866 resultados para Homeostasis Model Assessment


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At this time, each major automotive market bares its own standards and test procedures to regulate the vehicle green house gases emissions and, thus, fuel consumption. Hence, much are the ways to evaluate the overall efficiency of motor vehicles. The majority of such standards rely on dynamometer cycle tests that appraise only the vehicle as a whole, but fail to assess emissions for each component or sub-system. Once the amount of work generated by the power source of an ICE vehicle to overcome the driving resistance forces is proportional to the energy contained in the required amount of fuel, the power path of the vehicle can be straightforwardly modeled as a set of mechanical systems, and each sub-system evaluated for its share on the total fuel consumption and green house gases emission. This procedure enables the estimation of efficiency gains on the system due to improvement of particular elements on the vehicle's driveline. In this work a simple systematic mechanical model of an arbitrary smallsized hatch back was assembled and total required energy calculated for different regulatory cycles. All the modeling details of the energy balance throughout the system are presented. Afterward, each subsystem was investigated for its role on the fuel consumption and the generated emission quantified. Furthermore, the application of the modeling technique for different sets of sub-systems was introduced. Copyright © 2011 SAE International.

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A numerical study of mass conservation of MAC-type methods is presented, for viscoelastic free-surface flows. We use an implicit formulation which allows for greater time steps, and therefore time marching schemes for advecting the free surface marker particles have to be accurate in order to preserve the good mass conservation properties of this methodology. We then present an improvement by using a Runge-Kutta scheme coupled with a local linear extrapolation on the free surface. A thorough study of the viscoelastic impacting drop problem, for both Oldroyd-B and XPP fluid models, is presented, investigating the influence of timestep, grid spacing and other model parameters to the overall mass conservation of the method. Furthermore, an unsteady fountain flow is also simulated to illustrate the low mass conservation error obtained.

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This study investigated the effect of an Argon-based nonthermal plasma (NTP) surface treatment-operated chairside at atmospheric pressure conditions applied immediately prior to dental implant placement in a canine model. Surfaces investigated comprised: Calcium-Phosphate (CaP) and CaP + NTP (CaP-Plasma). Surface energy was characterized by the Owens-Wendt-Rabel-Kaelble method and chemistry by X-ray photoelectron spectroscopy (XPS). Six adult beagles dogs received 2 plateau-root form implants (n = 1 each surface) in each radii, providing implants that remained 1 and 3 weeks in vivo. Histometric parameters assessed were bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO). Statistical analysis was performed by Kruskall-Wallis (95% level of significance) and Dunn's post-hoc test. The XPS analysis showed peaks of Ca, C, O, and P for the CaP and CaP-Plasma surfaces. Both surfaces presented carbon primarily as hydro-carbon (CAC, CAH) with lower levels of oxidized carbon forms. The CaP surface presented atomic percent values of 38, 42, 11, and 7 for C, O, Ca, and P, respectively, and the CaPPlasma presented increases in O, Ca, and P atomic percent levels at 53, 12, and 13, respectively, in addition to a decrease in C content at 18 atomic percent. At 1 week no difference was found in histometric parameters between groups. At 3 weeks significantly higher BIC and BAFO were observed for CaPPlasma treated surfaces. Surface elemental chemistry was modified by the Ar-based NTP. Ar-based NTP improved bone formation around plateau-root form implants at 3 weeks compared with CaP treatment alone. © 2012 Wiley Periodicals, Inc.

