document_title: Preventive healthcare

question_text: restoration of effective function is the goal of which level of prevention

text: Preventive healthcare

text: Levels of prevention[edit]

text: Preventive healthcare strategies are described as taking place at the primal, primary, secondary, and tertiary prevention levels. In the 1940s, Hugh R. Leavell and E. Gurney Clark coined the term primary prevention. They worked at the Harvard and Columbia University Schools of Public Health, respectively, and later expanded the levels to include secondary and tertiary prevention.[9] Goldston (1987) notes that these levels might be better described as "prevention, treatment, and rehabilitation",[9] though the terms primary, secondary, and tertiary prevention are still in use today. The concept of primal prevention has been created much more recently, in relation to the new developments in molecular biology over the last fifty years,[10] more particularly in epigenetics, which point to the paramount importance of environmental conditions - both physical and affective - on the organism during its fetal and newborn life (or so-called primal life).[11]

text:
Level
Definition

Primal and primordial prevention
Any measure aimed at helping future parents provide their upcoming child with adequate attention, as well as secure physical and affective environments from conception to first birthday (i.e., over the child's primal period of life[12]).
Primordial prevention refers to measures designed to avoid the development of risk factors in the first place, early in life.[13][14]

Primary prevention
Methods to avoid occurrence of disease either through eliminating disease agents or increasing resistance to disease.[15] Examples include immunization against disease, maintaining a healthy diet and exercise regimen, and avoiding smoking.[16]

Secondary prevention
Methods to detect and address an existing disease prior to the appearance of symptoms.[15] Examples include treatment of hypertension (a risk factor for many cardiovascular diseases), cancer screenings[16]

Tertiary prevention
Methods to reduce the harm of symptomatic disease, such as disability or death, through rehabilitation and treatment.[15] Examples include surgical procedures that halt the spread or progression of disease[15]

Quaternary prevention
Methods to mitigate or avoid results of unnecessary or excessive interventions in the health system[17]

tag: table

text: Primal and primordial prevention[edit]

text: A separate category of "health promotion" has recently been propounded. This health promotion par excellence is based on the 'new knowledge' in molecular biology, in particular on epigenetic knowledge, which points to how much affective - as well as physical - environment during fetal and newborn life may determine each and every aspect of adult health.[18][19][20] This new way of promoting health is now commonly called primal prevention.[21] It consists mainly in providing future parents with pertinent, unbiased information on primal health and supporting them during their child's primal period of life (i.e., "from conception to first anniversary" according to definition by the Primal Health Research Centre, London). This includes adequate parental leave[22] - ideally for both parents - with kin caregiving[23] and financial help where needed.

text: Another related concept is primordial prevention which to refers to all measures designed to prevent the development of risk factors in the first place, early in life.[13][14]

text: Primary prevention[edit]

text: Primary prevention consists of traditional "health promotion" and "specific protection."[15] Health promotion activities are current, non-clinical life choices. For example, eating nutritious meals and exercising daily, that both prevent disease and create a sense of overall well-being. Preventing disease and creating overall well-being, prolongs our life expectancy.[1][15] Health-promotional activities do not target a specific disease or condition but rather promote health and well-being on a very general level.[1] On the other hand, specific protection targets a type or group of diseases and complements the goals of health promotion.[15] In the case of a sexually transmitted disease such as syphilis health promotion activities would include avoiding microorganisms by maintaining personal hygiene, routine check-up appointments with the doctor, general sex education, etc. whereas specific protective measures would be using prophylactics (such as condoms) during sex and avoiding sexual promiscuity.[1]

text: Food is very much the most basic tool in preventive health care. The 2011 National Health Interview Survey performed by the Centers for Disease Control was the first national survey to include questions about ability to pay for food. Difficulty with paying for food, medicine, or both is a problem facing 1 out of 3 Americans. If better food options were available through food banks, soup kitchens, and other resources for low-income people, obesity and the chronic conditions that come along with it would be better controlled [24] A "food desert" is an area with restricted access to healthy foods due to a lack of supermarkets within a reasonable distance. These are often low-income neighborhoods with the majority of residents lacking transportation .[25] There have been several grassroots movements in the past 20 years to encourage urban gardening, such as the GreenThumb organization in New York City. Urban gardening uses vacant lots to grow food for a neighborhood and is cultivated by the local residents.[26] Mobile fresh markets are another resource for residents in a "food desert", which are specially outfitted buses bringing affordable fresh fruits and vegetables to low-income neighborhoods. These programs often hold educational events as well such as cooking and nutrition guidance.[27] Programs such as these are helping to provide healthy, affordable foods to the people who need them the most.

text: Scientific advancements in genetics have significantly contributed to the knowledge of hereditary diseases and have facilitated great progress in specific protective measures in individuals who are carriers of a disease gene or have an increased predisposition to a specific disease. Genetic testing has allowed physicians to make quicker and more accurate diagnoses and has allowed for tailored treatments or personalized medicine.[1] Similarly, specific protective measures such as water purification, sewage treatment, and the development of personal hygienic routines (such as regular hand-washing) became mainstream upon the discovery of infectious disease agents such as bacteria. These discoveries have been instrumental in decreasing the rates of communicable diseases that are often spread in unsanitary conditions.[1]

text: Secondary prevention[edit]

text: Secondary prevention deals with latent diseases and attempts to prevent an asymptomatic disease from progressing to symptomatic disease.[15] Certain diseases can be classified as primary or secondary. This depends on definitions of what constitutes a disease, though, in general, primary prevention addresses the root cause of a disease or injury[15] whereas secondary prevention aims to detect and treat a disease early on.[28] Secondary prevention consists of "early diagnosis and prompt treatment" to contain the disease and prevent its spread to other individuals, and "disability limitation" to prevent potential future complications and disabilities from the disease.[1] For example, early diagnosis and prompt treatment for a syphilis patient would include a course of antibiotics to destroy the pathogen and screening and treatment of any infants born to syphilitic mothers. Disability limitation for syphilitic patients includes continued check-ups on the heart, cerebrospinal fluid, and central nervous system of patients to curb any damaging effects such as blindness or paralysis.[1]

text: Tertiary prevention[edit]

text: Finally, tertiary prevention attempts to reduce the damage caused by symptomatic disease by focusing on mental, physical, and social rehabilitation. Unlike secondary prevention, which aims to prevent disability, the objective of tertiary prevention is to maximize the remaining capabilities and functions of an already disabled patient.[1] Goals of tertiary prevention include: preventing pain and damage, halting progression and complications from disease, and restoring the health and functions of the individuals affected by disease.[28] For syphilitic patients, rehabilitation includes measures to prevent complete disability from the disease, such as implementing work-place adjustments for the blind and paralyzed or providing counseling to restore normal daily functions to the greatest extent possible.[1]

text: Leading causes of preventable death[edit]

text: United States[edit]

text: The leading cause of death in the United States was tobacco. However, poor diet and lack of exercise may soon surpass tobacco as a leading cause of death. These behaviors are modifiable and public health and prevention efforts could make a difference to reduce these deaths.[4]

text:
Leading causes of preventable deaths in the United States in the year 2000[4]

Cause
Deaths caused
 % of all deaths

Tobacco smoking
435,000
18.1

Poor diet and physical inactivity
400,000
16.6

Alcohol consumption
85,000
3.5

Infectious diseases
75,000
3.1

Toxicants
55,000
2.3

Traffic collisions
43,000
1.8

Firearm incidents
29,000
1.2

Sexually transmitted infections
20,000
0.8

Drug abuse
17,000
0.7

text: Worldwide[edit]

text: The leading causes of preventable death worldwide share similar trends to the United States. There are a few differences between the two, such as malnutrition, pollution, and unsafe sanitation, that reflect health disparities between the developing and developed world.[29]

text:
Leading causes of preventable death worldwide as of the year 2001[29]

Cause
Deaths caused (millions per year)

