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On today's episode (Episode 4) of Urban Puritano, we're having a Gospel Celebration! What is the Gospel all about? Why is it so simple a child can understand it and so profound that a philosopher-theologian can spend a lifetime studying it? Even angels contemplate and ponder the Gospel's message. What do you do with the Gospel? Are you ashamed of it or is it your highest honor and privilege? Let's scratch the surface of Romans 1:16-17 and find out what the Gospel essentially consists of!Background: According to the thrust on Romans 1: 1-15, the Gospel is a message concerning Jesus Christ, God's Son. This message originated with God and He revealed His plan and promises concerning Jesus Christ throughout His prophets in the Holy Scriptures. It is referred to as the gospel of His Son, who was resurrected from the dead and through whom we have received grace. The Gospel, then is a message of grace or unmerited favor for sinners among all nations. Why is this Christo-centric Gospel message even necessary? What does that imply about God? What does it imply about us? One major implication is: outside of God's grace in the Christ of Holy Scripture, there is nothing but bad news. Due to what we are, unrighteous, and due to what God is, absolutely righteous, we stand in need of the verdict against us to be overturned. This is very bad news, indeed.However, the thrust of the verses preceding vv 16-17 lead us in the direction of some other news. This other news isn't simply something we can take or leave. In light of our irremediably great predicament, the theme of vv 16-17 is good news.That is what the word "gospel" means. The gospel of Christ is good news for the sinner precisely where he needs it the most.What, then, does the Gospel message consist of? We will answer that question under two headings.(1) The Gospel is the power of God to salvation for everyone who believes it.(2) The Gospel reveals the righteousness of God from faith, to faith, and by faith.The conclusion of the matter is as this quote attributed to Martin Luther: "When I look at myself, I don't see how I can be saved. But when I look at Christ, I don't see how I can be lost." Or as Augustus Toplady wrote in "Rock of Ages": "Not the labor of my handsCan fulfill Thy law's demands;Could my zeal no respite know,Could my tears forever flow,All for sin could not atone;Thou must save, and Thou alone.Nothing in my hand I bring,Simply to Thy cross I cling;Naked, come to Thee for dress;Helpless, look to Thee for grace;Foul, I to the fountain fly;Wash me, Savior, or I die.While I draw this fleeting breath,When my eyes shall close in death,When I rise to worlds unknown,And behold Thee on Thy throne,Rock of Ages, cleft for me,Let me hide myself in Thee."To God alone be the glory! Salvation belongs to the Lord! Let's pray that God may use us to advance the Gospel wherever our cities of destruction may be until we reach the Celestial City. See you next time or see you in glory! 