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Background: It has been reported that titanium-zirconium alloy with 13-17% zirconium (TiZr1317) implants show higher biomechanical stability and bone area percentage relative to commercially pure titanium (cpTi) grade 4 fixtures. Purpose: This study aimed to determine whether the higher stability for TiZr1317 implants is associated with higher mechanical properties of remodeling bone in the areas around the implants. Materials and Methods: This study utilized 36 implants (n=18: TiZr1317, n=18: cpTi), which were placed in the healed ridges of the mandibular premolar and first molar of 12 mini pigs (n=3 implants/animal). After 4 weeks in vivo, the samples were retrieved, and resin-embedded histologic sections of approximately 100μm in thickness were prepared. In order to determine the nanomechanical properties, nanoindentation (n=30 tests/specimen) was performed on the bone tissue of the sections under wet conditions with maximum load of 300μN (loading rate: 60μN/s). Results: The mean (±standard deviation) elastic modulus (E) and hardness (H) for the TiZr1317 group were 2.73±0.50GPa and 0.116±0.017GPa, respectively. For the cpTi group, values were 2.68±0.51GPa and 0.110±0.017GPa for E and H, respectively. Although slightly higher mechanical properties values were observed for the TiZr1317 implants relative to the cpTi for both elastic modulus and hardness, these differences were not significant (E=p>0.75; H=p>0.59). Conclusions: The titanium-zirconium alloy used in this study presented similar degrees of nanomechanical properties to that of the cpTi implants. © 2013 Wiley Periodicals, Inc.

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The aim of the present study was to evaluate the Mini Nutritional Assessment (MNA), the Nutritional Risk Screening (NRS) 2002 and the American Society of Anesthesiologists Physical Status Score (ASA) as predictors of gait status and mortality 6 months after hip fracture. A total of eighty-eight consecutive patients over the age of 65 years with hip fracture admitted to an orthopaedic unit were prospectively evaluated. Within the first 72 h of admission, each patient's characteristics were recorded, and the MNA, the NRS 2002 and the ASA were performed. Gait status and mortality were evaluated 6 months after hip fracture. Of the total patients, two were excluded because of pathological fractures. The remaining eighty-six patients (aged 80·2 (sd 7·3) years) were studied. Among these patients 76·7 % were female, 69·8 % walked with or without support and 12·8 % died 6 months after the fracture. In a multivariate analysis, only the MNA was associated with gait status 6 months after hip fracture (OR 0·773, 95 % CI 0·663, 0·901; P= 0·001). In the Cox regression model, only the MNA was associated with mortality 6 months after hip fracture (hazard ratio 0·869, 95 % CI 0·757, 0·998; P= 0·04). In conclusion, the MNA best predicts gait status and mortality 6 months after hip fracture. These results suggest that the MNA should be included in the clinical stratification of patients with hip fracture to identify and treat malnutrition in order to improve the outcomes.

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Brazil has the largest cattle herd in the world with approximately 200 million head. An important feature of the Brazilian cattle industry is that most of its herd is raised on pasture, which constitutes one of the most economical and practical ways to produce and provide food for cattle. However, this production model is mishandled and can lead to soil degradation. Maintaining soil quality is essential for the conservation of natural ecosystems and the areas of production, thus soil quality improves the conditions for biogeochemical cycles. In this context, the objective of this study was to develop a device for testing the Inderbitzen way of assessing soil erodibility in two situations of usage and occupation. Therefore, one area was used as a sample collection occupied by grazing and the other as a forest fragment; both located in the city of Sorocaba in Sao Paulo State, Brazil. Thus, we concluded that the proposed device - the Inderbitzen - proved capable of assessing soil erodibility of the pasture and remnant forest. Accordingly, there was a tendency for a smaller loss of forest soils in the remnant when compared to the degraded pasture. The greatest resistance of the soil erosion in the forest remnant may be associated with the amount of organic matter released by the forest litter in all its diversity, influencing the quality of the structure of aggregates. © 2013 WIT Press.