Hypertension
7.8

Smoking
5.0

High cholesterol
3.9

Malnutrition
3.8

Sexually transmitted infections
3.0

Poor diet
2.8

Overweight and obesity
2.5

Physical inactivity
2.0

Alcohol
1.9

Indoor air pollution from solid fuels
1.8

Unsafe water and poor sanitation
1.6

text: Child mortality[edit]

text: In 2010, 7.6 million children died before reaching the age of 5. While this is a decrease from 9.6 million in the year 2000,[30] it is still far from the fourth Millennium Development Goal to decrease child mortality by two-thirds by the year 2015.[31] Of these deaths, about 64% were due to infection (including diarrhea, pneumonia, and malaria).[30] About 40% of these deaths occurred in neonates (children ages 1–28 days) due to pre-term birth complications.[31] The highest number of child deaths occurred in Africa and Southeast Asia.[30] In Africa, almost no progress has been made in reducing neonatal death since 1990.[31] India, Nigeria, Democratic Republic of the Congo, Pakistan, and China contributed to almost 50% of global child deaths in 2010. Targeting efforts in these countries is essential to reducing the global child death rate.[30]

text: Child mortality is caused by a variety of factors including poverty, environmental hazards, and lack of maternal education.[32] The World Health Organization created a list of interventions in the following table that were judged economically and operationally "feasible," based on the healthcare resources and infrastructure in 42 nations that contribute to 90% of all infant and child deaths. The table indicates how many infant and child deaths could have been prevented in the year 2000, assuming universal healthcare coverage.[32]

text:
Leading preventive interventions that reduce deaths in children 0–5 years old worldwide[32]

Intervention
Percent of all child deaths preventable

Breastfeeding
13

Insecticide-treated materials
7

Complementary feeding
6

Zinc
4

Clean delivery
4

Hib vaccine
4

Water, sanitation, hygiene
3

Antenatal steroids
3

Newborn temperature management
2

Vitamin A
2

Tetanus toxoid
2

Nevirapine and replacement feeding
2

Antibiotics for premature rupture of membranes
1

Measles vaccine
1

Antimalarial intermittent preventive treatment in pregnancy
<1%

text: Preventive methods[edit]

text: Obesity[edit]

text: Obesity is a major risk factor for a wide variety of conditions including cardiovascular diseases, hypertension, certain cancers, and type 2 diabetes. In order to prevent obesity, it is recommended that individuals adhere to a consistent exercise regimen as well as a nutritious and balanced diet. A healthy individual should aim for acquiring 10% of their energy from proteins, 15-20% from fat, and over 50% from complex carbohydrates, while avoiding alcohol as well as foods high in fat, salt, and sugar. Sedentary adults should aim for at least half an hour of moderate-level daily physical activity and eventually increase to include at least 20 minutes of intense exercise, three times a week.[33] Preventive health care offers many benefits to those that chose to participate in taking an active role in the culture. The medical system in our society is geared toward curing acute symptoms of disease after the fact that they have brought us into the emergency room. An ongoing epidemic within American culture is the prevalence of obesity. Eating healthier and routinely exercising plays a huge role in reducing an individuals risk for type 2 diabetes. About 23.6 million people in the United States have diabetes. Of those, 17.9 million are diagnosed and 5.7 million are undiagnosed. Ninety to 95 percent of people with diabetes have type 2 diabetes. Diabetes is the main cause of kidney failure, limb amputation, and new-onset blindness in American adults.[34]

text: Sexually transmitted infections[edit]

text: STIs are common both in history and in today's society. STIs can be asymptomatic or cause a range of symptoms. Condom and other barrier use reduces the risk of acquiring some STIs.[35] STI prophylaxis includes: condom use, abstinence, testing and screening a partner, regular health check-ups, and certain medications such as Truvada.

text: Thrombosis[edit]

text: Thrombosis is a serious circulatory disease affecting thousands, usually older persons undergoing surgical procedures, women taking oral contraceptives and travelers. Consequences of thrombosis can be heart attacks and strokes. Prevention can include: exercise, anti-embolism stockings, pneumatic devices, and pharmacological treatments.

text: Cancer[edit]

text: In recent years, cancer has become a global problem. Low and middle income countries share a majority of the cancer burden largely due to exposure to carcinogens resulting from industrialization and globalization.[36] However, primary prevention of cancer and knowledge of cancer risk factors can reduce over one third of all cancer cases. Primary prevention of cancer can also prevent other diseases, both communicable and non-communicable, that share common risk factors with cancer.[36]

text: Lung cancer[edit]

text: Lung cancer is the leading cause of cancer-related deaths in the United States and Europe and is a major cause of death in other countries.[37] Tobacco is an environmental carcinogen and the major underlying cause of lung cancer.[37] Between 25% and 40% of all cancer deaths and about 90% of lung cancer cases are associated with tobacco use. Other carcinogens include asbestos and radioactive materials.[38] Both smoking and second-hand exposure from other smokers can lead to lung cancer and eventually death.[37] Therefore, prevention of tobacco use is paramount to prevention of lung cancer.

text: Individual, community, and statewide interventions can prevent or cease tobacco use. 90% of adults in the US who have ever smoked did so prior to the age of 20. In-school prevention/educational programs, as well as counseling resources, can help prevent and cease adolescent smoking.[38] Other cessation techniques include group support programs, nicotine replacement therapy (NRT), hypnosis, and self-motivated behavioral change. Studies have shown long term success rates (>1 year) of 20% for hypnosis and 10%-20% for group therapy.[38]

text: Cancer screening programs serve as effective sources of secondary prevention. The Mayo Clinic, Johns Hopkins, and Memorial Sloan-Kettering hospitals conducted annual x-ray screenings and sputum cytology tests and found that lung cancer was detected at higher rates, earlier stages, and had more favorable treatment outcomes, which supports widespread investment in such programs.[38]

text: Legislation can also affect smoking prevention and cessation. In 1992, Massachusetts (United States) voters passed a bill adding an extra 25 cent tax to each pack of cigarettes, despite intense lobbying and a $7.3 million spent by the tobacco industry to oppose this bill. Tax revenue goes toward tobacco education and control programs and has led to a decline of tobacco use in the state.[39]

text: Lung cancer and tobacco smoking are increasing worldwide, especially in China. China is responsible for about one-third of the global consumption and production of tobacco products.[40] Tobacco control policies have been ineffective as China is home to 350 million regular smokers and 750 million passive smokers and the annual death toll is over 1 million.[40] Recommended actions to reduce tobacco use include: decreasing tobacco supply, increasing tobacco taxes, widespread educational campaigns, decreasing advertising from the tobacco industry, and increasing tobacco cessation support resources.[40] In Wuhan, China, a 1998 school-based program, implemented an anti-tobacco curriculum for adolescents and reduced the number of regular smokers, though it did not significantly decrease the number of adolescents who initiated smoking. This program was therefore effective in secondary but not primary prevention and shows that school-based programs have the potential to reduce tobacco use.[41]

text: Skin cancer[edit]

text: Skin cancer is the most common cancer in the United States.[42] The most lethal form of skin cancer, melanoma, leads to over 50,000 annual deaths in the United States.[42] Childhood prevention is particularly important because a significant portion of ultraviolet radiation exposure from the sun occurs during childhood and adolescence and can subsequently lead to skin cancer in adulthood. Furthermore, childhood prevention can lead to the development of healthy habits that continue to prevent cancer for a lifetime.[42]

text: The Centers for Disease Control and Prevention (CDC) recommends several primary prevention methods including: limiting sun exposure between 10 AM and 4 PM, when the sun is strongest, wearing tighter-weave natural cotton clothing, wide-brim hats, and sunglasses as protective covers, using sunscreens that protect against both UV-A and UV-B rays, and avoiding tanning salons.[42] Sunscreen should be reapplied after sweating, exposure to water (through swimming for example) or after several hours of sun exposure.[42] Since skin cancer is very preventable, the CDC recommends school-level prevention programs including preventive curricula, family involvement, participation and support from the school's health services, and partnership with community, state, and national agencies and organizations to keep children away from excessive UV radiation exposure.[42]

