many countries, this impact has been minimised by the combined efforts of preventative health measures and improved treatment methods. However, in low-income countries, infectious diseases remain the dominant cause of death and disability. The World Health Organization (WHO) estimates that infectious diseases (including respiratory infections) still account for around 23% (or around 14 million) of all deaths each year, and result in over 4.6 billion episodes of diarrhoeal disease and 243 million cases of malaria each year (Lozano et al. 2012, WHO 2009). In addition to the high level of mortality, infectious diseases disable many hundreds of millions of people each year, mainly in developing countries, with the global burden of disease from infectious diseases estimated to be around 300 million DALYs (disability-adjusted life years) (WHO 2012). The aim of this chapter is to outline the impact that infectious diseases and chronic diseases have on the health of the community, describe the public health strategies used to reduce the burden of those diseases, and discuss the historic and emerging disease risks to public health. This chapter examines the comprehensive approaches implemented to prevent both chronic and infectious diseases, and to manage and care for communities with these conditions.