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AIM: To study the antineoplastic efficacy of 10% aspirin intralesional injection on VX2 hepatic tumors in a rabbit model. METHODS: Thirty-two male rabbits (age: 6-9 wk; body weight: 1700-2500 g) were inoculated with VX2 hepatic tumor cells (104 cells/rabbit) via supraumbilical median laparotomy. On day 4 post-implantation, when the tumors were about 1 cm in diameter, the rabbits were randomly divided into the following groups (n = 8 each group) to assess early (24 h) and late (7 d) antineoplastic effects of intratumoral injection of 10% bicarbonate aspirin solution (experimental groups) in comparison to intratumoral injection of physiological saline solution (control groups): group 1, 24 h control; group 2, 24 h experimental; group 3, 7 d control; group 4, 7 d experimental. The serum biochemistry profile (measurements of glycemia, alkaline phosphatase, gamma-glutamyl transferase, aspartate aminotransferase, and alanine aminotransferase) and body weight measurements were obtained for all animals at the following time points: D0, before tumor implant; D4, day of treatment; D5, day of sacrifice for groups 1 and 2; D11, day of sacrifice for groups 3 and 4. Gross assessments of the abdominal and thoracic cavities were carried out upon sacrifice. The resected liver tissues, including hepatic tumors, were qualitatively (general morphology, signs of necrosis) and quantitatively (tumor area) assessed by histopathological analysis. RESULTS: Gross examination showed no alterations, besides the left hepatic lobe tumors, had occurred in the thoracic and abdominal cavities of any animal at any time point evaluated. However, the features of the tumor foci were distinctive between the groups. Compared to the control groups, which showed normal unabated tumor progression, the aspirin-treated groups showed imprecise but limited tumor boundaries and a general red-white coloration (indicating hemorrhaging) at 24 h post-treatment, and development of yellow-white areas of a cicatricial aspect at 7 d after treatment. At all time points evaluated, all except one biochemical parameters tested within the reference range (P > 0.05); a significant increase was detected in the alkaline phosphatase level of the control group 3 on D11 (P < 0.05). At 24 h post-treatment, the aspirintreated groups showed extensive coagulation necrosis accompanied by a remarkable absence of viable tumor foci; at 7 d after treatment, the tumors had completely disappeared in these animals and fibrous necrotic nodules had developed. In contrast, throughout the study course, the tumors of the control groups remained unchanged, showing tumor nodules without necrosis at the time point corresponding to 24 h post-treatment and increased amounts of tumor nodules at the time point corresponding to 7 d post-treatment. Quantitative analysis of the remaining tumor area revealed that the aspirin-treated groups had significantly smaller tumor foci at 24 h post-treatment (8.5% ± 0.7%) andat 7 d after treatment (11.0% ± 4.2%), compared to those in the control groups (24 h: 98.5% ± 1.5% and 7 d: 94.0% ± 2.7%; both, P < 0.005). CONCLUSION: Intralesional injection of a 10% aspirin solution causes destruction of VX2 hepatic tumors in rabbits without evidence of relapse at 7 d after treatment administration. © 2013 Baishideng.

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The aims of this study were to assess the validity and the feasibility of the qualitative behavior assessment (QBA) method as indicator of Nellore cattle temperament under field conditions, evaluating its associations with four other traditional methods and weight gain. The temperament and live weight of 2229 Nellore cattle was assessed at approximately 550 days of age. Five measurements of cattle temperament were recorded: flight speed test (FS, in m/s), visual scores of movement in the crush (MOV), crush score (CS), temperament score (TS), and the qualitative behavior assessment method (QBA), by using a list of 12 behavioral based adjectives as descriptors of temperament. Average daily weight gain (ADG) was calculated for each animal. For statistical analysis of QBA data, the Principal Component Analysis was used. A temperament index (TI) was defined for each animal using the scores for the first principal component. Pearson's correlation coefficients were estimated between TI with FS and ADG. A mixed model ANOVA was used to analyze the TI variation as a function of TS, CS, and MOV. The score plot for the first and second principal components was used to classify the cattle in four groups (from very bad to very good temperament). The first principal component explained 49.50% of the variation in the data set, with higher positive loadings for the adjectives 'agitated' and 'active', and higher negative loadings for 'calm' and 'relaxed'. TI was significantly correlated with FS (r=0.49; P<0.01) and ADG (r=-0.10; P<0.01). The means of ADG, FS, and the temperament scores (CS, TS, MOV) differed significantly (P<0.01) among the four groups, from very bad to very good temperament. The QBA method could discriminate different behavioral profiles of Nellore cattle and were in agreement with other traditional methods used as indicators of cattle temperament. Additional studies are needed to assess the inter- and intra-observers reliability and to study its association with physiological parameters. © 2013 Elsevier B.V.