text: Most skin cancer and sun protection data comes from Australia and the United States.[43] An international study reported that Australians tended to demonstrate higher knowledge of sun protection and skin cancer knowledge, compared to other countries.[43] Of children, adolescents, and adults, sunscreen was the most commonly used skin protection. However, many adolescents purposely used sunscreen with a low sun protection factor (SPF)in order to get a tan.[43] Various Australian studies have shown that many adults failed to use sunscreen correctly; many applied sunscreen well after their initial sun exposure and/or failed to reapply when necessary.[44][45][46] A 2002 case-control study in Brazil showed that only 3% of case participants and 11% of control participants used sunscreen with SPF >15.[47]

text: Cervical cancer[edit]

text: Cervical cancer ranks among the top three most common cancers among women in Latin America, sub-Saharan Africa, and parts of Asia. Cervical cytology screening aims to detect abnormal lesions in the cervix so that women can undergo treatment prior to the development of cancer. Given that high quality screening and follow-up care has been shown to reduce cervical cancer rates by up to 80%, most developed countries now encourage sexually active women to undergo a pap test every 3–5 years. Finland and Iceland have developed effective organized programs with routine monitoring and have managed to significantly reduce cervical cancer mortality while using fewer resources than unorganized, opportunistic programs such as those in the United States or Canada.[48]

text: In developing nations in Latin America, such as Chile, Colombia, Costa Rica, and Cuba, both public and privately organized programs have offered women routine cytological screening since the 1970s. However, these efforts have not resulted in a significant change in cervical cancer incidence or mortality in these nations. This is likely due to low quality, inefficient testing. However, Puerto Rico, which has offered early screening since the 1960s, has witnessed an almost a 50% decline in cervical cancer incidence and almost a four-fold decrease in mortality between 1950 and 1990. Brazil, Peru, India, and several high-risk nations in sub-Saharan Africa which lack organized screening programs, have a high incidence of cervical cancer.[48]

text: Colorectal cancer[edit]

text: Colorectal cancer is globally the second most common cancer in women and the third-most common in men,[49] and the fourth most common cause of cancer death after lung, stomach, and liver cancer,[50] having caused 715,000 deaths in 2010.[51]

text: It is also highly preventable; about 80 percent[52] of colorectal cancers begin as benign growths, commonly called polyps, which can be easily detected and removed during a colonoscopy. Other methods of screening for polyps and cancers include fecal occult blood testing. Lifestyle changes that may reduce the risk of colorectal cancer include increasing consumption of whole grains, fruits and vegetables, and reducing consumption of red meat (see Colorectal cancer).

text: Health disparities and barriers to accessing care[edit]

text: Access to healthcare and preventive health services is unequal, as is the quality of care received. A study conducted by the Agency for Healthcare Research and Quality (AHRQ)revealed health disparities in the United States. In the United States, elderly adults (>65 years old)received worse care and had less access to care than their younger counterparts. The same trends are seen when comparing all racial minorities (black, Hispanic, Asian) to white patients, and low-income people to high-income people.[53] Common barriers to accessing and utilizing healthcare resources included lack of income and education, language barriers, and lack of health insurance. Minorities were less likely than whites to possess health insurance, as were individuals who completed less education. These disparities made it more difficult for the disadvantaged groups to have regular access to a primary care provider, receive immunizations, or receive other types of medical care.[53] Additionally, uninsured people tend to not seek care until their diseases progress to chronic and serious states and they are also more likely to forgo necessary tests, treatments, and filling prescription medications.[54]

text: These sorts of disparities and barriers exist worldwide as well. Oftentimes there are decades of gaps in life expectancy between developing and developed countries. For example, Japan has an average life expectancy that is 36 years greater than that in Malawi.[55] Low-income countries also tend to have fewer physicians than high-income countries. In Nigeria and Myanmar, there are fewer than 4 physicians per 100,000 people while Norway and Switzerland have a ratio that is ten-fold higher.[55] Common barriers worldwide include lack of availability of health services and healthcare providers in the region, great physical distance between the home and health service facilities, high transportation costs, high treatment costs, and social norms and stigma toward accessing certain health services.[56]

text: Economics of lifestyle-based prevention[edit]

text: With lifestyle factors such as diet and exercise rising to the top of preventable death statistics, the economics of healthy lifestyle is a growing concern. There is little question that positive lifestyle choices provide an investment in health throughout life.[57] To gauge success, traditional measures such as the quality years of life method (QALY), show great value. However, that method does not account for the cost of chronic conditions or future lost earnings because of poor health.[58] Developing future economic models that would guide both private and public investments as well as drive future policy to evaluate the efficacy of positive lifestyle choices on health is a major topic for economists globally.

text: Americans spend over three trillion a year on health care but have a higher rate of infant mortality, shorter life expectancies, and a higher rate of diabetes than other high-income nations because of negative lifestyle choices.[59] Despite these large costs, very little is spent on prevention for lifestyle-caused conditions in comparison. The Journal of American Medical Association estimates that $101 billion was spent in 2013 on the preventable disease of diabetes, and another $88 billion was spent on heart disease.[60] In an effort to encourage healthy lifestyle choices, workplace wellness programs are on the rise; but the economics and effectiveness data are still continuing to evolve and develop.[61]

text: Health insurance coverage impacts lifestyle choices. In a study by Sudano and Baker, even intermittent loss of coverage has negative effects on healthy choices.[62] The potential repeal of the Affordable Care Act (ACA) could significantly impact coverage for many Americans, as well as “The Prevention and Public Health Fund” which is our nation’s first and only mandatory funding stream dedicated to improving the public’s health.[63] Also covered in the ACA is counseling on lifestyle prevention issues, such as weight management, alcohol use, and treatment for depression.[64] Policy makers can have substantial effects on the lifestyle choices made by Americans.

text: Because chronic illnesses predominate as a cause of death in the US and pathways for treating chronic illnesses are complex and multifaceted, prevention is a best practice approach to chronic disease when possible. In many cases, prevention requires mapping complex pathways[65] to determine the ideal point for intervention. In addition to efficacy, prevention is considered a cost-saving measure. Cost-effectiveness analysis of prevention is achievable, but impacted by the length of time it takes to see effects/outcomes of intervention. This makes prevention efforts difficult to fund—particularly in strained financial contexts. Prevention potentially creates other costs as well, due to extending the lifespan and thereby increasing opportunities for illness. In order to establish reliable economics of prevention[66] for illnesses that are complicated in origin, knowing how best to assess prevention efforts, i.e. developing useful measures and appropriate scope, is required.

text: Effectiveness[edit]

text: Overview

text: There is no general consensus as to whether or not preventive healthcare measures are cost-effective, but they increase the quality of life dramatically. There are varying views on what constitutes a "good investment." Some argue that preventive health measures should save more money than they cost, when factoring in treatment costs in the absence of such measures. Others argue in favor of "good value" or conferring significant health benefits even if the measures do not save money[7][67] Furthermore, preventive health services are often described as one entity though they comprise a myriad of different services, each of which can individually lead to net costs, savings, or neither. Greater differentiation of these services is necessary to fully understand both the financial and health effects.[7]

text: A 2010 study reported that in the United States, vaccinating children, cessation of smoking, daily prophylactic use of aspirin, and screening of breast and colorectal cancers had the most potential to prevent premature death.[7] Preventive health measures that resulted in savings included vaccinating children and adults, smoking cessation, daily use of aspirin, and screening for issues with alcoholism, obesity, and vision failure.[7] These authors estimated that if usage of these services in the United States increased to 90% of the population, there would be net savings of $3.7 billion, which comprised only about -0.2% of the total 2006 United States healthcare expenditure.[7] Despite the potential for decreasing healthcare spending, utilization of healthcare resources in the United States still remains low, especially among Latinos and African-Americans.[68] Overall, preventive services are difficult to implement because healthcare providers have limited time with patients and must integrate a variety of preventive health measures from different sources.[68]

