The Green Light on Buying a Car: How Consumer Decision-Making Interacts with Environmental Attributes in the New Vehicle Purchase Process.

Although it is commonly understood that the average U.S. new vehicle buyer ranks price and safety above environmental attributes, a stated ranking of one shopping criterion above another is not necessarily maintained when consumers make an actual purchase decision. In fact, the distribution of shopping criteria rankings is not well understood, and it is unclear how rankings translate to the attributes of purchased vehicles. This raises several related questions: What is the distribution of shopping criteria rankings across the U.S. and how do they differ among demographic groups and purchasers of different vehicle fuel types or body styles?How do consumers weigh their purchase criteria?How does the environmental impact of a vehicle rank as a purchase criterion for U.S. new vehicle buyers, and its importance differ among gender, age, or income groups?Do purchase criteria differ for consumers who state that they value the environment?Is a consumer's shopping criteria ranking of environmental attributes reflected in the vehicles they consider and ultimately purchase? We explore these issues using data from an extensive survey of new vehicle buyers in 2014, 2015, and 2016 (approximately 250,000 respondents per year). We broadly find the environmental criterion outranked by preference for safety and performance, but different patterns emerge across groups defined by household income, purchased vehicle fuel type, and other measures of respondent attitude toward the environment. Stated preferences for environmental attributes align with higher fuel economy and greater likelihood of electric or hybrid fuel type within considered and purchased vehicles.

Clinical characteristics of patients who test positive for Clostridium difficile by repeat PCR.

The high sensitivity of PCR assays for diagnosing Clostridium difficile infection (CDI) has greatly reduced the need for repeat testing after a negative result. Nevertheless, a small subset of patients do test positive within 7 days of a negative test. The aim of this study was to evaluate the clinical characteristics of these patients to determine when repeat testing may be appropriate. The results of all Xpert C. difficile PCR (Cepheid, Sunnyvale CA) tests performed in the clinical microbiology laboratory at New York-Presbyterian Hospital, Columbia University Medical Center (NYPH/CUMC) from 1 May 2011 through 6 September 2013, were reviewed. A retrospective case-control study was performed, comparing patients who tested positive within 7 days of a negative test result to a random selection of 50 controls who tested negative within 7 days of a negative test result. During the study period, a total of 14,875 tests were performed, of which 1,066 were repeat tests (7.2%). Eleven of these repeat tests results were positive (1.0%). The only risk factor independently associated with repeat testing positive was history of a prior CDI (odds ratio [OR], 19.6 [95% confidence interval {CI}, 4.0 to 19.5], P < 0.001). We found that patients who test positive for C. difficile by PCR within 7 days of a negative test are more likely to have a history of CDI than are patients who test negative with repeat PCR. This finding may be due to the high rate of disease relapse or the increased likelihood of empirical therapy leading to false-negative results in these patients.

US local action on heat and health: are we prepared for climate change?

OBJECTIVES: Global climate change is increasing the frequency of heat waves, hot weather, and temperature variability, which contribute to mortality and illness. Baseline information on local efforts to reduce heat vulnerability, including public advisories; minimizing greenhouse gas emissions; and mitigating urban heat islands, is lacking. METHODS: We designed a survey about local government programs to prevent health problems and reduce heat exposure during heatwaves and administered it to 285 US communities. RESULTS: Of 70 respondents, 26 indicated that excessive heat events are a significant issue for the local government; 30 had established preventive programs. Local government leadership and public health impacts of heat were cited most frequently as extremely important determinants of preventive programs, followed by implementation costs, economic impacts of hot weather, and greenhouse gas emissions mitigation. Cool paving materials and vegetated roofs were common heat mitigation strategies. Fact sheets and case studies were desired guidance for protecting communities during hot weather. CONCLUSIONS: New partnerships and financial resources are needed to support more widespread local action to prevent adverse health consequences of climate change and promote environmental sustainability.