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Includes bibliography.

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The present report assesses the economic and social impacts of climate change on the energy sector in Antigua and Barbuda, the Bahamas, Barbados, Belize, Cuba, Dominica, the Dominican Republic, Haiti, Grenada, Guyana, Jamaica, Saint Kitts and Nevis, Saint Vincent and the Grenadines, Saint Lucia, Suriname, and Trinidad and Tobago. In the study, the Artificial Neural Network methodology was employed to model the relationship between climate change and energy demand. The viability of the actions proposed were assessed using cost benefit analyses based on models from the National Renewable Energy Laboratory (NREL) of the United States of America.

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Changing precipitation patterns and temperature relate directly to water resources and water security. This report presents the findings of an assessment of the water sector in Grenada with respect to the projected impact of climate change. Grenada‘s water resources comprise primarily surface water, with an estimated groundwater potential to satisfy about 10%-15% of the present potable requirement. On the smaller islands Carriacou and Petite Martinique, domestic water is derived exclusively from rainwater catchments. Rainfall seasonality is marked and the available surface water during the dry season declines dramatically. Changing land use patterns, increase in population, expansion in tourism and future implementation of proposed irrigation schemes are projected to increase future water requirements. Economic modeling approaches were implemented to estimate sectoral demand and supply between 2011 and 2050. Residential, tourism and domestic demand were analysed for the A2, B2 and BAU scenarios as illustrated. The results suggest that water supply will exceed forecasted water demand under B2 and BAU during all four decades. However under the A2 scenario, water demand will exceed water supply by the year 2025. It is important to note that the model has been constrained by the omission of several key parameters, and time series for climate indicators, data for which are unavailable. Some of these include time series for discharge data, rainfall-runoff data, groundwater recharge rates, and evapotranspiration. Further, the findings which seem to indicate adequacy of water are also masked by seasonality in a given year, variation from year to year, and spatial variation within the nation state. It is imperative that some emphasis be placed on data generation in order to better project for the management of Grenada‘s water security. This analysis indicates the need for additional water catchment, storage and distribution infrastructure, as well as institutional strengthening, in order to meet the future needs of the Grenadian population. Strategic priorities should be adopted to increase water production, increase efficiency, strengthen the institutional framework, and decrease wastage. Grenada has embarked on several initiatives that can be considered strategies toward adaptation to the variabilities associated with climate change. The Government should ensure that these programs be carried out to the optimal levels for reasons described above. The ―no-regrets approach‖ which intimates that measures will be beneficial with or without climate change should be adopted. A study on the Costs of Inaction for the Caribbean in the face of climate change listed Grenada among the countries which would experience significant impacts on GDP between now and 2100 without adaptation interventions. Investment in the water sector is germane to building Grenada‘s capacity to cope with the multivariate impact of changes in the parameters of climate.