text: While these specific services bring about small net savings not every preventive health measure saves more than it costs. A 1970s study showed that preventing heart attacks by treating hypertension early on with drugs actually did not save money in the long run. The money saved by evading treatment from heart attack and stroke only amounted to about a quarter of the cost of the drugs.[69][70] Similarly, it was found that the cost of drugs or dietary changes to decrease high blood cholesterol exceeded the cost of subsequent heart disease treatment.[71][72] Due to these findings, some argue that rather than focusing healthcare reform efforts exclusively on preventive care, the interventions that bring about the highest level of health should be prioritized.[67]

text: Cohen et al. (2008) outline a few arguments made by skeptics of preventive healthcare. Many argue that preventive measures only cost less than future treatment when the proportion of the population that would become ill in the absence of prevention is fairly large.[8] The Diabetes Prevention Program Research Group conducted a 2012 study evaluating the costs and benefits (in quality-adjusted life-years or QALY's) of lifestyle changes versus taking the drug metformin. They found that neither method brought about financial savings, but were cost-effective nonetheless because they brought about an increase in QALY's.[73] In addition to scrutinizing costs, preventive healthcare skeptics also examine efficiency of interventions. They argue that while many treatments of existing diseases involve use of advanced equipment and technology, in some cases, this is a more efficient use of resources than attempts to prevent the disease.[8] Cohen et al. (2008) suggest that the preventive measures most worth exploring and investing in are those that could benefit a large portion of the population to bring about cumulative and widespread health benefits at a reasonable cost.[8]

text: There are at least four nationally implemented childhood obesity interventions in the United States: the Sugar-Sweetened Beverage excise tax (SSB), the TV AD program, active physical education (Active PE) policies, and early care and education (ECE) policies.[74] They each have similar goals of reducing childhood obesity. The effects of these interventions on BMI have been studied, and the cost-effectiveness analysis (CEA) has led to a better understanding of projected cost reductions and improved health outcomes.[75][76] The Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) was conducted to evaluate and compare the CEA of these four interventions.[74]

text: Gortmaker, S.L. et al. (2015) states: "The four initial interventions were selected by the investigators to represent a broad range of nationally scalable strategies to reduce childhood obesity using a mix of both policy and programmatic strategies... 1. an excise tax of $0.01 per ounce of sweetened beverages, applied nationally and administered at the state level (SSB), 2. elimination of the tax deductibility of advertising costs of TV advertisements for "nutritionally poor" foods and beverages seen by children and adolescents (TV AD), 3. state policy requiring all public elementary schools in which physical education (PE) is currently provided to devote ≥50% of PE class time to moderate and vigorous physical activity (Active PE), and 4. state policy to make early child educational settings healthier by increasing physical activity, improving nutrition, and reducing screen time (ECE)."

text: The CHOICES found that SSB, TV AD, and ECE led to net cost savings. Both SSB and TV AD increased quality adjusted life years and produced yearly tax revenue of 12.5 billion US dollars and 80 million US dollars, respectively.

text: Some challenges with evaluating the effectiveness of child obesity interventions include:

text:
The economic consequences of childhood obesity are both short and long term. In the short term, obesity impairs cognitive achievement and academic performance. Some believe this is secondary to negative effects on mood or energy, but others suggest there may be physiological factors involved.[77] Furthermore, obese children have increased health care expenses (e.g. medications, acute care visits). In the long term, obese children tend to become obese adults with associated increased risk for a chronic condition such as diabetes or hypertension.[78][79] Any effect on their cognitive development may also affect their contributions to society and socioeconomic status.
In the CHOICES, it was noted that translating the effects of these interventions may in fact differ among communities throughout the nation. In addition it was suggested that limited outcomes are studied and these interventions may have an additional effect that is not fully appreciated.
Modeling outcomes in such interventions in children over the long term is challenging because advances in medicine and medical technology are unpredictable. The projections from cost-effective analysis may need to be reassessed more frequently.

tag: ol

text: The cost-effectiveness of preventive care is a highly debated topic. While some economists argue that preventive care is valuable and potentially cost saving, others believe it is an inefficient waste of resources.[80] Preventive care is composed of a variety of clinical services and programs including annual doctor’s check-ups, annual immunizations, and wellness programs.

text: Clinical Preventive Services & Programs

text: Research on preventive care addresses the question of whether it is cost saving or cost effective and whether there is an economics evidence base for health promotion and disease prevention. The need for and interest in preventive care is driven by the imperative to reduce health care costs while improving quality of care and the patient experience. Preventive care can lead to improved health outcomes and cost savings potential. Services such as health assessments/screenings, prenatal care, and telehealth and telemedicine can reduce morbidity or mortality with low cost or cost savings.[81][82] Specifically, health assessments/screenings have cost savings potential, with varied cost-effectiveness based on screening and assessment type.[83] Inadequate prenatal care can lead to an increased risk of prematurity, stillbirth, and infant death.[84] Time is the ultimate resource and preventive care can help mitigate the time costs.[85] Telehealth and telemedicine is one option that has gained consumer interest, acceptance and confidence and can improve quality of care and patient satisfaction.[86]

text: Understanding the Economics for Investment

text: There are benefits and trade-offs when considering investment in preventive care versus other types of clinical services. Preventive care can be a good investment as supported by the evidence base and can drive population health management objectives.[87][82] The concepts of cost saving and cost-effectiveness are different and both are relevant to preventive care. For example, preventive care that may not save money may still provide health benefits. Thus, there is a need to compare interventions relative to impact on health and cost.[88]

text: Preventive care transcends demographics and is applicable to people of every age. The Health Capital Theory underpins the importance of preventive care across the lifecycle and provides a framework for understanding the variances in health and health care that are experienced. It treats health as a stock that provides direct utility. Health depreciates with age and the aging process can be countered through health investments. The theory further supports that individuals demand good health, that the demand for health investment is a derived demand (i.e. investment is health is due to the underlying demand for good health), and the efficiency of the health investment process increases with knowledge (i.e. it is assumed that the more educated are more efficient consumers and producers of health).[89]

text: The prevalence elasticity of demand for prevention can also provide insights into the economics. Demand for preventive care can alter the prevalence rate of a given disease and further reduce or even reverse any further growth of prevalence.[85] Reduction in prevalence subsequently leads to reduction in costs.

text: Economics for Policy Action

text: There are a number of organizations and policy actions that are relevant when discussing wthe economics of preventive care services. The evidence base, viewpoints, and policy briefs from the Robert Wood Johnson Foundation, the Organisation for Economic Co-operation and Development (OECD), and efforts by the U.S. Preventive Services Task Force (USPSTF) all provide examples that improve the health and well-being of populations (e.g. preventive health assessments/screenings, prenatal care, and telehealth/telemedicine). The Patient Protection and Affordable Care Act (PPACA, ACA) has major influence on the provision of preventive care services, although it is currently under heavy scrutiny and review by the new administration. According to the Centers for Disease Control and Prevention (CDC), the ACA makes preventive care affordable and accessible through mandatory coverage of preventive services without a deductible, copayment, coinsurance, or other cost sharing.[90]

text: The U.S. Preventive Services Task Force (USPSTF), a panel of national experts in prevention and evidence-based medicine, works to improve health of Americans by making evidence-based recommendations about clinical preventive services.[91] They do not consider the cost of a preventive service when determining a recommendation. Each year, the organization delivers a report to Congress that identifies critical evidence gaps in research and recommends priority areas for further review.[92]

text: The National Network of Perinatal Quality Collaboratives (NNPQC), sponsored by the CDC, supports state-based perinatal quality collaboratives (PQCs) in measuring and improving upon health care and health outcomes for mothers and babies. These PQCs have contributed to improvements such as reduction in deliveries before 39 weeks, reductions in healthcare associated blood stream infections, and improvements in the utilization of antenatal corticosteroids.[93]

text: Telehealth and telemedicine has realized significant growth and development recently. The Center for Connected Health Policy (The National Telehealth Policy Resource Center) has produced multiple reports and policy briefs on the topic of Telehealth and Telemedicine and how they contribute to preventive services.[94]