A report by the Wisconsin Policy Forum indicates that more retirees and fewer young people could create a workforce dilemma for the state in the coming years. The Milwaukee Metropolitan Association of Commerce, or MMAC, has partnered with the Milwaukee 7 to help companies in the region attract, retain and train workers in jobs that offer growth potential. In this episode of Brandstorm, Susan Koehn, vice president of the Talent & Industry Partnership and point person for this initiative, tells us more about the workforce issues facing southeastern Wisconsin and what is being done to help businesses now and in the future. Background According to Susan, Wisconsin’s economic development and workforce development organizations have historically operated as two, independent silos. Economic development focused on corporate attraction projects, brick and mortar projects and building infrastructure.  Workforce development was involved in talent and training. Neither side was talking to each other, while the skills gap was growing larger in southeastern Wisconsin. Industry was blaming education for not producing the right kinds of worker’s skills to fill the jobs that were needed, and education blamed industry for not saying what skills were needed. The recognition that talent was a key driver of economic growth sparked the first attempt to break down the walls between economic and workforce development around 2007/08.  The goal was to get the two sides talking to change the narrative. MMAC/Milwaukee 7 Partnership The MMAC is a membership-based Chamber of Commerce. The Milwaukee 7 is a regional economic development organization for the seven counties in southeastern Wisconsin: Kenosha, Milwaukee, Ozaukee, Racine, Walworth, Washington and Waukesha. When the Milwaukee 7 was formed in 2005, there was a realization that industry was involved in a zero-sum gain by poaching talent from each other. Collaboration was needed to bring in new businesses, expand existing companies and create new investments. The MMAC played a critical role in bringing the two organizations together and forming the Talent & Industry Partnership. Today, they share office space and staff and are working together to address the shortage of talent in the region. Wisconsin Policy Forum Report Takeaways Susan says the demographics are undeniable. The now-retiring Baby Boomers were followed by two million fewer Gen Xers and this trend has continued in birth rates. There are just fewer young people coming into the workforce. The recession may have also masked the talent shortage because there were fewer job openings. When the recession ended, companies that used to post jobs and receive hundreds of qualified applicants were now seeing three or four applications from people who did not qualify for the jobs. So, while the report wasn’t surprising to people like Susan, it did confirm what businesses were seeing on the ground. Analyzing Southeastern Wisconsin’s Labor Supply Working with Manpower Group, research was conduction that indicates the workforce gap in the region’s seven counties will hit 38,000 in job openings by 2021.  Where are we going to find the people to fill them? According to the Manpower research, there are pockets in the region where there are lots of potential workers who are on the sidelines and not working because they are no longer looking for jobs, are underemployed or ineligible. In fact, there are about 300,000 workers with a high school diploma, but no post-secondary degrees or credentials. Susan believes we could leverage of larger talent pool by taking a closer look at the job openings and determining if a college degree is really needed, or if an individual can come on board and be trained while on the job. She says, according to one of the tenets of sales, it costs far less to retain customers than acquire new ones. The same holds true for employees. Businesses can upskill the employees while on the job for far less and backfill some of the other jobs with higher education requirements with fresh talent. Filling the Future Skills Gap Southeastern Wisconsin is in a great position to improve the workforce dilemma through education and training. We have many excellent higher education institutions and a good K12 education system.  And, there is an openness now for industry and education to collaborate. The industry can assist by providing real-world, learning opportunities, such as sponsoring classroom projects, job shadowing, internships, and guest business speakers. About 68-75 percent of college internships convert to direct hires. Susan says legacy companies and industries in the region, like manufacturing, need to show innovation potential through more experiential learning opportunities. In fact, 67 percent of Americans believe more internships for young people would increase interest in manufacturing. In Wisconsin, schools are mandated to provide academic as well as career planning, starting at the 6th-grade level through high school. MMAC has a program called “Be the Spark” that takes 7th graders from Milwaukee Public Schools on business tours. There is a push to increase the number of schools offering computer science classes and technical education for trades like plumbing, electrical and construction is making a comeback. And finally, Susan says the Wisconsin Economic Development Committee (WEDC) has a program called “Think-Make-Happen that is targeting the likeliest candidates to attract and relocate to Wisconsin.  For instance, Wisconsin provides one of the most generous packages to provide support, incentives and free education to service members in the country.  The organization is also targeting alumni of Wisconsin institutions to come back and Midwest millennials who already live in colder climates to relocate to our state’s booming economy and great quality of life. Opportunities for Growth Industries with the greatest potential for growth in southeastern Wisconsin are financial services, healthcare systems and manufacturing companies that are intersecting with smart technology.  There is also an effort to build technology ecosystems like Milwaukee’s Water District. Susan says while the challenge to fill the skills gap in our region is urgent, it is giving way to new ideas and ways to innovate and collaborate.  The Industry & Talent Partnership can help businesses, individuals and schools by connecting them with the right organizations and resources they need. Connect with Susan: Email:             skoehn@mke7.com Website:         https://www.mmac.org Twitter:          @mke7talent

Background: According to Ulrich's psychoevolutionary theory, contact with green environments mitigates stress by activating the parasympathetic system, (specifically, by decreasing blood pressure (BP)). Experimental studies have confirmed this biological effect. However, greenness effects on BP have not yet been explored using an observational study design. We assessed whether surrounding residential greenness is associated with BP in 10 year-old German children. Methods: Systolic and diastolic BPs were assessed in 10 year-old children residing in the Munich and Wesel study areas of the German GINIplus and LISAplus birth cohorts. Complete exposure, outcome and covariate data were available for 2,078 children. Residential surrounding greenness was defined as the mean of Normalized Difference Vegetation Index (NDVI) values, derived from Landsat 5 TM satellite images, in circular 500-m buffers around current home addresses of participants. Generalized additive models assessed pooled and area-specific associations between BP and residential greenness categorized into area-specific tertiles. Results: In the pooled adjusted model, the systolic BP of children living at residences with low and moderate greenness was 0.90 +/- 0.50 mmHg (p-value = 0.073) and 1.23 +/- 0.50 mmHg (p-value = 0.014) higher, respectively, than the systolic BP of children living in areas of high greenness. Similarly, the diastolic BP of children living in areas with low and moderate greenness was 0.80 +/- 0.38 mmHg (p-value = 0.033) and 0.96 +/- 0.38 mmHg (p-value = 0.011) higher, respectively, than children living in areas with high greenness. These associations were not influenced by environmental stressors (temperature, air pollution, noise annoyance, altitude and urbanisation level). When stratified by study area, associations were significant among children residing in the urbanised Munich area but null for those in the rural Wesel area. Conclusions: Lower residential greenness was positively associated with higher BP in 10 year-old children living in an urbanised area. Further studies varying in participants' age, geographical area and urbanisation level are required.