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The economic impact of climate change on root crop, fisheries and vegetable production for Trinidad and Tobago under the A2 and B2 scenarios were modeled, relative to a baseline ―no climate change‖ case, where the mean temperature and rainfall for a base period of 1980 – 2000 was assumed for the years up to 2050. Production functions were used, using ARMA specifications to correct for serial autocorrelation. For the A2 scenarios, rainfall is expected to fall by approximately 10% relative to the baseline case in the 2020s, but is expected to rise thereafter, until by the 2040s rainfall rises slightly above the mean for the baseline case. For the B2 scenario, rainfall rose slightly above the mean for the baseline case in the current decade, but falls steadily thereafter to approximately 15% by the 2040s. Over the same period, temperature is expected to increase by 1.34C and 1.37C under A2 and B2 respectively. It is expected that any further increase in rainfall should have a deleterious effect on root crop production as a whole, since the above mentioned crops represent the majority of the root crops included in the study. Further expected increases in temperature will result in the ambient temperature being very close to the optimal end of the range for most of these crops. By 2050, the value of yield cumulative losses (2008$) for root crops is expected to be approximately 248.8 million USD under the A2 scenario and approximately 239.4 million USD under the B2 scenario. Relative to the 2005 catch for fish, there will be a decrease in catch potential of 10 - 20% by 2050 relative to 2005 catch potentials, other things remaining constant. By 2050 under the A2 and B2 scenarios, losses in real terms were estimated to be 160.2 million USD and 80.1 million USD respectively, at a 1% discount rate. For vegetables, the mean rainfall exceeds the optimal rainfall range for sweet peppers, hot peppers and melongene. However, while the optimal rainfall level for tomatoes is 3000mm/yr, other vegetables such as sweet peppers, hot peppers and ochroes have very low rainfall requirements (as low as 300 mm/yr). Therefore it is expected that any further decrease in rainfall should have a mixed effect on individual vegetable production. It is expected that any further increase in temperature should have a mixed effect on individual vegetable production, though model results indicated that as a group, an increase in temperature should have a positive impact on vegetable production. By 2050, the value of yield cumulative gains (2008$) for vegetables is expected to be approximately 54.9 million USD under the A2 scenario and approximately 49.1 million USD under the B2 scenario, given a 1% discount rate. For root crops, fisheries and vegetables combined, the cumulative loss under A2 is calculated as approximately 352.8 million USD and approximately 270.8 million USD under B2 by 2050. This is equivalent to 1.37% and 1.05% of the 2008 GDP under the A2 and B2 scenarios respectively by 2050. Sea Level Rise (SLR) by 2050 is estimated to be 0.255 m under A2 and 0.215 m under B2. GIS estimation indicated that for a 0.255 m sea level rise, combined with a 0.5 m high tide, there would be no permanent inundation of agricultural land in Trinidad. The total inundation area is 1.18 km2. This occurs only in the Caroni Watershed, on the western coast of Trinidad, and the areas are outside the Caroni Swamp. Even with an additional rise of 0.5 m to simulate a high rainfall event, the estimated inundated area is 4.67 km2, but with no permanent inundation, though likely to be subject to flooding. Based on eleven (11) evaluation criteria, the top potential adaptation options were identified: 1. Use of water saving irrigation systems and water management systems e.g. drip irrigation; 2. Mainstream climate change issues into agricultural management; 3. Repair/maintain existing dams; 4. Alter crop calendar for short-term crops; 5. Adopt improved technologies for soil conservation; 6. Establish systems of food storage; 7. Promote water conservation – install on-farm water harvesting off roof tops; 8. Design and implement holistic water management plans for all competing uses; 9. Build on- farm water storage (ponds and tanks); 10. Agricultural drainage; and 11. Installation of greenhouses. The most attractive adaptation options, based on the Benefit-Cost Ratio are: (1) Build on- farm water storage such as ponds and tanks (2) Mainstreaming climate change issues into agricultural management and (3) Water Harvesting. However, the options with the highest net benefits are, (in order of priority): (1) Build on- farm water storage such as ponds and tanks, (2) Mainstreaming climate change issues into agricultural management and (3) Use of drip irrigation. Based on the area burnt in Trinidad and Tobago between 2005 and 2009, the average annual loss due to fires is 1717.3 ha. At US$17.41 per carbon credit, this implies that for the total land lost to forest fires on average each year, the opportunity cost of carbon credit revenue is 74.3 million USD. If a teak reforestation programme is undertaken in Trinidad and Tobago, the net benefit of reforestation under a carbon credit programme would be 69 million USD cumulatively to 2050.