text: Policy actions and provision of preventive services do not guarantee utilization. Reimbursement has remained a significant barrier to adoption due to variances in payer and state level reimbursement policies and guidelines through government and commercial payers. Americans use preventive services at about half the recommended rate and cost-sharing, such as deductibles, co-insurance, or copayments, also reduce the likelihood that preventive services will be used.[95] Further, despite the ACA’s enhancement of Medicare benefits and preventive services, there were no effects on preventive service utilization, calling out the fact that other fundamental barriers exist.[96]

text: The Patient Protection and Affordable Care Act also known as just the Affordable Care Act or Obamacare was passed and became law in the United States on March 23, 2010.[97] The finalized and newly ratified law was to address many issues in the U.S. healthcare system, which included expansion of coverage, insurance market reforms, better quality, and the forecast of efficiency and costs.[98] Under the insurance market reforms the act required that insurance companies no longer exclude people with pre-existing conditions, allow for children to be covered on their parents plan until the age of 26, expand appeals that dealt with reimbursement denials. The Affordable Care Act also banned the limited coverage imposed by health insurances and insurance companies were to include coverage for preventive health care services.[99] The U.S. Preventive Services Task Force has categorized and rated preventive health services as either ‘”A” or “B”, as to which insurance companies must comply and present full coverage. Not only has the U.S. Preventive Services Task Force provided graded preventive health services that are appropriate for coverage they have also provided many recommendations to clinicians and insurers to promote better preventive care to ultimately provide better quality of care and lower the burden of costs.[100]

text:
Health insurance and Preventive Care
Healthcare insurance companies are willing to pay for preventive care despite the fact that patients are not acutely sick in hope that it will prevent them from developing a chronic disease later on in life.[101] Today, health insurance plans offered through the Marketplace, mandated by the Affordable Care Act are required to provide certain preventive care services free of charge to patients. Section 2713 of the Affordable Care Act, specifies that all private Marketplace and all employer-sponsored private plans (except those grandfathered in) are required to cover preventive care services that are ranked A or B by the US Preventive Services Task Force free of charge to patients.[102][103] For example, UnitedHealthcare insurance company has published patient guidelines at the beginning of the year explaining their preventive care coverage.[104]

text:
Evaluating Incremental Benefits of Preventive Care
Evaluating the incremental benefits of preventive care requires longer period of time when compared to acute ill patients. Inputs into the model such as, discounting rate and time horizon can have significant effects of the results. One controversial subject is use of 10-year time frame to assess cost effectiveness of diabetes preventive services by the Congressional Budget Office.[105]

text: The preventive care services mainly focuses on chronic disease,[106] the Congressional Budget Office has provided guidance that further research in the area of the economic impacts of obesity in the US before the CBO can estimate budgetary consequences. A bipartisan report published in May 2015, recognizes that the potential of the preventive care to improve patients health at individual and population levels while decreasing the healthcare expenditure.[107]


document_title: Cork cambium

question_text: what is the function of cork to the tree

root

text: Cork cambium

text: Cork cambium (pl. cambia or cambiums) is a tissue found in many vascular plants as part of the epidermis. The cork cambium is a lateral meristem and is responsible for secondary growth that replaces the epidermis in roots and stems. It is found in woody and many herbaceous dicots, gymnosperms and some monocots (monocots usually lack secondary growth). It is one of the plant's meristems – the series of tissues consisting of embryonic (incompletely differentiated) cells from which the plant grows. It is one of the many layers of bark, between the cork and primary phloem. The function of cork cambium is to produce the cork, a tough protective material.[1][2]

tag: p

text: Synonyms for cork cambium are bark cambium, pericambium and phellogen. Phellogen is defined as the meristematic cell layer responsible for the development of the periderm. Cells that grow inwards from there are termed phelloderm, and cells that develop outwards are termed phellem or cork (note similarity with vascular cambium). The periderm thus consists of three different layers:[1][2]

text:
phelloderm – inside of cork cambium; composed of living parenchyma cells
phellogen (cork cambium) – meristem that gives rise to periderm
phellem (cork) – dead at maturity; air-filled protective tissue on the outside

tag: ul

text: Growth and development of cork cambium is very variable between different species, and is also highly dependent on age and growth conditions, as can be observed from the different surfaces of bark, which may be smooth, fissured, tesselated, scaly, or flaking off.

text: Economic importance[edit]

text: Commercial cork is derived from the bark of the cork oak (Quercus suber). Cork has many uses including wine bottle stoppers, bulletin boards, coasters, hot pads to protect tables from hot pans, insulation, sealing for lids, flooring, gaskets for engines, fishing bobbers, handles for fishing rods and tennis rackets, etc. It is also a high strength-to-weight/cost ablative material for aerodynamic prototypes in wind tunnels, as well as satellite launch vehicle payload fairings, reentry surfaces, and compression joints in thrust-vectored solid rocket motor nozzles.[citation needed]

text: Many types of bark are used as mulch.


document_title: Lost in Space (2018 TV series)

question_text: where was lost in space tv show filmed

question_tokens: where was lost in space tv show filmed

text: Lost in Space (2018 TV series)

text: Premise[edit]

text: In the aftermath of an impact event that threatens the survival of humanity, the Robinson family is selected for the 24th mission of the Resolute (24th Colonist Group), an interstellar spacecraft carrying selected families to colonize the Alpha Centauri star system.

text: Before they reach their destination, an alien robot breaches the Resolute's hull. Forced to evacuate the mothership in short-range Jupiter spacecraft, scores of colonists, among them the Robinsons, crash on a nearby habitable planet. There they must contend with a strange environment and battle their own personal demons as they search for a way back to the Resolute.[1]

text: Cast[edit]

text: Main[edit]

text:
Molly Parker as mission commander Maureen Robinson, an aerospace engineer taking her family on the mission to colonize Alpha Centauri in hopes of building a new life on a better world. Married to John Robinson, she is the biological mother of Judy, Penny, and Will Robinson.[3]
Toby Stephens as John Robinson, former U.S. Marine and husband to Maureen. He is adoptive father to Judy and biological father to Penny and Will.[4]
Maxwell Jenkins as 11-year-old Will Robinson, who forms a tight bond with the Robot, which he saves from destruction during a forest fire.[5]
Taylor Russell as 18-year-old Judy Robinson, who serves as mission doctor, having received accelerated medical training.[6][7]
Mina Sundwall as 15-year-old Penny Robinson.[7][8]
Ignacio Serricchio as Don West, ship's mechanic and smuggler of luxury goods. He is accompanied by Debbie, which he calls his lucky chicken.[9]
Parker Posey as June Harris, a criminal and psychopath who assumes the identity of her sister Jessica to take her place on the colony ship and subsequently impersonates Dr. Zachary Smith during the attack to take his seat on an evacuating Jupiter ship. After landing on the planet, Harris attempts to sabotage the colonists' chances of rescue by the Resolute, all the while manipulating and gaslighting other survivors to avoid prosecution for her crimes.[10] The theft of the doctor's identity is a reference to the corresponding character of Dr. Smith in the original television series.[11]
Brian Steele as the Robot,[12] an alien robot being that Will encounters following the crash. The robot has a different form from the ones that appeared in the previous series and film.[13]

text: Recurring[edit]

text:
Raza Jaffrey as Victor Dhar, an officious politician whose arrogance and impatience mask an underlying sense of insecurity.[14]
Ajay Friese as Vijay Dhar, Victor's son and Penny's love interest
Cary-Hiroyuki Tagawa as Hiroki Watanabe, scientist and friend of Maureen
Kiki Sukezane as Aiko Watanabe, Hiroki's daughter
Yukari Komatsu as Naoko Watanabe, Hiroki's wife
Veenu Sandhu as Prisha Dhar, Victor's wife
Adam Greydon Reid as Peter Beckert
Amelia Burstyn as Diane
Iain Belcher as Evan
Shaun Parkes as Captain Radic, commander of the Resolute
Sibongile Mlambo as Angela Goddard,[15] a fellow survivor struggling with post traumatic stress disorder in the wake of her husband's death during the attack on the Resolute.