Background: According to recent guidelines, patients with coronary artery disease (CAD) should undergo revascularization if significant myocardial ischemia is present. Both, cardiovascular magnetic resonance (CMR) and fractional flow reserve (FFR) allow for a reliable ischemia assessment and in combination with anatomical information provided by invasive coronary angiography (CXA), such a work-up sets the basis for a decision to revascularize or not. The cost-effectiveness ratio of these two strategies is compared. Methods: Strategy 1) CMR to assess ischemia followed by CXA in ischemia-positive patients (CMR + CXA), Strategy 2) CXA followed by FFR in angiographically positive stenoses (CXA + FFR). The costs, evaluated from the third party payer perspective in Switzerland, Germany, the United Kingdom (UK), and the United States (US), included public prices of the different outpatient procedures and costs induced by procedural complications and by diagnostic errors. The effectiveness criterion was the correct identification of hemodynamically significant coronary lesion(s) (= significant CAD) complemented by full anatomical information. Test performances were derived from the published literature. Cost-effectiveness ratios for both strategies were compared for hypothetical cohorts with different pretest likelihood of significant CAD. Results: CMR + CXA and CXA + FFR were equally cost-effective at a pretest likelihood of CAD of 62% in Switzerland, 65% in Germany, 83% in the UK, and 82% in the US with costs of CHF 5'794, € 1'517, GBP 2'680 , and $2'179 per patient correctly diagnosed. Below these thresholds, CMR + CXA showed lower costs per patient correctly diagnosed than CXA + FFR. Conclusions: The CMR + CXA strategy is more cost-effective than CXA + FFR below a CAD prevalence of 62%, 65%, 83%, and 82% for the Swiss, the German, the UK, and the US health care systems, respectively. These findings may help to optimize resource utilization in the diagnosis of CAD.

Background: According to a national reference, 15% of German children and adolescents are overweight (including obese) and 6.3% are obese. An earlier study analysed the impact of childhood overweight and obesity on different components of direct medical costs (physician, hospital and therapists). To complement the existing literature for Germany, this study aims to explore the association of body mass index (BMI) with utilisation of pharmaceuticals and related costs in German children and adolescents. Methods: Based on data from 14, 836 respondents aged 3-17 years in the German Interview and Examination Survey for Children and Adolescents (KiGGS), drug intake and associated costs were estimated using a bottom-up approach. To investigate the association of BMI with utilisation and costs, univariate analyses and multivariate generalised mixed models were conducted. Results: There was no significant difference between BMI groups regarding the probability of drug utilisation. However, the number of pharmaceuticals used was significantly higher (14%) for obese children than for normal weight children. Furthermore, there was a trend for more physician-prescribed medication in obese children and adolescents. Among children with pharmaceutical intake, estimated costs were 24% higher for obese children compared with the normal weight group. Conclusions: This is the first study to estimate excess drug costs for obesity based on a representative cross-sectional sample of the child and adolescent population in Germany. The results suggest that obese children should be classified as a priority group for prevention. This study complements the existing literature and provides important information concerning the relevance of childhood obesity as a health problem.

Background: According to the hygiene hypothesis, infections in early life protect from allergic diseases. However, in earlier studies surrogate measures of infection rather than clinical infections were associated with decreased frequencies of atopic diseases. Exposure to infection indicating sub-clinical infection rather than clinical infection might protect from atopic diseases. Objective: to investigate whether exposure to acute respiratory infections within pregnancy and the first year of life is associated with atopic conditions at age 5 - 14 years and to explore when within pregnancy and the first year of life this exposure is most likely to be protective. Methods: Historical cohort study: Population level data on acute respiratory infections from the routine reporting system of the former German Democratic Republic were linked with individual data from consecutive surveys on atopic diseases in the same region (n = 4672). Statistical analyses included multivariate logistic regression analysis and polynomial distributed lag models. Results: High exposure to acute respiratory infection between pregnancy and age one year was associated with overall reduced odds of asthma, eczema, hay fever, atopic sensitization and total IgE. Exposure in the first 9 months of life showed the most pronounced effect. Adjusted odds ratio's for asthma, hay fever, inhalant sensitization and total IgE were statistical significantly reduced up to around half. Conclusion: Exposure to respiratory infection ( most likely indicating sub-clinical infection) within pregnancy and the first year of life may be protective in atopic diseases development. The postnatal period thereby seems to be particularly important.