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Climate change has the potential to impact on global, regional, and national disease burdens both directly and indirectly. Projecting and valuing these health impacts is important not only in terms of assessing the overall impact of climate change on various parts of the world, but also in terms of ensuring that national and regional decision-making institutions have access to the data necessary to guide investment decisions and future policy design. This report contributes to the research focusing on projecting and valuing the impacts of climate change in the Caribbean by projecting the climate change-induced excess disease burden for two climate change scenarios in Montserrat for the period 2010 - 2050, and by estimating the monetary value associated with this excess disease burden. The diseases initially considered in this report are variety of vector and water-borne impacts and other miscellaneous conditions; specifically, malaria, dengue fever, gastroenteritis/diarrheal disease, schistosomiasis, leptospirosis, ciguatera poisoning, meningococcal meningitis, and cardio-respiratory diseases. Disease projections were based on derived baseline incidence and mortality rates, available dose-response relationships found in the published literature, climate change scenario population projections for the A2 and B2 IPCC SRES scenario families, and annual temperature and precipitation anomalies as projected by the downscaled ECHAM4 global climate model. Monetary valuation was based on a transfer value of statistical life approach with a modification for morbidity. Using discount rates of 1%, 2% and 4%, results show mean annual costs (morbidity and mortality) ranges of $0.61 million (in the B2 scenario, discounted at 4% annually) – $1 million (in the A2 scenario, discounted at 1% annually) for Montserrat. These costs are compared to adaptation cost scenarios involving increased direct spending on per capita health care. This comparison reveals a high benefit-cost ratio suggesting that moderate costs will deliver significant benefit in terms of avoided health burdens in the period 2010-2050. The methodology and results suggest that a focus on coordinated data collection and improved monitoring represents a potentially important no regrets adaptation strategy for Montserrat. Also the report highlights the need for this to be part of a coordinated regional response that avoids duplication in spending.

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Climate change has the potential to impact on global, regional, and national disease burdens both directly and indirectly. Projecting and valuing these health impacts is important not only in terms of assessing the overall impact of climate change on various parts of the world, but also of ensuring that national and regional decision-making institutions have access to the data necessary to guide investment decisions and future policy design. This report contributes to the research focusing on projecting and valuing the impacts of climate change in the Caribbean by projecting the climate change-induced excess disease burden for two climate change scenarios in Saint Lucia for the period 2010 - 2050, and by estimating the non-market, statistical life-based costs associated with this excess disease burden. The diseases initially considered in this report are a variety of vector and water-borne impacts and other miscellaneous conditions; specifically, malaria, dengue fever, gastroenteritis/diarrhoeal disease, schistosomiasis, leptospirosis, ciguatera poisoning, meningococcal meningitis, and cardio-respiratory diseases. Disease projections were based on derived baseline incidence and mortality rates, available dose-response relationships found in the published literature, climate change scenario population projections for the A2 and B2 IPCC SRES scenario families, and annual temperature and precipitation anomalies as projected by the downscaled ECHAM4 global climate model. Monetary valuation was based on a transfer value of statistical life approach with a modification for morbidity. Using discount rates of 1, 2, and 4%, results show mean annual costs (morbidity and mortality) ranges of $80.2 million (in the B2 scenario, discounted at 4% annually) -$182.4 million (in the A2 scenario, discounted at 1% annually) for St. Lucia.1 These costs are compared to adaptation cost scenarios involving direct and indirect interventions in health care. This comparison reveals a high benefit-cost ratio suggesting that moderate costs will deliver significant benefit in terms of avoided health costs from 2010-2050. In this context indirect interventions target sectors other than healthcare (e.g. water supply). It is also important to highlight that interventions can target both the supply of health infrastructure (including health status and disease monitoring), and households. It is suggested that a focus on coordinated data collection and improved monitoring represents a potentially important no regrets adaptation strategy for St Lucia. Also, the need for this to be part of a coordinated regional response that avoids duplication in spending is highlighted.