text: Guest[edit]

text:
Selma Blair as Jessica Harris, June's wealthy younger sister
Bill Mumy as Dr. Zachary Smith, the real Dr. Smith, whose identity June steals

text: Episodes[edit]

text: This section's plot summaries may be too long or excessively detailed. Please help improve them by removing unnecessary details and making them more concise. (September 2018) (Learn how and when to remove this template message)

text:
No.TitleDirected byWritten byOriginal release date1"Impact"Neil MarshallMatt Sazama & Burk SharplessApril 13, 2018 (2018-04-13)
The spacecraft Resolute is carrying colonists, including the Robinson family, to Alpha Centauri. The Resolute is attacked and colonists escape in their Jupiter landing crafts but are hurled into a wormhole, crash-landing on an Earth-like planet. The Robinsons' craft, Jupiter 2, crashes into a glacial bed. The family evacuates before their craft sinks in rapidly freezing water. Eldest Robinson child Judy, a doctor, dives to the ship to retrieve power equipment. She becomes encased in ice, and with five hours of oxygen left in Judy's suit, John and son Will set out to collect magnesium that will melt the ice. Judy guides her sister, Penny, through a medical procedure to treat their injured mother, Maureen. Inside a cave, Will falls down a chasm, landing at the edge of a forest. Will finds a crashed alien ship and a dismembered robot that he helps to self-repair. In return, it saves Will as a forest fire nearly engulfs them. The family attempt to free Judy, but a sudden rainstorm hinders their progress. Will and the Robot arrive, and the Robot rescues Judy. In a flashback scene, a woman steals the identity of Dr. Zachary Smith and boards a Jupiter landing craft, along with Don West and Tam Roughneck.
2"Diamonds in the Sky"Neil MarshallMatt Sazama & Burk SharplessApril 13, 2018 (2018-04-13)
Don West and Smith survive the Jupiter 18 landing. While looking for other survivors, they find Angela Goddard, who is barely alive. When a storm approaches, Don and Angela take cover while Smith heads out. Meanwhile, the robot melts more ice to allow the Robinsons to start the process of recovering the Jupiter 2. Maureen, John, Will and the robot hike to another Jupiter crash site and then later to the robot's ship. They leave Penny and Judy behind to raise the ship out of the ice. Inside the alien ship, a holographic map of the planet is activated, showing John and Maureen they are in an unidentified galaxy. Outside, the robot touches the ship's hull, creating a mental connection to Will who learns what really happened on the Resolute. When Penny sees the storm approaching she raises the Jupiter 2 enough to exit with the ship's Chariot all-terrain vehicle to reach her family just in front of the storm. As they head back to Jupiter 2 they see a flare and find Smith, who claims to be alone.
3"Infestation"Tim SouthamZack EstrinApril 13, 2018 (2018-04-13)
In a flashback, Dr. Smith is revealed to be June Harris, the older, ex-con sister of Jess Harris, a successful businesswoman. Jess offers June her entire estate as she is leaving Earth, but June drugs Jess and assumes her sister's identity. Aboard the Resolute, she bumps into her sister's lover and there is a struggle ending in him getting blown out an airlock. June is arrested but escapes during the robot's attack. In the present, Maureen explains they are trillions of light years from Earth. At night, the ice layer over Jupiter 2 cracks, endangering the ship. They rush to complete repairs, but the engines are losing fuel. When Will and the robot discover large eel-like creatures in the conduits, the robot locks Will, along with Smith, in the storeroom for safety. The glacier shifts, which forces the crew to make an emergency take-off after flushing the eels from the engines. They escape with just enough fuel to land near a forest region. Comms pick up radio communication from other survivors and also from Resolute, who are searching for survivors. Somebody hacks the onboard 3D printer to make a gun. Will finds it, and hides the gun under his mattress, unaware Smith is watching.
4"The Robinsons Were Here"Alice TroughtonKatherine CollinsApril 13, 2018 (2018-04-13)
Stuck without fuel, the family initiates Jupiter 2's colonization protocol. Smith and Will discuss the robot, who does Will's bidding. Don West and Angela are rescued by the Watanabe family; Hiroki Watanabe reunites with John and Maureen at Jupiter 11 where Judy treats Angela. She tells Judy about the attack on Resolute. None of the other surviving families can fly either due to the giant eels consuming fuel. Maureen, John, and Don realize that the Resolute cannot receive messages when they discover it's comm dish broken off. Judy confronts Will about the robot attack on the Resolute. They decide to hide the robot in a nearby cave, unaware Smith is following them. On the way they meet Vijay Dhar, the son of another survivor group. While away, Maureen and John discuss their marital problems. The next morning, the kids return to Jupiter 2 before their parents arrive. Smith talks to the robot inside the cave, attempting to instill distrust in it about Will. When John and Maureen return home, the kids tell them that the robot wandered away.
5"Transmission"Deborah ChowKari DrakeApril 13, 2018 (2018-04-13)
The surviving colonists build a light tower to try signal the Resolute. Maureen, noticing strange weather phenomena discovers that the sun is paired with a black hole which will render the planet uninhabitable. Penny develops a crush on Vijay. When Don confronts Dr. Smith about the stolen flare gun she claims she took it by mistake. In a flashback, Maureen and the kids discuss pros versus cons of going to Alpha Centauri. Don tells Judy about his suspicions about Dr. Smith's identity. When Judy confronts Dr. Smith about this she lies and casts doubt on Don. When the colonists activate the light signal, Dr. Smith sneaks away and shuts off the perimeter fence, allowing a large reptilian creature to enter the camp and destroy the light tower. When another creature shows up Will calls the robot. It saves the survivors, assuming its original multi-limb form. The colonists recognize the robot from the attack on the Resolute.
6"Eulogy"Vincenzo NataliEd McCardieApril 13, 2018 (2018-04-13)
Maureen tells her family about the black hole. In a heated discussion John convinces the other survivors to allow the robot to stay and takes Will on a hike to discuss his responsibility for the robot's actions. He has Will fetch 27 large stones to build a memorial to the casualties. Don takes the community leader and Vijay's father, Victor Dhar, to retrieve the fuel in his Jupiter which crashed in the desert where there are none of the eel-like creatures. Don also retrieves identification of the real Dr. Smith, later showing Judy. Maureen learns that Hiroki knows the planet is dying. Penny tells Vijay about the black hole but swears him to secrecy, and they share a kiss. Dr. Smith manipulates the distraught Angela into firing a gun at the robot causing it to go into attack mode and accidentally injures John. Distraught, Will has the robot walk off a cliff and then places a stone on the memorial for the robot.
7"Pressurized"Tim SouthamVivian LeeApril 13, 2018 (2018-04-13)
While driving back to Jupiter 2, Judy is about to tell Dr. Smith she knows the truth about her when Don stops her. When Will is confronted by his mother, he confirms the robot 3D-printed the gun and that he hid it. Dr. Smith refuses blame for Angela's attack, and suggests Victor Dhar might have taken the gun. John and Maureen's rover gets stuck in a tar pit. As they sink to the bottom, Maureen admits to doctoring Will's test results. To escape the vehicle, Maureen uses the helium weather balloon to create a shielded path to the surface. Meanwhile, Smith locates the destroyed robot, but cannot get it to reassemble. Don's group speeds through a dangerous geyser field but a tube shakes loose and when Evan fixes the problem, a geyser blast flips the tanker on top of him. Victor realizes that a rock has punctured the tanker and if they move it they will lose most of the fuel. Despite this Don reluctantly sides with Judy and lifts the tanker, spilling the fuel, but Evan dies anyway. Back on Jupiter 2, Dr. Smith finally manages to reactivate the robot. When Victor returns home, Vijay tells him about the planet's coming demise. Victor decides to use what fuel they did retrieve to launch their own Jupiter 4.
8"Trajectory"Stephen SurjikKatherine Collins & Kari DrakeApril 13, 2018 (2018-04-13)
Maureen cannot talk Victor out of launching, but John sneaks aboard the Dhar's Jupiter 4 and triggers the emergency shut down. Later, he explains to the gathered colonists how the planet is about to become uninhabitable. Penny breaks off with Vijay for him telling his father. Maureen has a plan on how to launch despite the limited fuel, stripping out non-essential modules, and relying on old-school manual piloting. Judy tells Maureen the truth about the real Dr. Smith aboard Don's Jupiter. Returning to Jupiter 2, Maureen confines Dr. Smith to a holding cell. Dr. Smith now claims she is really Jessica Harris, a physicist. Maureen tells John about Smith, and he tells her that Don believes the Jupiter 4 is still too heavy to take off. With life support also removed, the pilot now needs a spacesuit and will need to withstand extreme G-forces. They select John, but not even he can regain consciousness fast enough to make all the maneuvers alone. When the Resolute sends a message that due to Hawking radiation they must leave the planet's orbit within 24 hours, Don reluctantly agrees to help pilot the ship. With his assistance the test run is a success. As John and Don launch in the Jupiter 4, Dr. Smith tricks Will and escapes to knock out Maureen right when John needs her instructions. With everyone watching, the ship explodes mid-air.
9"Resurrection"Tim SouthamStory by : Daniel McLellan Teleplay by : Kari DrakeApril 13, 2018 (2018-04-13)
Will tries to signal his father using his radio, convinced he survived the explosion. Dr. Smith drives Maureen to the alien wreck, where she tells her she did not know Maureen was needed for the ship launch. She promises to help Maureen get her children off the planet, if she in return helps Dr. Smith with the alien ship. Will discovers that the rocks he collected in the cave are petrified biomass that can fuel the Jupiter ships to reach the Resolute. While the colonists gather to harvest the biomass, Judy leaves to find Maureen. The colonists find enough biomass to power all the Jupiters, but they must sneak it out quietly so as to not wake winged predators roosting in the cave. When John manages to send a signal, Penny and others are trapped inside the cave after the creatures wake up. Throughout the episode, flashbacks reveal the Christmas Star not to be a meteor but an alien craft, and that its engine was used to build Resolute. The robot's attack was an attempt to retrieve the stolen engine. The group trapped in the cave manage to narrowly escape. Judy tracks Smith and Maureen. She manages to disable Dr. Smith, but the robot reactivates and is revealed to obey the Doctor's commands.
10"Danger, Will Robinson"David NutterMatt Sazama & Burk SharplessApril 13, 2018 (2018-04-13)
John and Don survived the explosion and are clinging to ship wreckage in orbit, with only a few hours of oxygen left. Will is upset to learn the robot now serves Dr. Smith. John responds to Will, confirming that he and Don are still alive. Will tries to bond with the robot again but is rejected. Victor Dhar hails them from the Resolute, telling them it will leave in just over an hour. Maureen traps Dr Smith and the robot in order to search for John and Don. Just as they are about to retrieve them, Dr Smith and the robot escape. Maureen leads the robot into the garage as an alien ship arrives to retrieve the engine. When the alien robot is about to kill Will, his robot remembers him and attacks the alien robot, saving Will. In the fight, both robots are flung out into space and the garage ramp is damaged. Will goes outside the hull to manually close the hatch. Afterwards, he loses his grip but is saved by his father, who was rescued by Dr. Smith. With everyone safely back on the Jupiter, Maureen is grateful to Dr. Smith, but still locks her up. Before they can dock with the Resolute, the alien engine aboard the Jupiter 2 sends it and the Robinsons to a different galaxy. Will recognizes its shape from the robot's sand drawing: Danger.