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Climate change is a naturally occurring phenomenon in which the earth‘s climate goes through cycles of warming and cooling; these changes usually take place incrementally over millennia. Over the past century, there has been an anomalous increase in global temperature, giving rise to accelerated climate change. It is widely accepted that greenhouse gas emissions from human activities such as industries have contributed significantly to the increase in global temperatures. The existence and survival of all living organisms is predicated on the ability of the environment in which they live not only to provide conditions for their basic needs but also conditions suitable for growth and reproduction. Unabated climate change threatens the existence of biophysical and ecological systems on a planetary scale. The present study aims to examine the economic impact of climate change on health in Jamaica over the period 2011-2050. To this end, three disease conditions with known climate sensitivity and importance to Jamaican public health were modelled. These were: dengue fever, leptospirosis and gastroenteritis in children under age 5. Historical prevalence data on these diseases were obtained from the Ministry of Health Jamaica, the Caribbean Epidemiology Centre, the Climate Studies Group Mona, University of the West Indies Mona campus, and the Meteorological Service of Jamaica. Data obtained spanned a twelve-year period of 1995-2007. Monthly data were obtained for dengue and gastroenteritis, while for leptospirosis, the annual number of cases for 1995-2005 was utilized. The two SRES emission scenarios chosen were A2 and B2 using the European Centre Hamburg Model (ECHAM) global climate model to predict climate variables for these scenarios. A business as usual (BAU) scenario was developed using historical disease data for the period 2000-2009 (dengue fever and gastroenteritis) and 1995-2005 (leptospirosis) as the reference decades for the respective diseases. The BAU scenario examined the occurrence of the diseases in the absence of climate change. It assumed that the disease trend would remain unchanged over the projected period and the number of cases of disease for each decade would be the same as the reference decade. The model used in the present study utilized predictive empirical statistical modelling to extrapolate the climate/disease relationship in time, to estimate the number of climate change-related cases under future climate change scenarios. The study used a Poisson regression model that considered seasonality and lag effects to determine the best-fit model in relation to the diseases under consideration. Zhang and others (2008), in their review of climate change and the transmission of vector-borne diseases, found that: ―Besides climatic variables, few of them have included other factors that can affect the transmission of vector-borne disease….‖ (Zhang 2008) Water, sanitation and health expenditure are key determinants of health. In the draft of the second communication to IPCC, Jamaica noted the vulnerability of public health to climate change, including sanitation and access to water (MSJ/UNDP, 2009). Sanitation, which in its broadest context includes the removal of waste (excreta, solid, or other hazardous waste), is a predictor of vector-borne diseases (e.g. dengue fever), diarrhoeal diseases (such as gastroenteritis) and zoonoses (such as leptospirosis). In conceptualizing the model, an attempt was made to include non-climate predictors of these climate-sensitive diseases. The importance of sanitation and water access to the control of dengue, gastroenteritis and leptospirosis were included in the Poisson regression model. The Poisson regression model obtained was then used to predict the number of disease cases into the future (2011-2050) for each emission scenario. After projecting the number of cases, the cost associated with each scenario was calculated using four cost components. 1. Treatment cost morbidity estimate. The treatment cost for the number of cases was calculated using reference values found in the literature for each condition. The figures were derived from studies of the cost of treatment and represent ambulatory and non-fatal hospitalized care for dengue fever and gastroenteritis. Due to the paucity of published literature on the health care cost associated with leptospirosis, only the cost of diagnosis and antibiotic therapy were included in the calculation. 2. Mortality estimates. Mortality estimates are recorded as case fatality rates. Where local data were available, these were utilized. Where these were unavailable, appropriate reference values from the literature were used. 3. Productivity loss. Productivity loss was calculated using a human capital approach, by multiplying the expected number of productive days lost by the caregiver and/or the infected person, by GDP per capita per day (US$ 14) at 2008 GDP using 2008 US$ exchange rates. 4. No-option cost. The no-option cost refers to adaptation strategies for the control of dengue fever which are ongoing and already a part of the core functions of the Vector Control Division of the Ministry of Health, Jamaica. An estimated US$ 2.1 million is utilized each year in conducting activities to prevent the post-hurricane spread of vector borne diseases and diarrhoea. The cost includes public education, fogging, laboratory support, larvicidal activities and surveillance. This no-option cost was converted to per capita estimates, using population estimates for Jamaica up to 2050 obtained from the Statistical Institute of Jamaica (STATIN, 2006) and the assumption of one expected major hurricane per decade. During the decade 2000-2009, Jamaica had an average inflation of 10.4% (CIA Fact book, last updated May 2011). This average decadal inflation rate was applied to the no-option cost, which was inflated by 10% for each successive decade to adjust for changes in inflation over time.