text: Production[edit]

text: Development[edit]

text: In October 2014, it was announced that Legendary Television and Synthesis Entertainment were developing a new reboot of Lost in Space and had hired screenwriting duo Matt Sazama and Burk Sharpless to pen the pilot episodes.[16] In November 2015, Netflix landed the project.[17][18] On June 29, 2016, Netflix ordered a full 10 episode season of Lost in Space, with Zack Estrin as executive producer and showrunner. Sazama, Sharpless, Kevin Burns, Jon Jashni, Neil Marshall, and Marc Helwig also serve as executive producers.[19]

text: Filming[edit]

text: Production on the first season began in February 2017, in Vancouver, British Columbia, and concluded in July 2017.[20][21] Season 2 began production in September 2018, in Iceland, and is set to conclude in January 2019.[22]

text: Release[edit]

text: The series was released on April 13, 2018, on Netflix.[1] On March 31, 2018, the series pilot was screened at Awesome Con in Washington, D.C..[23]

text: Reception[edit]

text: The review aggregator website Rotten Tomatoes reported a 68% approval rating with an average rating of 6.21/10, based on 65 reviews. The website's critical consensus reads: "Lost in Space's production values are ambitious enough to attract sci-fi adventure fans, while the story's large heart adds an emotional anchor to all the deep space derring-do."[24] Metacritic, which uses a weighted average, assigned a normalized score of 58 out of 100 based on 27 critics, indicating "mixed or average reviews".[25]

text: David Griffin of IGN gave the first season a rating of 8.5/10, calling it "an excellent sci-fi adventure with a slight villain problem," giving particular praise to the Robinson family, while criticizing Parker Posey's Dr. Smith as an unsophisticated and one-dimensional character who lacks redeeming qualities.[26] In contrast, Jen Chaney of Vulture characterized Posey's performance as providing "understated, sly comedic touches".[27]


document_title: Wish You Were Here (Pink Floyd song)

question_text: what is the meaning of the song wish you were here by pink floyd

text: Wish You Were Here (Pink Floyd song)

text: Composition[edit]

text: In the original album version, the song segues from "Have a Cigar" as if a radio had been tuned away from one station, through several others (including a radio play and one playing the opening of the finale movement of Tchaikovsky's Fourth Symphony), and finally to a new station where "Wish You Were Here" is beginning.[4] The radio was recorded from Gilmour's car radio. He performed the intro on a twelve-string guitar, processed to sound like it was playing through an AM radio, and then overdubbed a fuller-sounding acoustic guitar solo. This passage was mixed to sound as though a guitarist were listening to the radio and playing along. As the acoustic part becomes more complex, the 'radio broadcast' fades away and Gilmour's voice enters, becoming joined by the full band.[5]

text: The intro riff is repeated several times, before Gilmour plays further solos with scat singing accompaniment. A third verse follows, featuring an increasingly expressive vocal from Gilmour and audible backing vocals. At the end of the recorded song, the final solo crossfades with wind sound effects, and finally segues into the second section of the multi-part suite "Shine On You Crazy Diamond".

text: Lyrically, the song is often considered to be a direct tribute to Syd Barrett. However, on the documentary The Story of Wish You Were Here, Gilmour and Waters separately describe the original concept that differs from this interpretation. Waters, who mainly wrote the lyrics complementing Gilmour's initial riff idea and subsequent joint composition, describes the lyrics as being directed at himself, as his lyrics often are. Being present in one's own life and freeing one's self in order to truly experience life is a main topic in this song. Gilmour, on the other hand, recognizes that he does not ever perform the song without remembering Syd Barrett. Waters later adds that the song is nevertheless open to interpretation.[6]

text: Both David Gilmour and Roger Waters have praised the song as one of Pink Floyd's finest. Roger Waters has noted that the collaboration between himself and David Gilmour on the song was "...really good. All bits of it are really, really good. I'm very happy about it."[7] David Gilmour has playfully called Wish You Were Here "a very simple country song" and stated that "because of its resonance and the emotional weight it carries, it is one of our best songs."[8]

text: Recording[edit]

text: "Wish You Were Here" was recorded at Abbey Road Studios, as part of the sessions for the entire album.

text: A noted part of the song was a planned contribution by Stéphane Grappelli. A jazz violinist popular at the time and well known for his collaborations with Yehudi Menuhin, both violinists were recording in a downstairs studio at Abbey Road at the time. Gilmour had suggested that there be a little "country fiddle" at the end of the song and invited them to participate. Grappelli duly obliged (Menuhin declined) on arranging a session fee of £300, equivalent to £2,300 in 2018.[9] Ultimately during mixing it was decided to almost remove his contribution, although it can just be heard around 5:21. According to Waters it was decided that it would be insulting to credit Grappelli in the sleeve notes for something so inaudible, although he did receive the agreed-upon fee.[10][11][12]

text: As part of the Why Pink Floyd...? campaign, the Experience and Immersion versions of the Wish You Were Here album include an alternative version of the song where Grappelli's part is heard in the instrumental break after the second verse and throughout the third verse before a considerably extended outro. Other less obvious differences are audible, for example at the section leading into the second verse.

text: The master tape of the original recording includes an entire performance of pedal steel guitar and electric guitar solos, played by Gilmour, that were not used in the final mix.[citation needed]

text: Live performances[edit]

text: "Wish You Were Here" made its stage debut on the band's 1977 tour, which featured a performance of the entire album at every show. It was not played live by the band for nearly ten years after this, yet became a concert staple after its reappearance in 1987, and was performed at nearly all subsequent Pink Floyd concerts. In the original 1977 concert performances, Gilmour would play his Fender Stratocaster instead of acoustic guitar, while Snowy White played a twelve-string Ovation acoustic guitar. At these shows, Nick Mason tuned an actual transistor radio on stage to a local radio station, seguing into the pre-recorded part from the album to start the song and Richard Wright would perform an extended piano coda as the wind effects played. A live version is included on Pulse. When Pink Floyd were inducted into the Rock and Roll Hall of Fame,[13] Gilmour and Wright (Mason was in the audience) performed the song with the assistance of their presenter Billy Corgan on rhythm guitar.

text: Gilmour has made the song a part of most of his tours, and included a live version on his Live in Gdansk album.

text: "Wish You Were Here" was performed by Ed Sheeran with Mason on drums, Mike Rutherford of Genesis on guitar and Richard Jones of The Feeling on bass at the Closing Ceremony of 2012 Summer Olympics in London. A performer, dressed in a suit, tightrope-walked across the stadium and shook hands with a mannequin at the end, which then burst into flames, referencing the album's cover.

text: On 13 December 2014 David Gilmour was a guest performer at a concert by the Bombay Bicycle Club at Earls Court Arena, their concert being the final event ever to take place there before its demolition. Band member Jamie MacColl introduced Gilmour, saying; "This man gave me my first guitar and was one of the first people to play this venue and by my count has played here more than 27 times." Gilmour then played with the band on their song "Rinse Me Down" before a performance of "Wish You Were Here".

text: Other recorded versions by Pink Floyd[edit]

text: "Wish You Were Here" later appeared as the fifth track on A Collection of Great Dance Songs (with the radio intro following the end of a heavily edited "Shine On You Crazy Diamond") and as the 23rd track on the Echoes compilation[14] (with the radio intro following "Arnold Layne", and at the end crossfading with "Jugband Blues").

text: A live recording included on the 1995 live album P•U•L•S•E was issued as a single/EP. Its intro replicates the sound of the original, semi-ambient intro. The cover of the EP features two men whose faces are distorted by fish bowls, referring to the line "We're just two lost souls swimming in a fish bowl, year after year".

text: In 2005, Waters and Eric Clapton performed the song at the Tsunami Aid concert, and in 2005's Live 8, Waters rejoined his former bandmates in London to perform it, along with four other classic Pink Floyd songs. Waters sung half the verses during Live 8, while in the original version Gilmour did all the vocals.[15][16]

text: Personnel[edit]

text:
David Gilmour – six and twelve-string acoustic guitars, pedal steel guitar, tape effects, lead and backing vocals, scat singing
Nick Mason – drums, tape effects
Roger Waters – bass guitar, tape effects
Richard Wright – Steinway piano, Minimoog

text: Charts[edit]

text:
Chart (2007)
Peak
position

Norway (VG-lista)[17]
18

text:
Chart (2012)
Peak
position

Austria (Ö3 Austria Top 40)[18]
48

France (SNEP)[19]
192

Germany (Media Control AG)[20]
67

UK Singles (Official Charts Company)[21]
68

text: Wish You Were Here (Live)[edit]

text:
"Wish You Were Here (Live)"

Single by Pink Floyd

from the album Pulse

B-side

"Coming Back to Life (Live)"
"Keep Talking (Live)"

Released
20 July 1995

Format

CD
CD (maxi)
CD-R

Recorded
20 September (Cinecittà, Rome), 1994

Genre

Progressive rock
acoustic rock

Label

Capitol (US)
EMI (UK)

Songwriter(s)

Roger Waters
David Gilmour

Producer(s)

James Guthrie
David Gilmour

Pink Floyd singles chronology

"High Hopes" / "Keep Talking"
(1994)
"Wish You Were Here (Live)"
(1995)
"Louder than Words"
(2014)

"High Hopes" / "Keep Talking"
(1994)
"Wish You Were Here (Live)"
(1995)
"Louder than Words"
(2014)

text: "Wish You Were Here (Live)" is a live recording of Pink Floyd's title track off their ninth studio album Wish You Were Here, recorded by the band for their third live album, Pulse. "Wish You Were Here (Live)" was released as a single on 20 July 1995 in the United Kingdom and Europe, notably the very last single released by the band until October 2014.

text: Track listing[edit]

text:
CD[22]

No.
Title
Length

1.
"Wish You Were Here (Live)"
5:40

2.
"Coming Back to Life (Live)"
6:40

text:
CD Maxi[23]

No.
Title
Length

1.
"Wish You Were Here (Live)"
5:40

2.
"Coming Back to Life (Live)"
6:40

3.
"Keep Talking (Live)"
6:54

text:
Netherlands promotional single[24]

No.
Title
Length

1.
"Wish You Were Here (Live)"
5:40

text: Charts[edit]

text:
Chart (1995)
Peak
position

US Billboard Hot Mainstream Rock Tracks[25]
13

text: Release history[edit]

text:
Region
Date
Format
Label
Catalog no.

Netherlands[26]
20 July 1995

CD-R (Contemporary hit radio)
CD
CD (maxi)

EMI
PFSING1 (CD-R)
724388220828 (CD)
7243 8 82207 2 9 (CD maxi)

United Kingdom

CD
CD maxi

724388220828 (CD)
7243 8 82207 2 9 (CD maxi)

text: Covers[edit]

text: Wyclef Jean version[edit]

text:
"Wish You Were Here"

Single by Wyclef Jean

from the album The Ecleftic: 2 Sides II a Book

B-side
"No Woman, No Cry"

Released
3 December 2001

Format

CD single
cassette

Recorded
2000

Genre

Progressive rock
rap rock
acoustic

Length
4:06

Label
Columbia

Songwriter(s)

David Gilmour
Roger Waters
Jerry 'Wonder' Duplessis
Wyclef Jean

Producer(s)

Jerry 'Wonder' Duplessis
Wyclef Jean

Wyclef Jean singles chronology

"Perfect Gentleman"
(2001)
"Wish You Were Here"
(2001)
"Two Wrongs"
(2002)

"Perfect Gentleman"
(2001)
"Wish You Were Here"
(2001)
"Two Wrongs"
(2002)

text: "Wish You Were Here" served as the fourth and final single from Wyclef Jean's second studio album, The Ecleftic: 2 Sides II a Book. It was released in December 2001, peaking at #28 on the UK Singles Chart.[27]

text:
"Wish You Were Here" (Radio edit) – 4:04
"No Woman, No Cry" (Live version) – 4:33
"911" (Live version) – 4:23
"Wish You Were Here" (Video) – 4:25

text:
"Wish You Were Here" (LP version) – 4:25
"Perfect Gentleman" (Remix radio edit) – 3:59

text: Other covers[edit]

text: British singer-songwriter Ed Sheeran performed a cover of this song at the Closing Ceremonies of the London Olympic Games in 2012 with Mike Rutherford, Richard Jones, David Arnold and Nick Mason on drums.[28]

text: American metal band Avenged Sevenfold covered this song on the deluxe version of their 2016 album, The Stage, along with five other covers. They perform the song live with the lead vocalist of the band Halestorm, Lzzy Hale. [29]

text: American comedy rock duo Ninja Sex Party covered this song on their 2016 cover album Under the Covers, and also produced a music video. [30]

text: The song can also be heard in the movie War Dogs (2016 film). Although it has been cut from its instrumental introduction and starts directly at the first verse.